On behalf of the American Academy of Disability Evaluating Physicians, (AADEP), a duly constituted AMA delegated non-profit specialty society, I have prepared the following remarks. Having reviewed the document, A 21st Century System for Evaluating Veterans for Disability Benefits, I wish to stress the following points in support of changes to the Veterans Disability System:

1. I am a strong advocate for the adoption of national standards that are currently in use for the majority of jurisdictions in our country, including the AMA Guides to the Evaluation of Permanent Impairment, ICD and DSM codes. Importantly, the legislation should clearly provide for automatically incorporating updates for these resource standards when new editions are published.

2. Additional resources that will directly aid in this process include the AMA books-A Physician’s Guide to Return to Work, Guides to the Evaluation of Disease and Injury Causation, as well as other resources soon to be released.

3. A secondary benefit of promulgating these same current national standards and medical textbooks is that all evaluating parties will be speaking a common medical language. This also aids in teaching, as well as recruitment of personnel who are involved in the evaluation process.

4. Any unique aspects of the Veteran’s claims experience can then be applied to the impairment rating process so that any perceived area of inadequacy is addressed.

5. I advocate the formation of the recommended advisory committee to be constituted by representatives of both private and governmental sectors to monitor implementation, assess changes and provide direction to incorporate evolving concepts. The advisory committee must have at minimum, once yearly face-to-face meetings to carry out their duties. The Advisory committee must have recognized subcommittees that review education and training of personnel and another to review administrative claims handling including outcomes research. Important decisions regarding how the Veteran’s system chooses to define disability will need to be explored.

6. All claims and evaluations must be migrated to an electronic health record.

7. Consideration will need to be given to presumptive conditions which may streamline some of the claims processing.

8. A roundtable discussion is necessary in the upcoming months to further crystallize specific recommendations by all shareholders in the process, with continued outside input from private sector entities being essential.

9. AADEP stands ready to provide educational support and intellectual resources to guide any transition process.

10. AADEP is prepared to offer special accommodations for any active duty military personnel, reserve personnel, Veteran Affairs Staff, as well as governmental workers to our educational programs and academy.

I have read the Institute of Medicine report, and do wish to outline my recommendations from a private sector experience. In the community, an injured person files a claim within a recognized jurisdiction-usually at a state level. This triggers a claims handling by either a private insurance entity or a state mandated agency. Records are obtained and the patient is then referred to a physician for evaluation. A report is prepared in the format required by that jurisdiction. The findings on evaluation are then translated into an impairment rating, with subsequent administrative actions pursued.

Implementation of the recommendations of the report would bring our veterans system in a closer approximation to what I have just described. In particular, I must strongly underscore the need for a common language in this process which emanates from using already existing national standards including the AMA Guides, ICD and DSM coding. These resources are the product of multiple leaders throughout the world. The AMA Guides began in 1958 in response to the developing field of disability evaluation.  The mission has always been to bring the soundest possible reasoning to the impairment process. The Guides have become the community standard in the majority of states within our country. In essence, the Guides are the tools and rules of the disability trade. We have just produced the 6th edition of this seminal work and there are many companion books that go with this resource. Together, these books represent the efforts of experts around the country who regularly work in the disability field. There is also a mechanism of updating this information through a newsletter until there is the need for a more major revision. Through this mechanism that is used in the private sector, we can thoroughly describe and categorize the range of human injury. We are able to develop a fair, equitable, consistent rating on an individual’s impairment, small or large. Further, the Guides are aligned with the World Health Organization model of disablement termed the International Classification of Functioning, Disability and Health.

As with all jurisdictions, once an impairment rating process has occurred, then, like all jurisdictions, any specific, unique, coding or administrative concerns can then be added to the process. Indeed, in many jurisdictions, the evaluators may not even fully know all the subsequent claims processing above their impairment rating. In the current VA example, raters could take this report from the medical evaluation, and cohesively apply the disability rating with good reproducibility.

The use of these resources will allow for transition to an electronic health record system, which is currently the standard for the Veterans health system on the medical side. Tracking of data then becomes much easier.

To accomplish this process, all shareholders form the VA system must have a seat at preliminary roundtable discussions and have input into the recommendations from the advisory committee. The advisory committee must be charged and funded to meet at least once yearly, with quarterly telephonic meetings, in order to ensure implementation, assess outcomes and ensure proper education. I can not underscore enough the importance of education as this field is one that is not covered well or extensively in standard medical training and has many unique aspects which must be understood. By using the resources which I have identified as central to this process, the common language of impairment and disability will be broadened to all personnel involved in the process. I personally, as a citizen of this great country, and our organization AADEP that I am representing today, offer assistance to you in furthering this project.

Thank you for allowing me to help our country, but in particular, for giving me a chance to help those men and women who have provided for our security, that we can meet here today and try to repay their effort in some way. May g-d bless you in your deliberations.

2007 Annual Report
AADEP:  Doctors Teaching What They Do Best
21 Years
AADEP Fact Sheet

HISTORY

The Chicago-based American Academy of Disability Evaluating Physicians (AADEP) is a multi-disciplinary, collegial organization, which transcends the many specialties of its Fellows and Members. Founded by Orthopaedic Surgeons in 1987, the Academy celebrated its 20thAnniversary in 2006 in St. Petersburg, Florida. Just 75 physicians met at the First Annual Scientific Session in Detroit to hear 8 hours of continuing medical education. The 2008 meeting will offer more than 25 CME hours to 300 physicians. Nearly 2000 physicians have achieved Fellow status, the only enhanced credential for those physicians who evaluate disabilities or rate impairments. Nearly 300 have achieved a CEDIR (Certification in Evaluation of Disability and Impairment Rating). The Academy's mission is quality CME and its vision is to be the pre-eminent authority in disability evaluation. That mission stretched to Dublin and Amsterdam with EUMASS (European Union of Medical Assurance in Social Security) in June 2006, and to Majorca in 2007.

MEMBERSHIP

Membership has more than doubled since inception, AADEP now stands at 1050, 90% are Fellows and 37% are AMA members. Members represent 23 ABMS specialties, predominantly:

26% Orthopaedic Surgery
14% PM&R
13% Family/General Practice
10% Occupational Medicine
and are from all 50 states, Puerto Rico and six countries.

ASSOCIATE MEMBERSHIP

Fellows approved Associate Membership for all others on the evaluation team in 2003 - a major step toward an inclusion perspective. Associate members make up 3% of the total.

CONTINUING MEDICAL EDUCATION

AADEP has trained nearly 20,000 physicians since its founding. The Academy now provides advanced educational offerings to at least 2000 physicians annually. AADEP maintains its integrity and credibility as an educator with 45 volunteer faculty teaching more than 300 segments with average ratings of 4.5 on a 5.0 scale. AADEP is also an approved provider for mandated courses in Texas, Ohio and Pennsylvania. With publication of the AMA Guides to Evaluation of Permanent Impairment, 5Mh Edition, the need for impairment rating courses will grow. The real growth will be the disability focus, using Evidence Based Medicine skills and tools. Web based guidelines require additional education.

ACADEMY HALLMARKS

• Single Source of Focused Disability Evaluation Education

• High Energy Network of Experts

• Access to Physician Resources on Complex Issues

• Disability Medicine Standard Bearers

• Unique Certification (CEDIR)

• Clearinghouse of Best Available Evidence and EBM tools

• Practice Improvement with Evidence-Based Medicine

AMERICAN ACADEMY OF DISABILITY EVALUATING PHYSICIANS

223 West Jackson Boulevard
Suite 1104
Chicago, IL  60606-6900
Telephone:  1/800-456-6095

AADEP PROVIDES EXPERTS

• To Develop Resources

• To Create/Edit New Publications

• To Testify for Fairer Adjudication

• To Teach Best Practices

• To Fulfill Individual Physician Needs

• To Improve Injured Worker Outcomes

• To Consult with Physician Learners

AADEP PROVIDES PRE-EMINENT CME

• Outstanding Annual Scientific Session with internationally recognized faculty

• Customized Impairment Rating Courses

  • Texas (5-7 annually)

  • Ohio (one annually)

  • Pennsylvania (as mandated)

  • Washington (as requested)

  • Other States

AADEP PROVIDES ADDITIONAL CME

• 2-4 AMA Guides Impairment Rating Courses

• 5-6 MDA*/ODG** Courses

• Customized ODG Courses (as requested)

• Functional Capacity Exam Courses

• Customized Courses for Medical Associations/Healthcare Institutions

• At least 15-18 Live CME Activities Annually

*Medical Disability Advisor (MDA)

**Official Disability Guidelines (ODG)

AADEP DESIGNATES FELLOWS

• Recruits Members

• Provides Annual Comprehensive Education Course  (Austin, TX 2008)

• Peer Reviews Reports

• Evaluates Credentials

• Has Designated Nearly 2000 Nationally and Internationally

AADEP CERTIFIES EXPERTS

• Provides Specific Certification Exams (states, editions of Guides) – since 2002

• Certifies at Least 75 Annually as CEDIR (Certification in Evaluation of Disability and Impairment Rating (CEDIR)

• Approved Certification Provider in Texas

• Offers Exam at All Live CME Activities

AADEP EDUCATES

• Physicians

• Attorneys

• Psychologists

• Insurance Company Representatives

• Industrial Health Services Groups

• Occupational Health Nurses

• Certified Claims Managers

• Certified Vo-Rehab Consultants

• All Members of the Disability Arena

AADEP TESTIFIES

• For Institute of Medicine Committee on Social Security

• Before House Subcommittee on Veterans' Affairs

• AMA Committees

• Before State Boards of Inquiry

• As Expert or Peer Review Witnesses in Courts of Highest Jurisdiction on Legal Issues of Disability

AADEP VOLUNTEERS

• As Resource Authors
• As Contributing Authors
• As Reference Work Editors
• As Board Members
• As Researchers
• As Faculty for AADEP and Other Aligned Organizations

AADEP COLLABORATES

• With AMA as Member of House of Delegates

• With Governmental Bureaus/Agencies

• With Allied Product Developers

• With AMA Press

• With Affiliated Specialty Societies

• With Universities

• With Medical Practices

AADEP HEADQUARTERS IN CHICAGO

• Organized as Illinois not-for-profit in 1989

• Accredited CME Provider since 1991

• Provided Hundreds of CME Activities—Both Live and Distance Learning

• 1050 MD/DO Members

• 950 Fellows

• 50 Associate Members

AADEP INFORMS

• Reach by e-mail  aadep@aadep.org 

• Check website  www.aadep.org

• Call 1/800/456-6095

• Inquire of Headquarters for “hot line” to AADEP Fellows

• Talk to the Executive Director at Ext. 21