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![]() New Table of DisabilitiesApril 2006 EditionChapter 20
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Table 20.1 | Loss of Function – Cognition | This table is used to rate impairment of cognition. |
Table 20.2 | Loss of Function – Speech and Expression | This table is used to rate impairment of speech and/or expression. |
Table 20.3 | Loss of Function – Comprehension | This table is used to rate impairment in comprehension. |
Table 20.4 | Loss of Function – Cranial Nerves | This table is used to rate impairment in cranial nerve function. |
Table 20.5 | Loss of Function – Peripheral Nerves | This table is used to rate impairment of peripheral nerve function. |
Table 20.6 | Other Impairment – Seizures | This table is used to rate impairment from seizure disorders – major and minor. |
Table 20.7 | Other Impairment – Narcolepsy and Cataplexy | This table is used to rate impairment from narcolepsy and cataplexy. |
Table 20.8 | Other Impairment – Headaches | This table is used to rate impairment from headache conditions. |
Table 20.9 | Other Impairment – Miscellaneous Neurological | This table is used to rate impairment from miscellaneous neurological conditions. |
Chart 1 | Chart of Cranial Nerve Function | This reference chart describes the effect of a complete loss of function of a cranial nerve. |
Chart 2 | Chart of Peripheral Nerve Function | This reference chart describes the effect of a complete loss of function of a peripheral nerve. |
The tables that may be used to rate impairment from cerebral conditions are:
Table 20.1 | Loss of Function – Cognition | This table is used to rate impairment of cognition. |
Table 20.2 | Loss of Function – Speech and Expression | This table is used to rate impairment of speech and/or expression. |
Table 20.3 | Loss of Function – Comprehension | This table is used to rate impairment in comprehension. |
This section is used to rate impairment from conditions such as cerebral vascular accidents, dementia and other cognitive disorders (e.g. head injury).
Cognitive function deals with such aspects of knowledge as acquisition (learning), retention and recall (memory), and use (reasoning and problem solving). The Table 20.1 rating must relate only to cognitive deficits that were not present before the onset of the entitled condition.
Self reports of deteriorating mental function must be interpreted with caution. Dementia is often associated with a lack of insight or tendency to deny failing abilities. Self-reported complaints about poor memory may be more closely related to depressive symptoms than to true memory deficits. If there is doubt about the nature or extent of the deficit, formal neuropsychiatric testing may be required.
When rating dementia and other cognitive disorders, only Table 20.1 – Loss of Function – Cognition is to be used.
Note: Brain injury or disease which results in multiple deficits (e.g. head injury or cerebral vascular accident resulting in cognitive, psychiatric and physical impairments) is rated on individual merits.
Communication has two elements: expression and comprehension. "Expression" is the capacity to convey the content of one's mind to others. "Comprehension" means "understanding". It includes understanding of speech and gestures, recognition of sights and sounds, spatial and temporal orientation.
Expression and comprehension are to be rated separately by applying Table 20.2 and Table 20.3 respectively. Impairment ratings from these tables are to be added when criteria from both are applicable. Impairment ratings from these tables are not to include communication deficits that were present before the onset of the entitled condition.
Table 20.2 and Table 20.3 are to be used to rate impairment from neurological or neuromuscular conditions as well as local lesions involving the mechanisms of speech production.
Communication restricted by vision loss, hearing loss, or loss of hand function is not to be rated within this chapter.
Table 20.1 is used to rate impairment from cerebral conditions that affect cognition. The table contains three columns (categories) which are rated independently. The ratings are compared and the highest selected.
If more than one condition is to be rated from Table 20.1, the conditions are bracketed for assessment purposes.
Because of the close and overlapping relationship between neurology and psychiatry, neurological conditions may have emotional and behavioural symptoms. Emotional and behavioural symptoms that occur as a result of entitled brain injury or disease are rated within this chapter section. If a Member/Veteran/Client is entitled for both a condition which affects cognition and a psychiatric disorder, the Table 20.1 – Loss of Function – Cognition rating and the Chapter 21, Psychiatric Impairment rating are compared and the highest selected.
When entitled cognitive 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 20.2 is used to rate impairment of cerebral conditions that affect speech and/or the ability to write. The table contains three columns (categories) which are rated independently. The ratings are compared and the highest selected.
If more than one condition is to be rated from Table 20.2, the conditions are bracketed for assessment purposes.
When entitled speech and expression 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 20.3 is used to rate impairment of cerebral conditions that affect comprehension of oral and/or written language. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one condition is to be rated from Table 20.3, the conditions are bracketed for assessment purposes.
When entitled comprehension 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.
Only one rating may be given from Table 20.1. Each column in Table 20.1 is rated independently. If more than one rating is applicable within a column, the highest rating is selected as the column rating. The ratings from each column are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 20.1, only one criterion must be met at a level of impairment for that rating to be selected.
Table 20.1 – Loss of Function – Cognition
Rating | Cognitive | Emotional & Behavioural |
Personal Care |
Nil |
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Nine |
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Thirteen |
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Twenty-Three |
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Thirty-Two |
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Forty-Nine |
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Eighty-One |
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Step 1: | Determine a rating from each column in Table 20.1 (Loss of Function-Cognition). Compare and select the highest column rating as the Table 20.1 rating. |
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 from Table 20.2 . Each column in Table 20.2 is rated independently. If more than one rating is applicable within a column, the highest rating is selected as the column rating. The ratings from each column are compared and the highest selected.
Each bullet () represents one criterion. In order for a rating to be established for Table 20.2, all criteria designated at that rating level must be met.
Table 20.2 – Loss of Function – Speech and Expression
Rating | Criteria | ||
Speech | Conversation | Ability to Write | |
Nil |
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Four |
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Nine |
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Eighteen |
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Twenty-Six |
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Thirty-Four |
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*Dysgraphia is the inability to write properly due to an expression problem from an acquired neurological condition.
Only one rating may be given from Table 20.3. 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 20.3, only one criterion designated at that rating level must be met.
Table 20.3 – Loss of Function – Comprehension
Rating | Criteria |
Nil |
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Four |
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Nine |
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Twenty-One |
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Thirty-Four |
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Seventy |
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Eighty-One |
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*Alexia is a form of receptive aphasia in which there is inability to understand written language.
Step 1: | Determine a rating from each column in Table 20.2 (Loss of Function-Speech and Expression) (if applicable). Compare and select the highest column rating as the Table 20.2 rating. |
Step 2: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1. |
Step 3: | Determine a rating from Table 20.3 (Loss of Function – Comprehension) (if applicable). |
Step 4: | Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3. |
Step 5: | Add the ratings from Step 2 and Step 4. |
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. |
The tables that may be used to rate impairment from cranial and peripheral nerve conditions are:
Table 20.4 | Loss of Function – Cranial Nerves | This table is used to rate impairment of cranial nerve function. |
Table 20.5 | Loss of Function – Peripheral Nerves | This table is used to rate impairment of peripheral nerve function. |
Chart 1 | Chart of Cranial Nerve Function | This reference chart describes the effect of a complete loss of function of a cranial nerve. |
Chart 2 | Chart of Peripheral Nerve Function | This reference chart describes the effect of a complete loss of function of a peripheral nerve. |
The twelve pairs of cranial nerves emerge from the base of the brain to control sensory, motor and autonomic functions. Some of the nerves have a mixture of sensory, motor and/or autonomic fibres, while others are purely sensory or motor.
Table 20.4 – Loss of Function – Cranial Nerves rates impairment of cranial nerve conditions. Instructions are provided within this table when a rating for a cranial nerve condition is required from another table within this chapter or from another chapter.
When entitled conditions of the cranial nerves 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.
Peripheral nerves convey nerve impulses to and from the central nervous system (brain and spinal cord) to control sensory, motor and autonomic functions. A Member/Veteran/Client may have a disturbance of any one of or all of these functions. The disturbance may be partial or complete, unilateral or bilateral, of one nerve or of multiple nerves. A deficit in nerve conduction may result in a functional impairment.
Table 20.5 – Loss of Function – Peripheral Nerves rates impairment of specific peripheral nerves. The first column (category) is used to rate complete loss of nerve function at its origin. This includes paralysis and associated loss of sensation. The second column (category) is used when there is only a complete loss of sensation. A rating cannot be taken from both columns for the same peripheral nerve condition.
For peripheral nerve conditions not included in Table 20.5 (e.g. incomplete loss of function of a peripheral nerve or loss of sensation in a "glove" or "stocking" distribution) a rating may be applicable from Table 17.1 (Jumps to Chapter 17) – Loss of Function – Upper Limb or Table 17.9 (Jumps to Chapter 17) – Loss of Function – Lower Limb.
In cases where the same limb is affected by both a complete loss of a nerve's function at its origin and a condition which is rated from Table 17.1 (Jumps to Chapter 17) – Loss of Function – Upper Limb or Table 17.9 (Jumps to Chapter 17) – Loss of Function – Lower Limb, the conditions are bracketed for assessment purposes. The Table 20.5 rating is compared to the Table 17.1 (Jumps to Chapter 17) or the Table 17.9 (Jumps to Chapter 17) rating and the highest selected. For example, an entitled complete transection of the left ulnar nerve and an entitled complex regional pain syndrome of the left hand both require a rating. A rating for the complete transection of the left ulnar nerve is taken from Table 20.5 and a rating is taken from Table 17.1 (Jumps to Chapter 17) for the complex regional pain syndrome of the left hand. The ratings are compared and the highest selected. The conditions are bracketed for assessment purposes.
In cases where the same limb is affected by two or more complete losses of nerve function, a rating is selected for each nerve. The individual ratings are added and the conditions bracketed for assessment purposes.
For peripheral nerve conditions that cannot be rated in Table 20.5, Table 17.1 (Jumps to Chapter 17) or Table 17.9 (Jumps to Chapter 17), a rating will be determined based on individual merits.
Note: Only one rating for each upper limb or for the lower limbs as a functional unit may be obtained from Table 17.1 (Jumps to Chapter 17) and 17.9 (Jumps to Chapter 17) respectively, regardless of the number of entitled musculoskeletal or neurological conditions rated within these tables.
If more than one musculoskeletal or neurological condition is rated from these tables, the conditions are bracketed for assessment purposes.
In cases of peripheral motor, sensory or mixed polyneuropathy which affects the function of both the upper and lower limbs, a rating is not obtained from this chapter or from Chapter 17, Musculoskeletal Impairment. The impairment is rated from Chapter 19, Activities of Daily Living.
If a Member/Veteran/Client has impairment of autonomic function associated with a peripheral neuropathy (e.g. voiding dysfunction) or has a permanent complication from peripheral neuropathy (e.g. Charcot's joint), 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 entitled conditions of the peripheral nerves 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.
More than one rating may be applicable for each entitled unilateral or bilateral cranial nerve condition from Table 20.4. If more than one rating is applicable for an entitled condition, the ratings are added.
Note: Where applicable, Table 20.4 indicates the appropriate chapter or table to be used for rating cranial nerve conditions.
If partial losses exist, the ratings are to be reduced proportionately.
Table 20.4 – Loss of Function – Cranial Nerves
Cranial Nerve | Function | Apply | Complete Unilateral Loss Rating | Complete Bilateral Loss Rating |
I (olfactory) | Smell | NIL | 4 | |
II (optic) | Vision | Chapter 8 | ||
III, IV, VI (oculomotor, trochlear, abducens) | Eye Movement | Chapter 8 | ||
V (trigeminal) | Opthalmic Division (sensory) | 4 | 9 | |
Maxillary Division (sensory) | 4 | 9 | ||
Mandibular Division (sensory) | 4 | 9 | ||
Chewing | Chapter 14 | |||
Speech | Table 20.2 | |||
VII (facial) | Taste | NIL | 4 | |
Facial Expression | 9 | 18 | ||
Chewing | Chapter 14 | |||
Speech | Table 20.2 | |||
VIII (vestibulocochlear) | Hearing | Chapter 9 | ||
Balance | Chapter 9 | |||
IX, X, XI, XII (glossopharyngeal, vagus, spinal accessory, hypoglossal) | Swallowing | Table 20.9 | ||
Speech | Table 20.2 | |||
XI (spinal accessory) | Shoulder elevation/head rotation | 4 | 9 |
Refer to Chart 1 for a description of the effects of a complete loss of function of a cranial nerve.
Step 1: | Determine the rating from Table 20.4 (Loss of Function-Cranial Nerves). |
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 unilateral peripheral nerve condition from Table 20.5.
In cases where the same limb is affected by two or more complete losses of nerve function, a rating is selected for each nerve. The individual ratings are added and the conditions bracketed for assessment purposes.
Note: A rating cannot be taken from both columns for the same peripheral nerve condition.
Table 20.5 – Loss of Function – Peripheral Nerves
Rating | ||
Peripheral Nerve | Complete Unilateral Loss of Function (Motor and Sensation) | Complete Unilateral Loss of Function (Sensation Only) |
Greater Auricular | N/A | 1 |
Brachial Plexus: Upper Trunk (C5 and C6) | 34 | N/A |
Brachial Plexus: Middle Trunk (C7) | 34 | N/A |
Brachial Plexus: Lower Trunk (C8, T1) | 34 | N/A |
Full Brachial Plexus (C5, C6, C7, C8, and T1) | 65 | N/A |
Radial | 43 | 2 |
Median | 34 | 13 |
Ulnar | 26 | 4 |
Musculocutaneous Nerve of the Arm | 13 | 2 |
Axillary | 18 | 2 |
Long Thoracic | 4 | N/A |
Sciatic | 51 | 9 |
Femoral | 18 | 4 |
Obturator | 4 | NIL |
Common Peroneal | 18 | 4 |
Superficial Peroneal | 9 | 3 |
Deep Peroneal | 13 | NIL |
Tibial | 18 | 4 |
Posterior Femoral Cutaneous | N/A | 4 |
Lateral Cutaneous Nerve of the Thigh | N/A | 4 |
Ilioinguinal | NIL | 4 |
Refer to Chart 2 for a description of the effects of a complete loss of function of a peripheral nerve.
For peripheral nerve conditions that cannot be rated in Table 20.5, Table 17.1 (Jumps to Chapter 17) or Table 17.9 (Jumps to Chapter 17), a rating will be determined based on individual merits.
Step 1: | Determine the rating from Table 20.5 (Loss of Function – Peripheral Nerve). |
Note: | A rating cannot be taken from both columns of Table 20.5 for the same peripheral nerve condition.
If the same limb is affected by two or more complete losses of peripheral nerve function, a rating is selected for each nerve. The individual ratings are added and the conditions 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 rating at Step 4. |
This is the Disability Assessment. | |
Note: | If entitled bilateral peripheral nerve conditions require assessment, the steps must be repeated. |
Chart 1 describes what functions are affected as a result of a complete loss of a cranial nerve's function at its origin, unless otherwise specified.
Chart 1 may be used as reference for rating loss of function of cranial nerves.
Chart 1 – Chart of Cranial Nerve Function
Cranial Nerve | Functions Affected |
I Olfactory |
Motor – Nil Sensory – Loss of sense of smell |
II Optic |
Motor – Nil Sensory – Loss of vision |
III Oculomotor |
Motor – Eye movement – paralysis of internal rectus, superior rectus, inferior rectus, inferior oblique Sensory – Nil Clinical Presentation – Divergent strabismus, diplopia, ptosis of lid – Dilated pupil, loss of light and accommodation reflex – Eyeball deviated outward and slightly downward |
IV Trochlear |
Motor – Paralysis of superior oblique Sensory – Nil Clinical Presentation – Slight convergent strabismus – Cannot look down and out – May hold head tilted – Difficulty descending stairs |
V Trigeminal |
Motor (via mandibular branch) – Paralysis of muscles of mastication – Paralysis of tensor tympani may result in impaired hearing Sensory – Face, sinuses, oral cavity, tongue, part of the ear and the eye – Corneal anesthesia may present early 1st Division (opthalmic) – Sensory to forehead, upper eyelid, conjunctiva and side of the nose 2nd Division (maxillary) – Sensory to posterior side of the nose, lower eyelid, cheek, upper lip and lateral side of the orbital opening including upper teeth and hard palate 3rd Division (mandibular) – Sensory to lower lip and face, temporal regions and part of auricle – Muscles of mastication – Tensor tympani of the middle ear Clinical Presentation – Jaw deviates to affected side – Impaired hearing – Loss of corneal reflex |
VI Abducens |
Motor
– Paralysis of external or lateral rectus Sensory – Nil Clinical Presentation – Convergent strabismus and diplopia – Eyeball deviated inward |
VII Facial |
Motor (Bell's Palsy) – Paralysis of superficial muscles of the face and scalp – Disturbance in secretion of lacrimal and parotid glands Sensory – Loss of taste from anterior 2/3 of tongue Clinical Presentation – Facial asymmetry with smiling – Sagging of muscles of face and eyelid – Mouth droops – Unable to close eye or wrinkle forehead – Decreased salivation |
VIII Vestibulocochlear (Acoustic) (Auditory) |
Motor
– Nil Sensory – Cochlear portion: deafness – Vestibular portion: disorders of equilibrium Clinical Presentation – Cochlear portion: deafness, tinnitus – Vestibular portion: vertigo, nystagmus |
IX Glossopharyngeal |
Motor
– Dysphagia Sensory – Loss over posterior pharynx Clinical Presentation – Loss of gag reflex – Orthostatic dizziness |
X Vagus |
Motor
– Hoarseness, dysphagia Sensory – Pain or paresthesia of larynx, pharynx Clinical Presentation – Salivary gland dysfunction – Autonomic dysfunction of cardiopulmonary and gastrointestinal systems |
XI Spinal Accessory |
Motor
– Absence of cervical rotation – Absence of shoulder elevation Sensory – Nil Clinical Presentation – Cannot rotate head to healthy side or shrug affected shoulder – May have some dysphagia systems |
XII Hypoglossal |
Motor
– Paralysis of tongue Sensory – Nil Clinical Presentation – Tongue deviates to affected side with protrusion |
Chart 2 describes what functions are affected as a result of complete loss of a peripheral nerve's function at its origin, unless otherwise specified.
Chart 2 may be used as a reference for rating loss of function of peripheral nerves.
Chart 2 – Chart of Peripheral Nerve Function
Peripheral Nerve | Functions Affected |
Brachial plexus: Upper Trunk
(C5 and C6) (Erb Duchene palsy or waiter's tip) |
Motor
Shoulder – loss of abduction, internal rotation, external rotation Elbow – loss of flexion Sensory Incomplete loss over lateral aspect of arm and forearm Clinical Presentation Limb hangs limply at side, rotated medially. |
Brachial Plexus: Middle Trunk (C7) |
Motor
Rarely seen alone Paralysis of the triceps Elbow – loss of extension Wrist – weak extension Hands – weak extension Sensory Loss over radial aspect of forearm and hand |
Brachial Plexus:
Lower Trunk (C8 and T1) (Klumpke's palsy) |
Motor
Paralysis in all small muscles of hand May cause Horner's syndrome (T1). Sensory Radial side of forearm, hand and ulnar two fingers Clinical Presentation "Claw" hand Hyperextension MIP joints and flexion IP joint |
Radial
(C6, C7, C8 and T1) (musculospiral) |
Motor
At axilla – paralysis Elbow – loss of extension Wrist – loss of extension Fingers – loss of extension Unable to grip firmly At elbow Elbow extension maintained Loss of extension of wrist and fingers Sensory Posterior aspect arm and forearm Lateral area dorsum of hand Clinical Presentation Thumb turned into palm |
Median
(C6, C7, C8 and T1) |
At Elbow
Motor Wrist – weak flexion Thumb – loss of flexion Index and middle fingers – loss of flexion Sensory Loss over radial (lateral) aspect of palm Loss over palmar aspect of the radial 3 1/2 fingers Total loss over tips of index and middle fingers Clinical Presentation Hand looks flattened or "apelike". Atrophy of lateral forearm and thenar eminence Thumb at side of palm At Wrist Motor Thumb – cannot be opposed. Fingers – decreased ability to abduct Sensory As at elbow Clinical Presentation Thenar atrophy |
Ulnar
(C8, T1) |
Above Elbow
Motor Wrist – flexion weak with hand deviating to radial (lateral) side Fingers – loss of flexion PIP joints; loss of adduction; loss of abduction Thumb – loss of adduction Sensory Loss over ulnar (medial) portion of hand and ring finger; entire little finger Clinical Presentation "Claw" hand or "main en griffe" Ring and little finger hyperextended at MTP and flexed at PIP joints Atrophy medial aspect of forearm and hypothenar eminence Below Elbow Motor Wrist – flexion maintained Finger and thumbs as above |
Musculocutaneous nerve of the arm
(C5 and C6) |
Motor
At elbow Weakness in flexion and supination Sensory Loss over lateral side of forearm |
Axillary (circumflex) |
Motor
Shoulder – weakness of flexion, extension and initiation of abduction Difficulty raising to horizontal position Sensory Loss of sensation over lower half of deltoid muscle Clinical Presentation Wasting over the shoulder |
Long thoracic
(C5, C6, C7) |
Motor Shoulder – weakness in elevation beyond horizontal plane. Cannot raise arm above head. Sensory Nil Clinical Presentation Winged scapula |
Sciatic
(L4, L5, S1, S2, S3) |
Motor
At knee Loss or weakness of flexion At ankle, foot and toes Complete paralysis Sensory Pain often present Loss over posterior and lateral aspects of leg and foot Clinical Presentation Foot drop Walks with steppage gait: lifts foot high Unable to stand on heel or toes |
Femoral
(L2, L3 ,L4) (anterior crural) |
Motor
Hip – loss of flexion Knee – loss of flexion Sensory May be pain Loss over medial side of thigh, leg and foot Clinical Presentation May steady thigh with hand when walking |
Obturator
(L2, L3 ,L4) |
Motor Hip – weakness of external rotation and adduction Sensory Usually insignificant Minimal loss over medial side of thigh |
Common Peroneal
(L4, L5, S1, S2)
(external popliteal)(lateral popliteal) |
Motor Ankle and toes – loss of dorsiflexion Sensory Loss over lateral aspect of leg, foot and toes Clinical Presentation Foot drop and steppage gait Foot plantar flexed and inverted (equinovarus) |
Superficial Peroneal
(L5, S1) (musculocutaneous nerve of the leg) |
Motor Foot – weakness or loss of eversion Sensory Dorsal and lateral surface of leg |
Deep Peroneal
(anterior tibial) |
Motor Ankle and toes – loss of dorsiflexion Sensory Loss over 1st webspace of the foot |
Tibial
(L4, L5, S1, S2, S3) (posterior tibial internal popliteal) |
Motor Foot – loss of plantar flexion, adduction and inversion Sensory Causalgia common Loss over sole of the foot Clinical Presentation Toes separated Ankle dorsiflexed |
Posterior Femoral Cutaneous
(S1, S2, S3) (small sciatic nerve) |
Sensory Loss over perineum and posterior surface of the thigh and leg |
Lateral Cutaneous nerve of the thigh
(L2, L3) |
Sensory (meralgia paresthetica) Loss over the lower lateral quadrant of the buttock Loss over the lateral aspect of the thigh and knee |
Ilioinguinal
(L1) |
Sensory Loss over perineum and upper medial thigh |
The tables used to rate impairment from seizure disorders, narcolepsy and cataplexy, headache conditions and miscellaneous neurological conditions are:
Table 20.6 | Other Impairment – Seizures | This table is used to rate impairment from seizure disorders – major and minor. |
Table 20.7 | Other Impairment – Narcolepsy and Cataplexy | This table is used to rate impairment from narcolepsy and cataplexy. |
Table 20.8 | Other Impairment – Headaches | This table is used to rate impairment from headache conditions. |
Table 20.9 | Other Impairment – Miscellaneous Neurological | This table is used to rate impairment from miscellaneous neurological conditions. |
Table 20.6 is used to rate impairment from seizure disorders. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one type of seizure disorder is to be rated from Table 20.6, the conditions are bracketed for assessment purposes.
When entitled seizure disorders 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 20.7 is used to rate impairment from narcolepsy and cataplexy. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.
When entitled narcolepsy and cataplexy disorders 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 20.8 is used to rate impairment from headache conditions. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.
If more than one type of headache is to be rated from Table 20.8, the conditions are bracketed for assessment purposes.
When rating migraine headaches, common auras such as scotomas and flashing lights are considered to be included in the Table 20.8 rating. Migraine headaches associated with transient neurological deficits including but not limited to hemiplegia, dysarthria and ocular muscle weakness are rated on individual merits.
When entitled headache 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 20.9 is used to rate impairment from miscellaneous neurological conditions. 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.
When entitled miscellaneous neurological 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.
Only one rating may be given from Table 20.6. 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 20.6, follow the "ands" and "ors".
Table 20.6 – Loss of Function – Seizures
Rating | Criteria |
Nil |
|
Four |
|
Nine |
|
Eighteen |
|
Thirty-five |
|
Fifty |
|
Eighty-five |
|
A * major seizure is characterized by generalized tonic-clonic convulsion with unconsciousness.
A ** minor seizure is characterized by a brief interruption in consciousness or conscious control associated with staring, rhythmic eye blinking, or head nodding, or sudden jerking movements of the limbs and/or head, or sudden loss of postural control.
Step 1: | Determine the rating from Table 20.6 (Other Impairment – Seizures). |
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 from Table 20.7. 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 20.7, follow the "ands" and "ors".
Table 20.7 – Other Impairment – Narcolepsy and Cataplexy
Rating | Criteria |
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Step 1: | Determine the rating from Table 20.7 (Other Impairment – Narcolepsy and Cataplexy). |
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 from Table 20.8. 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 20.8, follow the "ands" and "ors".
Table 20.8 – Loss of Function – Headaches
Rating | Criteria |
Two |
|
Four |
|
Nine |
|
Thirteen |
|
Migraine headaches associated with transient neurological deficits including but not limited to hemiplegia, dysarthria and ocular muscle weakness is rated on individual merits.
Step 1: | Determine the rating from Table 20.8 (Other Impairment – Headaches). |
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 20.9. 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 20.9, only one criterion must be met at a level of impairment for that rating to be selected.
Table 20.9 – Other Impairment – Miscellaneous Neurological
Rating | Criteria |
Four |
|
Nine |
|
Thirteen |
|
Thirty-four |
|
Seventy-one |
|
*Trigeminal neuralgia with intractable pain (severe, persistent, ongoing pain that is unresponsive to the usual treatment modalities) is rated on individual merits.
Step 1: | Determine the rating from Table 20.9 (Other Impairment – Miscellaneous Neurological). |
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. | |
Note: | If more than one entitled condition requires rating from Table 20.9, the steps must be repeated. |