GAF Scores
As a medical-legal case developer, I often have cases where “emotional overlay” is an issue. Insurance Carriers love to see this phrase so they have another basis for denial of the claim. However, when chronic pain is an issue there is bound to be “emotional overlay”; when there is financial difficulties (no work, no money), there is bound to be “emotional overlay”; even when there is pre-existing depression, there is bound to be “emotional overlay” caused by the injury. Many of my clients are unable to work or resume normal social activities due to this “emotional overlay”. So, how to we get this condition diagnosed, quantified, and linked to the work related injury and/or treatment?
Physicians recognize depression in their patients and sometimes will refer to psychology for work-up–they can diagnose for me. Psychologists and psychiatrists can assign a Global Assessment of Functioning (GAF) score under the DSM-IV, Axis V diagnoses table. The GAF score describes a person’s ability to function based on behavioral characteristics. A score of 81-90 describes most of us on a fairly consistent basis: Absent of minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns. A GAF score of 51-60 describes many of our clients who have suffered loss of job, loss of financial security, loss of self-esteem, has chronic pain, and in serious interpersonal difficulties: Moderate symptoms OR moderate difficulty in social, occupational, or school functioning. Psychologists tell me that a GAF score in this range or below indicates severe inability to maintain a job–so they can quantify for me. Look at www.bsu.edu/csh/ssrc/media/pdf/gafpage.pdf for more information.
In order to get this problem linked to the injury, I need a Global Assessment of Functioning evaluation from a qualified Vocational Psychologist who will issue a report containing an opinion, to a reasonable degree of psychological certainty, that the injury and its sequelae have caused, contributed, or aggravated an emotional/behavioral impairment resulting in disability. Using a combination of AMA guides, this disability can be assigned an impairment rating as well.
QUESTION FOR KAREN SHELTON or others:
How does a GAF score relate to a permanent impairment rating, according to the AMA Guides, 5th Edition? Shelton hints at this in the last sentence discussing GAF Scores.