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In California, the doctors are mandated to use the AMA guides 5^th edition when rating their reports. L.C. Section 4660 and 4660.1. Almaraz Guzman can give them leeway to use the 6^th edition where they deem appropriate. Fraizer v. CDCR, ADJ8008017.

Almaraz Guzman II indicates a strict application of the AMA guides 5^th edition is rebuttable if the medical examiner does not feel the guides accurately depicts the applicant’s true level of impairment considering the impairment on ADL’s. A physician can utilize any chapter within the guides, the 4 corners, to reflect the applicant’s true impairment level.

Use of Figure 15-19, page 427, to rate spinal impairments. Some doctors have been using this table to rate general spinal impairments covered by DRE or ROM. Laury v. R.W. Concrete Contractors 2011 Cal. Wrk. Comp. P.D. LEXIS 77 and Wood v. U-Haul 2010 Cal. Wrk. Comp. P.D. LEXIS 535 offered conflicting results on whether figure 15-19 was allowed in an Almaraz Guzman II rebuttal. In Wood, the appeals board noted that figure 15-19 was not intended to determine PD, rather a conversion table used to covert WPI to a regional spine disability. They found the doctor’s report was not substantial medical evidence. In the Laury case, applicant had 5 spinal surgeries and the figure 15-19 analogy was allowed.

Another case, Michael Graham v. Pepsi Bottling Group, 2011 Cal. Wrk. Comp. Lexis 368, figure 15-19 was disallowed because the PQME did not adequately explain why that figure should be used.