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![]() New Table of DisabilitiesApril 2006 EditionChapter 17
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Table 17.1 | Loss of Function – Upper Limb | This table is used to rate impairment from musculoskeletal conditions which impact on the function of the upper limb as a whole. |
Table 17.2 | Loss of Function – Upper Limb – Shoulder | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion in the shoulder. |
Table 17.3 | Loss of Function – Upper Limb – Elbow | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion in the elbow. |
Table 17.4 | Loss of Function – Upper Limb – Wrist | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion in the wrist. |
Table 17.5 | Loss of Function – Upper Limb – Thumb and Fingers | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the thumb and fingers. |
Table 17.6 | Other Impairment – Fractures and Miscellaneous Musculoskeletal Conditions Upper Limb and Chest | This table is used to rate impairment from fractures and miscellaneous musculoskeletal conditions of the upper limb and chest. |
Table 17.7 | Other Impairment – Upper Limb – Amputations | This table is used to rate impairment from upper limb amputations. |
Table 17.8 | Other Impairment -Osteomyelitis – Upper Limb | This table is used to rate impairment from osteomyelitis of the upper limb. |
Table 17.9 | Loss of Function – Lower Limb | This table is used to rate impairment from musculoskeletal conditions which impact on the function of the lower limbs as a whole. |
Table 17.10 | Loss of Function – Lower Limb – Hip | This table is used to rate impairment from musculoskeletal conditions which affect the active range of motion of the hip. |
Table 17.11 | Loss of Function – Lower Limb – Knee | This table is used to rate impairment from musculoskeletal conditions which affect the active range of motion of the knee. |
Table 17.12 | Loss of Function – Lower Limb – Ankle | This table is used to rate impairment from musculoskeletal conditions which affect the active range of motion of the ankle. |
Table 17.13 | Loss of Function – Lower Limb – Feet and Toes | This table is used to rate impairment from musculoskeletal conditions of the feet and toes. |
Table 17.14 | Other Impairment – Fractures of Lower Limbs | This table is used to rate impairment from fractures of the lower limbs. |
Table 17.15 | Other Impairment – Lower Limb – Amputations | This table is used to rate impairment from lower limb amputations. |
Table 17.16 | Other Impairment -Osteomyelitis – Lower Limbs | This table is used to rate impairment from osteomyelitis of the lower limbs. |
Table 17.17 | Loss of Function – Cervical Spine | This table is used to rate impairment from musculoskeletal conditions affecting the cervical spine. |
Table 17.18 | Loss of Function – Thoracic Spine | This table is used to rate impairment from musculoskeletal conditions affecting the thoracic spine. |
Table 17.19 | Loss of Function – Lumbar Spine | This table is used to rate impairment from musculoskeletal conditions affecting the lumbar spine. |
Table 17.20 | Other Impairment – Coccyx, Pelvis, and Sacroiliac Joints | This table is used to rate impairment from musculoskeletal conditions affecting the coccyx, pelvis and sacroiliac joints. |
Table 17.21 | Other Impairment -Osteomyelitis – Spine and Pelvis | This table is used to rate impairment from osteomyelitis of the spine and pelvis. |
Chart 1 | Optimal Position of Joint Ankylosis – Upper Limb | This chart provides values for the optimal position of an ankylosed joint of the upper limb. |
Chart 2 | Average Range of Joint Motion – Upper Limb | This chart provides values for the average range of motion of specific joints of the upper limb. |
Chart 3 | Optimal Position of Joint Ankylosis – Lower Limb | This chart provides values for the optimal position of an ankylosed joint of the lower limb. |
Chart 4 | Average Range of Joint Motion – Lower Limb | This chart provides values for the average range of motion of specific joints of the lower limb. |
Chart 5 | Average Range of Joint Motion – Spine | This chart provides values for the average range of motion of the spine. |
Chart 6 | Nerve Root Compression Syndromes | This chart describes nerve root compression effects. |
The loss of function tables in this chapter are based on active (independent) range of motion. The active range of all movements in all joints should be recorded in degrees. Range of motion is measured from the anatomical neutral position in all joints with the exception of supination and pronation of the forearm which is measured from the neutral forearm position (mid supination/pronation). Use of a goniometer is preferred; however, visual assessment of degrees of movement is acceptable. Reference charts are provided indicating normal values for range of motion and optimal position of ankylosis of joints.
In any specific joint, certain movements of that joint are considered functionally more important. This functional importance has been considered and is reflected in the rating tables.
Ratings in the musculoskeletal impairment tables take into account the presence of pain which may accompany the musculoskeletal impairment and that may limit range of motion or function. In the musculoskeletal tables, pain is considered to be a part of many conditions and is considered to be present in most instances beyond minimal levels of impairment. The presence of pain, when introduced at a particular level in a table, is considered to be a distinguishing factor between rating levels. Once pain is identified to exist, it is considered to be present at successive levels.
A rating is determined from the applicable table for each entitled osteomyelitis condition.
The following instructions are to be followed when determining ratings for nerve root compression lesions of the spine and/or spinal cord injury or disease.
When rating impairment of the upper limbs, a higher rating may be appropriate for the dominant upper limb. When applicable, the tables within this section indicate ratings for both the dominant and non-dominant upper limb.
Selection of Tables and Charts
The tables that may be used to rate impairment from musculoskeletal upper limb and chest conditions are:Table 17.1 | Loss of Function – Upper Limb | This table is used to rate impairment from musculoskeletal conditions which impact on the function of the upper limb as a whole. |
Table 17.2 | Loss of Function – Upper Limb – Shoulder | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the shoulder. |
Table 17.3 | Loss of Function – Upper Limb – Elbow | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the elbow. |
Table 17.4 | Loss of Function – Upper Limb – Wrist | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the wrist. |
Table 17.5 | Loss of Function – Upper Limb – Thumb and Fingers | This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the thumb and fingers. |
Table 17.6 | Other Impairment – Fractures and Miscellaneous Musculoskeletal Conditions Upper Limbs and Chest | This table is used to rate impairment from fractures and miscellaneous musculoskeletal conditions of the upper limb and chest. |
Table 17.7 | Other Impairment – Upper Limb – Amputations | This table is used to rate impairment from upper limb amputations. |
Table 17.8 | Other Impairment -Osteomyelitis – Upper Limb | This table is used to rate impairment from osteomyelitis of the upper limb. |
Chart 1 | Optimal Position of Joint Ankylosis – Upper Limb | This chart provides values for the optimal position of an ankylosed joint of the upper limb. |
Chart 2 | Average Range of Joint Motion – Upper Limb | This chart provides values for the average range of motion of specific joints of the upper limb. |
Table 17.1 provides criteria for evaluating the ability to use the upper limb as a whole in performing every day activities. Only one rating may be selected for each upper limb. If more than one rating is applicable, the ratings are compared and the highest selected.
This table is used to rate specific conditions which include the following:
In cases of spinal cord injury or disease, refer to the instructions provided in the Introduction of this chapter.
If more than one condition of the same limb is to be rated from Table 17.1, the conditions are bracketed for assessment purposes.
When entitled upper limb conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.2 is used to rate impairment from musculoskeletal conditions of the shoulder. Only one rating may be selected for each shoulder. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one shoulder condition of the same limb is to be rated from Table 17.2, the conditions are bracketed for assessment purposes.
When entitled upper limb shoulder conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.3 is used to rate impairment from musculoskeletal conditions of the elbow. Only one rating may be selected for each elbow. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one elbow condition of the same limb is to be rated from Table 17.3, the conditions are bracketed for assessment purposes.
When entitled upper limb elbow conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.4 is used to rate impairment from musculoskeletal conditions of the wrist. Only one rating may be selected for each wrist. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one wrist condition of the same limb is to be rated from Table 17.4, the conditions are bracketed for assessment purposes.
When entitled upper limb wrist conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.5 is used to rate impairment from musculoskeletal conditions of the thumbs and fingers. One rating may be selected for each digit from Table 17.5. If more than one rating is applicable for a single digit, the ratings are compared and the highest selected.
If more than one condition of a single digit is entitled, the conditions are bracketed for assessment purposes.
When entitled upper limb thumb and finger conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.6 is used to rate impairment from fractures and miscellaneous musculoskeletal conditions of the upper limb and chest. One rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
If a fracture is intra-articular, the applicable joint table is also used to rate the impairment.
When entitled fractures and miscellaneous musculoskeletal conditions of the upper limb and chest result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.7 is used to rate impairment from upper limb amputations.
All amputations of the upper limb, regardless of the cause of the amputation (eg. vascular, trauma or infection), are rated from this table.
When previously entitled conditions are later removed by a newly entitled amputation, the new rating is based on Table 17.7 – Other Impairment – Upper Limb Amputations. However, in rare cases, if there is more than one entitled condition of an upper limb, the sum of the ratings could be higher than the amputation rating. In these cases, the ratings for the previously entitled conditions that applied immediately prior to the amputation are to be maintained.
When a non-entitled amputation removes a previously entitled condition(s), the rating for the entitled condition(s) that applied immediately prior to the amputation is to be maintained.
When entitled upper limb amputations result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.8 is used to rate impairment from osteomyelitis of the upper limb. One rating may be selected for each area of osteomyelitis. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
When entitled osteomyelitis of the upper limb results in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Only one rating may be given for each upper limb from Table 17.1. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.1, follow the “ands” and “ors”.
Table 17.1 – Loss of Function – Upper LimbDominant Rating | Non-Dominant Rating | Criteria |
Nil | Nil |
|
Two | One |
|
Four | Two |
|
Nine | Four |
|
Thirteen | Nine |
|
Twenty-one | Thirteen |
|
Thirty-four | Twenty-one |
|
Thirty-four | Thirty-four |
|
Fifty-two | Thirty-nine |
|
Step 1: | Determine the rating from Table 17.1 (Loss of Function – Upper Limb). |
Note: | Table 17.1 is used to rate specific conditions which include the following:
If more than one entitled upper limb condition in a single limb is to be assessed from Table 17.1, the conditions must be bracketed. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to Step 1 rating. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to rating at Step 4 |
This is the Disability Assessment. |
Only one rating may be given for each shoulder from Table 17.2. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.2, follow the “ands” and “ors”.
Table 17.2 – Loss of Function – Upper Limb – ShoulderDominant Rating | Non-Dominant Rating | Criteria |
Nil | Nil |
|
Four | Two |
|
Nine | Four |
|
Thirteen | Nine |
|
Twenty-one | Thirteen |
|
Twenty-six | Twenty-three |
|
Thirty-four | Thirty-six |
|
Fifty-two | Forty-five |
|
Step 1: | Determine the rating from Table 17.2 (Loss of Function – Upper Limb-Shoulder). |
Note: | If more than one shoulder condition in a single upper limb is to be rated, conditions must be bracketed. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each elbow from Table 17.3. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.3, follow the “ands” and “ors”.
Table 17.3 – Loss of Function – Upper Limb – ElbowDominant Rating | Non-Dominant Rating | Criteria |
Nil | Nil |
|
Four | Two |
|
Nine | Four |
|
Thirteen | Nine |
|
Twenty-one | Thirteen |
|
Twenty-six | Twenty-three |
|
Thirty-four | Twenty-six |
|
Step 1: | Determine the rating from Table 17.3 (Loss of Function – Upper Limb – Elbow). |
Note: | If more than one entitled elbow condition in a single upper limb is to be rated from Table 17.3, conditions must be bracketed. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each wrist from Table 17.4. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.4, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.4 – Loss of Function – Upper Limb – WristDominant Rating | Non-Dominant Rating | Criteria |
Nil | Nil |
|
Four | Two |
|
Nine | Four |
|
Thirteen | Nine |
|
Eighteen | Twelve |
|
Twenty-one | Fifteen |
|
Step 1: | Determine the rating from Table 17.4 (Loss of Function – Upper Limb – Wrist). |
Note: | If more than one entitled wrist condition in a single limb is to be rated from Table 17.4, conditions must be bracketed. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each digit from Table 17.5. If more than one rating is applicable for a single digit, the ratings are compared and the highest selected.
Each bullet (∙) in Table 17.5 represents one criterion. In order for a rating to be established for Table 17.5, all criteria designated at that rating level must be met.
Table 17.5 – Loss of Function – Thumb and FingersThumb | ||
Dominant Rating | Non-Dominant Rating | Criteria |
one | Nil |
|
Two | One |
|
Thirteen | Thirteen |
|
Eighteen | Eighteen |
|
Index or Middle Finger | ||
Dominant Rating | Non-Dominant Rating | Criteria |
One | Nil |
|
Two | One |
|
Five | Three |
|
Nine | Four |
|
Ring or Little Finger | ||
Dominant Rating | Non-Dominant Rating | Criteria |
Nil | Nil |
|
One | Nil |
|
Two | One |
|
Three | Two |
|
Step 1: | Determine the rating from Table 17.5 (Loss of Function – Upper Limb – Thumb and Fingers). |
Note: | One rating may be selected for each digit from Table 17.5. However, if more than one condition in a single digit is entitled, the conditions must be bracketed for assessment purposes. The applicable ratings are compared and the highest selected. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3 |
Step 5: | If partial entitlement exists, apply to rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each entitled condition from Table 17.6. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.6, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.6 – Other Impairment – Fractures and Miscellaneous Musculoskeletal Conditions of the Upper Limb and ChestRating | Criteria |
Nil |
|
One |
|
Two |
|
Three |
|
Four |
|
Step 1: | Determine the rating from Table 17.6 (Other Impairment – Fractures and Miscellaneous Conditions Upper Limb and Chest). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each entitled amputation condition or combination of entitled amputation conditions from Table 17.6. If more than one rating is applicable for an entitled condition or combination of entitled amputation conditions, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.7, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.7 – Other Impairment – Upper Limb AmputationsRating | Criteria |
Little Finger | |
One Two Three |
|
Ring Finger | |
One Two Four |
|
Middle Finger | |
Two Four Nine |
|
Index Finger | |
Three Six Nine |
|
Thumb | |
Nine Thirteen Eighteen |
|
Other | |
Nine |
|
Twenty-one |
|
Twenty-six |
|
Thirty-four |
|
Thirty-nine |
|
Forty-three |
|
Fifty-two |
|
Sixty-one |
|
Sixty-eight |
|
Seventy-one |
|
Seventy-six |
|
Eighty-five |
|
Amputations not included in this table will be rated on individual merits.
Step 1: | Determine the rating from Table 17.7 (Other Impairment – Upper Limb-Amputations). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating(s) at Step 1. |
Step 3: | Determine the Quality of Life rating(s). |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating(s) at Step 4. |
This is the Disability Assessment |
One rating may be given for each area of osteomyelitis of the upper limb from Table 17.8. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.8, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.8 – Other Impairment – Osteomyelitis – Upper LimbRating | Criteria |
One |
|
Four |
|
Nine |
|
Thirteen |
|
Step 1: | Determine the rating from Table 17.8 (Other Impairment Upper Limb – Osteomyelitis). |
Note: | One rating may be given for each entitled area of osteomyelitis in the upper limb. The steps must be repeated for each area entitled. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
The following values are a guide. The actual position of a surgical joint ankylosis may vary depending on the judgement of the surgeon taking into account the particular needs and circumstances of the Member/Veteran/Client.
Chart 1 – Optimal Position of Ankylosis of Joints – Upper LimbJoint | Optimal Position of Ankylosis |
Shoulder | Gleno-humeral joint at 45° of abduction with forward elevation of 30° and external rotation of 20°. |
Elbow | 90 – 100° of flexion. |
Wrist | 25 – 30° of dorsiflexion without any ulnar or radial deviation. |
Thumb IP MCP CMC |
20° of flexion. 25° of flexion. The metacarpal in opposition. |
Fingers DIP PIP MCP |
15 – 20° of flexion. 40 – 50° of flexion. 20 – 30° of flexion. |
All measurements in Chart 2 below are determined from an anatomical neutral position with the exception of supination and pronation of the forearm which are measured from the mid forearm neutral position.
Chart 2 – Average Range of Joint Motion – Upper LimbJoint | Movement | Range of Movement |
Shoulder | Abduction Flexion (forward elevation) External rotation Adduction Extension(backward elevation) Internal rotation |
180° 170° 90° 45° 30° 90° |
Elbow | Flexion Supination Extension Pronation |
140° 80° 0° 80° |
Wrist | Extension(dorsiflexion) Ulnar deviation Flexion(palmar flexion) Radial deviation |
60° 30° 70° 20° |
Thumb IP MCP CMC |
Flexion Extension Flexion Extension Abduction Adduction Opposition |
90° 20° 50° 0° 70° 0° Thumb to Fingers |
Fingers DIP PIP MCP |
Flexion Extension Flexion Extension Flexion Extension |
45 – 90° 0 – 20° 100° 0° 90° 30 – 45° |
Selection of Tables
The tables that may be used to rate impairment from musculoskeletal lower limb conditions are:Table 17.9 | Loss of Function - Lower Limbs |
This table is used to rate impairment from musculoskeletal conditions which impact on the function of the lower limbs as a whole. |
Table 17.10 | Loss of Function - Lower Limb – Hip |
This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the hip. |
Table 17.11 | Loss of Function - Lower Limb – Knee |
This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the knee. |
Table 17.12 | Loss of Function - Lower Limb – Ankle |
This table is used to rate impairment from musculoskeletal conditions affecting the active range of motion of the ankle. |
Table 17.13 | Loss of Function – Lower Limb – Feet and Toes | This table is used to rate impairment from musculoskeletal conditions of the feet and toes. |
Table 17.14 | Other Impairment – Fractures of Lower Limbs | This table is used to rate impairment from fractures of the lower limbs. |
Table 17.15 | Other Impairment – Lower Limb – Amputations | This table is used to rate impairment from lower limb amputations. |
Table 17.16 | Other Impairment – Osteomyelitis – Lower Limbs | This table is used to rate impairment from osteomyelitis of the lower limbs. |
Chart 3 | Optimal Position of Joint Ankylosis – Lower Limbs | This chart provides values for the optimal position of an ankylosed joint of the lower limb. |
Chart 4 | Average Range of Joint Motion – Lower Limb | This chart provides values for the average range of motion of specific joints of the lower limb. |
Table 17.9 provides criteria for evaluating the ability to use the lower limbs as a functional unit for performing every day activities such as walking and standing. Only one rating may be selected for the lower limbs as a unit. If more than one rating is applicable, the ratings are compared and the highest selected.
This table is used to rate specific conditions which include the following:
In cases of spinal cord injury or disease, refer to the instructions provided in the introduction of this chapter.
If more than one condition of the lower limb(s) is to be rated from Table 17.9, the conditions are bracketed for assessment purposes.
When entitled lower limb conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.10 is used to rate impairment from musculoskeletal conditions of the hip. Only one rating may be selected for each hip. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one hip condition of the same limb is to be rated from Table 17.10, the conditions are bracketed for assessment purposes.
When entitled lower limb hip conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.11 is used to rate impairment from musculoskeletal conditions of the knee. Only one rating may be selected for each knee. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one knee condition of the same limb is to be rated from Table 17.11, the conditions are bracketed for assessment purposes.
When entitled lower limb knee conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.12 is used to rate impairment from musculoskeletal conditions of the ankle. Only one rating may be selected for each ankle. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one ankle condition of the same limb is to be rated from Table 17.12, the conditions are bracketed for assessment purposes.
When entitled lower limb ankle conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.13 is used to rate impairment from musculoskeletal conditions of the feet and toes. Only one rating may be selected for each foot from Table 17.13. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one foot and/or toe condition of the same limb is to be rated from Table 17.13, the conditions are bracketed for assessment purposes.
When entitled lower limb feet and toe conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.14 is used to rate impairment from fractures of the lower limbs. One rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
If a fracture is intra-articular, the applicable joint table is also used to rate the impairment.
When entitled fractures of the lower limbs result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.15 is used to rate impairment from lower limb amputations.
All lower limb amputations regardless of the cause (e.g. vascular, trauma, or infection), are rated from this table.
Only one rating may be selected for each lower limb from Table 17.15. If more than one rating is applicable, the ratings are compared and the highest selected.
When previously entitled conditions are later removed by a newly entitled amputation, the new rating is based on Table 17.15 – Other Impairment – Lower Limb – Amputations. However, in rare cases, if there is more than one entitled condition of a lower limb, the sum of the ratings could be higher than the amputation rating. In these cases, the ratings for the previously entitled conditions that applied immediately prior to the amputation are to be maintained.
When entitled lower limb amputations result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
When a non-entitled amputation removes a previously entitled condition(s), the rating for the entitled condition(s) that applied immediately prior to the amputation is to be maintained.
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.16 is used to rate impairment from osteomyelitis of the lower limbs. One rating may be selected for each area of osteomyelitis. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
When entitled osteomyelitis of the lower limbs result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Only one rating may be given for the lower limbs as a functional unit from Table 17.9. When more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.9, follow the “ands” and “ors”.
Table 17.9 – Loss of Function – Lower LimbRating | Criteria |
Nil |
|
Two |
|
Four |
|
Nine |
|
Eighteen |
|
Twenty-one |
|
Thirty-four |
|
Fifty-two |
|
Eighty-one |
|
**Transfer means, for example, to move from one seat to another, from sitting to standing, on and off the toilet, in and out of bed.
Step 1: | Determine the rating from Table 17.9 (Loss of Function – Lower Limb) |
Note: | This table is used to rate specific conditions which include but are not limited to the following: - brain injury or disease which affects the function of one or both lower limb(s) - spinal cord injury or disease which affects the function of one or both lower limb(s) - complex regional pain syndromes Type 1 and Type 2 affecting the lower limb(s). - compartment syndrome conditions of the lower limb(s) - peripheral neurological conditions of the lower limb(s) which are not rated from Table 20.5 Jumps to Chapter 20 contained in Chapter 20, Neurological Impairment. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each hip from Table 17.10. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.10, follow the “ands” and “ors”.
Table 17.10 – Loss of Function – Lower Limb – HipRating | Criteria |
Nil |
|
Four |
|
Thirteen |
|
Twenty-six |
|
Thirty-one |
|
Thirty-nine |
|
Forty-three |
|
Fifty-two |
|
Step 1: | Determine the rating from Table 17.10 (Loss of Function – Lower Limb – Hip). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each knee from Table 17.11. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.11, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.11 – Loss of Function – Lower Limb – KneeRating | Criteria |
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Twenty-six | All three of the following:
|
Thirty-four |
|
Forty-three |
|
A clinically *unstable knee describes a knee joint that is demonstrated to be unstable by a physician on clinical or operative examination.
**Flail joint is a joint exhibiting abnormal and paradoxical mobility.
Step 1: | Determine the rating from Table 17.11 (Loss of Function – Lower Limb – Knee). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each ankle from Table 17.12. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.12, follow the “ands” and “ors”.
Table 17.12 – Loss of Function – AnkleRating | Criteria |
Nil |
|
Two |
|
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Twenty-Six |
|
A clinically *unstable ankle describes an ankle joint that is demonstrated to be unstable by a physician on clinical or operative examination.
**Flail joint is a joint exhibiting abnormal and paradoxical mobility.
Step 1: | Determine the rating from Table 17.12 (Loss of Function – Lower Limb- Ankle). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Table 17.13 is used to rate impairment from musculoskeletal conditions of the feet and toes. Only one rating may be given for each foot from Table 17.13 for any musculoskeletal condition or combination of conditions. If more than one rating is applicable for a foot, the ratings are compared and the highest selected.
All conditions listed in Table 17.13 refer to unilateral conditions.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.13, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.13 – Loss of Function- Lower Limb – Feet and ToesRating | Criteria |
Nil |
|
One |
|
Two |
|
Three |
|
Four |
|
Seven |
|
Ankylosis of the subtalar joint in an unfavourable position of function is rated on individual merits.
*Treatment includes use of orthotic devices and use of medications.
Step 1: | Determine the rating from Table 17.13 (Loss of Function – Lower Limb – Feet and Toes). |
Note: | If more than one foot and/or toe condition of a single limb is entitled and requires assessment all entitled conditions of that foot are bracketed together. All applicable ratings are compared and the highest selected. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Only one rating may be given for each entitled condition from Table 17.14. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.14, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.14 – Other Impairment- Fracture of the Lower LimbsRating | Criteria |
Nil |
|
One |
|
Three |
|
Seven |
|
Thirteen |
|
Fractures that result in non-union will be assessed on individual merits.
Fractures of the phalanges resulting in ankylosis will be assessed in Table 17.13.
Step 1: | Determine the rating from Table 17.14 (Other Impairment – Fractures Lower Limbs). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Table 17.15 is used to rate impairment from lower limb amputations.
Only one rating may be given for each lower limb from Table 17.15 for entitled amputations. If more than one rating is applicable, the ratings are compared and the highest is selected.
Each bullet () in Table 17.15 represents one criterion. Only one criteria must be met at a particular level in Table 17.15 in order for that rating to be selected.
Table 17.15 – Other Impairment – Lower Limb AmputationsRating | Criteria |
Two |
|
Four |
|
Seven |
|
Thirteen |
|
Eighteen |
|
Twenty-six |
|
Forty-three |
|
Fifty-two |
|
Sixty-one |
|
Sixty-three |
|
Sixty-eight |
|
Seventy-six |
|
*Hind quarter amputation is an amputation of the entire hip joint as well as a portion of the pubic rami and a portion of the ischial tuberosity.
Amputations not included in this table will be rated on individual merits.
Step 1: | Determine the rating from Table 17.15 (Other Impairment – Lower Limb -Amputations). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
One rating may be given for each area of osteomyelitis of the lower limb from Table 17.16. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.16, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.16 – Other Impairment – Osteomyelitis – Lower LimbRating | Criteria |
One |
|
Four |
|
Nine |
|
Thirteen |
|
Step 1: | Determine the rating from Table 17.16 (Other Impairment – Lower Limb Osteomyelitis). |
Note: | One rating may be given for each entitled area of osteomyelitis of the lower limbs. The steps must be repeated for each area entitled. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
The following values are a guide. The actual position of a surgical joint ankylosis may vary depending on the judgement of the surgeon taking into account the particular needs and circumstances of the Member/Veteran/Client.
Chart 3 – Optimal Position of Joint Ankylosis – Lower LimbJoint | Optimal Position of Ankylosis |
Hip | 25 – 30° of flexion, 0 – 10° external rotation, 2 – 5° of adduction. |
Knee | 10 – 15° flexion with good alignment. |
Ankle | The neutral position without flexion, extension, varus or valgus. |
Hip | Flexion Abduction Internal rotation Extension Adduction External rotation |
120° 40° 30° 30° 20° 45° |
Knee | Flexion Extension |
130° 0° |
Ankle | Dorsiflexion Inversion Plantar flexion Eversion |
25° 30° 40° 20° |
Selection of Tables
The tables that may be used to rate impairment from musculoskeletal spine, pelvis and sacroiliac joint conditions are:
Table 17.17 | Loss of Function – Cervical Spine | This table is used to rate impairment from musculoskeletal conditions affecting the cervical spine. |
Table 17.18 | Loss of Function – Thoracic Spine | This table is used to rate impairment from musculoskeletal conditions affecting the thoracic spine. |
Table 17.19 | Loss of Function – Lumbar Spine | This table is used to rate impairment from musculoskeletal conditions affecting the lumbar spine. |
Table 17.20 | Other Impairment – Coccyx, Pelvis and Sacroiliac Joints | This table is used to rate impairment from musculoskeletal conditions affecting the coccyx, pelvis and sacroiliac joints. |
Table 17.21 | Other Impairment – Osteomyelitis – Spine and Pelvis. | This table is used to rate impairment from osteomyelitis of the spine and pelvis. |
Chart 5 | Average Range of Joint Motion – Spine | This chart is used as a reference with regard to the average range of motion of the cervical, thoracic and lumbar spine. |
Chart 6 | Nerve Root Compression Syndromes | This chart describes nerve root compression effects. |
Table 17.17 is used to rate impairment from musculoskeletal conditions of the cervical spine. Only one rating may be selected from Table 17.17. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one cervical condition is to be rated from Table 17.17, the conditions are bracketed for assessment purposes.
Nerve root compression lesions of the cervical spine are rated from this table.
In cases where a spinal cord injury or disease is to be rated, refer to the instructions provided in the Introduction of this chapter.
When entitled cervical spine conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.18 is used to rate impairment from musculoskeletal conditions of the thoracic spine. Only one rating may be selected from Table 17.18. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one thoracic spine condition is to be rated from Table 17.18, the conditions are bracketed for assessment purposes.
Nerve root compression lesions due to a thoracic spine condition are rated on individual merits.
In cases where a spinal cord injury or disease is to be rated, refer to the instructions provided in the Introduction of this chapter.
When entitled thoracic spine conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.19 is used to rate impairment from musculoskeletal conditions of the lumbar spine. Only one rating may be selected from Table 17.19. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one lumbar spine condition is to be rated from Table 17.19, the conditions are bracketed for assessment purposes.
Nerve root compression lesions of the lumbar spine are rated from this table.
In cases where a spinal cord injury or disease is to be rated, refer to the instructions provided in the introduction of this chapter.
When entitled lumbar spine conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.20 is used to rate musculoskeletal impairment from coccyx, pelvis, and sacroiliac joint conditions. A rating may be given from Table 17.20 for each entitled area. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
For purposes of assessment, sacroiliac joint disease is considered to be bilateral.
When entitled conditions of the coccyx, pelvis and sacroiliac joint result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Table 17.21 is used to rate impairment from osteomyelitis of the spine and pelvis. One rating may be selected for each area of osteomyelitis. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
When entitled osteomyelitis of the spine and pelvis results in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).
If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Only one rating may be given for the cervical spine from Table 17.17. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet (∙) represents one criterion. In order for a rating to be established for Table 17.17 follow the “ands” and “ors”.
Table 17.17 – Loss of Function – Cervical SpineRating | Criteria |
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Twenty-one |
|
Twenty-six |
|
Thirty-four |
|
Step 1: | Determine the rating from Table 17.17 (Loss of Function – Cervical Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.17 (Loss of Function – Cervical Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine a rating from Table 17.1 (Loss of Function – Upper Limb). |
Note: | If one upper limb is affected, determine a rating for the affected limb. or If both upper limbs are affected, determine the appropriate rating for each limb and add the ratings. |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare Step 2 and Step 4 and select the highest. |
Step 6: | Determine the Quality of Life rating. |
Step 7: | Add the ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.17 (Loss of Function – Cervical Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1 . |
Step 3: | Determine a rating from Chapter 19 (Activities of Daily Living). |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare Step 2 and Step 4 and select the highest. |
Step 6: | Determine the Quality of Life rating. |
Step 7: | Add the ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment. |
Only one rating may be given for the thoracic spine from Table 17.18. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet (∙) represents one criterion. In order for a rating to be established for Table 17.18 all criteria designated at that rating level must be met.
Table 17.18 – Loss of Function – Thoracic SpineRating | Criteria |
Nil |
|
One |
|
Two |
|
Three |
|
Nine |
|
Thirteen |
|
Note: In rating the thoracic spine, one should concentrate on the rotation movements as opposed to flexion and extension movements which are primarily a function of the lumbar spine.
Nerve root compression lesions of the thoracic spine will be rated on individual merits.
Step 1: | Determine the rating from Table 17.18 (Loss of Function -Thoracic Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.18 (Loss of Function -Thoracic Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the rating(s) from Table 17.1 (Loss of Function – Upper Limbs). |
Note: | If one upper limb is affected, determine a rating for the affected limb. or If both upper limbs are affected, determine the appropriate rating for each limb and add the ratings. |
Step 4 | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare ratings at Step 2 and Step 4 and select the highest. |
Step 6: | Determine the Quality of Life rating |
Step 7: | Add ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.18 (Loss of Function -Thoracic Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the rating(s) from Table 17.9 ( Loss of Function – Lower Limbs). |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare ratings at Step 2 and Step 4 and select the highest. |
Step 6: | Determine the Quality of Life rating. |
Step 7: | Add ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.18 (Loss of Function -Thoracic Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine rating from Chapter 19 (Activities of Daily Living). |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare ratings at Step 2 and Step 4 and select the highest. |
Step 6: | Determine the Quality of Life rating. |
Step 7: | Add ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment |
Only one rating may be given for the lumbar spine from Table 17.19. If more than one rating is applicable, the ratings are compared and the highest selected.
Each bullet (∙) represents one criterion. In order for a rating to be established for Table 17.19, follow the “ands” and “ors”.
Table 17.19 – Loss of Function – Lumbar SpineRating | Criteria |
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Twenty-one |
|
Thirty-one |
|
Thirty-four |
|
Thirty-nine |
|
* Sciatica is defined as pain radiating in the distribution of a lumbar or sacral dermatome, below the level of the knee with or without associated neurosensory and motor deficits.
**Intractable pain is severe, persistent, ongoing pain that is unresponsive to the usual treatment modalities.
Step 1: | Determine the rating from Table 17.19 (Loss of Function – Lumbar Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Step 1: | Determine the rating from Table 17.19 (Loss of Function – Lumbar Spine). |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine rating from Table 17.9 (Loss of Function – Lower Limb(s) ( if applicable). |
Note: | If an entitled lumbar spinal cord injury or disease condition affects the function of one or both lower limbs, a rating is necessary from Table 17.9 ( Loss of Function – Lower Limb). Regardless if one or both lower limbs are affected, the appropriate rating from Table 17.9 is compared to the Table 17.19 rating and the highest selected. |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Compare the Step 2 and Step 4 ratings and select the highest. |
Step 6: | Determine the Quality of Life rating. |
Step 7: | Add ratings at Step 5 and Step 6. |
Step 8: | If partial entitlement exists, apply to the rating at Step 7. |
This is the Disability Assessment. |
Only one rating may be given from Table 17.20 for each of the following areas: coccyx, pelvis and sacroiliac joints. For purposes of assessment, sacroiliac joint disease is considered to be bilateral. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
Each bullet (∙) represents one criterion. In order for a rating to be established for Table 17.20, only one criterion must be met at a level of impairment for that rating to be selected.
Table 17.20 – Other Impairment – Coccyx, Pelvis and Sacroiliac JointsRating | Criteria |
Nil |
|
One |
|
Four |
|
Seven |
|
Thirteen |
|
Thirty-four |
|
* Intractable pain is severe, persistent, ongoing pain that is unresponsive to the usual treatment modalities.
Step 1: | Determine the rating from Table 17.20 (Other Impairment – Coccyx, Pelvis and Sacroiliac joint[s]). |
Note: | One rating is selected from Table 17.20 for each entitled condition of the coccyx and pelvis. One rating is selected from Table 17.20 for entitled conditions of the sacroiliac joints regardless of whether the condition is unilateral or bilateral. The steps must be repeated for each area entitled. |
Step 2: | Does the Partially Contributing Table apply? If yes, apply to the rating(s) at Step 1. |
Step 3: | Determine the Quality of Life rating(s). |
Step 4: | Add ratings at Step 2 and Step 3. |
Step 5: | If partial entitlement exists, apply to the rating(s) at Step 4. |
This is the Disability Assessment. |
Only one rating may be given from Table 17.21 for each area of osteomyelitis affecting the spine and pelvis. If more than one rating is applicable for an area, the ratings are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 17.21, all criteria designated at that rating level must be met.
Table 17.21 – Other Impairment – Osteomyelitis – Spine and PelvisRating | Criteria |
One |
|
Four |
|
Nine |
|
Thirteen |
|
Step 1: | Determine the rating from Table 17.21 (Other Impairment -Osteomyelitis – Spine and Pelvis). |
Note: | One rating may be given for each entitled area of osteomyelitis of the spine and pelvis.
The steps must be repeated for each area entitled. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to the rating at Step 1. |
Step 3: | Determine the Quality of Life rating. |
Step 4: | Add the ratings at Step 2 and Step 3 |
Step 5: | If partial entitlement exists, apply to the rating at Step 4. |
This is the Disability Assessment. |
Joint | Movement | Range of Movement |
Cervical Spine | Flexion Right lateral flexion Right rotation Extension Left lateral flexion Left rotation |
60° 45° 70° 60° 45° 70° |
Thoraco-lumbar Spine* | Flexion Right lateral flexion Right rotation Extension Left lateral flexion Left rotation |
90° 35° 35° 30° 35° 35° |
*As a general rule each thoracic vertebrae contributes to about 3 degrees of flexion (3 x 12 = 36 degrees total flexion due to the thoracic spine) and each lumbar vertebrae to about 9 degrees of flexion (9 x 5 = 45 degrees total flexion due to lumbar spine) for a total flexion of the thoracolumbar spine of 81 degrees.
This chart provides a description of the common findings associated with nerve root compression syndromes at the cervical and lumbar spine levels.
Chart 6 – Nerve Root Compression SyndromesNerve Root | Nerve Root Compression Effects |
C5 Root Compression Syndrome | Weakness of shoulder abduction and elbow flexion. Loss of biceps reflex. Sensory loss over the lateral aspect of the upper arm. |
C6 Root Compression Syndrome | Weakness of elbow flexion. Weak biceps reflex. Sensory loss over the radial (lateral) aspect of the forearm and the thumb. |
C7 Root Compression Syndrome | Weakness of elbow extension. Loss of triceps reflex. Sensory loss over dorsal aspect of arm and forearm and of middle finger. |
C8 Root Compression Syndrome | Weakness of finger flexion. Sensory loss over the ulnar (medial) aspect of the forearm and of the ring and little fingers. |
L4 Root Compression Syndrome | Weakness of knee extension. Weakness of patellar/knee jerk reflex. Sensory loss over medial aspect of the lower leg, particularly the area above medial malleolus. |
L5 Root Compression Syndrome | Weakness of ankle dorsiflexion and extension of great toe. Heel walking is impaired. Weakness of hip abduction. Trendelenburg test may be positive. Sensory loss over lateral aspect of the lower leg and the medial aspect of the dorsum of the foot. |
S1 Root Compression Syndrome | Weakness of plantar flexion of the ankle. Toe walking is impaired. Weakness of gluteus maximus. Hip extension is impaired. Weakness of Achilles/ankle jerk reflex. Sensory loss over the posterolateral aspect of the thigh and leg and the lateral aspect of the foot. |