Guidelines for the assessment of permanent impairment Version 3

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2.11 For purposes of interpreting Table 11 (p 48, AMA 4 Guides) “abnormal sensation” includesdisturbances in sensation such as dysaesthesia, paraesthesia and cold intolerance. “Decreasedsensibility” includes anaesthesia and hypoaesthesia.Impairment Due to Other Disorders of the Upper Extremity2.12 The section “Impairment Due to Other Disorders of the Upper Extremity” (Section 3.1m, pp 58 -65 AMA 4 Guides), should be rarely used in the context of work-related injuries. The medicalassessor must take care to avoid duplication of impairments when using this section.2.13 Radiographs for carpal instability (p 61, AMA 4 Guides) should only be considered, ifavailable, along with the clinical signs. X-ray examination should not be performed solely forthis assessment.2.14 Strength evaluations (pp 64 - 65, AMA 4 Guides) and Table 34 must not be used, as they areunreliable indicators of impairment. Where actual loss of muscle bulk has occurred theassessment can be completed by analogy, for example with a relevant peripheral nerve injury.Similar principles can be applied where tendon transfers have been performed or afteramputation reattachment, if no other suitable methods of impairment assessment are available.Impairment of the upper extremity due to complex regional pain syndrome2.15 The section, "Causalgia and Reflex Sympathetic Dystrophy" (p 56, AMA 4 Guides) should notbe used. These conditions have been better defined since publication of the AMA 4 Guides. Thecurrent terminology is Complex Regional Pain Syndrome (CRPS) type I (referring to what wastermed Reflex Sympathetic Dystrophy) and Complex Regional Pain Syndrome type II (referring towhat was termed Causalgia).2.16 For a diagnosis of Complex Regional Pain Syndrome at least eight (8) of the following 11criteria must be present. The criteria are: skin colour that is mottled or cyanotic; cool skintemperature; oedema; skin dry or overly moist; skin texture that is smooth and non elastic; softtissue atrophy (especially fingertips); joint stiffness and decreased passive motion; nailchanges with blemished, curved or talon-like nails; hair growth changes with hair falling out,longer or finer; x-rays showing trophic bone changes or osteoporosis; bone scan showingfindings consistent with CRPS.2.17 When the diagnosis of Complex Regional Pain Syndrome has been established, impairmentdue to CRPS type I (previously Reflex Sympathetic Dystrophy (RSD)) is evaluated as follows:(i)Rate the upper extremity impairment resulting from the loss of motion of each individualjoint affected by CRPS.WCT Guidelines 1 October 2011 11
(ii) Rate the upper extremity impairment resulting from sensory deficits and pain accordingto the grade that best describes the severity of interference with activities of daily livingas described in Table 11a (p 48, AMA 4 Guides). The value selected represents the upperextremity impairment. A nerve multiplier is not used.(iii) Combine the upper extremity value for loss of joint motion (step 1) with the value forpain and sensory deficits (step 2) using the Combined Values Chart (pp 322 - 324, AMA4 Guides).(iv) Convert the upper extremity impairment to whole person impairment by using Table 3 (p20, AMA 4 Guides).2.18 When the diagnosis of Complex Regional Pain Syndrome has been established,impairment due to CRPS type II (previously Causalgia) is evaluated as follows:(i)Rate the upper extremity impairment resulting from the loss of motion of each individualjoint affected by CRPS.(ii) Rate the upper extremity impairment present resulting from sensory deficits and painaccording to the methods described in section 3.1k (pp 46 - 56, AMA 4 Guides) and Table11a (p 48, AMA 4 Guides).(iii) Rate the upper extremity impairment resulting from motor deficits and loss of power ofthe injured nerve according to the determination method described in section 3.1k (pp 46- 56, AMA 4 Guides) and Table 12a (p 49, AMA 4 Guides).(iv) Combine the upper extremity impairment percentages for loss of joint motion (step 1),pain and sensory deficits (step 2) and motor deficits (step 3) using the Combined ValuesChart (pp 322 - 324, AMA 4 Guides).(v) Convert the upper extremity impairment to whole person impairment by using Table 3 (p20, AMA 4 Guides).WCT Guidelines 1 October 2011 12
Page 1 and 2: GUIDELINES FOR THE ASSESSMENT OFPER
Page 3 and 4: ForewordThe Workers Rehabilitation
Page 5 and 6: Table of ContentsPage No.Foreword .
Page 7 and 8: Causation of permanent impairment1.
Page 9 and 10: 1.18 Using these Guidelines and the
Page 11 and 12: Adjustments for Effects of Prosthes
Page 13 and 14: stable and the assessment of perman
Page 15: 2.8 Although range of motion appear
Page 19 and 20: 3.7 Use of worksheets is essential.
Page 21 and 22: Table 3.2: Lower Extremity Workshee
Page 23 and 24: Table 3.3. Impairment for ankylosis
Page 25 and 26: Table 3.4Tibial Nerve Impairment Va
Page 27 and 28: Table 4.1 Assessing spinal impairme
Page 29 and 30: Specific interpretation of the AMA
Page 31 and 32: Definitions of clinical findings co
Page 33 and 34: 4.22 When allocating the worker to
Page 35 and 36: Sexual Functioning4.30 Sexual dysfu
Page 37 and 38: 4.45 One or more end plate fracture
Page 39 and 40: 5.7 Headache or other pain potentia
Page 41 and 42: Table 5.2Criteria for rating impair
Page 43 and 44: Chapter 6Ear, Nose and Throat, and
Page 45 and 46: Scarring5% for loss of sense of tas
Page 47 and 48: 7.7 In order to measure the impairm
Page 49 and 50: impairment using precisely the meth
Page 51 and 52: Table 7.3TravelClass 1Class 2Class
Page 53 and 54: Table 7.7 Conversion TableClass1Cla
Page 55 and 56: Psychiatric Impairment Rating Scale
Page 57 and 58: 7.21 Examples1. A worker suffers a
Page 59 and 60: Chapter 8Impairment of Other Body S
Page 61 and 62: Pneumoconiosis (AMA 5 Guides, Secti
Page 63 and 64: 8.23 Hypertensive Cardiovascular Di
Page 65 and 66: The Digestive SystemIntroduction an
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Where there is a range of values in
Page 69 and 70:
Appendix 1GlossaryCauda equina synd
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WorkCover Tasmania - Template for R
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