Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

impairment or "disability" evaluation wherein each physician examines andreports without any protocol. In these cases, it is impossible to comparediscrepant reports, for there can be no reasonable certainty that eitherphysician has made all of the same observations as the other or hasexamined the same body parts or systems in a similar way. Quitecommonly, the physicians have looked at different aspects of the samebody part and have honestly reported their findings. For example, onephysician may include measurement of rotation or lateral bend of thespine, whereas another may make no mention of having observed thesemovements.Or one physician may report forward bend in terms of "reaches to10 inches from the floor,” and another may say of the same patient"forward bending limited to 80°”. Or, in another case, one physician mayreport measurement of thigh circumferences showing a difference of morethan 1 inch, and another may simply comment that there is no atrophywithout having measured. Without standardization of both the evaluationand reporting procedures, the recipient of the information has a difficultchoice to make in deciding which report to believe or which one deservesgreater "weight" This outcome is neither reasonable nor fair and tends togive rise to inappropriate and avoidable adversary confrontations.When physicians follow the Guides to measure and report theirfindings of impairment, then the recipients and users of this informationmay be held accountable to assess the results in accordance with theGuides. Because issues of medical fact should already have been settledby this stage in the process, the recipients should not find it necessary to(arbitrarily) give weight to or choose among conflicting "opinions" ofphysicians. By consulting the standardized medical evaluation protocols,the reference tables and the reporting protocol, the reviewer may verifywith complete confidence whether or not all necessary information wascollected. If so, the correctness of the rating may be verified bycomparing the findings to the tables. In those cases where physiciansdisagree on the clinical findings, clearly further medical evaluation isnecessary. It is not appropriate for the reviewer to overcome a deficiencyin medical information by giving greater weight to the (unsupported)opinion of any of the physicians.A simple number, the impairment rating, although it may have beenderived from a well structured complex set of thorough observations,does not convey any information about the person or the impact of theimpairment on the person's capacity to meet personal, social, oroccupational demands. In fact, information is lost in arriving at thenumber. Consequently, the strength of the medical support for a disabilitydetermination is dependent on the completeness and reliability of themedical documentation submitted. Knowledge of the course of anindividual's medical condition over time is essential in reaching an