Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
211The value obtained should be rounded to the nearest whole number.
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211 The value obtained should be rounded to the nearest whole number.
Figure 8-B: Body Mass Index criteria
| BMI | Category | Health risk |
| <18 | Very underweight. | Long-term hazard to health. |
| 18-20 | Underweight. | Low risk to health. |
| 20-25 | Acceptable. | Least risk for morbidity and minimal mortality. |
| 25-30 | Overweight. | Low risk to health. |
| 30-40 | Morbid obesity. | High degree of risk to health. |
8.1 Upper digestive tract – oesophagus, stomach, duodenum, small intestine and pancreas
Table 8.1: Upper digestive tract – oesophagus, stomach, duodenum, small intestine and pancreas
See notes to Table 8.1 for further information.
| 0 | Symptoms of upper digestive tract disease with or without anatomical loss or pathological alteration present. | Continuous drug treatment not required to control symptoms. |
| 10 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | One of the following:<br>Continuous drug treatment required to control symptoms, signs or nutritional deficiencyAppropriate dietary modifications required to control symptoms or signs. |
| 20 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | Both of the following:<br>Continuous drug treatment required to control symptoms, signs or nutritional deficiencyAppropriate dietary modifications required to control symptoms or signs. |
| 30 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | Any one of the following:<br>Continuous drug treatment does not completely control symptoms, signs or nutritional deficiencyAppropriate dietary modifications do not completely control symptoms, signs or nutritional deficiencyWeight loss with a BMI<20. |
| 40 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | Any two of the following:<br>Continuous drug treatment does not completely control symptoms, signs or nutritional deficiencyAppropriate dietary modifications do not completely control symptoms, signs or nutritional deficiencyWeight loss with a BMI<20. |
| 50 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | All of the following:<br>Continuous drug treatment does not completely control symptoms, signs or nutritional deficiencyAppropriate dietary modifications do not completely control symptoms, signs or nutritional deficiencyWeight loss with a BMI<20. |
| 60 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | All of the following:<br>Continuous drug treatment has little effect on symptoms, signs or nutritional deficiencyAppropriate dietary modifications have little effect on symptoms, signs or nutritional deficiencyAssistance required with most or all activities of daily livingWeight loss with a BMI<20. |
| 70 | Symptoms of upper digestive tract disease, with anatomical loss or pathological alteration present. | All of the following:<br>Severe impairment of nutritional status uncontrolled by any treatment or dietary modificationsAssistance required with all activities of daily livingWeight loss with a BMI<20. |
Section 211 - Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 - The value obtained should be rounded to the nearest whole number. | Zoe
Notes to Table 8.1
Continuous drug treatment includes H2 receptor antagonists, proton pump inhibitors, corticosteroids, and pancreatic enzyme supplementation.
Continuous drug treatment does not include antacids, or mixed antacid and alginic acid preparations.
Modified diet does not include the avoidance of a few, or selected, food items. It refers to special diets devised to manage symptoms of the disease and maximise nutrition (for example, lactose-free diet, gluten-free diet).
8.2 Lower gastrointestinal tract – colon and rectum
Table 8.2: Lower gastrointestinal tract – colon and rectum
See notes to Table 8.2 for further information.
| 0 | Signs and/or symptoms of colonic or rectal disease occur infrequently, and/or are of brief duration. | No requirement for any of the following as short term treatment:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>No systemic manifestations.<br>and<br>Weight and nutrition can be maintained at desirable levels. |
| 10 | Signs and/or symptoms of colonic or rectal disease occur more frequently, and/or are of longer duration. | Generally no requirement for any of the following as long-term treatment to control disease although may be needed short term:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>No systemic manifestations.<br>and<br>Weight and nutrition can be maintained at desirable levels. |
| 20 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | Requirement for at least one of the following as long-term treatment to control disease:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>No systemic manifestations.<br>and<br>Weight and nutrition can be maintained at desirable levels. |
| 30 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | Requirement for all of the following as long-term treatment to control disease:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>No systemic manifestations.<br>and<br>Weight and nutrition can be maintained at desirable levels. |
| 40 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | Requirement for all of the following as long-term treatment to control disease:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>Presence of one of the following:<br>Systemic manifestations (for example, fever, anaemia)Weight loss with a BMI<20. |
| 50 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | Requirement for all of the following as long-term treatment to control disease:<br>Limitation of activities of daily livingModified dietMedication.<br>and<br>Presence of both of the following:<br>Systemic manifestations (for example, fever, anaemia)Weight loss with a BMI<20. |
| 60 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | None of the following long-term treatments control the disease:<br>Modified dietMedication.<br>and<br>Presence of at least one of the following:<br>Limitation of activities of daily livingSystemic manifestations (for example, fever, anaemia)Weight loss with a BMI<20. |
| 70 | Objective evidence of colonic or rectal disease, with anatomical loss or alteration. | None of the following long-term treatments control the disease:<br>Modified dietMedication.<br>and<br>Presence of all of the following:<br>Systemic manifestations (for example, fever, anaemia)Assistance required with activities of daily livingWeight loss with a BMI<20. |
Notes to Table 8.2
Medication does not include fibre supplements, vitamins or other nutritional supplements (unless there is a demonstrated vitamin deficiency), or over the counter preparations.
Modified diet does not include the avoidance of a few, or selected food items. It refers to special diets devised to manage the symptoms of the disease and maximise nutrition (for example, lactose free diet, gluten free diet).
| 0 | Signs of organic anal disease are absent.<br>or<br>There is no anatomical loss or alteration. | Incontinence of flatus, or other mild or intermittent anal symptoms which can be controlled by treatment. |
| 10 | Signs of organic anal disease are present.<br>or<br>There is anatomical loss or alteration. | Mild incontinence of flatus.<br>and/or<br>Mild incontinence of liquid stool.<br>and<br>Mild or intermittent anal symptoms controlled by treatment. |
| 20 | Signs of organic anal disease are present.<br>or<br>There is anatomical loss or alteration. | Moderate daily faecal incontinence requiring continual treatment.<br>or<br>Continual anal symptoms incompletely controlled by treatment. |
| 30 | Signs of organic anal disease are present.<br>or<br>There is anatomical loss or alteration. | Moderate daily faecal incontinence requiring continual treatment.<br>and<br>Continual anal symptoms incompletely controlled by treatment. |
| 40 | Signs of organic anal disease are present.<br>and<br>There is anatomical loss or alteration. | Total faecal incontinence despite treatment.<br>or<br>Signs of organic anal disease with severe symptoms unresponsive or not amenable to treatment. |
Assessment for surgically created stomas is only allowed when the stoma is permanent and not a defunctioning or temporary stoma.
8.5 Liver – chronic hepatitis and parenchymal liver disease
Table 8.5: Chronic hepatitis and parenchymal liver disease
See notes to Table 8.5 for further information.
| %WPI | Primary criteria<br>(all criteria must be present) | Secondary criteria<br>(all criteria must be present) |
| 0 | Evidence of persistent or intermittent liver disease.<br>Histological severity – very mild. | Liver function tests may be normal or mildly abnormal.<br>No history of jaundice, ascites or bleeding oesophageal varices in the last three years.<br>Adequate nutritional state. |
| 10–15 | Evidence of persistent liver disease. Histological severity – mild. | Biochemistry abnormal.<br>No history of jaundice, ascites, or bleeding oesophageal varices in the last three years.<br>Adequate nutritional state. |
| 30 | Evidence of chronic liver disease. Histological severity – moderate. | Biochemistry abnormal.<br>History of jaundice, ascites or bleeding oesophageal varices in the last 12 months.<br>Adequate nutritional state |
| 40 | Evidence of progressive, chronic liver disease. Histological severity – severe. | Biochemistry abnormal.<br>History of jaundice ascites, or bleeding oesophageal varices in the last 12 months.<br>Adequate nutritional state. Easily fatigued. |
| 50 | Evidence of progressive, chronic liver disease. Histological severity – chronic hepatitis with cirrhosis. | Biochemistry abnormal.<br>History of jaundice ascites, and/or bleeding oesophageal varices in the last 12 months.<br>Nutritional state adversely affected. Fatigue and physical weakness. |
| 65 | Evidence of progressive, chronic liver disease. Histological severity – chronic hepatitis with cirrhosis.<br>Persistent signs of hepatic insufficiency. | Biochemistry abnormal.<br>History of jaundice, ascites and/or bleeding oesophageal varices in the last 12 months.<br>Nutritional state adversely affected. Profound fatigue and physical weakness. |
| 75 | Evidence of advanced, irreparable chronic liver disease.<br>Histological severity – chronic hepatitis with cirrhosis.<br>Persistent signs of advanced hepatic insufficiency. | Biochemistry abnormal.<br>History of jaundice, ascites and/or bleeding oesophageal varices in the last 12 months.<br>Nutritional state adversely affected. Profound fatigue and physical weakness.<br>Assistance required with activities of daily living. |
Notes to Table 8.5
Signs of liver disease include: the stigmata of liver disease (spider angiomata, palmar erythema, and gynaecomastia); jaundice; palpably enlarged liver; evidence of abnormal liver size on ultrasound; evidence of intrahepatic lesions on ultrasound or positive antibodies to any of the viruses known to have the potential to cause chronic liver disease.
Jaundice does not include a mild elevation of plasma bilirubin with normal liver enzymes.
Liver function tests include estimates of total bilirubin, albumin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), and gamma glutamyl transferase (GGT).
All the criteria, both primary and secondary, must be present before a particular WPI rating can be allocated. However, liver biopsy is not mandatory and should not be undertaken solely for the purpose of permanent impairment assessment.
Where liver biopsy has not been undertaken the histological criteria may be disregarded.
Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
8.6 Biliary tract
Table 8.6: Biliary tract
See note to Table 8.6 for further information.
| 0 | Cholecystectomy with no biliary tract sequelae. |
| 10 | History of biliary type pain without identifiable biliary disease.<br>or<br>Documented history of one to three episodes of biliary colic per year with identifiable biliary disease. |
| 20 | Documented history of four to six episodes of biliary colic per year with identifiable biliary disease. |
| 30 | Documented history of more than six episodes of biliary colic per year with identifiable biliary disease. |
| 40 | Permanent irreparable obstruction of the hepatic or common bile duct with recurrent cholangitis or permanent stent. |
| 50 | Permanent common bile duct obstruction with progressive liver disease manifest as persistent jaundice with intermittent hepatic insufficiency. |
| 65 | Permanent common bile duct obstruction with progressive liver disease manifest as persistent jaundice and hepatic insufficiency. |
| 75 | Permanent and irreparable common bile duct obstruction with advanced liver disease manifest as persistent jaundice and hepatic insufficiency. |
Note to Table 8.6
Biliary tract dysfunction should only be assessed after cholecystectomy or other appropriate biliary tract surgery, except where there are sound medical reasons for not undertaking surgery.
8.7 Hernias of the abdominal wall
Table 8.7: Hernias of the abdominal wall
See note to Table 8.7 for further information.
| 5 | Abdominal wall defect with slight protrusion of abdominal contents palpable with increased abdominal pressure, readily reducible. |
| 10 | Palpable abdominal wall defect with frequent or persistent protrusion of abdominal contents with increased abdominal pressure, manually reducible. |
| 25 | Palpable abdominal wall defect with persistent, irreducible or irreparable protrusion of abdominal contents at the site of defect, causing limitation of activities of daily living. |
Note to Table 8.7
Hernias should be assessed only after surgical repair, except where there are sound medical reasons for repair not being undertaken.
CHAPTER 9 – THE MUSCULOSKELETAL SYSTEM
9.0 Introduction
214 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
216 The range of motion to be measured is the range of active motion. The assessor should be satisfied that the claimant is making an appropriate effort to demonstrate the maximal range and that the measurements are consistent (that is, several repetitions). The normal ranges of motion of individual joints in the musculoskeletal system are set out on the next page.
Figure 9-B: Tables of normal ranges of motion of joints
Table
Joint
Plane
ROM from
ROM through
ROM to
9.1
Hindfoot/Ankle (subtalar)
Frontal
Eversion 20°
0°
Inversion 30°
9.2
Ankle (talocrural)
Sagittal
Extension 20°
0°
Flexion 40°
9.3
Knee
Sagittal
Extension 0°
Flexion 150°
9.4
Hip
Rotation
External Rotation 50°
0°
Internal Rotation 40°
9.4
Hip
Frontal
Abduction 40°
0°
Adduction 20°
9.4
Hip
Sagittal
Extension 30°
0°
Flexion 100°
9.8.1.a
Thumb – IP joint
Extension 30°
0°
Flexion 80°
9.8.1.a
Thumb – MP joint
Extension 40°
0°
Flexion 60°
9.8.1.b
Thumb – radial abduction/ adduction
15° (full radial adduction)
50° (full radial abduction)
9.8.1.b
Thumb adduction
0cm
8cm
9.8.1.b
Thumb opposition
0cm
8cm
9.8.1.c
Index and middle fingers – DIP joint
Extension 30°
0°
Flexion 70°
9.8.1.c
Index and middle fingers – PIP joint
Extension 30°
0°
Flexion 100°
9.8.1.c
Index and middle fingers – MP joint
Extension 20°
0°
Flexion 90°
9.8.1.d
Ring and little fingers – DIP joint
Extension 30°
0°
Flexion 70°
9.8.1.d
Ring and little fingers – PIP joint
Extension 30°
0°
Flexion 100°
9.8.1.d
Ring and little fingers – MP joint
Extension 20°
0°
Flexion 90°
9.9.1.a
Wrist
Sagittal
Extension 60°
0°
Flexion 60°
9.9.1.b
Wrist
Frontal
Radial Deviation 20°
0°
Ulnar deviation 30°
9.10.1.a
Elbow
Sagittal
Extension 0°
0°
Flexion 140°
9.10.1.b
Elbow (forearm)
Rotation
Supination 80°
0°
Pronation 80°
9.11.1.a
Shoulder
Sagittal
Extension 40°
0°
Flexion 180°
9.11.1.b
Shoulder
Rotation
External rotation 90°
0°
Internal Rotation 90°
9.11.1.c
Shoulder
Frontal
Abduction 180°
0°
Adduction 50°
PART I – THE LOWER EXTREMITIES – FEET AND TOES, ANKLES, KNEES AND HIPS
PART I – INTRODUCTION
219 The impairments assessed for each region in the lower extremity are combined to obtain the overall impairment of the lower extremity for the individual extremity, subject to the notes accompanying the applicable tables, or any indication that combination is not permitted.
220 Where a hip or knee arthroplasty procedure has been undertaken, assess the lower extremity impairment rating for arthroplasty in accordance with the AMA5, then convert that rating into a WPI rating using Table 17-33 of the AMA5.
221 A WPI rating for one lower extremity may be combined with a WPI rating for the other lower extremity, except in the case of WPI ratings under Table 9.7: Lower extremity function, where the notes accompanying Table 9.7 are followed.
224 If the assessor considers that the impairment is not adequately assessed using Table 9.1: Feet and toes, Table 9.2: Ankles, Table 9.3: Knees or Table 9.4: Hips, and the condition does not cause a reduction in the range of motion of a joint but there is significant interference with gait, the assessor should consider the effect of the injury on gait and assess the WPI rating using Table 9.7: Lower extremity function. Table 9.7 cannot be used if the condition causes a reduction in the range of motion of a joint and an assessment can be made under any one or more of Table 9.1, Table 9.2, Table 9.3 or Table 9.4.
225 If permanent, conditions such as sesamoiditis, plantar fasciitis, plantar tendonitis, and pes planus, should be assessed under Table 9.7: Lower extremity function.
228 A chronic pain condition affecting the lower extremities should be assessed using the same methodology as for the upper extremity in accordance with Section 9.13.3 (Chronic pain conditions).
Steps in calculating lower extremity impairment
| Step 1 | Add abnormal motion/ankylosis impairment values within an individual joint. |
| Step 2 | Combine abnormal motion/ankylosis impairment values for different joints in the toes. |
| Step 3 | Add impairment values obtained for each individual toe and combine this value with the impairment values for other joints in the foot to obtain the total abnormal motion/ankylosis impairment assessment for a foot. |
| Step 4 | Combine with abnormal motion/ankylosis impairment assessments for different regions in the lower extremity (that is, knee and hip). |
| Step 5 | Combine with impairment values for peripheral nerve injuries. |
| Step 6 | Combine with impairment values for amputation. |
9.1 Feet and toes
229 Table 9.1: Feet and toes assesses impairments to range of motion of the feet and toes, including ankylosis of one or more joints.
230 In relation to impairment constituted by the loss, or the loss of the use, of a toe, the threshold for compensation for an injury resulting in a permanent impairment constituted by such a loss is 1% WPI under this Guide.
231 The maximum WPI rating under Table 9.1: Feet and toes is 2% for an injury resulting in impairment of two or more of the 2nd, 3rd, 4th and 5th toes of one foot.
232 In the case of toes, the ankylosis referred to in Table 9.1: Feet and toes is that of the metatarso-phalangeal joint.
233 Ankylosis of the interphalangeal joints of the 2nd, 3rd, 4th or 5th toe attracts a WPI rating of 0%. The position of function is the neutral position.
Table 9.1: Feet and toes
| 0 | Ankylosis of any one of the 2nd, 3rd, 4th or 5th toes in position of function. |
| 1 | Interphalangeal flexion of the 1st toe restricted to less than 20°.<br>Metatarso-phalangeal extension of the 1st toe restricted to a range of 15°-30°.<br>Metatarso-phalangeal extension of any one of the 2nd, 3rd, 4th and 5th toes restricted to less than 10°. Subtalar inversion restricted to a range of 10°-20°.<br>Subtalar eversion restricted to less than 10°.<br>Ankylosis of:<br>any one of the 2nd, 3rd, 4th or 5th toes in full extension or full flexionany two of the 2nd, 3rd, 4th or 5th toes in position of functionthe 2nd, 3rd and 4th toes in position of function. |
| 2 | Metatarso-phalangeal extension of the 1st toe restricted to less than 15°.<br>Metatarso-phalangeal extension of any two of the 2nd, 3rd, 4th or 5th toes restricted to less than 10°. Subtalar inversion restricted to less than 10°.<br>Ankylosis of:<br>any two of the 2nd, 3rd or 4th toes, plus the 5th toe, in position of functionany two of the 2nd, 3rd, 4th or 5th toes in full extension or full flexionall four of the 2nd, 3rd, 4th and 5th toes in position of functionthe 2nd toe with any two of the 3rd, 4th or 5th toes in full extensionthe 3rd, 4th and 5th toes in full extension or full flexionthe 2nd and 3rd toes with either of the 4th or 5th toes in full flexion. |
| 3 | Ankylosis of:<br>all four of the 2nd, 3rd, 4th and 5th toes in full flexion or full extensionthe 2nd toe with the 4th and 5th toes in full flexion. |
| 4 | Ankylosis of:<br>the 1st toe in position of function or full extensionthe 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in position of function. |
| 5 | Ankylosis of:<br>the 1st toe in full flexionthe 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in full extensionthe 1st toe with any two or three of the 2nd, 3rd, 4th or 5th toes in position of function. |
| 6 | Ankylosis of:<br>the 1st toe with any two or three of the 2nd, 3rd, 4th or 5th toes in full extensionthe 1st toe with all four of the 2nd, 3rd, 4th and 5th toes in position of functionthe 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in full flexion. |
| 7 | Ankylosis of:<br>the 1st toe with any two of the 2nd, 3rd, 4th or 5th toes in full flexionthe 1st toe with all four of the 2nd, 3rd, 4th and 5th toes in full extension. |
| 8 | Ankylosis of the 1st toe with any three or all four of the 2nd, 3rd, 4th and 5th toes in full flexion. |
| 10 | Ankylosis of hindfoot with tibia-os calcis angle of 100° to 110°. |
| 15 | Ankylosis of hindfoot with tibia-os calcis angle of 90° to 95°. |
| 20 | Ankylosis of hindfoot with tibia-os calcis angle of less than 90°. |
9.2 Ankles
234 Table 9.2: Ankles assesses impairments to range of motion and deformity of the ankle, as well as ankylosis. Ankle deformity with movement is assessed separately from ankylosis.
235 Ankylosis in the optimal position is equivalent to a WPI of 4%. The optimal position is the neutral position without flexion, extension, varus or valgus. This is the base level of ankylosis impairment in the ankle.
236 When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.2: Ankles for ankylosis in each direction. Then add the base figure of 4% WPI for ankylosis in the optimal position.
237 The maximum WPI rating for multiple impairments of the ankle and hindfoot is 25% WPI. If the total WPI rating obtained by adding different WPI ratings is higher than 25% WPI, then the final WPI rating for the ankle is 25%.
Table 9.2: Ankles
| %WPI | Criteria<br>(one required – different conditions may be assessed separately – but see notes on ankylosis above) |
| 3 | Plantar flexion capability restricted to 15°-20°.<br>Dorsiflexion restricted to less than 10°. |
| 4 | Ankylosis in optimal position only (see paragraph 235 above). |
| 5 | Deformity with:<br>varus angulation of 10°valgus angulation of 10°-20°.<br>Ankylosis not in optimal position:<br>in less than 10° of internal malrotationin 15° of external malrotation. |
| 6 | Plantar flexion capability restricted to 10° or less.<br>Plantar flexion contracture of 10°-15°. |
| 7 | Ankylosis not in optimal position:<br>in 10° to 15° of dorsiflexion or plantar flexion. |
| 10 | Deformity with varus angulation of 15°-20°.<br>Ankylosis not in optimal position:<br>in varus angulation of 5°in valgus angulation of 10° to 15°in 10° to 15° of internal malrotationin 20° to 25° of external malrotation |
| 12 | Plantar flexion contracture of at least 20°. |
| 15 | Ankylosis not in optimal position:<br>in 20° to 25° of plantar flexionin at least 20° of dorsiflexionin varus angulation of 10° to 15°in valgus angulation of 20° to 25°in 20° to 25° of internal malrotationin 30° to 35° of external malrotation. |
| 17 | Ankylosis not in optimal position:<br>in varus angulation of 20° to 25°. |
| 20 | Deformity with varus angulation of 25° or greater. |
| 21 | Ankylosis not in optimal position:<br>in varus angulation of at least 30°in at least 30° of plantar flexionin valgus angulation of at least 30°in at least 30° of internal malrotationin at least 40° of external malrotation. |
9.3 Knees
238 Table 9.3: Knees assesses impairments to range of motion and deformity of the knee, as well as ankylosis. Knee deformity with movement is assessed separately from ankylosis. ‘Deformity’ is measured by the femoral-tibial angle: 3°‑10° valgus is considered normal.
239 Ankylosis in the optimal position is equivalent to 27% WPI. The optimal position is 10°-15° of flexion with good alignment. This is the base level of ankylosis impairment in the knee. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.3: Knees for ankylosis in each direction. Then add the base figure of 27% WPI for ankylosis in the optimal position.
240 The maximum WPI rating for multiple impairments of the knee is 40% WPI. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the knee is 40%.
Table 9.3: Knees
| 5 | Flexion of 80°-105°.<br>Flexion contracture of 5°.<br>Deformity with:<br>varus angulation of 2° valgus-0° (neutral)valgus angulation of 10°-12°.<br>Ankylosis not in optimal position:<br>in 10° to 15° of internal malrotationin 10° to 15° of external malrotationin less than 10° of varusin 10° to 15° of valgusin 20° to 25° of flexion. |
| 10 | Flexion of 60°-75°.<br>Flexion contracture of 10°-15°.<br>Deformity with:<br>varus angulation of 1°-7°valgus angulation of 13°-15°.<br>Ankylosis not in optimal position:<br>in 20° to 25° of internal malrotationin 20° to 25° of external malrotationin 10° to 15° of varusin 20° to 25° of valgusin 30° to 35° of flexion. |
| 13 | Ankylosis not in optimal position:<br>in at least 30° of internal malrotationin at least 30° of external malrotationin at least 20° of varusin at least 30° of valgusin at least 40° of flexion. |
| 14 | Flexion of 30°-55°.<br>Flexion contracture of 20° or greater.<br>Deformity with:<br>varus angulation of 8°-12°valgus angulation of 16°-20°. |
| 20 | Flexion of less than 30°.<br>Deformity with:<br>varus angulation of more than 12°valgus angulation of more than 20°. |
| 27 | Ankylosis in optimal position only (see paragraph 239 above). |
9.4 Hips
241 Table 9.4: Hips assesses impairments of range of motion and deformity of the hip, as well as ankylosis. Hip deformity with movement is assessed separately from ankylosis.
242 Ankylosis in the optimal position is 20% WPI. The optimal position is 25°-40° of flexion with neutral rotation, abduction and adduction. This is the base level of ankylosis impairment in the hip. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.4 for ankylosis in each direction. Then add the base figure of 20% WPI for ankylosis in the optimal position.
243 The maximum WPI rating for multiple impairments of the hip is 40%. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the hip is 40%.
Table 9.4: Hips
| 2 | Flexion restricted to 80°-100°.<br>Flexion contracture of 10°-15°.<br>Internal rotation restricted to 10°-15°.<br>External rotation restricted to 20°-30°.<br>Abduction restricted to 15°‑25°.<br>Adduction restricted to 15° or less.<br>Abduction contracture of 5° or less. |
| 5 | Flexion restricted to 50°-70°.<br>Flexion contracture of 20°-25°.<br>Internal rotation restricted to less than 10°.<br>External rotation restricted to less than 20°.<br>Abduction restricted to 5°-10°.<br>Abduction contracture of 6°-10°.<br>Ankylosis not in optimal position:<br>in 20° to 40° of flexionin at least 5° of internal rotationin 10°-15° of external rotation. |
| 10 | Flexion restricted to less than 50°.<br>Flexion contracture of 30° or more.<br>Abduction restricted to less than 5°.<br>Abduction contracture of 11°-20°.<br>Ankylosis not in optimal position:<br>in 10° to 50° of flexionin at least 10° of internal rotationin at least 20° of external rotationin 5°-10° of abductionin at least 5° of adduction. |
| 15 | Abduction contracture of more than 20°.<br>Ankylosis not in optimal position:<br>in 0° to 60° of flexionin at least 20° of internal rotationin at least 30° of external rotationin 15°-20° of abductionin at least 10° of adduction. |
| 20 | Ankylosis in optimal position (see paragraph 242 above).<br>Ankylosis not in optimal position:<br>in at least 70° of flexionin at least 30° of internal rotationin at least 40° of external rotationin at least 25° of abductionin at least 15° of adduction. |
246 A WPI rating from Table 9.5: Lower extremity amputations may be combined with other WPI ratings for lower extremity conditions above the amputation site.
Table 9.5: Lower extremity amputations
| 0 | Amputation through:<br>interphalangeal joint (distal or proximal) of any one of 2nd, 3rd, 4th or 5th toesany phalanx of any one of the 2nd, 3rd, 4th or 5th toes.<br>Amputation of any portion of soft tissue of any toe. |
| 1 | Amputation of any one of the 2nd, 3rd, 4th or 5th toes at the metatarso-phalangeal joint. |
| 2 | Amputation of:<br>the first toe at the interphalangeal jointany toe except the first toe through the metatarsalany two of the 2nd, 3rd, 4th or 5th toes at the metatarso-phalangeal joint. |
| 3 | Amputation of any three of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint. |
| 4 | Amputation of all four of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint. |
| 5 | Amputation of the first toe at the metatarso-phalangeal joint. |
| 8 | Amputation of the first metatarsal (first toe). |
| 10 | Amputation of all toes of one foot at the metatarso-phalangeal joints. |
| 16 | Transmetatarsal amputation. |
| 18 | Midfoot amputation. |
| 25 | Syme amputation of hindfoot. |
| 28 | Amputation of lower leg more than 7.5cm below knee. |
| 32 | Amputation of lower leg 7.5cm or less below knee.<br>Knee disarticulation.<br>Amputation above knee distal to midthigh. |
| 36 | Amputation above knee through midthigh. |
| 40 | Amputation above knee proximal to midthigh.<br>Hip disarticulation. |
| 50 | Hemipelvectomy. |
9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities
| Grading | Sensory deficits or pain Criteria | Motor function Criteria |
| 0 | No sensation.<br>or<br>Severe pain that prevents all activity. | No contraction. |
| 1 | No protective sensibility with abnormal sensations.<br>or<br>Severe pain that prevents most activity. | A flicker. |
| 2 | Decreased protective sensibility with abnormal sensations.<br>or<br>Severe pain that prevents some activity. | Active movement with gravity eliminated. |
| 3 | Diminished light touch and two-point discrimination with some abnormal sensations.<br>or<br>Slight pain that interferes with some activity. | Active movement against gravity. |
| 4 | Diminished light touch with or without minimal abnormal sensations.<br>or<br>Pain that is forgotten during activity. | Active movement against gravity and resistance. |
| 5 | Normal sensation.<br>or<br>No pain. | Normal power. |
9.6.1 Spinal nerve root impairment affecting the lower extremity
249 Values obtained for pain, discomfort and/or sensory loss may be combined with values obtained for loss of strength, using the combined values chart (see Appendix 1).
Table 9.6.1: Spinal nerve root impairment affecting the lower extremity
Impairment causing pain, discomfort and/or sensory loss Grading Impairment causing loss of strength Grading
5 4 3 2 1 0 5 4 3 2 1 0
Nerve root %WPI %WPI Nerve root
L3 0 1 1 2 3 3 0 2 3 5 7 8 L3
L4 0 1 1 2 3 3 0 3 6 8 12 14 L4
L5 0 1 1 2 3 3 0 3 6 9 13 15 L5
S1 0 1 1 2 3 3 0 2 3 5 7 8 S1
9.6.2 Peripheral nerve injuries affecting the lower extremities
251 WPI ratings obtained for sensory impairment may be combined with WPI ratings for dysaesthesia, and the total combined with WPI ratings for motor impairment, using the combined values chart (see Appendix 1).