Permanent Impairments (Universal Bodily Injury Compensation) Regulation

MB Reg. 41/1994

Manitoba — Regulations

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This is an unofficial version . If you need an official copy, use the bilingual (PDF) version .

As of July 8, 2026, this is the most current version available.

It has been in effect since May 11, 2015.

Last amendment included: M.R. 61/2015

Previous version(s)

19 Oct. 2009 to 10 May 2015

Note: Earlier consolidated versions are not available online.

Amendments

Amendment

Title

Registered

Published

61/2015

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

11 May 2015

erratum

26 Dec. 2009

173/2009

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

19 Oct. 2009

31 Oct. 2009

41/2008

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

29 Feb. 2008

8 Mar. 2008

33/2007

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

23 Feb. 2007

10 Mar. 2007

37/2003

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

18 Feb. 2003

1 Mar. 2003

41/2000

Permanent Impairments (Universal Bodily Injury Compensation) Regulation, amendment

14 Apr. 2000

29 Apr. 2000

* Errata published before April 1, 2014, and amending regulations registered before January 1, 2000, were published only in the Manitoba Gazette . They are not available online.

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Permanent Impairments (Universal Bodily Injury Compensation) Regulation, M.R. 41/94

Règlement sur les déficiences permanentes (indemnisation universelle pour dommages corporels), R.M. 41/94

The Manitoba Public Insurance Corporation Act , C.C.S.M. c. P215

Loi sur la Société d'assurance publique du Manitoba , c. P215 de la C.P.L.M.

Regulation 41/94

Registered February 10, 1994

bilingual version (HTML)

Règlement 41/94

Date d'enregistrement : le 10 février 1994

version bilingue (HTML)

Section

1 Compensation for permanent impairment based on

Schedule

ENHANCEMENT FOR SYMMETRICAL ORGANS

2 Evaluation of impairment to symmetrical parts of the body

3 Application of

section 2

4 Percentage fixed for deficit existing before accident

COMPUTATION ON SUCCESSIVE REMAINDERS

5 Computation of more than one permanent impairment

Section 5 not to be applied to percentage based on enhancement factor

APPLICATION OF ENHANCEMENT FACTOR

7 Where sections 2 to 5 apply to a victim

8 Coming into force

Schedule

Schedule of Permanent Impairments

B Calculation of Successive Remainders

Table des matières

Article

1 Indemnité pour déficience permanente

ACCROISSEMENT POUR LES ORGANES SYMÉTRIQUES

2 Évaluation des déficiences influant sur des organes symétriques

3 Application de l'article 2

4 Pourcentages attribués aux déficits préexistants

CALCUL RELATIF AUX RÉSIDUS SUCCESSIFS

5 Calcul de plusieurs déficiences permanentes

6 Inapplication de l'article 5

APPLICATION DU FACTEUR D'ACCROISSEMENT

7 Application des articles 2 à 5

8 Entrée en vigueur

Annexe

Annexe des déficiences permanentes

B Calcul des résidus successifs

Compensation for permanent impairment based on

Schedule

1 Compensation for permanent impairments shall be determined on the basis of

Schedule A.

Indemnité pour déficience permanente

1 L'indemnité pour déficience permanente est calculée d'après l'annexe A.

ENHANCEMENT FOR SYMMETRICAL ORGANS

ACCROISSEMENT POUR LES ORGANES SYMÉTRIQUES

Evaluation of impairment to symmetrical parts of the body

2 Subject to sections 3 and 4 and

Schedule A, where a permanent anatomicophysiological deficit resulting from an accident impairs symmetrical parts of the body, or impairs a part of the body that is symmetrical to a part of the body that was permanently impaired before the accident, the evaluation of the permanent impairment for the purpose of

Part 2 of the Act is determined by multiplying the total percentage of anatomicophysiological deficits impairing the more severely impaired symmetrical part of the body by an enhancement factor of .25 and adding the percentage thus obtained to the percentage attributed to the deficit resulting from the accident.

Évaluation des déficiences influant sur des organes symétriques

Sous réserve des articles 3 et 4 et de l'annexe A, lorsqu'un déficit anatomophysiologique résultant d'un accident influe sur des organes symétriques ou sur un organe symétrique à un autre organe qui était atteint d'une déficience permanente avant l'accident, la déficience permanente s'évalue comme suit pour l'application de la

partie 2 de la Loi : on multiplie par le facteur d'accroissement de 0,25 la somme des pourcentages des déficits anatomophysiologiques de l'organe le plus atteint et on additionne le pourcentage ainsi obtenu aux pourcentages attribués aux déficits résultant de l'accident.

Application of

section 2 Section 2 does not apply to an anatomicophysiological deficit that

(

a) affects an internal organ;

(

b) affects an organ controlling vision, balance or hearing;

(

c) results from an injury to the central nervous system; or

(

d) affects teeth.

M.R. 61/2015

Application de l'article 2

L'article 2 ne s'applique pas dans le cas des déficits anatomophysiologiques qui :

a) influent sur les organes internes;

b) influent sur les organes de contrôle de la vision, de l'équilibre et de l'ouïe;

c) résultent de dommages corporels au système central nerveux;

d) influent sur les dents.

R.M. 61/2015

Percentage fixed for deficit existing before accident

4 For the purpose of

section 2, the percentage of an anatomicophysiological deficit existing before an accident shall be fixed under

Schedule A or, if the anatomicophysiological deficit does not appear in

Schedule A, by using

Schedule A as a guideline in accordance with subsection 129(2) of the Act.

M.R. 41/2008

Pourcentages attribués aux déficits préexistants

4 Pour l'application de l'article 2, les pourcentages des déficits anatomophysiologiques qui existaient avant l'accident sont attribués en conformité avec l'annexe A. Si ces déficits ne figurent pas à l'annexe A, les pourcentages sont attribués d'après les déficits du même genre qui y sont indiqués, conformément au paragraphe 129(2) de la Loi .

R.M. 41/2008

COMPUTATION ON SUCCESSIVE REMAINDERS

CALCUL RELATIF AUX RÉSIDUS SUCCESSIFS

Computation of more than one permanent impairment

5(1) Where a victim has more than one permanent impairment, the percentage of the most severe impairment is computed on the basis of 100% and the percentages of the other impairments, starting with the highest, are computed on the successive remainders, in accordance with

Schedule B.

Calcul de plusieurs déficiences permanentes

5(1) Lorsqu'une victime subit plus d'une déficience permanente, le pourcentage de la déficience la plus importante se calcule sur 100 % et les pourcentages des autres déficiences, en commençant par le plus élevé, se calculent sur les résidus successifs, conformément à l'annexe B.

5(2) [Repealed] M.R. 37/2003

M.R. 37/2003

5(2) [Abrogé] R.M. 37/2003

R.M. 37/2003

Section 5 not to be applied to percentage based on enhancement factor

Section 5 does not apply to the percentage obtained by applying the enhancement factor referred to in

section 2.

Inapplication de l'article 5

L'article 5 ne s'applique pas aux pourcentages obtenus par l'application du facteur d'accroissement visé à l'article 2.

APPLICATION OF ENHANCEMENT FACTOR

APPLICATION DU FACTEUR D'ACCROISSEMENT

Where sections 2 to 5 apply to a victim

7 Where sections 2 to 5 apply to a victim, the percentage resulting from the enhancement factor referred to in

section 2 is added to the other percentages of deficits after the computation on successive remainders has been made.

Application des articles 2 à 5

7 Lorsque les articles 2 à 5 s'appliquent à une victime, les pourcentages résultant du facteur d'accroissement prévu à l'article 2 ne s'additionnent aux autres pourcentages qu'après le calcul sur les résidus successifs.

Coming into force

8 This regulation comes into force on March 1, 1994.

Entrée en vigueur

8 Le présent règlement entre en vigueur le 1 er mars 1994.

February 3, 1994 Manitoba Public Insurance Corporation/

3 février 1994 Pour la Société d'assurance publique du Manitoba,

J.W. Bardua, President and General Manager/président et directeur général

SCHEDULE A

SCHEDULE OF PERMANENT IMPAIRMENTS

DIVISION 1: MUSCULO-SKELETAL SYSTEM

Subdivision 1: Upper limb

Subdivision 2: Lower limb

Subdivision 3: Spine

DIVISION 2: CENTRAL AND PERIPHERAL NERVOUS SYSTEM

Subdivision 1: Skull, Brain and Carotid Vessels

Subdivision 2: Spinal Cord

Subdivision 3: Cranial Nerves

Subdivision 4: Peripheral Nervous System

DIVISION 3: MAXILLOFACIAL SYSTEM

Subdivision 1: TMJ Joints

Subdivision 2: Fronto-Orbito-Nasal Area

Subdivision 3: Throat and Related Structures

DIVISION 4: VISION

DIVISION 5: UROGENITAL SYSTEM AND FETUS

DIVISION 6: RESPIRATORY SYSTEM

DIVISION 7: DIGESTIVE TRACT

DIVISION 8: CARDIOVASCULAR SYSTEM

DIVISION 9: ENDOCRINE SYSTEM

Subdivision 1: Hypothalamus, Pituitary, Thyroid And Parathyroid Glands

Subdivision 2: Pancreas (Endocrine Function)

Subdivision 3: Adrenal Glands

DIVISION 10: HEMATOPOIETIC SYSTEM

DIVISION 11: COGNITIVE FUNCTION

DIVISION 12: VESTIBULOCOCHLEAR APPARATUS

DIVISION 13: THE SKIN

Subdivision 1: Facial Disfigurement

Subdivision 2: Disfigurement of Other Parts Of The Body

Subdivision 3: Disfigurement From Partial or Total Amputation

DIVISION I: THE MUSCULOSKELETAL SYSTEM

Subdivision 1: The Upper Limb

0.1 Definition

In this Division, "non-specified abnormal healing" means an anatomic abnormality at the end of the expected healing process, which is not specified elsewhere in the Schedule, such as the change in angulation of the fracture fragment, rotational abnormalities or shortening.

1. Shoulder and arm

1.1 Amputations

(

a) forequarter amputation

60%

(

b) shoulder disarticulation

56%

(

c) above elbow amputation (proximal third of the humerus)

54%

(

d) above elbow amputation (middle & distal third of the humerus)

52%

1.2 Fractures

(

a) fracture of the sternum, clavicle, scapula or humerus with non-specified abnormal healing

(a.1) rib fractures, documented by imaging study (per rib, up to a maximum of 2%)

0.5%

(

b) humeral fracture:

(

i) with angulation of more than 15 degrees

(ii) with angulation of 5 to 15 degrees

2.5%

(iii) with shortening of more than 4 cm

(iv) with shortening of 2 to 4 cm

(

v) with shortening of 1 to 2 cm

1.5%

(

c) chronic osteomyelitis of any upper limb bone with active drainage

1.3 Non-bony disruption

(

a) as a general rule:

(

i) complete non-bony disruption or avulsion fracture affecting the upper limb

(ii) partial non-bony disruption or avulsion fracture affecting the upper limb

If the disruption is associated with range of motion loss of an adjacent joint, then an additional range of motion loss impairment may be rated in

section 1.5 of this subdivision.

(

b) exceptions to the general rule in clause (a):

(

i) rotator cuff tear:

(

A) imaging positive, full thickness:

I) with no known prior rotator cuff pathology

II) with known prior rotator cuff pathology

(

B) partial thickness

(ii) biceps tendon rupture (distal or proximal):

(

A) with no strength deficit in supination or elbow flexion

(

B) with a loss of strength in supination or elbow flexion

1.4 Ligamentous and other soft tissue disruptions

(

a) acromioclavicular and sternoclavicular joint injuries:

(

i) grade I separation

(ii) grade II separation

(iii) grade III separation

(

b) glenohumeral instability – traumatic gleno-humeral dislocation (confirmed by plane radiography):

(

i) no recurrence of dislocation within one year of motor vehicle collision:

(

A) without prior instability

(

B) with prior instability

(ii) recurrence of dislocation within one year of motor vehicle collision:

(

A) without prior instability

(

B) with prior instability

(

C) with Bankhart lesion, Hill Sachs deformity or labral tear, add

1.5 Range of motion loss of the shoulder joint complex

(

a) flexion-extension (motion in the scapular plane):

Combined range of motion in degrees: Normal total range of motion for this plane is 230 degrees.

(

i) less than 61

(ii) 61 to 120

(iii) 121 to 180

(iv) greater than 180

(

b) abduction-adduction (motion in the coronal plane):

Combined range of motion in degrees: Normal total range of motion for this plane is 230 degrees.

(

i) less than 61

(ii) 61 to 120

(iii) 121 to 180

(iv) greater than 180

(

c) internal rotation – external rotation:

Combined gleno-humeral range of motion in degrees: Normal total range of motion for this plane is 180 degrees.

(

i) less than 46

(ii) 46 to 90

(iii) 91 to 135

(iv) greater than 135

2. Elbow and forearm

2.1 Amputations

(

a) elbow disarticulation (including amputation of the proximal third of the forearm)

50%

(

b) below elbow amputation (middle third of the forearm)

47%

2.2 Fractures

(

a) fractures of the radius, ulna or humerus, with non-specified abnormal healing

(

b) fracture of the radius:

(

i) with angulation of more than 15 degrees

(ii) with angulation of 5 to 15 degrees

2.5%

(iii) with shortening of more than 4 cm

(iv) with shortening of 2 to 4 cm

(

v) with shortening of 1 to 2 cm

1.5%

(

c) fracture of the ulna:

(

i) with angulation of more than 15 degrees

(ii) with angulation of 5 to 15 degrees

2.5%

(iii) with shortening of more than 4 cm

(iv) with shortening of 2 to 4 cm

(

v) with shortening of 1 to 2 cm

1.5%

2.3 Non-bony disruptions

(

a) complete non-bony disruption or avulsion fracture, affecting the elbow or forearm

(

b) partial non-bony disruption or avulsion fracture, affecting the elbow or forearm

2.4 Ligamentous and other soft tissue disruptions

(

a) ulnar and radial collateral injuries:

(

i) grade I sprain

(ii) grade II sprain

(iii) grade III sprain

2.5 Range of motion loss at the elbow

(

a) flexion-extension:

Combined range of motion: Normal total range of motion for this plane is 140 degrees.

(

i) no movement

14%

(ii) 1 to 40

12%

(iii) 41 to 80

(iv) 81 to 120

(v) 121 to 135

(vi) greater than 135

(

b) pronation-supination:

Combined range of motion: Normal total range of motion for this plane is 160 degrees.

(

i) no movement

(ii) 1 to 50

(iii) 51 to 100

(iv) 101 to 140

(v) 141 to 150

(vi) greater than 150

3. Wrist and hand

3.1 Amputations

(

a) wrist disarticulation (including the distal third of the forearm)

45%

(

b) transmetacarpal or MCP disarticulation:

(i) 1 st metacarpal

22%

(ii) 2 nd or 3 rd metacarpal (each)

11%

(iii) 4 th or 5 th metacarpal (each)

5.5%

If multiple metacarpals are affected, the impairment ratings are combined , not added .

(

c) trans-digital (proximal phalanx) or PIP disarticulation:

(

i) thumb

11%

(ii) index or middle fingers (each)

(iii) ring or small fingers (each)

If multiple digits are affected, the impairment ratings are combined , and not added .

(

d) trans-digital (middle or distal phalanx) or DIP disarticulation:

(

i) thumb

11%

(ii) index or middle fingers (each)

(iii) ring or small fingers (each)

If multiple digits are affected, the impairment ratings are combined , and not added .

3.2 Fractures

(

a) scaphoid fracture

(

b) scaphoid fracture with avascular necrosis

(

c) scaphoid fracture with non-union or pseudarthrosis

(

d) colles fracture with anatomic reduction

(

e) colles fracture with greater than 15 degrees of angulation of radius

(

f) avascular necrosis of lunate

(

g) fracture of a carpal, metacarpal or phalanx with abnormal healing

If any of the above are associated with range of motion loss, apply sections 3.5a and 3.5b for further impairment rating.

3.3 Non-bony disruptions

(

a) complete non-bony disruption or avulsion fracture, affecting the wrist or hand

(

b) partial non-bony disruption or avulsion fracture, affecting the wrist or hand

If the disruption is associated with range of motion loss of an adjacent joint, then an additional range of motion loss impairment may be rated under

section 3.5a or 3.5b.

3.4 Soft tissue and ligamentous disruptions

(

a) carpal instability: To be rated by report of a health care practitioner. The radiological appearance, including carpal height, carpal translation and degree of joint arthrosis must be used to determine mild, moderate and severe impairment.

(

i) mild

(ii) moderate

(iii) severe

12%

(

b) triangular fibrocartilage complex tears

(

c) carpal tunnel syndrome: Rate according to the neurologic impairment guidelines (see Division 2 Subdivision 4).

3.5a Range of motion loss of the wrist

(

a) flexion-extension:

Combined range of motion in degrees: Normal total range of motion for this plane is 120 degrees.

(

i) no movement

(ii) 1 to 30

(iii) 31 to 60

(iv) 61 to 90

(v) 91 to 100

(vi) greater than 100

(

b) radial deviation – ulnar deviation:

Combined range of motion in degrees: Normal total range of motion for this plane is 50 degrees.

(

i) no movement

(ii) 1 to 25

(iii) 26 to 40

(iv) greater than 40

3.5b Range of motion loss of the hand

(

a) thumb IP flexion-extension:

Combined range of motion: Normal total range of motion for this plane is 80 degrees.

(

i) ankylosis in faulty position

(ii) ankylosis in functional position

(iii) 1 to 40

(iv) 41 to 70

0.5%

(

v) greater than 70

(

b) thumb MCP flexion-extension:

Combined range of motion: Normal total range of motion for this plane is 60 degrees.

(

i) no movement

(ii) 1 to 30

(iii) 31 to 50

0.5%

(iv) greater than 50

(

c) thumb adduction:

This motion is evaluated by measuring the distance in centimeters from the flexor crease of the IP joint of the thumb to the distal palmar crease overlying the MCP joint of the small finger.

(i) 8 cm

(ii) 6 cm

(iii) 4 cm

(iv) 2 cm

0.5%

(

v) less than 2 cm

(

d) thumb radial abduction:

Combined range of motion: Normal total range of motion for this plane is 50 degrees.

(

i) no movement

(ii) 1 to 25

(iii) 26 to 40

0.5%

(iv) greater than 40

(

e) thumb opposition:

This motion is evaluated by measuring the distance in centimeteres from the flexor crease of the IP joint of the thumb to the distal palmar crease overlying the MCP joint of the middle finger.

(i) 8 cm

(ii) 6 cm

(iii) 4 cm

(iv) 2 cm

0.5%

(

v) less than 2 cm

(

f) finger DIP flexion-extension:

Combined range of motion: Normal total range of motion for this plane is 70 degrees.

(

i) no movement

(ii) 1 to 35

0.5%

(iii) 36 to 70

(

g) finger PIP flexion-extension:

Combined range of motion: Normal total range of motion for this plane is 130 degrees.

(

i) no movement

(ii) 1 to 65

0.5%

(iii) 66 to 130

(

h) finger MCP flexion-extension:

Combined Range of Motion: Normal total range of motion for this plane is 110 degrees.

(

i) no movement

(ii) 1 to 55

0.5%

(iii) 56 to 110

Subdivision 2: Lower Limb

1. Pelvis

1.1 Amputation

(

a) hemipelvectomy

50%

1.2 Fractures

(

a) undisplaced, non-articular, healed fracture with no other complications

(

b) fracture involving the sacroiliac joint

(

c) fracture involving the acetabulum (to be rated under

section 2.4 – Range of motion loss at the hip)

(

d) pelvic fracture with non-specified abnormal healing

1.3 Pelvic range of motion loss

Clinical tests to identify range of motion loss of the sacroiliac joint lack sufficient inter-rater reliability to be considered reliable. Therefore, impairments for pelvic range of motion loss are not rated.

2. Hip and thigh

2.1 Amputation

(

a) hip disarticulation (including proximal 1/3 of the femur)

45%

(

b) above knee amputation:

(

i) proximal

45%

(ii) mid-thigh

40%

(iii) distal

35%

2.2 Fractures

(

a) injuries to the acetabulum or the head of the femur requiring a prosthetic joint replacement, including any shortening of the lower limb

15%

(b) [repealed] M.R. 61/2015

(

c) intra-articular fracture of the femur

Fracture complications:

(

d) femoral shaft fractures with angulation:

(

i) greater than 20 degrees

(ii) 10 to 20 degrees

(

e) femoral shaft fractures with mal-rotation:

(

i) greater than 20 degrees

(ii) 10 to 20 degrees

(

f) resulting in avascular necrosis:

(

i) leading to hip arthroplasty (see clause (

b) of this section)

(ii) without arthroplasty (to be rated according to range of motion loss in 2.4)

(

g) femoral fractures with non-specified abnormal healing

2.3 Non-bony disruptions

(

a) complete non-bony disruption or avulsion fracture, affecting the hip or thigh

(

b) partial non-bony disruption or avulsion fracture, affecting the hip or thigh

If a disruption referred to in clause (

a) or (

b) is associated with range of motion loss of an adjacent joint, then an additional range of motion loss impairment may be rated under

section 2.4 (Range of motion loss at the hip).

2.4 Range of motion loss at the hip

(

a) hip joint ankylosis:

(

i) in a position prohibiting gait

25%

(ii) in a position allowing gait

20%

(

b) range of motion restriction:

(

i) flexion-extension:

Combined range of motion in degrees: Normal total range of motion for this plane is 150 degrees.

(A) 0 to 30

10%

(B) 31 to 60

(D) 91 to 120

(

E) greater than 120

(ii) internal-external rotation:

Combined range of motion in degrees: Normal total range of motion for this plane is 90 degrees.

(A) 0 to 30

(B) 31 to 60

(

C) greater than 60

(iii) abduction-adduction:

Combined range of motion in degrees: Normal total range of motion for this plane is 60 degrees.

(A) 0 to 15

(B) 15 to 45

(

C) greater than 45

2.5 Thigh muscular atrophy

Thigh muscular atrophy of 2 cm or more, as measured 15 cm above the superior pole of the patella, including any resulting weakness, resulting from non-bony disruption, underlying fracture or objective knee condition

3. Knee and leg

3.1 Amputations

(

a) knee disarticulation, including proximal below knee amputation, not suitable for a patellar tendon bearing (PTB) prosthesis

32%

(

b) below knee amputation suitable for a PTB prosthesis

28%

3.2 Fractures

(

a) tibial, fibular or patellar fractures with non-specified abnormal healing

Fracture complications:

(

b) patellar fractures resulting in its surgical removal

(

c) fracture or dislocation of the patella resulting in quadriceps atrophy

(

d) leg (tibial or fibular) fractures resulting in single or multi-planar angulation:

(

i) greater than 15 degrees

(ii) 10 to 15 degrees

(

e) leg (tibial or fibular) fractures resulting in mal-rotation:

(

i) greater than 20 degrees

(ii) 10 to 20 degrees

(

f) knee, thigh or leg injuries requiring a knee arthroplasty

(

g) intra-articular fracture of the knee

These awards include any limb shortening or weakness.

3.3 Non-bony disruptions

(

a) complete non-bony disruption or avulsion fracture, affecting the knee or leg

(

b) partial non-bony disruption or avulsion fracture, affecting the knee or leg

If a disruption under clause (

a) or (

b) is associated with range of motion loss of an adjacent joint, then an additional range of motion loss impairment may be rated under

section 3.5 (Range of motion loss at the knee).

3.4 Ligamentous and other soft tissue disruptions

In general, the higher the grade of ligament injury, the greater the impairment and the corresponding impairment rating. Most grade I and II knee joint ligament injuries heal without functional sequelae, and therefore do not warrant an impairment rating.

(

a) cruciate or collateral ligament injuries associated with:

(

i) occasional instability not interfering with occupational or recreational function.

(ii) regular episodes of instability that interferes with occupational or recreational function

(iii) frequent episodes of instability that limits most occupational and recreational function

10%

(iv) frequent episodes of instability prohibiting all occupational and recreational function

15%

(

b) meniscal tears (medial or lateral)

(

c) post-traumatic patellofemoral pain syndrome with objective signs

(

d) chondral injury (confirmed by MRI or arthroscopy)

3.5 Range of motion loss at the knee

(

a) ankylosis:

(

i) in a faulty position (recurvatum, varus, valgus, malrotation), including any damage to the patella, shortening of the lower limb, or muscular atrophy or weakness

20%

(ii) in a functional position, including any damage to the patella, shortening by 3 cm or less, altered alignment (recurvatum, varus, valgus, rotation) or muscular atrophy or weakness

15%

(

b) flexion:

Active range of motion in degrees:

(i) 5 to 60

14%

(ii) 61 to 80

(iii) 81 to 110

(iv) greater than 110

(

c) flexion contracture:

Active range of motion in degrees away from the neutral position (knee straight position):

(

i) less than 5

(ii) 5 to 9

(iii) 10 to 20

(iv) greater than 20

14%

3.6 Leg muscular atrophy

Leg muscular atrophy of 1.5 cm or more, as measured 15 cm below the inferior pole of the patella, including any weakness, resulting from non-bony disruption, underlying fracture or objective knee or ankle condition, not including ankylosis

4. Ankle and foot

4.1 Amputations

(

a) amputation at the ankle (Symes)

25%

(

b) mid-tarsal amputation (Chopart)

18%

(

c) tarsometatarsal amputation (Lisfranc)

18%

(

d) transmetatarsal amputation

16%

(

e) amputation of all five toes at the MTP joint

(

f) amputation with loss of the distal end of the first metatarsal

(

g) bone amputation of the great toe at the MTP joint

(

h) amputation of the distal end of the fifth metatarsal

(

i) amputation of the great toe at the IP joint

(

j) total or partial amputation of the 2nd, 3rd, 4th and 5th toes, (per toe)

4.2 Fractures

Fracture complications:

(

a) fracture of the tibia or fibula:

(

i) with angulation of more than 15 degrees

(ii) with angulation of 5 to 15 degrees

2.5%

(iii) with shortening of more than 4 cm

(iv) with shortening of 2 to 4 cm

(

v) with shortening of 1 to 2 cm

1.5%

(

b) avascular necrosis of the talus

(

c) avascular necrosis of the navicular

(

d) chronic osteomyelitis of any lower limb bone with active drainage

(

e) post-traumatic tarsal/metatarsal deformity necessitating the use of a custom-fitted shoe or orthosis to accommodate for the condition

0.5%

(

f) fractures of the tibia, fibula, tarsal or metatarsal bones with non-specified abnormal healing

4.3 Non-bony disruptions

(

a) complete non-bony disruption or avulsion fracture, affecting the foot or ankle

(

b) partial non-bony disruption or avulsion fracture, affecting the foot or ankle

If a disruption referred to in clause (

a) or (

b) is associated with range of motion loss of an adjacent joint, then an additional range of motion loss impairment may be rated under

section 4.5 (Range of motion loss at the foot or ankle).

(

c) achilles tendon rupture

4.4 Ligamentous and other soft tissue disruptions

(

a) ligament injury resulting in chronic ankle instability

1.5%

4.5 Range of motion loss at the foot or ankle

(

a) ankylosis of the ankle or foot:

(

i) subtalar, midtarsal, tibiotalar (panarthrodesis)

12%

(ii) tibiotalar up to 10º of plantar flexion, with loss of inversion and eversion

(iii) subtalar and midtarsal (triple arthrodesis)

(iv) subtalar

(

v) tarsal-metatarsal

2.5%

(vi) metatarsophalangeal:

(

A) big toe

1.5%

(

B) any other toe

0.5%

(vii) interphalangeal:

(

A) big toe

(

B) any other toe

0.5%

(

b) range of motion restriction:

(

i) tibiotalar plantar flexion in degrees

(A) 1 to 10

(B) 11 to 20

(

C) greater than 20

(ii) tibiotalar dorsiflexion in degrees:

(A) 0 to 10

(

B) greater than 10

(iii) sub-talar

(iv) midtarsal

(

v) toe

(

A) big toe

(

B) any other toe

Subdivision 3: The Spine

In the following sections 1 to 4, a reference to fusion denoted by "*" includes bony fusion using an internal fixation device or bone graft material.

1. Cervical spine

(a) *fusion of the atlanto-occipital joint (C0-C1), including post-traumatic bony alterations

(b) *fusion of the atlanto-axial joint (C1 and C2), including post-traumatic bony alterations

12%

(

c) non-union of the odontoid process following a fracture:

(

i) with evidence of radiographic instability (as per Table 1.1)

(ii) without evidence of radiographic instability (as per Table 1.1)

(iii) accompanied by myelopathy (see Division 2 Subdivision 3).

(

d) impaired active range of motion of the atlanto-axial joint (C1 and C2), following a fracture or ligamentous injury, as documented by evidence of range of motion restriction in rotation (inclinometer method)

2.5%

(

e) instability of the atlanto-axial joint (C1 and C2), following a fracture or ligamentous injury, as documented by evidence of excessive motion on flexion extension views:

(

i) forward slippage (ii) forward slippage > 5mm

(iii) accompanied by myelopathy: (see Division 2 Subdivision 3)

(f) *fusion of C3-7 vertebrae, including any post-traumatic bony alterations, (e.g. laminectomy, vertebrectomy, and discectomy), if applicable, per inter-space

(

g) excessive active range of motion of C3-7 following a ligamentous injury as documented by radiographic instability on flexion extension views (as per Table 1.1), per inter-space

(

h) vertebral body fracture (non-compression):

(

i) with radiographic instability (as per Table 1.1)

(ii) without radiographic instability (as per Table 1.1)

(iii) with associated myelopathy (see Division 2 Subdivision 3).

(

i) vertebral body compression fracture with radiographic instability on flexion extension views (as per Table 1.1):

(

i) loss of height, more than 50%

(ii) loss of height, from 25% to 50%

(iii) loss of height, less than 25%

(

j) vertebral body compression fracture without radiographic instability on flexion extension views (as per Table 1.1), including any range of motion restriction:

(

i) loss of height, more than 50%

(ii) loss of height, from 25% to 50%

(iii) loss of height, less than 25%

2. Thoracic spine

(

a) vertebral body compression fracture with radiographic instability on flexion extension views (as per Table 1.1):

(

i) loss of height, more than 50%

(ii) loss of height, from 25% to 50%

(iii) loss of height, less than 25%

(

b) vertebral body compression fracture without radiographic instability on flexion extension views (as per Table 1.1), including any range of motion restriction:

(

i) loss of height, more than 50%

(ii) loss of height, from 25% to 50%

(iii) loss of height, less than 25%

(c) *fusion of two or more adjacent thoracic vertebrae, including any post-traumatic bony alterations, (e.g. laminectomy, vertebrectomy, and discectomy), if applicable; per inter-space

(

d) vertebral body fracture (non-compression):

(

i) with radiographic instability (as per Table 1.1)

(ii) without radiographic instability (as per Table 1.1)

(iii) with associated myelopathy: (see Division 2 Subdivision 3)

(

e) excessive active range of motion following a ligamentous injury as documented by radiographic instability on flexion extension views (as per Table 1.1)

(

f) excessive active range of motion following a costovertebral fracture or dislocation, including any range of motion restriction or radiographic instability, per spinal segment

0.5%

3. Lumbar spine

(

a) vertebral body compression fracture with radiographic instability (as per Table 1.1):

(

i) loss of height, more than 50%

(ii) loss of height, 25% to 50%

(iii) loss of height, less than 25%

(

b) vertebral body compression fracture without radiographic instability (as per Table 1.1), including any range of motion restriction:

(

i) loss of height, more than 50%

(ii) loss of height, 25% to 50%

(iii) loss of height, less than 25%

(c) *fusion of two or more adjacent lumbar vertebrae, including any post-traumatic bony alterations, (e.g. laminectomy, vertebrectomy, and discectomy), if applicable; per interspace

(

d) vertebral body fracture (non-compression):

(

i) with radiographic instability (as per Table 1.1)

(ii) without radiographic instability (as per Table 1.1)

(iii) with associated myelopathy: (see Division 2 Subdivision 3)

(

e) excessive active range of motion following a ligamentous injury as documented by radiographic instability on flexion extension views (as per Table 1.1)

4. Other spinal impairments

(

a) post-traumatic alteration of an intervertebral disc (e.g. disc herniation, internal disc disruption, disc space infection, discectomy) including any range of motion restriction or radiographic instability, per spinal segment:

(

i) with associated myelopathy: (see Division 2 Subdivision 3)

(ii) with associated radiculopathy: (see Division 2 Subdivision 4)

(iii) without associated myelopathy or radiculopathy

(

b) complete laminectomy including removal of both laminae and spinous processes including any radiographic evidence of range of motion restriction or instability (as per Table 1.1), per spinal segment

(

c) partial laminectomy, laminotomy or foraminotomy, with preservation of one lamina, per spinal segment

(

d) post-traumatic alteration of a spinous process, transverse process, lamina or zygapophyseal joint following a fracture, spondylolysis or pseudarthrosis, including any radiographically documented range of motion restriction or instability (as per Table 1.1), per spinal segment

0.5%

(

e) post-traumatic alteration of the coccyx with or without coccygectomy

0.5%

Table 1.1

Vertebral Level

Slippage in mm

C1-2

See Above

C3-7

3.5

T1-L4

L5-S1

DIVISION 2: CENTRAL AND PERIPHERAL NERVOUS SYSTEM

Definitions:

In this Division,

"autonomic dysreflexia" means an alteration of autonomic reflexes associated with quadriplegia or paraplegia above the T6 level that can result in sudden and sustained elevation of blood pressure; (« dysréflexie autonome »)

"paraplegia" means a neurological injury affecting the trunk and lower limbs (but sparing the upper limbs and head) that manifests with alterations in motor power and control and sensory loss below the level of injury. This condition is associated with certain types of spinal cord injuries. It may be complete or incomplete; (« paraplégie »)

"quadriplegia" means a neurological injury affecting both upper and lower limbs, that manifests with alterations in motor power and control and sensory loss below the level of injury. This condition is associated with certain types of spinal cord injuries. It may be complete or in complete. (« quadriplégie »)

Subdivision 1: Skull, Brain And Carotid Vessels

1. Alteration of brain tissue

1.1 Cerebral concussion or contusion

(

a) minor (post-traumatic amnesia (PTA) (

b) moderate (PTA > 30 min 5 min (

c) severe (> 24 hrs of (PTA) or > 1 hr (LOC))

(

d) post concussion syndrome: (see sections 4.6, 4.7 and 4.9 of this subdivision)

1.2 Post-traumatic alteration of tissue

(

a) with laceration or intracerebral hematoma

(

b) with epidural hematoma

(

c) with subdural hematoma

(

d) with subarachnoid hemorrhage

(

e) with leakage of cerebrospinal fluid (CSF) via one of the paranasal sinuses or via the external auditory meatus, including any elevation, craniotomy, craniectomy and plasty

(

f) evidence of encephalomalacia or shear/axonal injury

Alteration of the skull

2.1 Post-traumatic bony alteration

(

a) following a linear skull fracture of the base

(

b) following a linear skull fracture of the calvarium

(

c) following a craniotomy or a craniectomy

(

d) following trephination, per incision

0.5%

2.2 Bony deformity following a depressed fracture of the calvarium

(

a) without dural laceration:

(

i) requiring a craniectomy and cranioplasty, including elevation

(ii) requiring elevation

(iii) not requiring elevation

(

b) with dural laceration:

(

i) with associated hemorrhage: (see

section 2.1 of this subdivision)

(ii) with associated vascular injury: (see

section 3.1 of this subdivision)

3. Alteration of cerebrovascular supply

3.1 Internal carotid artery occlusion

(

a) internal carotid artery occlusion

10%

(

b) associated with hemiplegia: (see subdivision 2)

3.2 Internal carotid artery stenosis

(

a) more than 70%

(b) 50 to 70%

(

c) less than 50%

(

d) associated with hemiplegia: (see subdivision 2)

3.3 Hydrocephalus

(

a) not requiring a cerebrospinal fluid shunt

(

b) requiring a cerebrospinal fluid shunt

15%

4. Functional alteration of the brain

4.1 Upper limb function

(

a) inability to use both upper limbs for self care with evidence of both proximal and distal upper limb neurological dysfunction

80%

(

b) inability to use one upper limb for self care with evidence of both proximal and distal upper limb neurological dysfunction

60%

(

c) difficulty in using both upper limbs for self care with evidence of either proximal or distal upper limb neurological dysfunction bilaterally

50%

(

d) difficulty in using one upper limb for self care with evidence of either proximal or distal upper limb neurological dysfunction

40%

(

e) difficulty manipulating objects with impaired prehension confined to only one of the upper limbs, allowing independence in self-care

30%

(

f) difficulty manipulating objects with no impairment in prehension in either upper limb, allowing independence in self-care

20%

(

g) upper limb clumsiness (e.g. tremor, dysmetria, dysdiadochokinesis) with impaired prehension confined to only one of the upper limbs, allowing independence in self-care

15%

(

h) upper limb clumsiness (e.g. tremor, dysmetria, dysdiadochokinesis) with no impairment in prehension in either upper limb, allowing independence in self-care

10%

4.2 Station and gait assessment

(

a) inability to stand or walk

50%

(

b) ability to stand, but great difficulty or inability to walk

40%

(

c) moderate difficulty in walking on irregular surfaces, stairways or uneven terrain

15%

(

d) slight difficulty in walking

4.3 Bladder function

(

a) incontinence or urinary retention:

(

i) complete loss of sphincter control

20%

(ii) partial loss of sphincter control

10%

(iii) dysfunction in the form of frequency or hesitancy

(

b) alteration of the bladder with enterocystoplasty

10%

(

c) alteration of the bladder without enterocystoplasty

(

d) Class 1, 2 or 3 renal functional impairment (See Division 5 —

section 2).

4.4 Anorectal Function

(

a) complete loss of control

10%

(

b) limited control

4.5 Sexual dysfunction

(

a) Class 1: sexual functioning is possible with difficulty of erection or ejaculation in men or lack of awareness, excitement, or lubrication in either sex

(

b) Class 2: reflex sexual functioning is possible but there is no awareness

10%

(

c) Class 3: infertility or total absence of sexual functioning, or both

15%

4.6 Communication disorders (dysphasia, aphasia, alexia, agraphia, acalculia and other communication disorders)

(

a) a communication disorder that results in the person's complete inability to understand and use language

95%

(

b) a communication disorder that does not affect the person's ability to understand linguistic symbols, but severely impairs his or her ability to use sufficient or appropriate language

70%

(

c) a communication disorder that does not affect the person's ability to understand linguistic symbols, but moderately impairs his or her ability to use sufficient or appropriate language

40%

(

d) a communication disorder that results in minor communication difficulties

10%

4.7 Alterations of consciousness (posttraumatic epilepsy, syncope, cataplexy, narcolepsy, and other neurological disorders and alterations of consciousness)

(

a) an alteration of consciousness, such as stupor, coma or another disorder or disturbance, including adverse effects of medication, that prevents the person from performing the activities of daily living to such an extent that he or she requires continuous supervision in an institutional or confined setting

100%

(

b) an alteration of consciousness, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires periodic supervision in an institutional or confined setting for 50% or more of the time

70%

(

c) an alteration of consciousness, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires periodic supervision in an institutional or confined setting for less than 50% of the time

35%

(

d) an alteration of consciousness, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires supervision but not in an institutional or confined setting

15%

(

e) an alteration of consciousness, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living but not to such an extent that he or she requires supervision

10%

4.8 Disturbances of vision

To be rated according to Division 4.

4.9 Alterations of the higher cognitive or integrative mental functions (organic cerebral syndrome, dementia and neurologic deficiencies)

(

a) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that prevents the person from performing the activities of daily living to such an extent that he or she requires continuous supervision in an institutional or confined setting

100%

(

b) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires periodic supervision in an institutional or confined setting for 50% or more of the time

80%

(

c) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires periodic supervision in an institutional or confined setting for less than 50% of the time

45%

(

d) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living to such an extent that he or she requires supervision but not in an institutional or confined setting

15%

(

e) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that impairs the person's ability to perform the activities of daily living but not to such an extent that he or she requires supervision

4.10 Endocrine dysfunction

To be rated according to Division 9.

Subdivision 2: Spinal Cord

Spinal cord injuries must be classified according to the American Spinal Injury Association (ASIA) scale as follows:

(

a) ASIA Grade A = Complete: No sensory or motor function is preserved below the neurological level of the lesion (including the sacral segments).

(

b) ASIA Grade B = Sensory Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5 (light touch, pin prick at S4-S5: or deep anal pressure (DAP), AND no motor function is preserved more than three levels below the motor level on either side of the body.

(

c) ASIA Grade C = Incomplete: There is preservation of some motor function below the neurological level of the lesion, and the majority of key muscles below the neurological level have a muscle grade less than 3.

(

d) ASIA Grade D = Incomplete: There is preservation of some motor function below the neurological level of the lesion, and the majority of key muscles below the neurological level have a muscle grade greater than or equal to 3.

(

e) ASIA Grade E = Normal: Motor and sensory function is normal.

The motor index score provides a numerical scoring system to document changes in motor function. Each of the key muscles is graded according to the motor grading scale (grade 1 to 5). A normal score is as follows:

Right

Key Muscle

Left

Total Score = 100 (Maximum Score Possible)

The following information is required in order to determine the impairment rating for a spinal cord injury:

(

a) spinal level of injury (e.g. the site of fracture or dislocation if any);

(

b) neurological level of injury (the motor and sensory level of injury as determined by physical exam for both the right and left side of the body);

(

c) whether the lesion is complete or incomplete;

(

d) the ASIA Grade; and

(

e) the motor index score.

1. Complete quadriplegia or paraplegia (ASIA Grade A)

1.1 Quadriplegia, including all anatomical and physiological deficits inherent in this condition as well as any vertebrospinal impairments and grafting, if applicable:

(

a) C5 level or higher

100%

(

b) C6 level

95%

(

c) C7 level

90%

(

d) C8 or T1 level

85%

1.2 Paraplegia, including all anatomical and physiological deficits inherent in this condition as well as any vertebrospinal impairments and grafting, if applicable:

(

a) T2 to T7 level

80%

(

b) below T7

75%

(

c) conus and cauda equina lesions

70%

2. Incomplete Quadriplegia Or Paraplegia with Complete or Partial Preservation of Sensation Only and No Motor Preservation (ASIA Grade B)

2.1 Quadriplegia, including all anatomical and physiological deficits inherent in this condition as well as any vertebrospinal impairments and grafting, if applicable:

(

a) C5 level or higher

95%

(

b) C6 level

90%

(

c) C7 level

85%

(

d) C8 or T1 level

80%

2.2 Paraplegia, including all anatomical and physiological deficits inherent in this condition as well as any vertebrospinal impairments and grafting, if applicable:

(

a) T2 to T7 level

75%

(

b) below T7

70%

(

c) conus and cauda equina lesions

65%

3. Incomplete quadriplegia or paraplegia with partial preservation of motor power, with or without sensory preservation (ASIA Grades C and D)

3.1 Upper limb function

(

a) inability to use both upper limbs for self care with evidence of both proximal and distal upper limb neurological dysfunction

80%

(

b) inability to use one upper limb for self care with evidence of both proximal and distal upper limb neurological dysfunction

60%

(

c) difficulty in using both upper limbs for self care with evidence of either proximal or distal upper limb neurological dysfunction bilaterally

50%

(

d) difficulty in using one upper limb for self care with evidence of either proximal or distal upper limb neurological dysfunction

40%

(

e) difficulty manipulating objects with impaired prehension confined to only one of the upper limbs, allowing independence in self-care

30%

(

f) difficulty manipulating objects with no impairment in prehension in either upper limb, allowing independence in self-care

20%

(

g) upper limb clumsiness (e.g. tremor, dysmetria, dysdiadochokinesis) with impaired prehension confined to only one of the upper limbs, allowing independence in self-care

15%

(

h) upper limb clumsiness (e.g. tremor, dysmetria, dysdiadochokinesis) with no impairment in prehension in either upper limb, allowing independence in self-care

10%

3.2 Station and gait assessment

(

a) inability to stand or walk

50%

(

b) ability to stand, but great difficulty or inability to walk

40%

(

c) moderate difficulty in walking on irregular surfaces, stairways or uneven terrain

15%

(

d) slight difficulty in walking

3.3 Bladder function

(

a) incontinence or urinary retention:

(

i) complete loss of sphincter control

20%

(ii) partial loss of sphincter control

10%

(iii) dysfunction in the form of frequency or hesitancy

(

b) alteration of the bladder with enterocystoplasty

10%

(

c) alteration of the bladder without enterocystoplasty

(

d) Class 1, 2 or 3 renal functional impairment (See Division 5 —

section 2).

3.4 Anorectal Function

(

a) complete loss of control

10%

(

b) limited control

3.5 Sexual dysfunction

(

a) Class 1: sexual functioning is possible with difficulty of erection or ejaculation in men or lack of awareness, excitement, or lubrication in either sex

(

b) Class 2: reflex sexual functioning is possible but there is no awareness

10%

(

c) Class 3: infertility or total absence of sexual functioning, or both

15%

3.6 Autonomic dysreflexia:

(

a) controlled by medication

(

b) frequent occurrences with medication

15%

3.7 Class 1, 2, 3 or 4 respiratory functional impairment (See Division 6 —

section 2).

Subdivision 3: Cranial Nerves

1. Olfactory nerves (Right and Left)

(

a) total loss (R/O functional anosmia with ammonia test)

(

b) distortion of smell (if present add to above %):

(

i) unpleasant but not interfering with ADL (e.g. eating)

(ii) unpleasant and occasionally interfering with ADL (e.g. eating)

(iii) unpleasant and constantly interfering with ADL (e.g. eating)

2. Optic nerve and visual pathways: (see Division 3 Subdivision 5)

3. Occulomotor (left and right) and eye parasympathetic input

(

a) ptosis:

(

i) droop but pupil not covered

0.5%

(ii) lid partially covers pupil interfering with vision

(iii) complete ptosis

(iv) if complete and bilateral

25%

(

v) if uncorrectable with surgery/bracing, rate as if blind.

(

b) pupil dilation:

(

i) If symptomatic (i.e. photophobia/visual blurring)

(

c) diplopia:

(

i) In gaze off midline – correctable with prisms

(ii) In gaze off midline – not correctable with prisms

(iii) In primary gaze – correctable with prisms

(iv) In primary gaze – not correctable with prisms

4. Trochlear, and Abducens

(

a) diplopia: See Division 4 (Vision)

NOTE: Combinations of dysfunction of these three nerves (regarding diplopia) are not additive, even if bilateral (the impairment is the inability to maintain conjugate gaze).

5. Trigeminal

Add impairment ratings to arrive at a total. If bilateral, add impairment ratings for each side to arrive at a total impairment rating.

(

a) motor (unilateral or bilateral):

(

i) detectable weakness but no functional impairment

(ii) weakness with resulting difficulty chewing

(iii) weakness with resulting difficulty swallowing

(iv) weakness with resulting difficulty speaking

(

v) weakness with malalignment resulting in pain

(vi) dystonic or other involuntary movement of jaw:

(

A) mild or no treatment needed

(

B) moderate controllable with treatment

(

C) severe uncontrollable, with pain

10%

(

b) sensory - rate according to the following table:

Class 1

No impairment

Class 2

hypoesthesia

Class 3

complete loss

V1 (includes EYE)

(

c) with associated pain (Painful dysesthesia or typical neuralgia):

(

i) controlled by medication

(ii) partially controlled by medication, or not functionally limiting

(iii) uncontrolled by medication and functionally limiting

10%

6. Facial Nerve

(

a) motor:

(

i) stapedius weakness:

(

A) stapedius reflex lost with sonophobia

(ii) facial weakness:

(add 2% if weakness results in difficulty eating)

(add 2% if weakness results in difficulty speaking)

(

A) Class 1: no weakness

(

B) Class 2: weakness but full eye closure

(

C) Class 3: weakness with incomplete eye closure

(

D) Class 4: near complete paralysis

(

E) Class 5: complete paralysis

(iii) facial synkinesia

(iv) hemifacial spasms

Where facial weakness is associated with alteration in form and symmetry, (see Division 13 – The Skin).

(

b) sensory:

(

i) loss of sensation in ear canal

(

c) lacrimation:

(

i) dry eyes(s), no drops needed

0.5%

(ii) dry eye(s), needing drops

(iii) excessive tearing (crocodile tears)

(

d) salivation:

(

i) dysfunction leading to dry mouth

(

e) taste:

(

i) incomplete loss (very difficult to clinically confirm)

0.5%

(ii) total loss (i.e. bilateral lesion)

(iii) distortion: (if present add to impairment rating determined under (

i) or (ii)

(

A) Unpleasant not distracting

(

B) Unpleasant and occasionally interfering with ADL (e.g. eating)

(

C) Unpleasant and constantly interfering with ADL (e.g. eating)

7. Auditory Nerve:

(

a) acoustic (cochlear division): hearing loss and tinnitus (see Division 12 - Vestibulocochlear Apparatus);

(

i) hearing loss (see Division 12 – Vestibulocochlear Apparatus);

(ii) tinnitus:

(

A) slight (Class 1): Not severe; not constant; only bothers patient in quiet environment

0.5%

(

B) moderate (Class 2): Greater than slight, constantly present; worse in quiet environments; bothers the patient when trying to concentrate; disturbs sleep

(

C) severe (Class 3): Serious complaints from patient; causing difficulties with concentration, sleep and activities of daily living

For a Class 2 or Class 3 rating, tinnitus must be present on a constant basis for more than 3 consecutive months.

(

b) Vestibular division (see Division 12 – Vestibulocochlear Apparatus).

8. Glossopharyngeal, Vagal, and Hypoglossal

(

a) dysphagia (swallowing difficulty) (see Division 3 – Maxillofacial System, Throat and Related Structures);

(

b) dysphonia, dysarthria (abnormal speech) (see Division 3 – Maxillofacial System, Throat and Related Structures);

(

c) neuralgia:

(

i) controlled by medication

(ii) partially controlled by medication, or not functionally limiting

(iii) uncontrolled by medication, and functionally limiting

10%

(

d) spasmodic dysphonia: rate according to degree of dysphonia described above.

9. Spinal accessory

(

a) wasted muscles with weakness

(

b) cervical dystonia (spasmodic torticollis):

(

i) with neck and head deviation:

(

A) minimal not functionally limiting, but socially embarrassing

(

B) moderate: unable to perform certain tasks (e.g. driving)

10%

(

C) severe: interferes with ADL

15%

Subdivision 4: Peripheral Nervous System

Motor impairment or sensory impairment is determined under Tables 2.1, 2.2 and 2.3 and the following grading systems:

Motor impairment:

(

a) grade 5: no loss of motor function and absence of weakness;

(

b) grade 4: weakness against strong resistance, including any muscular atrophy;

(

c) grade 3: weakness against minor resistance, with full range of motion against gravity, including any muscular atrophy;

(

d) grade 2: weakness with full range of motion with gravity eliminated, including any muscular atrophy;

(

e) grade 1: weakness with less than full range of motion, even with gravity eliminated, including muscular atrophy;

(

f) grade 0: complete paralysis, including muscular atrophy.

Sensory impairment:

(

a) grade 1: no sensory impairment;

(

b) grade 2: hypesthesia including dysesthesia, paresthesia and hyperesthesia (altered sensation);

(

c) grade 3: anesthesia including pain (loss of sensation).

1. Brachial plexus

(

a) all 3 trunks, with complete motor and sensory impairment

60%

(

b) upper trunk (Erb-Duchesne syndrome) with complete motor and sensory impairment

49%

(

c) middle trunk with complete motor and sensory impairment

23%

(

d) lower trunk (Klumpke-Dejerine syndrome) with complete motor and sensory impairment

46%

NOTE: Maximum for upper limb neurological impairment is 60%.

2. Lumbosacral plexus

(

a) complete motor and sensory impairment

28%

3. Sensory Loss

Permanent, post-traumatic alteration of the skin sensation in the region of post-traumatic skin impairment, such as a scar or abrasion. (see Table 3.1)

Table 2.1: Nerve Roots

Impaired structure

Motor impairment grades

Sensory impairment grades

Upper Limb:

C-5

n/a

4.5%

13.5%

18%

n/a

C-6

n/a

10.5%

16%

21%

n/a

C-7

n/a

11.5%

17%

23%

n/a

C-8

n/a

14.5%

22%

29%

n/a

T-1

n/a

3.5%

10.5%

14%

n/a

Lower Limb:

L-2

n/a

L-3

n/a

L-4

n/a

3.5%

10.5%

14%

n/a

L-5

n/a

7.5%

11%

15%

n/a

S-1

n/a

Table 2.2: Peripheral Nerves – Head, Neck and Upper Limbs

Impaired Structure

Motor impairment grades

Sensory impairment grades

Head and neck:

greater occipital

n/a

0.5%

lesser occipital

n/a

0.5%

auricular branch of C2-3

n/a

0.5%

Upper limbs:

Axillary

n/a

10.5%

16%

21%

n/a

1.5%

dorsal scapular

n/a

1.5%

n/a

long thoracic

n/a

4.5%

n/a

medial antebrachial cutaneous

n/a

medial brachial cutaneous

n/a

1.5%

median nerve:

above midforearm

n/a

6.5%

13%

19.5%

26%

n/a

11.5%

23%

anterior interosseous

n/a

4.5%

n/a

below midforearm

n/a

4.5%

n/a

11.5%

23%

digital sensory branches:

radial side of thumb

n/a

ulnar side of thumb

n/a

3.5%

radial side of index finger

n/a

1.5%

ulnar side of index finger

n/a

radial side of middle finger

n/a

1.5%

ulnar side of middle finger

n/a

radial side of ring finger

n/a

0.5%

Musculocutaneous

n/a

7.5%

11%

15%

n/a

1.5%

pectoral (lateral)

n/a

pectoral (medial)

n/a

radial (triceps lost)

n/a

12.5%

19%

25%

n/a

1.5%

radial (triceps spared)

n/a

10.5%

15%

21%

n/a

1.5%

subscapular (lower)

n/a

1.5%

n/a

subscapular (upper)

n/a

1.5%

n/a

Suprascapular

n/a

2.5%

7.5%

10%

n/a

1.5%

Thoracodorsal

n/a

1.5%

4.5%

n/a

ulnar:

above midforearm

n/a

14%

21%

28%

n/a

below midforearm

n/a

10.5%

16%

21%

n/a

digital branches:

ulnar side of ring finger

n/a

0.5%

radial side of small finger

n/a

0.5%

ulnar side of small finger

n/a

0.5%

Table 2.3: Peripheral Nerves – Lower Limbs

Impaired Structure

Motor impairment grades

Sensory impairment grades

Inguinal region

iliohypogastric nerve

n/a

ilioinguinal nerve

n/a

Thigh, leg and foot

Femoral

n/a

3.5%

10.5%

14%

n/a

gluteal (inferior)

n/a

2.5%

7.5%

10%

n/a

gluteal (superior)

n/a

genitofemoral nerve

n/a

lateral femoral cutaeous

n/a

Obturator

n/a

posterior thigh cutaneous

n/a

Sciatic

n/a

7.5%

15%

22.5%

30%

n/a

10%

Peroneal

Common

n/a

3.5%

10.5%

14%

n/a

deep (above mid-leg)

n/a

7.5%

10%

n/a

deep (below mid-leg)

n/a

0.5%

1.5%

n/a

0.5%

Superficial

n/a

Tibial

above knee

n/a

3.5%

10.5%

14%

n/a

posterior (above midcalf)

n/a

2.5%

7.5%

10%

n/a

posterior (below midcalf)

n/a

1.5%

4.5%

n/a

medial plantar

n/a

0.5%

1.5%

n/a

lateral plantar

n/a

0.5%

1.5%

n/a

Sural

n/a

Table 3.1: Sensory Loss

Class

Symptom or Condition

Impairment Rating

Class 1

Altered cutaneous sensation surrounding all or a portion of the residual scar

Class 2

A region of skin alteration that does not conform to the territory of a peripheral nerve

Class 3

A region of skin alteration that conforms to a portion of the territory of an anatomically defined peripheral nerve

50% of the rating listed in Tables 2.2 and 2.3

Class 4

A region of skin alteration that conforms to the typical territory of an anatomically defined peripheral nerve

100% of the rating listed in Tables 2.2 and 2.3

DIVISION 3: MAXILLOFACIAL SYSTEM

Subdivision 1

1. Temporomandibular joints (TMJ)

1.1 Range of motion loss

(

a) bilateral TMJ ankylosis:

(

i) prior to growth plate fusion

40%

(ii) after growth plate fusion

30%

(

b) jaw excursion (as measured between the free edge of the upper and lower incisors):

(

i) current opening less than 6 mm

25%

(ii) current opening 6 to 10 mm

17%

(iii) current opening 10 to 20 mm

10%

(iv) current opening 20 to 30 mm

(

v) current opening greater than 30 mm

(

c) reduction of laterotrusion:

(

i) current laterotrusion less than 5 mm

(ii) current laterotrusion 5 to 8 mm

(iii) current laterotrusion greater than 8 mm

(

d) reduction of protrusion:

(

i) current protrusion less than 4 mm

(ii) current protrusion 4 to 7 mm

(iii) current protrusion greater than 7 mm

1.2 Miscellaneous dysfunction

(

a) deviation in form

(

b) disc displacement with reduction

(

c) disc displacement without reduction

(

d) post-traumatic degenerative change

(

e) craniofacial muscle disorder characterized by chronic protective muscle guarding

2. Maxilla

2.1 Loss of hard palate and dental arch

20%

2.2 Loss of hard palate

10%

2.3 Loss of soft palate

(

a) with rhinolalia:

(

i) severe

10%

(ii) minor

(

b) with tubal dysfunction

(

c) without rhinolalia or tubal dysfunction

2.4 Loss of dental arch

(

a) loss of edentulous supporting tissues, precluding successful use of a removable prosthesis

10%

(

b) allowing a complex prosthesis to be worn

(

c) allowing a simple prosthesis to be worn

2.5 Malalignment of the palate and dental arch

(

a) with serious malocclusion and TMJ dysfunction

(

b) with obstruction to the nasopharynx and tubal dysfunction

(

c) with minor malocclusion

2.6 Periodontal problems despite adequate consolidation of the palate and dental arch

2.7 Non-union or mal-union of the palate and dental arch

3. Mandible

3.1 Body or ramus

(

a) loss of tissue with non-union

10%

(

b) mal-union:

(

i) with malocclusion and TMJ dysfunction

6.5%

(ii) with malocclusion, but without TMJ dysfunction

3.2 Loss of dental arch

(

a) loss of edentulous supporting tissues, precluding successful use of a removable prosthesis

10%

(

b) allowing a complex prosthesis to be worn

(

c) allowing a simple prosthesis to be worn

3.3 Neck of condyle (See subsection 1.1 above).

4. Alteration or loss of teeth

4.1 Previously healthy teeth

(

a) central incisor

(

b) lateral incisor

(

c) canine

(

d) first premolar

(

e) second premolar

(

f) first molar

(

g) second molar

(

h) third molar

4.2 Previously damaged teeth

(

a) central incisor

0.5%

(

b) lateral incisor

0.5%

(

c) canine

0.5%

(

d) first premolar

0.5%

(

e) second premolar

0.5%

(

f) first molar

0.5%

(

g) second molar

0.5%

(

h) third molar

0.5%

Subdivision 2 – Fronto-Orbito-Nasal Area

1. The Orbit

1.1 Impairment of orbital walls causing displacement of the eye

(

a) unilateral:

(

i) mild

(ii) moderate

(iii) severe

(

b) bilateral:

(

i) mild

(ii) moderate

(iii) severe

Orbital problem may lead to secondary visual impairment (see Division 4).

1.2 Disruption of medial or lateral canthus

(

a) unilateral:

(

i) minor

(ii) major

(

b) bilateral:

(

i) minor

1.5%

(ii) major

1.3 Disruption of lacrimal apparatus

(

a) unilateral

(

b) bilateral

1.4 Malar bone and zygoma: non-specified abnormal healing (per side)

1.4.1 and 1.4.2 [Repealed] M.R. 61/2015

2. Nasal impairment

2.1 Airflow obstruction

(

a) unilateral

(

b) bilateral

2.2 Mucosal dysfunction causing bleeding, crusting and patient discomfort

(

a) unilateral

(

b) bilateral

2.3 Septal perforation

(

a) less than 2 cm

0.5%

(b) 2 cm or more

2.4 Olfactory disruption (see Division 2, Subdivision 3 - Cranial Nerves).

2.5 Alteration in form and symmetry (see Division 13, Subdivision 1 - Facial Disfigurement, Table 13.1)

3. Paranasal Sinuses

3.1 Alteration of the walls and mucosa of an ethmoid or sphenoid sinus

1.5%

3.2 Alteration of the walls and mucosa of a frontal or maxillary sinus

3.3 Alteration of any other craniofacial bony structure

4. Salivary glands

4.1 Hyposalivation: disruption of salivation significant enough to cause problems with

patient discomfort, deglutition and articulation

Subdivision 3: Throat and Related Structures

Multiple deficits

In the event of multiple deficits in this subdivision, multiply the total of the impairment ratings for the applicable classes by 0.7.

Example: (Respiration Impairment + Deglutition Impairment + Speech Impairment) × .7

(20% + 10% + 25%) × .7 = 38.5%

1. Respiration

Apply the permanent impairment rating for the applicable class of upper airway dysfunction set out in Table 3.1 below. Table 3.1 applies only to respiratory difficulty attributed to upper airway dysfunction. For lower respiratory tract functional impairment, see Division 6 (The Respiratory System).

Table 3.1: Classes of air passage deficits

Class 1 – 5%

Class 2 – 10%*

Class 3 – 15%

Class 4 – 20%

Class 5 – 25%

A recognized air passage defect persists.

Dyspnea does not occur at rest.

Dyspnea is not produced by walking or climbing stairs freely, performance of other usual activities of daily living, stress, prolonged exertion, hurrying, hill climbing, recreation** requiring intensive effort or similar activity.

A recognized air passage defect exists.

Dyspnea does not occur at rest.

Dyspnea is not produced by walking freely on the level, climbing at least one flight of ordinary stairs, or the performance of other usual activities of daily living.

A recognized air passage defect exists.

Dyspnea does not occur at rest.

Dyspnea is produced by stress, prolonged exertion, hurrying, hill climbing, recreation except sedentary forms, or similar activity.

A recognized air passage defect exists.

Dyspnea occurs at rest, although patient is not necessarily bedridden.

Dyspnea is produced by walking more than one or two blocks on the level or climbing one flight of ordinary stairs even with periods of rest; performance of other usual activities of daily living, stress, hurrying, hill climbing, recreation, or similar activity.

A recognized air passage defect exists

Severe dyspnea occurs at rest; spontaneous respiration is inadequate. Respiratory ventilation is required.

Dyspnea is aggravated by the performance of any of the usual activities of daily living beyond personal cleansing, dressing, grooming, or its equivalent.

Partial obstruction of oropharynx, upper trachea (to fourth ring), lower trachea, bronchi, or complete obstruction of the nose (bilateral) or nasopharynx.

Partial obstruction of oropharynx, laryngo-pharynx, larynx, upper trachea (to fourth ring), lower tracheal, bronchi, or complete obstruction of the nose (bilateral) or nasopharynx

Partial obstruction of oropharynx, laryngo-pharynx, larynx, upper trachea (to fourth ring), lower trachea, or bronchi

Partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to fourth ring), lower trachea, or bronchi

* Patients with successful permanent tracheostomy or stoma should be rated at 25% impairment of the whole person.

** Prophylactic restriction of activity, such as strenuous competitive sport, does not exclude patient from Class 1.

2. Mastication and Deglutition

2.1 Dietary restriction

(

a) Class 1: Diet is limited to semisolid or soft foods

(

b) Class 2: Diet is limited to liquid foods

10%

(

c) Class 3: Ingestion of food requires tube feeding or gastronomy

25%

3. Taste

3.1 Minor loss of taste

0.5%

3.2 Major loss of taste

4. Speech Impairment (see Table 3.2)

Table 3.2: Speech Impairment

Class of Impairment

Audibility

Intelligibility

Functional Efficiency

Rating

Class 1

Can produce speech of intensity sufficient for most of the needs of everyday speech communication, although this sometimes may require effort and occasionally may be beyond patient's capacity.

Can perform most of the articulatory acts necessary for everyday speech communication, although listeners occasionally ask the patient to repeat and the patient may find it difficult or impossible to produce a few phonetic units.

Can meet most of the demands of articulation and phonation for everyday speech communication with adequate speed and ease, although occasionally the patient may hesitate or speech slowly.

Class 2

Can produce speech of intensity sufficient for many of the needs of everyday speech communication; is usually heard under average conditions; however, may have difficulty in automobiles, buses, trains, stations, restaurants, etc.

Can perform many of the necessary articulatory acts for everyday speech communication. can speak name, address, etc. and be understood by a stranger, but may have numerous inaccuracies; sometimes appears to have difficulty articulating.

10%

Class 3

Can produce speech of intensity sufficient for some of the needs of everyday speech communication, such as close conversation; however, has considerable difficulty in such noisy places as listed above; the voice tires rapidly and tends to be come inaudible after a few seconds.

Can perform some of the necessary articulatory acts for everyday speech communication; can usually converse with family and friends; however, strangers may find it difficult to understand the patient, who often may be asked to repeat.

Can meet some of the demands of articulation and phonation for everyday speech communication with adequate speed and ease, but often can sustain consecutive speech only for brief periods; may give the impression of being rapidly fatigued.

15%

Class 4

Can produce speech of intensity sufficient for a few of the needs of everyday speech communication; can barely be heard by a close listener or over the telephone, perhaps may be able to whisper audibly but has no louder voice.

Can perform a few of the necessary articulatory acts for everyday speech communication; can produce some phonetic units; may have approximations for a few words such as names of own family members; however, unintelligible out of context.

Can meet a few of the demands of articulation and phonation for everyday speech communication with adequate speed and ease, such as single words or short phrases, but cannot maintain uninterrupted speech flow; speech is labored, rate is impractically slow.

20%

Class 5

Can produce speech of intensity sufficient for none of the needs of everyday speech communication.

Can perform none of the articulatory acts necessary for everyday speech communication.

Can meet none of the demands of articulation and phonation for everyday speech communication with adequate speed and ease.

25%

DIVISION 4: VISION

1. Impairment ratings for vision loss

1.1 Bilateral loss of vision

80%

1.2 Alteration of vision

(

a) homonymous or bitemporal quadrantanopsia or hemianopsia

35%

(

b) aphakia

12%

(

c) pseudophakia

1.3 Unilateral loss of vision with enucleation

30%

1.4 Unilateral loss of vision without enucleation

25%

1.5 Paralysis of accommodation or loss of near vision

1.6 Iridoplegia or fixed mydriasis causing photophobia, disturbance of close-up vision or dizziness

1.5%

1.7 Impairment of colour vision

0.5%

1.8 Other impairments to vision

The maximum impairment award for injury to a single eye is 30% (equivalent to unilateral loss of vision). Other impairments to vision are evaluated in accordance with the following evaluation process:

"aphakia" means absence of the lens of an eye, occurring congenitally or as a result of trauma or surgery; (« aphakie »)

"pseudophakia" means replacement of the natural lens with an artificial lens. (« pseudophakie »)

2. Process for evaluating vision

2.1 Criteria for evaluating vision

A deficit of the visual system occurs where there is a deviation from normal in one or more functions of the eye.

Visual integrity requires:

(

a) integrity of corrected visual acuity for distance and close up;

(

b) integrity of the field of vision; and

(

c) ocular motility without diplopia.

The evaluation of these three functions is necessary in determining the visual deficit and their coordinated action is essential to optimal sight.

Other ocular functions or problems that affect the coordinated functions of the eye are awarded percentages of deficit in accordance with the scale prescribed for those functions.

2.2 Methods for evaluating vision

(

a) Determination of central visual acuity

Visual acuity test charts: For distance vision tests, the Snellen test chart with non-serif block letters or numbers, the illiterate E chart, or Landolt's broken-ring chart are acceptable. For near vision, charts with print similar to that of the Snellen chart, with Revised Jaeger Standard print, or with American point-type notation for use at 35 cm (14 inches) are acceptable.

The far test distance should simulate infinity at 6m (20 feet) or no less than 4 m (13 feet 1 inch). The near test distance should be fixed at 35 cm (14 inches), in keeping with the Revised Jaeger Standard. Adequate and comfortable illumination must be diffused onto the test card at a level about three times greater than that of the usual rule of illumination.

Acuity should be measured for near and far, both without correction and with the best spectacle correction, or with contact lens correction if usually worn. If, however, contacts are not usually worn, it is not necessary to fit them to determine the best acuity. Note that certain ocular conditions, particularly corneal disorders, may be better corrected with contact lenses.

Table 4.1 – Loss (in %) of central vision in a single eye

Snellen rating for distance in feet

Approximate Snellen rating for near in inches

14 14

14 18

14 21

14 24

14 28

14 35

14 40

14 45

14 60

14 70

14 80

14 88

14 112

14 140

20 15

20 20

20 25

20 30

20 40

20 50

20 60

20 70

20 80

20 100

20 125

20 150

20 200

20 300

20 400

20 800

In Table 4.1 the upper number shows the percentage loss of central vision without allowance for the monocular pseudophakia. The lower number shows the percentage loss of central vision with allowance for monocular aphakia or monocular pseudophakia.

Using Table 4.1, the examiner identifies the Snellen rating for near vision along the top row, and Snellen rating for distance along the first column. Reading down from the former and across from the latter, the examiner locates two impairment values for the loss of central vision where the column and row cross.

Monocular aphakia or monocular pseudophakia is considered to be an additional central vision impairment. If either are present, the remaining central vision is decreased by 50%, as shown in Table 4.1.

(

b) Determination of extent of visual fields

The extent of the visual field is determined by the use of standard perimetry using the values shown in Table 4.2.

Table 4.2: Stimuli equivalent to the Goldmann Kinetic Stimulus

Phakic

Aphakic

Goldman (kinetic)

III – 4e

IV – 4e

ARC perimeter (kinetic)

3 mm white at radius 330 mm

6 mm white at radius 330 mm

Allergan-Humphrey (static, size 3)

10dB

6dB

Octopus (static, size 3)

7dB

3dB

The results may be transferred to the chart shown below.

The extent of the normal visual fields for the eight principal meridians are shown in Table 4.3.

Table 4.3: Normal Visual Fields for Eight Principal Meridians

Direction of vision

Degrees of field

Temporally

Down temporally

Direct down

Down nasally

Nasally

Up nasally

Direct up

Up temporally

Total

Any scotomata within the field should be subtracted from the maximum number of degrees for that meridian. An additional 5% should be included for an inferior quadrantic loss, and 10% for an inferior hemianopic loss, as loss of inferior field is of greater functional consequence.

The Esterman 120 binocular field test should be used for any binocular field.

The extent of the field can be defined on the field chart by drawing a line outside the location of the furthest 10 decimal point in each meridian. Assume that if any stimuli 10 decibels or greater are seen within the 20 or 30 degree field, that there will be no field remaining beyond this. But if the 10-decibel stimulus is seen out of the edge of the 30-degree field, then the extent of loss cannot be known unless a larger field is tested.

If an automated central field is normal, it may be accepted the entire field is normal unless the ocular exam or history suggests otherwise, in which case a full field should be tested.

Table 4.4: Deficit of visual field

Degrees Lost

(total)

Degrees retained

(total)

Deficit

Degrees lost

(total)

Degrees retained

(total)

Deficit

Degrees lost

(total

Degrees retained

(total)

Deficit

500*

* or more

When the central visual field is impaired, the percentage of deficit is that of the concomitant loss of visual acuity. If the visual acuity is normal, the percentage of deficit is calculated on the basis of the degrees lost.

(

c) Determination of ocular motility

Abnormal ocular motility and binocular diplopia — Unless a patient has diplopia with 30º of the center of fixation, the diplopia rarely causes significant visual impairment. An exception is diplopia on looking downward. The extent of diplopia in the various directions of gaze is determined on an arc perimeter at 33 cm or with a bowl perimeter. A tangent screen also is acceptable for evaluating the central 30º. Examination is made in each of the eight major meridians by using a small test light or the projected light of approximately Goldmann III-4e without adding coloured lenses or correcting prisms.

Diplopia within the central 20º is estimated to be a 100% impairment of ocular motility. This is applied to the injured eye only.

To determine the impairment of ocular motility, the patient is seated with both eyes open and the chin resting in the chin rest and centred so that the eyes are equidistant from the sides of the central fixation target.

The presence of diplopia is then plotted along the eight meridians of a suitable visual field chart. The impairment percentage for loss of ocular motility due to diplopia in the meridian of maximum impairment can be determined according to the following chart. When there is diplopia of the same eye along multiple meridians, the corresponding impairment percentages are combined.

Percentage of deficit of ocular motility of an eye in the field of diplopia

(

d) Determination of the visual efficiency of an eye

The methods described in clause (a), (

b) and (

c) above are used to evaluate:

(

i) visual acuity,

(ii) the field of vision, and

(iii) ocular motility.

The percentage of visual efficiency of each eye is determined by the following formula:

A × B × C = E

In this formula:

A is the percentage of visual acuity retained;

B is the percentage of visual field retained;

C is the percentage of ocular motility retained; and

E is the percentage of visual efficiency of the eye.

(

e) Determination of efficiency of entire visual system

The percentage of efficiency of binocular vision is determined by the following formula

3A/4 + B/4 = E

In this formula:

A is the percentage of visual efficiency of the better eye;

B is the percentage of visual efficiency of the other eye;

E is the percentage of visual efficiency of binocular vision.

The percentage of deficit for the entire visual system is the difference between the percentage of visual efficiency of binocular vision (the percentage determined for E in the above formula) and 100%.

DIVISION 5: UROGENITAL SYSTEM AND FETUS

1. Urinary tract tissue disruption

1.1 Kidney impairment

(

a) removal of both kidneys, including renal transplantation

40%

(

b) loss of one kidney

10%

(

c) reduction or loss of renal function (See

section 2 – Renal Functional impairment);

(

d) with associated anemia (See Division 10 – The Hematopoietic System).

1.2 Ureteric impairment:

(

a) any ureteric diversion

10%

(

b) with associated reduction or loss of renal function (See

section 2 – Renal Functional impairment)

1.3 Bladder impairment:

(

a) bladder removal, including the resulting loss of control of urination or urinary by-pass

35%

(

b) incontinence or urinary retention:

(

i) complete loss of sphincter control

20%

(ii) partial loss of sphincter control

10%

(iii) dysfunction in the form of frequency or hesitancy

(

c) alteration of the bladder with enterocystoplasty

10%

(

d) alteration of the bladder without enterocystoplasty

1.4 Urethral impairment

(

a) surgically uncorrectable fistula

7.5%

(

b) stenosis requiring monthly treatments

(

c) stenosis requiring quarterly treatments

1.5 Alteration of tissue following a posterolumbar incision or a laporotomy

2. Renal functional impairment

(

a) Class 1:

creatinine clearance of 30 to 80 mL/min

intermittent symptoms and signs of upper urinary tract dysfunction are present that do not require continuous treatment or surveillance

Impairment rating

15%

(

b) Class 2:

creatinine clearance of 10 to 30 mL/min

creatinine clearance is greater than 30 mL/min, but symptoms and signs of upper urinary tract dysfunction are incompletely controlled by continuous treatment or surveillance

Impairment rating

50%

(

c) Class 3

creatinine clearance is less than 10 mL/min

creatinine clearance is greater than 10 mL/min, but symptoms and signs of upper urinary tract dysfunction persists despite continuous medical or surgical treatment

Impairment rating

75%

3. Reproductive organ tissue disruption

3.1 Male genitalia

(

a) loss of penis

15%

(

b) post-traumatic alteration of penis

10%

(

c) loss of both testicles (including epididymides and spermatic cords):

(

i) before the end of puberty

20%

(ii) after puberty

10%

(

d) loss of a testicle (including epididymus and spermatic cord)

(

e) alteration of the prostate (including seminal vesicles)

(

f) loss of the prostate (including seminal vesicles)

10%

(

g) with associated urinary incontinence from any of above (See 1.3 – Bladder impairment).

3.2 Female genitalia

3.2.1 Internal genitalia:

(

a) loss of both ovaries (including fallopian tubes):

(

i) before the end of puberty

20%

(ii) after puberty

10%

(

b) loss of a single ovary (including fallopian tube)

(

c) loss of the uterus (including cervix):

(

i) before the end of menopause

10%

(ii) after menopause

(iii) alteration of cervix only

(

d) loss of an ovary with or without the fallopian tube

(e) *alteration of tissue following a cesarean

section

*Necessitated by the MVA.

3.2.2 External genitalia:

(

a) loss of the clitoris, vulva or vagina

(

b) alteration of the clitoris, vulva or vagina

2.5%

3.3 Loss of fetus

4. Sexual dysfunction

(

a) Class 1: sexual functioning is possible with difficulty of erection or ejaculation in men or lack of awareness, excitement, or lubrication in either sex

(

b) Class 2: reflex sexual functioning is possible but there is no awareness

10%

(

c) Class 3: infertility or total absence of sexual functioning, or both

15%

DIVISION 6: RESPIRATORY SYSTEM

1. Respiratory system tissue disruption

1.1 Loss of a lung

20%

1.2 Loss of a pulmonary lobe

1.3 Alteration of tissue following

(

a) thoracotomy

(

b) thoracostomy or penetrating chest wound (single or multiple)

1.4 Phrenic nerve injury

(

a) with associated alteration of pulmonary function (see

section 2 – Respiratory functional impairment).

1.5 Tracheal stenosis

(According to Table 3.1 – Classes of Air Passage Deficits – in Division 3)

1.6 Alteration of tissue following a tracheotomy or penetrating throat wound:

(

a) tracheotomy

(

b) tracheostomy

2. Respiratory functional impairment

2.1

Interpretation – In

section 2.2,

"D CO " means diffusion capacity of carbon monoxide, being a measure of the efficiency of gas transfer across the lung; (« DL CO »)

"FEV 1 " means forced expiratory volume in 1 second, being the volume of air exhaled in the first second of a forced expiratory maneuver; (« VEMS »)

"FVC" means forced vital capacity, being the volume of air one can exhale with a forced expiratory maneuver. (« CVF »)

2.2 Impairment ratings

(

a) Class 1

Both FVC and FEV1 are greater than 80% of predicted

AND

FEV 1 /FVC is greater than 70% of predicted;

AND

D CO is greater than 70% of predicted

(

b) Class 2

15%

Either FVC or FEV 1 is between 60% and 80% of predicted;

D CO is between 60% and 80% of predicted.

(

c) Class 3

35%

FVC is between 50% and 59% of predicted;

FEV 1 is between 40% and 59% of predicted

D CO is between 40% and 59% of predicted.

(

d) Class 4

75%

FVC is less than 50% of predicted;

FEV 1 is less than 40% of predicted

D CO is less than 40% of predicted.

DIVISION 7: THE DIGESTIVE TRACT

In this division, the different impairment rating classes consider both tissue disruption and functional loss together.

1. Impairment rating criteria for the upper GI tract

(

a) Class 1

2.5%

Either

(

i) symptoms or signs of upper digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and continuous treatment is not required, and weight can be maintained at a desirable level.

(

b) Class 2

7.5%

Either

(

i) symptoms and signs of upper digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and dietary or medical treatments are required for control of symptoms/signs, and weight loss does not exceed 10% below desirable body weight.

(

c) Class 3

25%

Either

(

i) symptoms and signs of upper digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and

(iii) dietary or medical treatments do not completely control symptoms/signs, or

(iv) weight loss is 10% to 20% below desirable body weight.

(

d) Class 4

40%

Either

(

i) symptoms and signs of upper digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and

(iii) dietary or medical treatments do not completely control symptoms/signs, or

(iv) weight loss is more than 20% below desirable body weight.

2. Impairment rating criteria for the lower GI tract

2.1 Colon and rectum

(

a) Class 1

2.5%

Either

(

i) symptoms or signs of lower digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and continuous treatment is not required, and weight can be maintained at a desirable level.

(

b) Class 2

7.5%

Either

(

i) symptoms and signs of lower digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and dietary or medical treatments are required for control of symptoms/signs, and weight loss does not exceed 10% below desirable body weight.

(

c) Class 3

25%

Either

(

i) symptoms and signs of lower digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and

(iii) dietary or medical treatments do not completely control symptoms/signs, or

(iv) weight loss is 10% to 20% below desirable body weight.

(

d) Class 4

40%

Either

(

i) symptoms and signs of lower digestive tract disease are present, or

(ii) there is anatomic loss or alteration of tissue,

and

(iii) dietary or medical treatments do not completely control symptoms/signs, or

(iv) weight loss is more than 20% below desirable body weight.

2.2 Anal Impairment

(

a) Class 1

2.5%

There is either

(

i) evidence of anatomic loss or alteration of tissue, or

(ii) mild incontinence of stool,

and symptoms can be controlled by treatment.

(

b) Class 2

7.5%

There is evidence of anatomic loss or alteration of tissue and either

(

i) there is moderate incontinence of stool, requiring continual treatment, or

(ii) symptoms are incompletely controlled by treatment.

(

c) Class 3

20%

There is evidence of anatomic loss or alteration of tissue, and either

(

i) complete fecal incontinence is present, or

(ii) symptoms are unresponsive to treatment.

3. Impairment rating criteria for the liver and biliary tract

3.1 Liver tissue disruption

(

a) liver trauma not requiring surgery

(

b) blunt trauma or laceration requiring surgery

20%

Residual hepatic functional impairment:

(

a) Class 1

There is objective evidence of persistent liver disease, there are no symptoms or signs of ascites, jaundice, or other significant hepatic complications, and biochemical studies indicate minimal disturbance in hepatic function.

(

b) Class 2

15%

There is objective evidence of chronic liver disease, there are no symptoms, or signs of ascites, jaundice, or esophageal bleeding, and biochemical studies indicate severe disturbance in hepatic function.

(

c) Class 3

40%

There is

(

i) objective evidence of progressive chronic liver disease, or

(ii) history of jaundice, ascites, or bleeding of upper gastrointestinal varices, or

(iii) intermittent hepatic encathalopathy.

(

d) Class 4

70%

There is

(

i) objective evidence of progressive chronic liver disease, or

(ii) persistent jaundice or bleeding, esophageal varices,

and there are central nervous system manifestations of hepatic insufficiency.

3.2 Biliary tract

(

a) Class 1

There is occasional biliary tract dysfunction with documented biliary tract disease.

(

b) Class 2

20%

There is recurrent biliary tract dysfunction despite ongoing treatment.

(

c) Class 3

40%

There is obstruction of the bile tract with recurrent cholangitis.

(

d) Class 4

75%

There is persistent jaundice and progressive liver disease due to obstruction of the common bile duct.

4. Impairment rating criteria for the abdominal wall, inguinal and femoral regions

4.1 Hernia-related impairments

(

a) Class 1

Palpable defect in supporting structures of abdominal wall and slight protrusion at site of defect with increased abdominal pressure where the defect is readily reducible.

(

b) Class 2

15%

Palpable defect in the supporting structures of abdominal wall where frequent or persistent protrusion at site of defect may increase with intra-abdominal pressure and is manually reducible.

(

c) Class 3

25%

Palpable defect in supporting structures of abdominal wall where persistent, irreducible, or irreparable protrusion at the site of the defect has occurred causing limitation in normal activities.

4.2 Post-operative abdominal wall-related impairments

(

a) alteration of tissue following a laparotomy

(

b) alteration of tissue following a laparoscopy or penetrating abdominal wound

DIVISION 8: CARDIOVASCULAR SYSTEM

1. Cardiac lesions: According to Table 8.1

2. Thoracic arterial lesions

(

a) surgically corrected alteration of the ascending thoracic aorta

(

b) surgically corrected alteration of the descending thoracic aorta

(

c) functional limitations (See Table 8.1).

3. Peripheral arterial lesions

(

a) surgically corrected alteration of the abdominal aorta

(

b) surgically corrected alteration of a peripheral artery

(

c) functional alteration following a unilateral sympathectomy

(

d) alteration of a blood vessel corrected by transluminal angioplasty

(

e) functional limitations (See Tables 8.2 and 8.3).

4. Venous and lymphatic lesions

(

a) post-traumatic venous insufficiency or lymphatic insufficiency:

(

i) minor, well controlled by medical treatment

(ii) moderate, not completely controlled by medical treatment

(iii) severe, not controlled by medical treatment, with trophic problems, but without recurring ulceration

(iv) very severe, not controlled by medical treatment, with trophic problems and recurring ulceration

12%

(

b) superficial venous insufficiency

Table 8.1 Functional limitations following cardiovascular injury

Class

Symptoms

Impairment Rating

Class 1

(over 7 mets)

(

a) cardiovascular lesion without angina nor shortness or breath with strenuous or rapid or prolonged exertion or when undergoing a maximum stress test

2.5%

(

b) cardiovascular lesion whereby ordinary physical activity does not cause angina such as walking and climbing stairs, however, angina occurs with strenuous or rapid or prolonged exertion or when undergoing a maximum stress test

7.5%

Class 2

(5, 6, 7 mets)

(

a) cardiovascular lesion without angina nor shortness of breath when performing physical activity such as walking, climbing stairs or carrying packages

15%

(

b) cardiovascular lesion with minor limitation characterized by angina or shortness of breath:

for physical activity such as walking at a brisk pace, walking uphill,

for walking or stair climbing after meals, or in cold, or in wind,

under emotional stress,

in the morning after waking,

when walking more than 2 blocks on a level, and

climbing 1 flight of ordinary stairs at a fast pace or more than 1 flight of ordinary stairs at a normal pace and in normal conditions

30%

Class 3

(2 to 4 mets)

moderate limitation characterized by angina or shortness of breath for physical activities such as walking 1 to 2 city blocks on level ground or climbing 1 flight of stairs in normal conditions and at a normal pace

45%

Class 4

(under 2 mets)

severe limitation characterized by angina or shortness of breath for physical activities such as walking a few steps or while performing movements needed for personal hygiene; angina or shortness of breath may occur at rest or during sleep

80%

Table 8.2 Functional Limitations Following A Lower Limb Vascular Lesion

Symptoms

Impairment Rating

Severe arterial insufficiency, with trophic skin changes and ulceration, with inability to walk

45%

Intermittent claudication, occurring when walking at an ordinary pace over a distance of less than 75 meters

30%

Intermittent claudication, occurring when walking at an ordinary pace over a distance of 75 to 120 meters

20%

Intermittent claudication, occurring when walking at an ordinary pace for a distance of over 120 meters, but less than 300 meters

10%

Slightly inhibiting intermittent claudication, occurring when walking at an ordinary pace over a distance of 300 to 500 meters

Table 8.3 Functional Limitations Following An Upper Limb Vascular Lesion

Symptoms

Impairment Rating

Severe arterial insufficiency, with trophic skin changes and ulceration, inhibiting exertion or causing ischemic pain at rest

45%

Arterial insufficiency causing significant intermittent ischemic pain that occurs with light exertion

30%

Arterial insufficiency causing intermittent ischemic pain that occurs with moderate exertion

15%

Arterial insufficiency causing intermittent ischemic pain that occurs with heavy exertion

DIVISION 9: ENDOCRINE SYSTEM

Subdivision 1: Hypothalamus, Pituitary, Thyroid And Parathyroid Glands

1. Total hypopituitarism, including diabetes insipidus

60%

2. Partial hypopituitarism, excluding diabetes insipidus, requiring replacement of

(

a) thyroid hormone

(

b) cortisone acetate

10%

(

c) estrogen/testosterone when fertility is not an issue

10%

(

d) loss of fertility

20%

(

e) growth hormone in a child or adolescent

20%

(

f) growth hormone in an adult

3. Diabetes insipidus

10%

4. Impairment of the parathyroid glands

10%

5. Alteration of the thyroid gland not requiring hormone therapy

6. Alteration or loss of the thyroid gland requiring hormone therapy

Subdivision 2: Pancreas (Endocrine Function)

For exocrine pancreatic impairments, refer to

Section 1 of Division 7: The Gastrointestinal Tract

1. *Diabetes mellitus

(

a) controlled without the use of insulin or oral medication

(

b) control requiring the use of oral medication

10%

(

c) control requiring insulin therapy

30%

*Diabetes may occur following MVA-related trauma by one of several mechanisms. If the pancreas is traumatised, there may be sufficient tissue injury to impair insulin production resulting in tertiary diabetes . Certain drugs, e.g. Prednisone, can induce secondary diabetes by altering the hormonal balance. If this drug (or similar drug) is used to treat an MVA-related condition, then the diabetic complication is also considered accident related.

Finally a claimant with pre-existing Type 1 or 2 diabetes, or a claimant with borderline diabetes, may have their metabolism altered by prolonged inactivity (e.g. bedrest) associated with the treatment of their MVA-related condition. This alteration in their diabetic status is usually temporary.

Subdivision 3: Adrenal Glands

1. Loss of one adrenal gland

2. Loss of both adrenal glands requiring hormone therapy

15%

DIVISION 10: THE HEMATOPOIETIC SYSTEM

1. Tissue Disruption

1.1 Spleen

(

a) injury not requiring surgery

(

b) injury requiring splenic repair or partial splenectomy

(

c) injury resulting in total splenectomy

10%

(

d) injury causing some loss of splenic function (see

section 2 – Functional Impairment of the Hematopoietic System).

1.2 Thymus

(

a) injury not requiring surgery

(

b) injury requiring partial thymectomy

(

c) injury resulting in total thymectomy

(

d) injury causing some loss of splenic function (see

section 2 – Functional Impairment of the Hematopoietic System).

2. Functional Impairment of the Hematopoietic System

2.1 Red blood cells

Symptoms

Hemoglobin Level g/L

Transfusion Requirement

Impairment Rating

None

100-120

None

Minimal

80-100

None

15%

Moderate

50-80*

2-3 Units every 4-6 weeks

40%

Severe

50-80*

2-3 Units every 2 weeks

75%

*level prior to transfusion

2.2 White blood cells (WBC)

(

a) conditions leading to a decreased WBC count

Symptoms

WBC Level g/L

Transfusion Requirement

Impairment Rating

None

3-10

None

Minimal

1-3

None

15%

Moderate

(

b) conditions leading to an increased WBC count

by report: 0 to 75%

2.3 Platelet and clotting factors

(

a) conditions leading to a permanent alteration in the platelet count

by report: 0 to 10%

(

b) conditions leading to a permanent alteration in clotting factors

by report: 15 to 50%

DIVISION 11: PSYCHIATRIC CONDITION, SYNDROME OR PHENOMENON

Class

Symptom or condition

Impairment rating

Class 1

A psychiatric condition, syndrome or phenomenon that, including adverse effects of medication, impairs the person's ability to perform the activities of daily living, ability to function socially or sense of well-being, to such an extent that he or she requires continuous supervision in an institutional or confined setting.

100%

Class 2

A psychiatric condition, syndrome or phenomenon that, including adverse effects of medication, impairs the person's ability to perform the activities of daily living, ability to function socially or sense of well-being, to such an extent that he or she requires periodic supervision in an institutional or confined setting for 50% or more of the time.

70%

Class 3

A psychiatric condition, syndrome or phenomenon that, including adverse effects of medication, impairs the person's ability to perform the activities of daily living, ability to function socially or sense of well-being, to such an extent that he or she requires periodic supervision in an institutional or confined setting for less than 50% of the time.

35%

Class 4

15%

Class 5

A psychiatric condition, syndrome or phenomenon that, including adverse effects of medication, impairs the person's ability to perform the activities of daily living, ability to function socially or sense of well-being, to such an extent that he or she requires regular medication, psychiatric intervention or both on an occasional basis (less than once per month).

DIVISION 12: VESTIBULOCOCHLEAR APPARATUS

Impairment rating procedure

In this Division, the whole-person impairment rating is determined by combining the separate impairment ratings for hearing loss, vestibular (labyrinthine) function and tinnitus in accordance with the following formula:

(H × 0.8) + (V × 0.9) + (T × 0.8) = 1

In this formula:

H is the impairment rating for hearing loss determined determined under

section 3;

V is the impairment rating for vestibular function determined under

section 4;

T is the impairment rating for tinnitus determined under

section 5; and

I is the whole-person impairment rating.

1. Ear or pinna

See Table 13.1 – Evaluation of facial disfigurement, in Division 13 – The Skin.

2. External canal injury (e.g. stenosis)

(

a) unilateral, mild

0.5%

(

b) unilateral, moderate

(

c) unilateral, sever

(

d) bilateral

3. Hearing

Permanent hearing impairment may be classified as wither unilateral or bilateral.

Unaided:

(

a) profound bilateral sensory neural hearing loss

(Defined as > 60 ISO according to Table 12.1)

30%

(

b) unilateral sensory neural hearing loss profound

(Defined as > 60 ISO according to Table 12.1)

(

c) reduction in hearing other than above

(see Table 12.1).

Table 12.1 Impairment rating for hearing loss

Reduction of Hearing in Decibels (DB)*

Impairment Rating

Most Impaired Ear

Less Impaired Ear

25 ISO or less

0.5%

2.5%

25 - 29 ISO

1.0%

5.0%

30 - 34 ISO

1.5%

7.5%

35 - 39 ISO

2.0%

10.0%

40 - 44 ISO

2.5%

12.5%

45 - 49 ISO

3.0%

16.0%

50 - 54 ISO

3.5%

17.5%

55 - 59 ISO

4.0%

20.0%

60 ISO or more

5.0%

25.0%

* According to the average obtained by a valid audiogram on frequencies of 500, 1000 and 2,000 cycles.

Addendum to Table 12.1

Reduction in speech discrimination score below 80% in affected ear multiplies hearing impairment by a factor of 2. For example, a hearing loss of over 35 to 40 ISO in the most impaired ear = 2% whole-person impairment. However, if the affected ear speech discrimination is 4. Vestibular function

4.1 Loss of labyrinth (as determined by clinical examination and/or electronystagmography):

(

a) complete loss of one labyrinth

(

b) complete loss of both labyrinths

10%

4.2 Functional criteria of vestibular impairment

Class

Symptom or condition

Impairment Rating

Class 1

Peripheral or central vertigo does not affect the capacity to perform activities of daily living (ADL).

2.5%

Class 2

Peripheral or central vertigo does not affect the capacity to perform most ADL, but certain activities, such as driving an automobile or riding a bicycle, may endanger the safety of the patient or others.

7.5%

Class 3

Peripheral or central vertigo necessitating continuous supervision for the performance of most ADL such as personal hygiene, household chores, or walking.

30%

Class 4

Peripheral or central vertigo requiring continuous supervision for the performance of most ADL and requiring confinement of the patient at home or an institution.

50%

Vestibular injury may be compensated over time and should be rated at both 6 and 12 months after injury to establish whether it has become static.

5. Tinnitus, unilateral or bilateral

Class

Symptom or condition

Impairment Rating

Class 1

(mild)

Tinnitus is intermittent and noticeable only in quiet environment.

0.5%

Class 2

(moderate)

Tinnitus is constantly present and bothersome in quiet environments, disturbing concentration and sleep.

1.0%

Class 3

(severe)

Tinnitus is constantly present and bothersome in most environments, disturbing concentration, sleep and activities of daily living.

2.0%

DIVISION 13: THE SKIN

Definitions

In this Division,

"alteration in form and symmetry" means a skin or surface disfigurement that results in a change in tissue bulk, consistency, length or texture. It does not refer to the presence of a scar; (« modification de la forme et de la symétrie »)

"conspicuous" means a skin disfigurement that is readily discernable with the unaided eye; (« apparent »)

"faulty scar" means a scar that is misaligned, irregular, depressed, deeply adhering, pigmented, scaly, retractile, keloidal or hypertrophic; (« cicatrice vicieuse »)

"flat scar" means a scar that is almost linear, at the same level as the adjoining tissue and almost the same colour, causing no contraction or distortion of neighboring structures; (« cicatrice non vicieuse »)

"inconspicuous" means a skin disfigurement that is not readily discernable with the unaided eye. (« non apparent »)

Subdivision 1: Facial Disfigurement

1. Rating facial disfigurement

For the purpose of rating facial disfigurement, reference must be made to each of the following anatomical elements:

(

a) the forehead;

(

b) the orbits;

(

c) the eyelids;

(

d) the visible part of the ocular globes;

(

e) the cheeks;

(

f) the nose;

(

g) the lips;

(

h) the ears;

(

i) the chin.

2. Impairment rating procedure for facial disfigurement

2.1 The degree of facial disfigurement is first classified in terms of its physical appearance, in order to determine the appropriate impairment class.

2.2 For disfigurement classes 1-4, the impairment percentage for disfigurement is fixed with respect to scarring and the alterations in form and symmetry, up to a maximum impairment percentage for disfigurement prescribed for each class (see Table 13.1.)

2.3 Where there is evidence of both scarring and alterations in form and symmetry, both impairments are rated and the percentages for both are added up to the maximum percentage prescribed for that class.

2.4 For classes 5 and 6, scarring and the alterations in form and symmetry are considered jointly and the impairment percentage awarded is the maximum prescribed for the class (see Table 13.2.)

Table 13.1 Evaluation of facial disfigurement

Part 1

Classification According To Appearance

Alteration in Form and Symmetry

Scarring

Maximum Impairment Rating for the Class

Class 1

No impairment

Inconspicuous change

Inconspicuous

Class 2

Very minor impairment

Inconspicuous change

Conspicuous

1% per cm

Class 3

Minor impairment

Conspicuous change that

Conspicuous and

(

a) affects one anatomical element

(

a) flat scar

1% per cm 2

(

b) affects two anatomical elements

(

b) faulty scar

2% per cm

(

c) affects more than two anatomical elements

Class 4

Moderate impairment

Conspicuous change that holds one's attention and

Conspicuous and

15%

(

a) affects one anatomical element

10%

(

a) flat scar

1% per cm 2

(

b) affects two anatomical elements

12%

(

b) faulty scar

3% per cm

(

c) affects more than two anatomical elements

15%

Table 13.2: Evaluation of facial disfigurement

Part 2

Classification According To Appearance

Alteration in Form and Symmetry and Scarring

Impairment Rating Percent

Class 5

Severe impairment

Involving several facial anatomic elements

20%

Class 6

Disfiguration

Involving all facial anatomic elements

30%

Subdivision 2: Disfigurement Of Other Parts Of The Body

1. Impairment rating procedure for disfigurement of other parts of the body

1.1 Where there is impairment only by alteration in form and symmetry, the degree of impairment is calculated and the percentage of disfigurement prescribed for that part of the body is awarded (see Table 13.3).

1.2 Where there is impairment only by scarring, the surface area of the scar is measured and the impairment percentage prescribed per cm2 is awarded, up to the maximum impairment percentage prescribed for that part of the body (see Table 13.3).

1.3 Where there are both alterations in the form and symmetry and scarring, the higher of the two percentages obtained under either heading is awarded, without exceeding up to the maximum impairment percentage prescribed for that part of the body (see Table 13.3).

1.4 The maximum impairment per region is listed in the last column of Table 13.3. Where a body region has two sides (right/left or front/back) the maximum impairment % listed in the table is to be considered the maximum per side.

1.5 For the purposes of rating disfigurement for other parts of the body, the body regions may be defined as follows:

(

a) scalp and skull – Beginning at the hairline in front and following the hairline around the side to the back;

(

b) neck – The skin overlying C1-C7 posteriorly and the cricoid cartilage to the sternal notch anteriorly;

(

c) arms, shoulders and elbow – Extending from the acromion process and axillary folds to the olecranon process and cubital fossa. The scapulae, supraspinous fossa and supraclavicular fossa are considered as part of the trunk for the purposes of rating of disfigurement;

(

d) forearms - Beginning at the distal aspect of the elbow (as defined above) and extending to the wrist crease;

(

e) wrists and hands - Beginning at the wrist crease and extending distally to the fingertips;

(

f) trunk – This region includes both the suprascapular and supraclavicular fossae. It extends distally to the inguinal ligaments (anteriorly) and the iliac crests (posteriorly);

(

g) lower Limbs – Begins at the distal aspect of the trunk (as defined above) and extends distally to the tips of the toes. Note that the buttock is considered to be part of the lower limb and not the trunk.

2. Disfigurement due to discoloration

Permanent, post-traumatic alteration of the skin's natural color (as compared to adjacent unaffected areas), but does not include pigmented scars, pigmented amputation stumps or pigmented skin due to venous or lymphatic insufficiency. (see Table 13.4)

Table 13.3: Evaluation Of Disfigurement For Other Parts Of The Body

Body Region

Alteration in Form and Symmetry

Scarring

Maximum Impairment Rating

Scalp and skull

Minor or moderate change

Conspicuous

0.5%/cm 2

Severe change

Neck

Minor or moderate change

Conspicuous

1.0%/cm 2

Severe change

Arms, shoulders and elbows

Minor or moderate change

Conspicuous

0.5%/cm 2

Severe change

Forearms

Minor or moderate change

Conspicuous

1.0%/cm 2

Severe change

Wrists and hands

Minor or moderate change

Conspicuous

1.0%/cm 2

Severe change

Trunk

Minor or moderate change

Conspicuous

0.5%/cm 2

Severe change

Lower limbs

Minor or moderate change

Conspicuous

1.0%/cm 2

Severe change

Table 13.4: Disfigurement Due to Discoloration

Class

Discoloration of the Skin

Impairment Rating

Class 1

Conspicuous and affecting a body region other than the face

Class 2

Conspicuous and affecting the face

Subdivision 3: Disfigurement From Partial Or Total Amputation

1. Disfigurement from amputation

The percentage awarded for a disfigurement due to amputation takes into account the scars inherent in amputation.

2. Eye

Enucleation with or without replacement by prosthesis, including impairment inherent in the resulting appearance

3. Upper limb

(

a) forequarter disarticulation

12%

(

b) shoulder disarticulation

11%

(

c) above elbow amputation

10%

(

d) elbow disarticulation

(

e) below elbow amputation

(

f) wrist disarticulation

(

g) amputation of a thumb, per phalanx

1.5%

(

h) amputation of a finger other than the thumb, per phalanx, up to a maximum of 6%

0.5%

(

i) amputation of a metacarpal, per metacarpal, up to a maximum of 2%

0.5%

4. Lower limb

(

a) hemipelvectomy

12%

(

b) hip disarticulation

10%

(

c) above knee amputation

(

d) knee disarticulation

(

e) below knee amputation

(

f) ankle amputation (Symes)

(

g) midtarsal amputation (Chopart)

(

h) tarsometatarsal amputation (Lisfranc)

(

i) transmetatarsal amputation

(

j) amputation of a great toe, per phalanx

0.5%

(

k) amputation of a metatarsal, per metatarsal, up to a maximum of 1%

0.25%

(

l) amputation of a toe other than the great toe, per phalanx

0.1%

M.R. 41/2000 ; 37/2003 ; 173/2009 ; 61/2015

ANNEXE A

ANNEXE DES DÉFICIENCES PERMANENTES

Table des matières

SECTION 1 : SYSTÈME MUSCULO-SQUELETTIQUE

Sous-section 1 : membre supérieur

Sous-section 2 : membre inférieur

Sous-section 3 : colonne vertébrale

SECTION 2 : SYSTÈMES NERVEUX CENTRAL ET PÉRIPHÉRIQUE

Sous-section 1 : crâne, cerveau et carotides

Sous-section 2 : moelle épinière

Sous-section 3 : nerfs crâniens

Sous-section 4 : système nerveux périphérique

SECTION 3 : SYSTÈME MAXILLO-FACIAL

Sous-section 1 : articulation temporo-mandibulaire

Sous-section 2 : région fronto-orbito-nasale

Sous-section 3 : gorge et éléments associés

SECTION 4 : VISION

SECTION 5 : SYSTÈME GÉNITO–URINAIRE ET FOETUS

SECTION 6 : APPAREIL RESPIRATOIRE

SECTION 7 : SYSTÈME DIGESTIF

SECTION 8 : SYSTÈME CARDIO-VASCULAIRE

SECTION 9 : SYSTÈME ENDOCRINIEN

Sous-section 1 : hypothalamus, hypophyse, thyroïde et parathyroïdes

Sous-section 2 : pancréas (fonction endocrinienne)

Sous-section 3 : surrénales

SECTION 10 : SYSTÈME HÉMATOPOÏÉTIQUE

SECTION 11 : FONCTIONS COGNITIVES

SECTION 12 : APPAREIL COCHLÉO–VESTIBULAIRE

SECTION 13 : PEAU

Sous-section 1 : déficience physionomique

Sous-section 2 : préjudice esthétique aux autres parties du corps

Sous-section 3 : préjudice esthétique consécutif à une amputation partielle ou totale

SECTION 1 : SYSTÈME MUSCULO-SQUELETTIQUE

Sous-section 1 : membre supérieur

0.1 Définition

Dans la présente section, « anomalie de guérison non spécifique » s'entend d'une anomalie anatomique présente à la fin du processus de guérison qui n'est pas mentionnée ailleurs dans l'annexe, notamment les déviations de fractures, les décalages en rotation et les raccourcissements.

1. Épaule et bras

1.1 Amputation :

a) désarticulation interscapulo-thoracique

60 %

b) désarticulation de l'épaule

56 %

c) amputation au-dessus du coude (tiers proximal de l'humérus)

54 %

d) amputation au-dessus du coude (tiers moyen ou distal de l'humérus)

52 %

1.2 Fracture :

a) fracture du sternum, de la clavicule, de l'omoplate ou de l'humérus avec anomalie de guérison non spécifique

1 %

a.1) fracture des côtes révélée par une radiologie (par côte, jusqu'à un maximum de 2 %)

0,5 %

b) fracture de l'humérus :

(

i) déviation de plus de 15°

5 %

(ii) déviation de 5° à 15°

2,5 %

(iii) raccourcissement de plus de 4 cm

5 %

(iv) raccourcissement de 2 à 4 cm

3 %

(

v) raccourcissement de 1 à 2 cm

1,5 %

c) ostéomyélite chronique à un os du membre supérieur avec excrétions

3 %

1.3 Rupture non osseuse :

a) règle générale :

(

i) rupture non osseuse complète ou fracture par arrachement à un membre supérieur

2 %

(ii) rupture non osseuse partielle ou fracture par arrachement à un membre supérieur

1 %

si la rupture est associée à une perte d'amplitude des mouvements d'une articulation adjacente, on ajoute le taux correspondant à la perte d'amplitude des mouvements indiqué à l'article 1.5 de cette sous-section;

b) exceptions à la règle générale de l'alinéa a) :

(

i) rupture de la coiffe des rotateurs :

(

A) IRM positive, complète :

(

I) sans pathologie antérieure connue de la coiffe des rotateurs

5 %

(II) avec pathologie antérieure connue de la coiffe des rotateurs

2 %

(

B) partielle

2 %

(ii) rupture (distale ou proximale) de tendon au biceps :

(

A) sans diminution de la force musculaire à la supination ou à la flexion du coude

1 %

(

B) avec perte de la force musculaire à la supination ou à la flexion du coude

2 %

1.4 Rupture d'un ligament ou d'un autre tissu mou :

a) lésion acromio-claviculaire ou sterno-claviculaire :

(

i) entorse du premier degré

0 %

(ii) entorse du deuxième degré

1 %

(iii) entorse du troisième degré

2 %

b) instabilité gléno-humérale – luxation traumatique gléno-humérale (confirmée par un cliché radiologique) :

(

i) aucune récidive dans les 12 mois suivant la collision :

(

A) sans instabilité antérieure

3 %

(

B) avec instabilité antérieure

2 %

(ii) luxation récidivante au cours des 12 mois suivant la collision :

(

A) sans instabilité antérieure

5 %

(

B) avec instabilité antérieure

2 %

(

C) avec lésion de Bankhart, lésion de Hill-Sachs ou rupture du bourrelet, ajouter

1 %

1.5 Perte d'amplitude des mouvements de l'appareil articulaire de l'épaule :

a) flexion – extension (par rapport à l'omoplate) :

mesure combinée de l'amplitude du mouvement : l'angle maximal normal de ce mouvement est de 230°;

(

i) moins de 61°

9 %

(ii) de 61° à 120°

5 %

(iii) de 121° à 180°

2 %

(iv) plus de 180°

0 %

b) abduction – adduction (par rapport à la tête de l'humérus) :

mesure combinée de l'amplitude du mouvement : l'angle maximal normal de ce mouvement est de 230°;

(

i) moins de 61°

6 %

(ii) de 61° à 120°

3 %

(iii) de 121° à 180°

1 %

(iv) plus de 180°0 %

c) rotation interne – rotation externe :

mesure combinée de l'amplitude du mouvement gléno-huméral : l'angle maximal normal de ce mouvement est de 180°;

(

i) moins de 46°

6 %

(ii) de 46° à 90°

3 %

(iii) de 91° à 135°

1 %

(iv) plus de 135°

0 %

2. Coude et avant-bras

2.1 Amputations :

a) désarticulation du coude (y compris amputation du tiers proximal de l'avant-bras

50 %

b) amputation au-dessous du coude (tiers moyen de l'avant-bras)

47 %

2.2 Fracture :

a) fracture mal guérie, sans plus de précision, du radius, du cubitus ou de l'humérus

1 %

b) fracture du radius :

(

i) avec déviation de plus de 15°

5 %

(ii) avec déviation de 5° à 15°

2,5 %

(iii) avec raccourcissement de plus de 4 cm

5 %

(iv) avec raccourcissement de 2 à 4 cm

3 %

(

v) avec raccourcissement de 1 à 2 cm

1,5 %

c) fracture du cubitus :

(

i) avec déviation de plus de 15°

5 %

(ii) avec déviation de 5° à 15°

2,5 %

(iii) avec raccourcissement de plus de 4 cm

5 %

(iv) avec raccourcissement de 2 à 4 cm

3 %

(

v) avec raccourcissement de 1 à 2 cm

1,5 %

2.3 Rupture non osseuse :

a) rupture non osseuse complète ou fracture par arrachement au coude ou à l'avant-bras

2 %

b) rupture non osseuse partielle avec fracture par arrachement au coude ou à l'avant-bras

1 %

2.4 Rupture d'un ligament ou d'un autre tissu mou :

a) lésions collatérales du cubitus et du radius :

(

i) entorse du premier degré

0 %

(ii) entorse du deuxième degré

1 %

(iii) entorse du troisième degré

2 %

2.5 Perte d'amplitude des mouvements du coude :

a) flexion – extension :

mesure combinée de l'amplitude du mouvement : l'angle maximal normal de ce mouvement est de 140°;

(

i) aucun mouvement

14 %

(ii) de 1° à 40°

12 %

(iii) de 41° à 80°

7 %

(iv) de 81° à 120°

4 %

(

v) de 121° à 135°

1 %

(vi) plus de 135°

0 %

b) pronation – supination :

mesure combinée de l'amplitude du mouvement : l'angle maximal normal de ce mouvement est de 160°;

(

i) aucun mouvement

9 %

(ii) de 1° à 50°

4 %

(iii) de 51° à 100°

3 %

(iv) de 101° à 140°

2 %

(

v) de 141° à 150°

1 %

(vi) plus de 150°

0 %

3. Poignet et main

3.1 Amputation :

a) désarticulation du poignet (y compris amputation du tiers distal de l'avant-bras)

45 %

b) amputation ou désarticulation des métacarpiens :

(i) 1 er métacarpien

22 %

(ii) 2 e ou 3 e métacarpien (chacun)

11 %

(iii) 4 e ou 5 e métacarpien (chacun)

5,5 %

si plusieurs métacarpes ont été touchés, les taux sont combinés et non additionnés ;

c) amputation (phalange proximale) ou désarticulation interphalangienne proximale :

(

i) pouce

11 %

(ii) index ou majeur (chacun)

8 %

(iii) annulaire ou auriculaire (chacun)

4 %

si plusieurs doigts ont été touchés, les taux sont combinés et non additionnés ;

d) amputation (phalange moyenne ou distale) ou désarticulation interphalangienne distale :

(

i) pouce

11 %

(ii) index ou majeur (chacun)

5 %

(iii) annulaire ou auriculaire (chacun)

3 %

si plusieurs doigts ont été touchés, les taux sont combinés et non additionnés .

3.2 Fracture :

a) fracture du scaphoïde

0 %

b) fracture du scaphoïde avec nécrose avasculaire

2 %

c) fracture du scaphoïde avec pseudarthrose ou absence de soudure de l'os fracturé

2 %

d) fracture de Colles avec réduction anatomique

0 %

e) fracture de Colles avec déviation du radius de plus de 15°

2 %

f) nécrose avasculaire du semi–lunaire

2 %

g) fracture mal guérie d'un carpe, d'un métacarpe ou d'une phalange

1 %

si l'une ou l'autre des fractures susmentionnées est associée à une perte d'amplitude des mouvements, consulter les articles 3.5a et 3.5b pour calculer les taux.

3.3 Rupture non osseuse :

a) rupture non osseuse complète ou fracture par arrachement au poignet ou à la main

2 %

b) rupture non osseuse partielle ou fracture par arrachement au poignet ou à la main

1 %

3.4 Rupture d'un ligament ou d'un autre tissu mou :

a) instabilité carpienne : taux établi en fonction du rapport d'un praticien des soins de santé. C'est l'aspect du cliché radiologique, y compris la taille et le déplacement du carpe, et la gravité de l'arthrose articulaire qui permettent de déterminer si la déficie

Document details

Collection	Manitoba — Regulations
Citation	MB Reg. 41/1994
Type	regulation
Volume / chapter	041-94
Language	en
Format	html
Source	PROVINCIAL
Identifier	fc863fbb71afbafb1f57a3b2f335f0f88ec4d712

Source file is stored in the law ingest library (html).

Permanent Impairments (Universal Bodily Injury Compensation) Regulation

Table of Contents

Section

Schedule

ENHANCEMENT FOR SYMMETRICAL ORGANS

section 2

COMPUTATION ON SUCCESSIVE REMAINDERS

Section 5 not to be applied to percentage based on enhancement factor

APPLICATION OF ENHANCEMENT FACTOR

Schedule

Schedule of Permanent Impairments

Article

ACCROISSEMENT POUR LES ORGANES SYMÉTRIQUES

CALCUL RELATIF AUX RÉSIDUS SUCCESSIFS

APPLICATION DU FACTEUR D'ACCROISSEMENT

Annexe

Annexe des déficiences permanentes

Schedule

Schedule A.

ENHANCEMENT FOR SYMMETRICAL ORGANS

ACCROISSEMENT POUR LES ORGANES SYMÉTRIQUES

section 2

Section 2 does not apply to an anatomicophysiological deficit that

M.R. 61/2015

R.M. 61/2015

section 2, the percentage of an anatomicophysiological deficit existing before an accident shall be fixed under

Schedule A or, if the anatomicophysiological deficit does not appear in

Schedule A, by using

Schedule A as a guideline in accordance with subsection 129(2) of the Act.

M.R. 41/2008

R.M. 41/2008

COMPUTATION ON SUCCESSIVE REMAINDERS

CALCUL RELATIF AUX RÉSIDUS SUCCESSIFS

Schedule B.

M.R. 37/2003

R.M. 37/2003

Section 5 not to be applied to percentage based on enhancement factor

Section 5 does not apply to the percentage obtained by applying the enhancement factor referred to in

section 2.

APPLICATION OF ENHANCEMENT FACTOR

APPLICATION DU FACTEUR D'ACCROISSEMENT

section 2 is added to the other percentages of deficits after the computation on successive remainders has been made.

Coming into force

Entrée en vigueur

SCHEDULE A

SCHEDULE OF PERMANENT IMPAIRMENTS

Table of Contents

DIVISION 1: MUSCULO-SKELETAL SYSTEM

DIVISION 2: CENTRAL AND PERIPHERAL NERVOUS SYSTEM

DIVISION 3: MAXILLOFACIAL SYSTEM

DIVISION 4: VISION

DIVISION 5: UROGENITAL SYSTEM AND FETUS

DIVISION 6: RESPIRATORY SYSTEM

DIVISION 7: DIGESTIVE TRACT

DIVISION 8: CARDIOVASCULAR SYSTEM

DIVISION 9: ENDOCRINE SYSTEM

DIVISION 10: HEMATOPOIETIC SYSTEM

DIVISION 11: COGNITIVE FUNCTION

DIVISION 12: VESTIBULOCOCHLEAR APPARATUS

DIVISION 13: THE SKIN

DIVISION I: THE MUSCULOSKELETAL SYSTEM

section 1.5 of this subdivision.

section 3.5a or 3.5b.

section 2.4 – Range of motion loss at the hip)

section 2.4 (Range of motion loss at the hip).

section 3.5 (Range of motion loss at the knee).

section 4.5 (Range of motion loss at the foot or ankle).

T1-L4

L5-S1

DIVISION 2: CENTRAL AND PERIPHERAL NERVOUS SYSTEM

Definitions:

section 2.1 of this subdivision)

section 3.1 of this subdivision)

section 2).

section 2).

section 2).

DIVISION 3: MAXILLOFACIAL SYSTEM

DIVISION 4: VISION

A × B × C = E

3A/4 + B/4 = E