Download: (PART II OF II) Click Here
ACT 917 OF 1999
(From May 28, 1999)
Official Journal No. 43601 of June 9, 1999
PRESIDENCY OF THE REPUBLIC
Which is modified by Decree 692 of 1995.
THE PRESIDENT OF THE REPUBLIC OF COLOMBIA
To the best of their constitutional and legal powers, especially those conferred by Article 189, paragraph 11 of the Constitution, Article 41 of Law 100 of 1993 and article 5. Act 361 of 1997,
DECREES:
Article 1. SCOPE.
Unique Handbook for the disability rating contained in this decree applies to all inhabitants of the country, workers from the public, official, semi official, in all its orders, and the private sector in general, to determine loss of earning capacity from all sources, in accordance with the provisions of Articles 38, following and consistent Law 100 of 1993, 46 Decree-Law 1295 of 1994 and the 5th. Law 361/97.ARTICLE 2. DEFINITIONS OF DISABILITY, PERMANENT DISABILITY PARTIAL WORK CAPACITY AND WORK DAILY.
For purposes of the application and enforcement of this decree, Adopt the following definitions:
a) Disability: Disability is considered with the person who for any reason, any origin, not caused intentionally, had lost 50% or more of their working capacity.
b) Permanent partial disability, permanent disability is considered partial to the person who for any reason, any origin, present a loss of earning capacity equal to or greater than 5% and below 50%.
c) Capacity for Work: means an individual's work capacity all the skills, abilities, skills and / or potential physical, mental and social, allowing you to perform in a regular job. d) Regular job: work is understood as usual that office, work or occupation performed by the individual capacity for work, training and / or technical or vocational training, receiving compensation equivalent to salary or income, and which listed the Social Security System.
ARTICLE 3. DATE OF DECLARATION OF THE STRUCTURE OR LOSS OF WORKING CAPACITY.
The date on which the individual generates a loss in their ability to work on a permanent and final. For any contingency, this date must be documented with medical records, clinical and diagnostic support, and may be earlier or correspond to the date of qualification. In any case, while the person receiving temporary disability allowance, there is no place to claim the benefits arising from disability.
ARTICLE 4. REQUIREMENTS AND PROCEDURES FOR QUALIFICATION ON THE BASIS OF DISABILITY AND OPINION.
For purposes of qualifying disability, the qualifiers will be guided by requirements and procedures in this manual to give an opinion. Should note that this opinion is the document that, as a matter of evidence, contains the concept emit expert raters on the degree of permanent partial disability, disablement or death of a member and be based on:
a) Considerations of factual about the situation is being assessed, which relate the events that led to the accident, illness or death, indicating the circumstances of manner, time and place within which they occurred, and CLINICAL DIAGNOSIS technical-scientific, supported by clinical history, occupational history and diagnostic aids required in accordance with the specificity of the problem.
b) Established a clinical diagnosis, we proceed to determine the loss of working capacity of the individual, through procedures defined in this manual. In any case, this determination must be made by the managers with qualified scientific, technical and ethically, with their respective official academic recognition. In case you need concepts, additional examinations or tests shall be performed and recorded in the terms set out in this manual.
c) Given that a loss of earning capacity, it made the INTEGRAL OF THE DISABILITY RATING, which is recorded in the opinion, in the forms and instructions that for that purpose by the Ministry of Labour and Social Security, which must be registered at least: the origin of illness, accident or death, the degree of loss of earning capacity caused by the accident or illness, the date format of the disability and the reasoning based on diagnostic and other reports additives, such as reporting the accident or the death certificate, if applicable.
d) The opinion must contain mechanisms to allow those concerned to exercise the remedies provided under the current rules, in order to ensure an objective dispute its contents in case of disagreement, both in substance and in terms of procedure.
PARAGRAPH. The normal consequences of aging, alone, with no pathology on aggregate, do not generate failure for the purposes of qualifying for disability in the Social Security System. Should co-exist with such pathology consequences may include within the definition of agreement with the impairment, disability and handicap for.
ARTICLE 5. DETERMINATION OF PERMANENT PARTIAL DISABILITY.
The determination of the statement, evaluation, review, grade and source of permanent partial disability, will be made by:
1. The Professional Risk Managers, in accordance with the provisions of article 42 Decree-Law 1295 of 1994, through their own or contract labor committees. They should evaluate the loss of earning capacity, based on this single qualification Manual Disability, in order to ensure access to the rights that persons affiliated to social security.
2. Health Promoting Enterprises (EPS) and the Subsidised Regime Administrators (ARS) in accordance with the provisions of article 5. Act 361 of 1997, will assess the loss of earning capacity, based on the Single User Rating Disabilities provided in this Decree, in order to ensure access to rights that people have with limitation. For this purpose, these entities must have a multidisciplinary team responsible for such status, in accordance with the regulations for that purpose issued by the Ministry of Health. In case of dispute about the extent and origin of the limitation determined, it will go to the Boards of the disability rating, according to the procedures defined by the standards prevailing in the area.
ARTICLE 6. RATING THE STATE OF DISABILITY.
The rating and issue an opinion on the state of disability corresponds to the Disability Rating Board, who will hear the following cases:
a) The rating and review of the loss of earning capacity and permanent partial disability, in case of dispute.
b) The rating of origin, degree, date of structuring and reviewing the state of disability.
c) The classification of the origin of the accident and disease, based on Law 100 of 1993, Decree Law 1295 of 1994 and other regulations, in case of dispute.
d) The classification of the origin of death in case of dispute.
Meetings of the Disability Rating must issue the opinion of the disability which, in all cases accurately reflect the contents of the record of each case reviewed by it and the outcome of the deliberations of the members in charge of branding. Similarly, corresponding to the respective Board member reporting the opinion, who can accept it or appeal it to the competent authorities.
ARTICLE 7. QUALIFYING CRITERIA FOR THE COMPREHENSIVE DISABILITY.
For purposes of the integral rating of disability are taken into account the biological functional components, psychological and social human being, understood in terms of the consequences of illness, accident or age, and defined as follows:
a) DEFICIENCY: Deficiency means any loss or abnormality of structure or psychological, physiological or anatomical, which can be temporary or permanent, among which include the existence or occurrence of an anomaly, defect or loss caused by member, organ, tissue or other body structure, as well as proprietary systems of mental function. Represents the manifestation of a pathological condition and in principle reflects disturbances at the organ.
b) DISABILITY: Disability means any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being caused by a deficiency, characterized by excesses or deficiencies in the performance and behavior in a normal or routine activity, which can be temporary or permanent, reversible or irreversible, and progressive or regressive. Represents the objectification of the deficiency and therefore reflects changes to the level of the individual.
c) DISABILITY: Disability means any disadvantage for a given individual, resulting from an impairment or disability that limits or prevents the performance of a role, which is normal for you based on age, sex, factors social, cultural and occupational. It is characterized by the difference between performance and expectations of the individual himself or group to which it belongs. Represents the socialization of impairment and disability as it reflects the cultural, social, economic, environmental and occupational, that for the individual arising from the presence of them and alter their environment.
ARTICLE 8. PERCENTAGE DISTRIBUTION OF THE CRITERIA FOR THE TOTAL OF THE DISABILITY RATING.
To perform the integral rating of disability, is given a score to each of the criteria described in the previous article, whose sum equals 100% of the total loss of earning capacity, within the following maximum ranges of scores:
STANDARD RATE (%)
50 Deficiency
Disabilities 20
Handicap 30
Total 100
PARAGRAPH 1. Where there is no deficiency or its value is zero (0) no disability may be described or disability. Therefore, the loss of earning capacity resulting report with a value of zero (0).
PARAGRAPH 2. In accordance with paragraph 1 of article 34 Decree-Law 1295 of 1994, for qualifying in the case of work accidents and occupational diseases, the existence of previous conditions is not caused to increase the degree of disability or the benefits payable to the worker. Similarly, when there are deficiencies of congenital or acquired before complying with legal minimum ages for work and the individual has been approved occupational and socially, these deficiencies are not taken into account for the classification of the loss of working capacity occupational origin, unless they have been aggravated or have thrown up.
PARAGRAPH 3. Given that a patient suffering from a deficiency improves functional status to receive a prosthesis, reduce a defined proportion of the overall deficit of the segment that receives, as follows:
a) For aesthetic prosthesis subtract 10% of the value of global deficiency found;
b) For functional prosthesis 20% of the overall deficit found, and
c) For cosmetic and functional prostheses 30% of the overall deficit found.
Example:
Enucleation of left eye with normal right eye: 15% deficiency. In this case, it is an aesthetic prosthesis and therefore subtracted 10% from 15%. Ie, 1.5%, to a final value of overall deficit of 13.5%.
ARTICLE 9. GENERAL INSTRUCTIONS FOR QUALIFIERS.
The "Manual single disability rating of" established based on criteria and components defined in the previous articles, a uniform method compulsory for the legal determination of the loss of working capacity that provides an individual at the time of evaluation.
The rating of the loss of working capacity of the individual must be made known once the definitive diagnosis of the disease, treatment is completed and on completion of comprehensive rehabilitation process, or even without finishing the same, there is an unfavorable medical concept recovery or improvement. The Manual consists of three books, namely:
1. The first deals with deficiencies. Consists of fourteen (14) chapters that correspond to the evaluation of damage or partial or total absence of different organ systems. Contains a number of criteria and special tables of values to describe the damage;
2. The second deals with Disabilities, broken down into seven (7) categories, which include the additional level of seriousness, and
3. The Third, defines seven (7) categories of disability. To determine the values of impairments, disabilities and handicaps should follow the following instructions:
a) For the deficiencies: The degree of deficiency referred to the First Book which relates to organic systems, are expressed as percentage of functional loss (global failure). To facilitate the exercise of the assessor or the Qualifying Board, contains a series of tables of values for organs or systems, which can escape the values for this component. However, in cases that are affected two or more organs or systems, partial values of the respective global deficiencies must be combined using the following formula:
1
A + (50-A) B
100
Where A and B correspond to the different deficiencies. A being the highest value and B the lowest value. This will combine the values for A and B. This is called ® combined sum. If there are more than two values, they must be pre-ordered from highest to lowest value, to proceed to combine on the formula.
Example: A = 20%
B = 10% Combined sum = 20 + (50 -20) X10 = 23%
100
Given that the value of the limb deficiency may reach 100%, you should use the following formula when they combined limb deficiencies:
1A + (100-A) B
100
It must calculate the overall deficit for each chapter and only then will a combination of global impairment values between chapters to find the final overall deficit.
Who legally can or should determine the loss of working capacity of a person, take into account that the deficiency must be demonstrable anatomically, physiologically and psychologically, or in combination. Such abnormalities may be determined by testing a diagnostic aid affiliate, regarding the signs and symptoms.
The pathologies that manifest themselves only symptoms, not easily possible to define who qualifies. Thus, decisions on the rates of disability must be supported with the patient's medical history and diagnostic testing aid, complementing clinical criteria. The results obtained with additional diagnostic tests should match the anatomic, physiological and / or mental detectable by such tests, and confirm the signs found during the medical examination. The patient's statements which only consider the description of their discomfort without the support of signs or additional examinations have no value to establish a deficiency.
Where applicable, it should support the opinion with the concept of Occupational Health to determine the source of the injury. There are other cases in which, following the specific instructions for each lesion, may be added or limb deficiencies in the evaluation of damage to the brain is selected from the different degrees of deficiency the most value to the overall deficit as final.
b) Disability: the case of determining the value of disability, we proceed to perform an arithmetic sum of all disabilities with which characterize the lesion. The result of this sum corresponds to the final value of disability to be registered.
c) In the Disabilities: for determining the value of disability should assess the patient in each of the categories of scale assigned to each of the Disabilities. In each of them has the highest value (mutually exclusive) and then added each of them. The result of this sum corresponds to the final of the handicap to be registered.
d) In determining the integral: For the final integral rating of the degree of loss of earning capacity of the person, in accordance with the specifications of this manual and tables, are added arithmetically those percentages for the values of the deficiency, disability and handicap, the legal assessor assigned to each of them.
ARTICLE 10. INSTRUCTIONS FOR MEDICAL INTER-CONSULTORES.
To determine the loss of earning capacity, qualifiers must have the technical background on the objective medical conditions studied. These records are provided by physicians or inter-consultores of the IPS to which the patient is affiliated. For purposes of complying with this requirement, qualifiers inter-consultores should require the appropriate medical and technical concept, fulfilling the following requirements:
1. Inter-consultor the treating physician or expert advice that keeps your specialty (recognition and determination of diagnosis and clinical status of a particular disease that presents an affiliate), must consider that his report will be used by the assessor to determine the loss in earning capacity that has that individual.
2. Therefore, you should consider the expertise is requested in order to determine exclusively the professional consultant and as accurately as possible, the extent and the commitment of the pathology presented by the patient. Record should avoid personal opinions or ideas on the degree of disability of individuals studied, because such an assessment is a matter that belongs only to those who can legally determine.
3. The doctor should interconsultor decision solely on the diagnosis of a member, using language similar to the Manual.
4. In the presence of situations difficult to assess, you should inform the assessor about the examinations or tests of additional diagnostic aid should be made to give an accurate report. In no case can be taken into account reviews provided by patients or persons concerned.
5. There must be consistency between the history told by the worker, provided legal review and the doctor's conclusions interconsultor. Any inconsistencies should be reviewed and clarification, and inform the assessor and the competent authority.
6. The doctor inter-consultor shall act exclusively in relation to their specialty, on the points requested by the qualifier, among which may contain at least the following: Date of care, diagnosis, treatment received or implied, concept and prognosis.
ARTICLE 11. INTERPRETATION OF THE RULES OF THE MANUAL.
To understand this Manual shall apply the following rules of interpretation:
1. The words used in their natural and obvious meaning, or has the meaning in the dictionary of the Real Academia de la Lengua.
2. The terms of technical content for use with the meaning in their fields.
3. The definitions and concepts set out in the manual, be construed in context and with their own meaning in it.
4. When a disease or diagnosis does not appear in the text of this Manual, or can not be approved at the same, be referred to the interpretation of similar instruments from other countries or international bodies such as the Committee of Experts of the ILO, Manual of Consequences of Disease and the WHO Manual on Disabilities American Medical Association AMA.
ARTICLE 12. BOOK ONE-OF DEFICIENCIES.
CHAPTER I
1. Musculoskeletal system
1.1 GENERAL
As a high percentage of applications for disability rating under joint pathologies or spinal cord, it is important to make a correct assessment of conditions in this system.
This chapter includes the study of the percentages of impairment related to:
Spine ·
· Extremely superior.
· Extremely inferior.
· Amputees.
The loss of function may be due to limited mobility caused by injury, pain, ankylosis, deformity, amputations or coexistence of two or more of these diseases. In all cases it is important to consider the individual's dominant hemisphere, since the functions of daily life are more dependent on the dominant upper limb (right or left handed). The dysfunction of the nondominant upper extremity results in a lower deficiency that dysfunction of the dominant limb. For the assessment of the dominant hand, once you get the value of the overall deficit resulting from this segment should be added proportionately to 20% of that value through the combination of values, without exceeding the maximum value assigned to the overall deficit of the segment of the injury evaluated. For the assessment of the remaining segments of the dominant upper limb add a proportional value of 10%.
Steps to get the final value of the overall deficit of the dominant hand:
1. Global deficiency X 0.2 = segment to add value in combination with the overall deficit of the segment.
2. Final overall deficit = total deficiency combined global + segment to add value obtained from the formula of the preceding paragraph. When there is damage to several axes, joints or segments should take into account the evaluation criteria described below:
TABLE No. 1.0: TABLE OF VALUATION OSTEOARTICULAR
Segment Concept Restriction of movement assessed Ankylosis
1. Impaired articulation of their range of motion in several axes. Calculate spine weaknesses of each axis, then arithmetically adding the values of all axes, which corresponds to the overall deficit. Calculate deficiencies in each axis, then take the higher value of all and this will be the overall deficit. Upper and lower extremities. Calculate deficiencies tip of each axis, then add them arithmetically. Then weigh the overall deficit. Calculate deficiencies tip of each axis, then choose the highest value and ponder a deficiency global.
2. Several joints in the same segment. Spine Combining values overall deficiencies of each joint. Combining values overall deficiencies of each joint. Upper and Combining values. Except fingers. Combination of values. Lower Calculate fingers deficiency finger at each joint, add them and then weigh up global deficiency. Calculate the deficiency of each finger joint, add them and then weigh up global deficiency.
3. Multiple injuries in different
Spine Segments Combination of values. Combination of values. Upper extremities. Combination of values. Combination of values. Lower extremities Combining values except knuckles. Calculate the deficiency of each knuckle and then add limb deficiency and weight to global. Combination of values.
1.2 SPINE
For practical reasons, the study spinal injuries are distributed as follows:
Cervical · Region.
Dorso lumbar · Region.
· Other spinal injuries.
· Scoliosis.
· Fractures.
· Hernias.
· Osteoporosis.
· Dislocations.
If there are neurological problems, these should be considered and analyzed in accordance with those reported in the chapter on neurological disorders.
1.2.1 Cervical Region.
1.2.1.1 Restriction of movement right or left lateral tilt
TABLE No. 1.1: CERVICAL REGION - RIGHT OR LEFT SIDE TILT
Lateral tilt from the neutral position to: Global Lost Deficiency Held (%)
0 º 40 º 0 º 1.0
10 º 30 º 10 º 1.0
20 º 20 º 20 º 0.5
30 º 10 º 30 º 0.5
40 º 0 º 40 º 0.0
Restriction of movement:
Extent of lateral inclination = 80 degrees.
The tilt left or right side, corresponding to 25% of full cervical motion.
Ankylosis 1.2.1.2 tilt left or right side
TABLE No. 1.2: CERVICAL REGION - RIGHT OR LEFT SIDE TILT ankylosis:
Stagnant region in: global deficiency (%)
0 (neutral) 10.0
10 º 13.0
20 º 15.0
30 º 18.0
40 ° (left-right lateral flexion
Complete)
20.0
1.2.1.3 Restriction of movement: clockwise or restriction of movement: You should use the Table No. 1.13, to determine the deficiency associated with ankylosis of several vertebrae.
TABLE No. 1.3: CERVICAL REGION - clockwise or
Lateral tilt from neutral position to:
Global Lost Deficiency Held (%)
0 º 30 º 0 º 2.0
10 º 20 º 10 º 1.0
20 º 10 º 20 º 0.5
30 º 0 º 30 º 0.0
Restriction of movement:
Amplitude of lateral rotation = 60 degrees. The rotation left or right, corresponding to 35% of full cervical motion.
1.2.1.4 Ankylosis: clockwise or
TABLE No. 1.4: CERVICAL REGION - LEFT-RIGHT ROTATION ankylosis: stuck in Region: global deficiency (%)
0 (neutral) 10
10 ° 13
20 ° 16
30 ° (lateral rotation der. Left. Complete) 20
1.2.1.5 Restriction of movement: flexion or extension
Table No.1.5: CERVICAL REGION - flexion or extension
Restriction of movement:
Extent of Extension = 60 degrees flexion. Flexion or extension, is 40% full cervical motion.
Flexion or extension from neutral position to:
Global Lost Deficiency Held (%)
0 º 30 º 0 º 2.0
10 º 20 º 10 º 1.5
20 º 10 º 20 º 0.5
30 º 0 º 30 º 0.0
1.2.1.6 Ankylosis: flexion or extension
TABLE No.1.6: REGION CERVICAL FLEXION OR EXTENSION-ankylosis.
Stagnant region in: global deficiency (%)
0 ° (neutral position) 10
10 ° 13
20 ° 16
30 ° (flexion or full extension) 20 is applied to a cervical vertebra, where more than two vertebrae should refer to Table 1.13.
1.2.2 thoracolumbar region
Call No.1.13 TABLE to determine the appropriate overall deficit by ankylosis of several vertebrae.
1.2.2.1 Restriction of movement: flexion or extension
Table No.1.7: thoracolumbar REGION - flexion or extension
Restriction of movement:
Mean range of flexion - extension = 120 degrees.
Flexion or extension, is 40% complete thoracolumbar motion.
Flexion from neutral 0 ° to:
Lost Conserved global Deficiency
(%)
0 º 90 º 0 º 4.5
10 º 80 º 10 º 4.0
20 # 70 # 20 # 3.5
30 º 60 º 30 º 3.0
40 º 50 º 40 º 2.5
50 º 40 º 50 º 2.0
60 º 30 º 60 º 1.5
70 º 20 º 70 º 1.0
80 º 10 º 80 º 0.5
90 º 0 º 90 º 0.0
Extension from neutral position to:
Global Lost Deficiency Held
(%)
0 º 30 º 0 º 1.5
10 º 20 º 10 º 1.0
20 º 10 º 20 º 0.5
30 º 0 º 30 º 0.0
1.2.2.2 Ankylosis: flexion or extension
TABLE NO.1.8: thoracolumbar REGION - flexion or extension-ankylosis.
Stagnant region in: global deficiency (%)
0 ° (neutral position) 15.0
10 º 17.0
20 º 18.0
30 º 20.0
40 º 21.5
50 º 23.5
60 º 25.0
70 26.5
80 º 28.5
90 ° (full flexion) 30.0
Stagnant region at:
0 ° (neutral position) 15.0
10 º 20.0
20 º 25.0
30 ° (fully extended) 30.0
1.2.2.3 Lateral tilt
The sum of these values is the overall deficit of the restriction of movement in the lateral inclination of the thoracolumbar region. AAA
Table No.1.9: thoracolumbar REGION - RIGHT OR LEFT SIDE TILT
Restriction of movement:
Lateral Extent of right or left tilt = 40 degrees. The tilt left or right side, corresponding to 25% of full back injury. Lateral tilt from the neutral position: Global Lost Deficiency Held (%)
0 º 30 º 0 º 2.0
10 º 20 º 10 º 1.5
20 º 10 º 20 º 0.5
1.2.2.4 Ankylosis: lateral tilt.
TABLE Ankylosis No.1.10 consult, for the corresponding overall deficit.
See Table No.1.13 stagnating for several vertebrae to calculate the overall deficit.
TABLE No.1.10: thoracolumbar REGION - RIGHT ANGLE O IZQUIERDAANQUILOSIS
Stagnant region in: global deficiency (%)
0 ° (neutral position) 15
10 ° 23
20 degrees (full left lateral flexion right) 30
1.2.2.5 Restriction of movement, clockwise or
TABLE No.1.11: thoracolumbar REGION - clockwise or
Restriction of movement:
Mean range of rotation = 60 degrees. The rotation left or right, corresponding to 35% of the entire thoracolumbar motion. Rotation from the neutral position (0 °) to: Global Lost Deficiency Held (%)
0 º 30 º 0 º 2.5
10 º 20 º 10 º 2.0
20 º 10 º 20 º 1.0
30 º 0 º 30 º 0.0
1.2.2.6 Ankylosis: clockwise or
See Table No.1.13 be to several vertebrae ossified to calculate the overall deficit of the individual.
TABLE No.1.12: REGION thoracolumbar-clockwise or-ankylosis
Stagnant region in: global deficiency (%)
0 ° (neutral position) 15.0
10 º 20.0
20 º 25.0
30 ° (Rotate Left or right) 30.0
1.2.2.7 Listesis cervical disc and lumbar back
For the evaluation of disk listesis cervical and lumbar back, see Table No.1.16.
TABLE No. 1.13: MULTIPLE VERTEBRAE: Ankylosis - cervical and thoracolumbar region favorable position (neutral) (%) Global Deficit (%) adversely Deficiency Global Position (%)
2 Cervical Cervical any any 1.75 0.75 2
3 Cervical Cervical any any 3.25 1.75 3
4 Neck is. Cervical either 2.5 4 5.0
5 Cervical Neck anyone any 03.25 5 6.78
6 Cervical Neck anyone any 8.25 3.5 6
Cervical Neck 7 5.0 7 10.0 0.5 C7 and C7 D1 D1 1.0
2 Dorsal Dorsal any any 0.5 0.5 2
3 Dorsal Dorsal any any 1.0 0.5 3
4 Dorsal Dorsal any any 1.25 0.75 4
5 Dorsal Dorsal any any 1.75 1.0 5
6 Dorsal Dorsal anyone any 01.25 6 2.25
7 Dorsal Dorsal anyone any 01.25 7 2.75
8 Dorsal Dorsal any any 3.25 1.5 8
9 Dorsal Dorsal any any 3.75 1.75 9
10 Dorsal Dorsal any any 4.0 2.0 10
11 25.2 11 Dorsal Dorsal any either 4.5
Dorsal Dorsal 12 2.5 12 5.0 0.75 D12 and D12 and L1 L1 1.5
2 Lumbar Lumbar any any 2.5 1.25 2
3 Lumbar Lumbar any any 5.0 2.5 3
4 Lumbar Lumbar any any 7.5 3.75 4
Lumbar Lumbar 5 5.0 5 10
C1-C7-C7 C1 5.0 10.0
D1 D1-D12-D12 2.5 5.0
L1-L5 5.0 10.0 L1-L5
C1-D12 7.0 13.0 C1-D1
D1-D1-L5 L5 7.0 13.0
C1-C1-L5 L5 10.5 17.5
1.2.3 OTHER INJURIES OF THE SPINE
1.2.3.1. Scoliosis
The extent, severity and systemic effects of scoliosis depends on the intensity of their curvatures. The deficiency of this concept is shown in the following table.
TABLE No. 1.14: Scoliosis
Global deficiency DORSAL CURVATURE (%) LUMBAR BACK (%) LUMBAR (%)
20 ° 4.5 8.5 3.0
20 º to 30 º 12.0 6.0 5.7
30 º to 40 º 12.0 10.0 18.5
40 º to 50 º 15.0 13.5 22.5
+ 50 ° 18.0 16.5 24.5
1.2.3.2. Vertebral fractures
TABLE No. 1.15: compression fracture of a vertebra body of a vertebra: Disabilities (%) 0% compression (cured) 0.0
2.5 25% Compression
5.0 50% Compression
+ 50% compression 10.0
Fracture of posterior elements 2.5
The continuum of a spinous process will result in a 0% overall deficit. The pedicles, plates, articular processes and transverse processes under consideration include all deficiency due to fracture of posterior elements of a vertebra.
Deficiency resulting from compression of the body of a fractured vertebra and posterior elements are combined, not added.
Fracture of two or more vertebrae.
1. Separately calculate and record the person's overall deficit caused by the fracture of the vertebrae.
2. To determine the deficiency caused by the fracture of two or more vertebrae to use the formula for combination of values.
1.2.3.3. Spinal pain syndromes.
TABLE No. 1.16: Pain Syndromes column
Deficiency Syndromes spinal pain (%)
Post-traumatic cervicobrachialgia without clinical, radiographic and electromyographic. 0.0
Post-traumatic cervicobrachialgia without clinical, radiographic and electromyographic
mild to moderate. 12.5
Herniated disc operated without sequelae. 2.5
Inoperable herniated disc according to medical criteria. 15.0
Herniated disc operated with clinical and electromyographic mild sequelae. 7.5
Operated disc herniation with moderate clinical sequelae and electromyographic 10.0
Operated disc herniation with severe clinical sequelae and electromyographic 20.0
No impact traumatic spondylolisthesis electromyographic Grade I Grade II Grade III Grade IV 1.02.03.05.0
Traumatic spondylolisthesis with mild to moderate impact electromyographic 7.5
Traumatic spondylolisthesis with electromyographic impact severa20.0
Traumatic spondylolisthesis, operated without sequel electromyographic 0.0
Traumatic spondylolisthesis, operated with mild to moderate sequel electromyographic 7.5
Traumatic spondylolisthesis, operated with severe electromyographic 20.0 sequel
Post-traumatic low back pain without clinical, radiographic and electromyographic 0.0
Post-traumatic back pain with moderate clinical and radiographic changes, without changes
2.5 electromyographic
Post-traumatic back pain, with severe abnormalities and radiographic unchanged
5.0 electromyographic
Sciatica without clinical, radiographic and electromyographic 0.0
Sciatica with clinical manifestations and radiographic and / or electromyographic mild to moderate.
5.0
1.2.3.4. Generalized osteoporosis of the spine. If symptoms and signs confirmed:
1. Compression fracture of a vertebral body with loss of at least 50% of the estimated size of the body, not caused by direct or indirect trauma, pathological fracture or minor trauma.
2. Multiple vertebral fractures non-traumatic origin directly or indirectly. In either of these two cases, the overall deficit corresponds to 40%.
1.3 UPPER LIMB
For purposes of determining the percentage of overall deficit and must be referred the deficiency of each component of the tip with the most relevant. For the classification of upper-limb deficiencies means compromised anatomical distribution segment. Consideration should be given if the limb under study is dominant or not,
as set out in paragraph 1.1 of this chapter. In cases of amputation, anatomical deformity and functional loss total, according to the etiology of both hands, both feet or one hand and one foot, give a value for the overall deficit of 40%, without the need for the table . The tables in this chapter refer to unilateral deficiency.
1.3.1 Shoulder Joint
1.3.1.1. Restriction of movement, front and rear elevation.
TABLE No. 1.17: SHOULDER JOINT - FRONT AND REAR ELEVATION
Restriction of movement:
Average amplitude of the lift forward and back = 190 degrees.
Elevation forward from neutral 0 ° to: Lost Preserved
Upper Extremity Impairment (%) Global impairment (%)
0 º 150 º 0 º 16.0 5.0
10° 140° 10° 15.0 4.5
20 130 20 14.0 4.0
30 120 30 13.0 4.0
40 110 40 12.0 3.5
50 100 50 11.0 3.5
60 90 60 9.0 2.0
70 80 70 8.0 2.5
80 70 80 7.0 2.0
90 60 90 6.0 2.0
100 50 100 5.0 1.5
110 40 110 4.0 1.0
120 30 120 3.0 1.0
130 20 130 2.0 0.5
140 10 140 1.0 0.5
150 0 150 0.0 0.0
Lift back from the neutral position (0 °) to:
0 º 40 º 0 º 4.0 1.0
10 º 30 º 10 º 3.0 1.0
20 º 20 º 20 º 2.0 0.5
30 º 10 º 30 º 1.0 0.5
40 º 0 º 40 º 0.0 0.0
1.3.1.2 Ankylosis: front and rear lift
TABLE No.1.18: Shoulder joint - anterior elevation above Lifting And POSTERIORANQUILOSIS joint stuck in: limb deficiency (%) overall deficiency (%)
0 ° (neutral position) 60.0 18.0
10 º 53.0 16.0
20 º 47.0 14.0
30 º 40.0 12.0
40 ° 45.0 13.5
50 ° 50.0 15.0
60 ° 55.0 16.5
70 º 60.0 18.0
80 ° 65.0 19.5
90 ° 70.0 21.0
100 º 75.0 22.5
110 º 80.0 24.0
120 º 85.0 25.5
130 º 90.0 27.0
140 º 95.0 28.5
150 degrees (full forward elevation) 100.0 30.0
Arthritic joint in rear elevation:
0 º (neutral) 9.0 30.0
10 º 35.0 10.5
20 º 40.0 12.0
30 º 45.0 13.5
40 º (full lift backwards) 50.0 15.0
1.3.1.3. Restriction of movement: Abduction - Adduction:
TABLE No. 1.19: Shoulder Joint - abduction and adduction
Restriction of movement:
Average range of abduction-adduction = 180 degrees. Abduction from the neutral position 0 ° Lost Preserved Deficiency Upper extremity (%) overall deficiency (%)
0 º 150 º 0 º 17.0 5.0
10 º 140 º 10 º 16.0 5.0
20 º 130 º 20 º 14.0 4.0
30 º 120 º 30 º 13.0 4.0
40 º 110 º 40 º 12.0 5.3
50 º 100 º 50 º 11.0 5.3
60 º 90 º 60 º 10.0 3.0
70 º 80 º 70 º 9.0 3.0
80 º 70 º 80 º 8.0 5.2
90 º 60 º 90 º 7.0 2.0
100 º 50 º 100 º 6.0 2.0
110 º 40 º 110 º 4.0 1.0
120 º 30 º 120 º 3.0 1.0
130 º 20 º 130 º 2.0 0.5
140 º 10 º 140 º 1.0 0.5
150 º 0 º 150 º 0.0 0.0
Adduction from the neutral position 0 ° to
0 º 30 º 0 º 3.0 1.0
10 º 20 º 10 º 2.0 0.5
20 º 10 º 20 º 1.0 0.5
30 º 0 º 30 º 0.0 0.0
1.3.1.4 Ankylosis: abduction or adduction:
TABLE No. 1.20: Shoulder Joint - abduction and adduction ankylosis stuck in: upper limb deficiency (%) overall deficiency (%)
0 ° 60.0 18.0
10 º 56.0 17.0
20 º 51.0 15.5
30 º 47.0 14.0
40 ° 42.0 12.5
45 ° 40.0 12.
50 ° 43.0 13.0
60 ° 49.0 14.5
70 º 54.0 16.0
80 ° 60.0 18.0
90 ° 66.0 20.0
100 º 71.0 21.5
110 º 77.0 23.0
120 º 83.0 25.0
130 º 89.0 26.5
140 º 94.0 28.0
150 º 30.0 100.0
0 ° 60.0 18.0
10 º 73.0 22.0
20 º 87.0 26.0
30 º 30.0 100.0
1.3.1.5 Restriction of Movement: Internal and External Rotation
TABLE No. 1.21: Shoulder Joint - INTERNAL AND EXTERNAL ROTATION
Restriction of movement:
Average amplitude of rotation = 130 degrees.
Internal rotation from neutral position 0 ° Lost Preserved upper limb deficiency (%) Global Deficit (%)
0 º 40 º 0 º 6.0 1.0
10 º 30 º 10 º 5.0 1.0
20 º 20 º 20 º 3.0 0.5
30 º 10 º 30 º 2.0 0.5
40 º 0 º 40 º 0.0 0.0
External rotation from neutral position 0 ° Lost Preserved upper limb deficiency (%) Global Deficit (%)
0 º 90 º 0 º 14.0 4.0
10 º 80 º 10 º 12.0 5.3
20 º 70 º 20 º 11.0 5.3
30 º 60 º 30 º 9.0 3.0
40 º 50 º 40 º 8.0 5.2
50 º 40 º 50 º 6.0 2.0
60 º 30 º 60 º 5.0 5.1
70 º 20 º 70 º 3.0 1.0
80 º 10 º 80 º 2.0 0.5
90 º 0 º 90 º 0.0 0.0
Ankylosis 1.3.1.6: Internal and External Rotation
TABLE No. 1.22: Shoulder Joint - INTERNAL ROTATION EXTERNAANQUILOSIS arthritic joint in internal rotation, upper limb deficiency (%) Global Deficit (%)
0 ° 60.0 18.0
10 º 70.0 21.0
20 º 80.0 24.0
30 º 90.0 27.0
40 º 30.0 100.0
External rotation:
0 ° 60.0 18.0
10 º 50.0 15.0
20 º 40.0 12.0
30 º 49.0 14.5
40 ° 57.0 17.0
50 ° 66.0 20.0
60 ° 74.0 22.0
70 º 83.0 25.0
80 ° 91.0 27.5
90 º 30.0 100.0
1.3.2 Elbow joint
1.3.2.1 Restriction of movement: Flexion - Range of Motion Extension: 150 degrees. Movement arc value: 60%.
Neutral: 0 ° in full extension.
TABLE No. 1.23: ELBOW JOINT - FLEXION AND EXTENSION
Restriction of movement:
Average amplitude of rotation = 150 degrees.
Retained active flexion: limb deficiency (%) Global Deficit (%)
0 º 39 05.11
10 º 36.0 11.0
20 º 34.0 10.0
30 º 31.0 5.9
40 º 29.0 5.8
50 º 26.0 8.0
60 º 23.0 7.0
70 º 21.0 5.6
80 º 18.0 5.5
90 º 16.0 5.0
100 º 13.0 4.0
110 º 10.0 3.0
120 ° 8.0 5.2
130 ° 5.0 5.1
140 ° 3.0 1.0
150 ° 0.0 0.0
Extension to: limb deficiency (%) Global Deficit (%) 0 º (neutral) 0.0 0.0
10 ° 2.0 0.5
20 ° 4.0 1.0
30 ° 6.0 2.0
40 ° 8.0 5.2
50 º 10.0 3.0
60 º 12.0 5.3
70 º 14.0 4.0
80 º 16.0 5.0
90 º 18.0 5.5
100 º 20.0 6.0 *
110 º 22.0 5.6
120 º 24.0 7.0
130 º 26.0 8.0
140 º 28.0 5.8
150 º 30.0 9.0
1.3.2.2. Ankylosis: flexion or extension
TABLE No 1.24 Articulation ON ELBOW FLEXION OR EXTENSION - stuck in joint ankylosis: Upper limb deficiency (%) overall deficiency (%) 0 (neutral) 65.0 19.5
10 º 64.0 19.0
20 º 62.0 18.5
30 º 61.0 18.5
40 ° 59.0 17.5
50 ° 58.0 17.5
60 ° 56.0 17.0
70 º 55.0 16.5
80 ° 53.0 16.0
90 ° 52.0 15.5
100 º 15.0 * 50.0
110 º 59.0 17.5
120 º 68.0 20.5
130 º 77.0 23.0
140 º 86.0 26.6
150 ° (full flexion) 95.0 28.5
* Functional Position (1)
(1) In case of bilateral ankylosis of the elbows, the functional position is not necessarily the same for both, but for the overall deficit can be calculated using the figures in the table above and conversion metrics TABLE No. 1.48 .
1.3.2.3. Restriction of movement: rotation, supination-pronation
Range of motion: 160 degrees (80th + 80th supination-pronation).
The movement of rotation, supination-pronation, accounts for 40% of elbow movement.
TABLE No. 1.25: ELBOW JOINT - ROTATION, pronation and supination
Restriction of movement:
Average amplitude of rotation = 160 degrees.
Rotation from the neutral position 0 ° to: Lost Preserved upper limb deficiency (%) overall deficiency (%)
0 º 80 º 0 º 13.0 4.0
10 º 70 º 10 º 11.0 5.3
20 º 60 º 20 º 10.0 3.0
30 º 50 º 30 º 8.0 5.2
40 º 40 º 40 º 7.0 2.0
50 º 30 º 50 º 5.0 5.1
60 º 20 º 60 º 3.0 1.0
70 º 10 º 70 º 2.0 0.5
80 º 0 º 80 º 0.0 0.0
1.3.2.4. Ankylosis: pronation-supination elbow
TABLE No. 1.26: ELBOW JOINT - PRONATION Supination - ankylosis: Articulation stuck in: Upper Extremity Impairment (%) overall deficiency (%)
0 ° (neutral position) 65.0 19.5
10 º 69.0 20.5
20 º 73.0 22.0
30 º 76.0 23.0
40 ° 80.0 24.0
50 ° 84.0 25.0
60 ° 88.0 26.5
70 º 91.0 27.5
80 ° (supination or full pronation) 95.0 28.5
1.3.3. Wrist joint
1.3.3.1. Restriction of movement, dorsiflexion of the wrist.
TABLE No 1.27: WRIST JOINT - DORSAL FLEXION
Average amplitude of FLEX BACK-PALMAR = 130 degrees.
Dorsiflexion from neutral position 0 ° to: Lost Preserved Superior limb deficiency (%) overall deficiency (%)
0 º 60 º 0 º 10.0 3.0
10 º 50 º 10 º 8.0 5.2
20 º 40 º 20 º 6.0 2.0
30 ° 30 ° 30 ° 5.0 5.1
40 º 20 º 40 º 3.0 1.0
50 º 10 º 50 º 2.0 0.5
60 º 0 º 60 º 0.0 0.0
1.3.3.2. Ankylosis: dorsiflexion of the wrist.
TABLE No. 1.28: WRIST JOINT: FLEX BACK - stuck in joint ankylosis: upper limb deficiency (%) Global Deficit (%)
0 º (neutral) 9.0 30.0
10 º 28.0 5.8
20 º 27.0 8.0
30 º 25.0 5.7
40 ° 47.0 14.0
50 ° 68.0 20.5
Comentarios