Permanent Disability; Rating; AMA Guides. AME's report constituted substantial evidence to support inclusion of applicant's grip loss as an impairment in rating permanent disability under strict reading of AMA Guides and pursuant to Almaraz/Guzman, when AME explained that loss of grip strength provided most accurate basis for describing applicant's residual impairment, and that, based upon AME's opinion and DEU rating, applicant suffered 30% permanent disability as a result of his industrial injuries to right shoulder, rotator cuff and biceps tendon. See Medina panel decision.