Guidelines for the assessment of permanent impairment Version 3

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Chapter 3Lower Extremity ImpairmentIntroduction3.1 The lower extremity is discussed in section 3.2 of Chapter 3 in the AMA 4 Guides (pp 75 - 93).This section is complex and provides a number of alternative methods of assessing permanentimpairment involving the lower extremity. An organised approach is essential and findingsshould be carefully documented on a worksheet.The Approach to Assessment of the Lower Extremity3.2 There are several different forms of evaluation that can be used as indicated in sections 3.2a to3.2m of the AMA 4 Guides (pp 75 - 89). Table 3.1 in these Guidelines indicates which evaluationmethods can and cannot be combined for the assessment of each injury. This table can only be usedto assess one combination at a time. It may be possible to perform several different evaluations aslong as they are reproducible and meet the conditions specified below and in the AMA 4 Guides.The most specific method, or combination of methods, of impairment assessment should beused. When more than one equally specific method or combination of methods of rating the sameimpairment is available, the method providing the highest rating should be chosen. Table 3.2 canbe used to assist the process of selecting the most appropriate method(s) of rating lower extremityimpairment.3.3 Where more than one impairment parameter of lower extremity impairment exists for a single lowerextremity impairment the permissible combination table (Table 3.1) must be applied as describedabove.3.4 Where more than one extremity impairment arises from a work-related injury each impairment isassessed and combined to give the total lower extremity percentage impairment, then this value isconverted to a % person impairment.3.5 If the contralateral uninjured joint has a less than average mobility, the impairment value(s)corresponding with the uninjured joint can serve as a baseline and are subtracted from thecalculated impairment for the injured joint, only if there is a reasonable expectation the injuredjoint would have had similar findings to the uninjured joint before injury. The rationale for thisdecision should be explained in the impairment assessment report.3.6 The assessed impairment of a part or region can never exceed the impairment due to amputation ofthat part or region. For a lower limb, therefore, the maximum evaluation is 40% whole personimpairment.WCT Guidelines 1 October 2011 13
3.7 Use of worksheets is essential. Table 3.2 of these Guidelines is such a worksheet and may be used inthe assessment of permanent impairment of the lower extremity.3.8 Table 3.1 should be referred to in order to determine which impairments can be combined and whichcannot (see 3.2 above)Specific Interpretation of the AMA 4 GuidesLeg length Discrepancy3.9 When true leg length discrepancy is determined clinically (p 74, AMA 4 Guides) the method usedmust be indicated (for example, tape measure from anterior superior iliac spine).Clinicalassessment of leg length discrepancy is an acceptable method but if computerised tomography filmsare available, they should be used in preference. Such an examination should not be orderedsolely for determining leg lengths.3.10 Table 35 (p 75, AMA 4 Guides) should have the element of choice removed such thatGait Derangementimpairments for leg length should be read as the higher figure of the range quoted, being 0, 3,5, 7, or 8 for whole person impairment, or 0, 9, 14, 19, or 20 for lower limb impairment.3.11 Assessment of impairment based on gait derangement should be used as the method of lastresort (pp 75-76 AMA 4 Guides). Methods most specific to the nature of the disorder shouldalways be used in preference. If gait derangement is used it cannot be combined with anyother impairment evaluation in the lower extremity. It can only be used if no other validmethod is applicable and reasons why it is chosen should be provided in the impairmentassessment report.3.12 Any walking aid utilised must be permanent and not temporary.3.13 In the application of Table 36 (p 76 of AMA 4) item b. is deleted as the Trendelenburg sign isnot sufficiently reliable.Muscle Atrophy (unilateral)3.14 This section of the AMA 4 Guides (p 76) is not applicable if the limb other than that being assessedis abnormal (for example, if varicose veins cause swelling, or if there is other injury).3.15 In the use of Table 37 (p 77, AMA 4 Guides) the element of choice should be removed in theimpairment rating and only the higher figure used. Therefore, for the thigh, the whole personimpairment should be assessed as 0, 2, 4, or 5%, or lower limb impairment as 0, 8, 13, or 13%respectively. For the calf, the equivalent figures have the same numerical values.WCT Guidelines 1 October 2011 14
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 and 16: 2.8 Although range of motion appear
Page 17: (ii) Rate the upper extremity impai
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
Page 67 and 68: 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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