The current edition is the Fifth Edition, published seven years ago in November 2000, and the preceding Fourth Edition was published in 1993. The AMA Guides to the Evaluation of Permanent Impairment serve as the basis for defining impairment in most workers' compensation jurisdictions (in the United States and internationally), and the use of the most recent Edition will be required immediately by certain state jurisdictions and will be required for Federal and Longshore & Harbor Workers' Act cases. Many states require the use of the "most recent Edition" of the Guides either by statute or code; the states that will therefore use the Sixth Edition include Alaska, Hawaii, Kentucky, Louisiana, Mississippi, Montana, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Vermont and Wyoming. The most recent edition is also the standard for automobile casualty and personal injury cases, and is used internationally, including in Australia, Canada, Hong Kong, Korea, New Zealand, and South Africa. Therefore the availability of this new Sixth Edition will have a profound impact. It is imperative that physicians, attorneys and claims professionals using the Guides learn the new approaches defined in the Sixth Edition. View further information on the Sixth Edition at www.sixthedition.com.

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The Guides defines the process for evaluating impairment. Clinical discussions among physician colleagues regarding potential severity of an illness or injury typically involve four basic points of consideration: 1) what is the problem (diagnosis); 2) what symptoms and resulting functional difficulty does the patient report; 3) what are the physical findings pertaining to the problem; and 4) what are the results of clinical studies. In a similar manner, these same basic considerations are used by the physicians to evaluate and communicate about impairment. The Sixth Edition expands the spectrum of diagnoses recognized in impairment rating, considers functional consequences of the impairment as a part of each physician's detailed history, refines the physical examination, and clarifies appropriate clinical testing.

The Sixth Edition uses the framework based upon the International Classification of Functioning, Disability and Health (ICF). There are five impairment classes which permit the rating of the patient from no impairment to most severe. Diagnosis-based grids were developed for each organ system. These grids arrange diagnoses into five classes of impairment severity, according to the consensus-based dominant criterion, ranging from Class 0 normal to Class 5 very severe impairment. Diagnoses and associated criteria will define the Class of impairment and associated potential impairment values. The final impairment is determined by adjustments that may include functional reports, physical findings, and the results of clinical tests. The basic template of the diagnosis-based grid is common to each organ system and chapter; therefore there is greater internal consistency and ease in determining impairment.