Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part II of II) - CHAPTER VII 7. CARDIOVASCULAR SYSTEM 7.1 General - 7.2 HEART DISEASES

MANUAL SINGLE NATIONAL DISABILITY
(PART II OF II)

CHAPTER VII
7. CARDIOVASCULAR SYSTEM

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7.1 General

Disability Rating

Manual / Colombia

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The varying degrees of permanent impairment of the cardiovascular system are the result of anatomical or functional abnormality of the same. In this chapter we define the criteria and methods for determining the degree of permanent impairment of individuals with cardiovascular disorders.

The evaluation of the cardiovascular system failure has certain characteristics and considerations other than those of other organ systems. You should consider the injury creates a permanent impairment only after exhausting the therapeutic measures, surgical or rehabilitation, or after a reasonable time of the occurrence of an acute episode, for example, the time required for development of collateral circulation after coronary occlusion. It requires a period of at least 6 months before assessing permanent impairment caused by acute myocardial infarction. Any request for disability qualification before this deadline will be rejected. If surgery has made the observation period should be at least a year.

One of the problems in the cardiovascular assessment is the frequent disparity between physical signs and symptoms found. A chronic patient may have a normal physical examination, including ECG and radiological tests and be severely limited by angina.

For practical reasons, we have established four groups of diseases that affect this system:

1. Heart disease.

2. Hypertensive vascular disease.

3. Arterial vascular disease affecting the extremities.

4. Diseases of the venous system.

When clinical findings are such that a patient can not be classified into one of these groups, or conditions beyond that classification, assessment of deficiency must be combined according to each of the diseases.

7.2 HEART DISEASES

The history and physical examination of the heart may give positive signs in most cases, but tests should help confirm diagnosis. There are different types of heart disease, congenital or acquired, as well as necrosis of the myocardium by ischemic disease. All these myocardial lesions, particularly hypertrophic cardiomyopathy and valvular stenosis, can cause major damage such as heart failure, syncope, effort and rhythm disorders, without evidence of growth of cavities in the radiological study.

7.2.1 Heart acquired for evaluation must take into account that the electrocardiogram and Doppler ultrasound can show all the significant changes reflecting morphological abnormalities of wall thickening and changes in the flow (Doppler) and valves. A normal Doppler ultrasound virtually excludes the presence of valvular disease in adults and the presence of hypertrophic cardiomyopathy.

7.2.2 ischemic myocardial disease

Coronary artery disease can cause severe disability that causes angina. This pain is classically described as pain, crushing, burning, or burning type, located in the retrosternal region, caused by the effort, should be described specifically in relation to the triggers, type, degree, level of intensity, character , location, duration and response to nitrates or rest. Irradiated manifestations of pain such as sore throat, jaw, shoulders, arms and hands are of equal validity to be considered as angina, as well as typical retrosternal pain. The presence of pain at rest or it is evolving over time, with decreased functional capacity, increased requirements of nitrates, new onset of functional capacity 3-4, should be suspected unstable angina, and therefore The assessment of disability should be deferred until they have completed the diagnostic approach by the treating physician and of course, until the picture is stable. This last group of people should be considered under observation and treatment. Many patients with chronic stable angina and unstable behave when they added an aggravating factor such as anemia, thyroid disease or intercurrent infections.

7.2.3 Congenital Heart Disease

The presence of congenital damage must be established by physical signs and diagnostic tests aid. May produce different effects among which one can mention the obstruction of ventricular outflow tract, either right or left as they are the infundibular stenosis and may lead to the capitulation of the respective ventricle. Others produce an overload of the lesser circulation because of increased pulmonary flow to be a short circuit from left to right, which may affect adulthood.

TABLE No. 7.1: CRITERIA FOR THE ASSESSMENT OF GLOBAL IMPAIRMENT BY ORGANIC HEART DISEASE

Class Description of criteria Global Deficit (%)

I · There organic heart disease but no symptoms. · Walking and climbing stairs freely and carry out daily activities without limitations. · Efforts prolonged emotional tension, the rush, the higher slopes, sports or similar activities do not trigger symptoms. • There are no signs of congestive heart failure. 1.0-7.4

II · There organic heart disease but no symptoms at rest. · Walk freely about flat, up at least one floor down stairs and carry out daily activities without symptoms. · Efforts prolonged emotional tension, the rush, the higher slopes, sports or similar activities, trigger symptoms. • There are no signs of congestive heart failure. 7.5-22.4

III · There organic heart disease without symptoms at rest. Symptoms to walk more than one or two blocks on level ground, climbing one flight of stairs normal, and carry out daily activities. Symptoms with emotional stress, running, climbing slopes, sports or similar activities. · There may be signs of congestive heart failure to yield to treatment. 22.5-37.4

IV · There organic heart disease with symptoms at rest. • Any activity that goes beyond the personal or equivalent upsets growing. · Symptoms of heart failure or anginal syndrome may occur even at rest. · Signs congestive heart failure are usually resistant to therapy. 37.5-49.5

The following are examples of Heart Disease Causing a deficiency Class

IV:

1. Rheumatic valve disease or rheumatic aortic lesions such as this notice or severe shortcomings, if they have a history of syncope, pulmonary edema or heart failure and the diagnosis was confirmed at least by Doppler echocardiography. Injuries mitral stenosis and both chronic and severe shortages

2. Cardiomyopathy, hypertrophic cardiomyopathy, particularly in long form will be considered in class IV, in individuals with marked dilatation, persistent and possibly progressive ventricular diameters, and in the young individual, with arrhythmias, syncope and family history of sudden death included in this group.

3. Pericardial: Include chronic constrictive injury of the pericardium, treatable with surgery and venous congestion produced important.

4. Myocardial ischemic angina who meets the following requirements:

· Chronic stable angina with a poor prognosis and high risk. This can be demonstrated by positive exercise test but with ST segment depression equal to or greater than 2.0 mm, significant drop in pressure with the effort associated with other evidence of pump failure, dangerous arrhythmias with significant effort and low cardiac abnormalities frequency or low load.

· Chronic angina with low functional capacity, and when you run out of therapeutic measures.

· Chronic angina where angiography shows high-risk lesions or poor global ventricular function and ejection fraction of 30% or more.

Old myocardial infarction · which meet some of the conditions given for angina or heart failure with congestion and dangerous arrhythmias.

· Levels of myocardial failure with persistent congestive heart failure with hepatomegaly, pulmonary congestion and peripheral edema on physical examination, despite adequate therapy and well run. Dilation and persistent left ventricular hypertrophy or chronic pulmonary heart.

Cardiac Arrhythmias appellants · generated by digital, resulting in uncontrolled repeated episodes of cardiac syncope or documented by Holter and refractory to treatment.

· Aneurysm of the aorta or its major branches, with acute or chronic dissection not controlled by medical or surgical treatment, or congestive heart failure as described, or renal or fainting spells.

HYPERTENSIVE VASCULAR DISEASE 7.3

Hypertensive vascular disease by itself produces no changes unless it causes severe anatomical damage in one or more of the following four target organs: heart, brain, kidney and eyes. It also produces the same damage if sequelae of vascular changes in the Central Nervous System or limbs or other organs. The criterion for assessing damage resulting from hypertensive cardiovascular disease or condition is based on symptoms, physical signs, lab diagnostic aid, electrocardiogram, stress testing, echocardiography and other procedures.

TABLE No. 7.2: GLOBAL IMPAIRMENT BY HYPERTENSION

Class Description of criteria Deficiency

Diastolic pressure with antihypertensive Additional signs: Global (%)

I asymptomatic patients with diastolic pressure is repeatedly above 90 mm Hg. Do not include abnormalities in urine analysis and testing. Do not have a history of hypertension, vascular brain injury. • There is no evidence of left ventricular hypertrophy. • The fundus may be normal or minimal narrowing of the arterioles. 1.0-7.4

II asymptomatic patients with diastolic pressure is repeatedly above 90 mm Hg.

· You can find proteinuria or abnormal urine sediment, without impairment of renal function. · May have a history of hypertension, vascular brain injury. · The Fund may be cross-eyed and exudates arterial old. 7.5-22.4

III asymptomatic patients with diastolic pressure is clearly between 90 mmHg.

· Pressure frequent diastolic readings above 120 mmHg. · There proteinuria and abnormal urine sediment with impaired renal function, manifested by increased BUN and creatinine and creatinine clearance less than 50%. · There cerebro-vascular injury residual hypertension, with persistent neurological deficits. · There

Left ventricular hypertrophy evident at physical examination, electrocardiogram and chest radiograph without evidence of congestive heart failure. · When Fundus is copper or silver, tortuous vessels, arterio-venous crossings, with or without haemorrhages and exudates . 22.5-37.4

IV diastolic pressure is clearly between 90 mmHg. · Pressure frequent diastolic readings above 120 mmHg. · There proteinuria and abnormal urine sediment with impaired renal function, manifested by increased BUN and creatinine and creatinine clearance less than 50. · Brain injury -vascular hypertension with persistent neurological deficit and significant. · left ventricular hypertrophy · History of Congestive Heart Failure. · retinopathy manifested by alterations in the arterioles, the retina or optic nerve. • O the patient has hypertrophy with or Congestive heart failure, even in the presence of digital and Duret. 37.5-49.5

7.4 VASCULAR DISEASE AFFECTING EXTREMITIES

Vascular diseases affecting the limbs refer to those involving the arterial territory and the venous system. The assessment in each case considers three aspects:

1. Clinical severity.

2. Findings noninvasive, duplex Doppler segmental pressures that registers, pulse, flow and imaging, ankle-brachial index, contrast studies such as angiography and venography, which define the location and extent of obstruction, vessels involved, distal, etc. . 3. Medical and surgical treatment performed (see Tables No.7.3 and 7.4).

TABLE No. 7.3 DEFICIENCY PRODUCED BY GLOBAL ARTERIAL VASCULAR DISEASE AFFECTING EXTREMITIES

Class Description of criteria Global Deficit (%)

I · there disease or vascular disease. • There are no intermittent claudication or rest pain. · There transient edema. 0

There II disease or vascular disease and one or more of the following symptoms: ·

Intermittent claudication when walking for less than 100 meters at a normal pace. • Evidence Vascular physical deterioration, the presence of single finger stump amputee painless evaluated at least 6 months after surgery. Presence of moderate edema, uncontrolled with support elastic. 2.5 - 9.9

There III disease or vascular disease, with one or more of the symptoms following: • Intermittent pain when walking between 25 and 100 meters at a normal pace. • Evidence vascular physical deterioration, such as amputation of two or more fingers of a limb with vascular disease that persists. · manifestations of intermittent claudication and vascular damage in the contralateral limb after revascularization elsewhere.

Presence of marked edema which is partially controlled with elastic support. 10.0-22.4

There IV disease or vascular disease, with one or more of the following symptoms:

· Intermittent claudication while walking less than 25 meters, or have pain even when at rest. Any activity that goes beyond the personal or equivalent upsets growing.

• Evidence vascular physical deterioration as amputation level

ankle or above, or two or more fingers tips, with persistence of vascular disease.

· Failure of arterial bypass surgery of the limb involved. Presence of marked edema did not improve with elastic support. 22.5 - 37.4

V There is disease or vascular disease, with one or more of the following symptoms:

· Pain strong and steady even at rest. · Physical evidence of vascular damage and amputation at the ankle of both legs and amputation of all fingers of two or more limbs, with persistence of vascular disease. Without the possibility of surgery, or to failure of her 37.5 - 47.5 Examples of Arterial Vascular Diseases Causing a Disability Class IV or V:

a) Intermittent claudication without being able to visualize the common femoral artery or the deep, of limb arteriography.

b) intermittent claudication or absence of beats femoral, popliteal, posterior tibial or media, or plethysmography Doppler in an extremity;

c) amputation at or above the hock due to peripheral vascular disease.

d) Failure of peripheral arterial bypass surgery.

TABLE No. 7.4 AMPUTATION DUE TO DEFICIENCY OF BLOOD DISEASES

Global% deficiency

Type Upper Extremity

Amputation of the fourth of the trunk 35.0

Dislocation of the shoulder at 30.0

Amputation of arm above the deltoid insertion 30.0

Amputation of the arm between deltoid insertion and elbow joint 27.5

Elbow disarticulation at 27.5

Forearm amputation below the elbow joint with insertion of the biceps tendon 27.5

Forearm amputation below the elbow 27.0

Disarticulation at the wrist 27.0

Midcarpal or amputation of the hand mediometacarpiana 27.0

Amputation of all fingers except the thumb at the metacarpophalangeal joints 16.0

Amputation of thumb at the level of meta-carpo phalangeal joint or bone resection carpometa-carpal 12.5

At the joint interfalángica7.5

Lower extremity. 40.0 hemipelvectomy

Disarticulation at the hip joint 35.0

Amputation above the knee joint with small stump (3 inches or less below the tuberosity of ischium) 30.0

Amputation above the knee joint with functional stump 25.0

Disarticulation at the knee joint 20.0

Gritti-Stokes amputation 17.5

Amputation below the knee joint with small stump (3 inches or less below intercondylar node) 17.5

Amputation below the knee joint with functional stump 17.5

Amputation at the ankle (or Syne) 15.0

Partial amputation of the foot (or Chopart) 12.5

Amputation mediometatarsiana 12.5

Amputation of all toes in 10.5

Amputation of the more knuckle metatarsal bone resection 7.5

Amputation of the knuckle higher at the metatarsophalangeal 6.5

At the level of the metatarsophalangeal joint proximal 3.5

At the joint interfalángica3.5

Amputation of the remaining toes (from 2 to 5 º) with resection of the metatarsal bone 1.5

At the level of the metatarsophalangeal 0.5

At the level of the proximal interphalangeal joint 0.0

A level of 0.0 distal interphalangeal joint

TABLE No. 7.5 DEFICIENCY GLOBAL SYSTEM FOR VENOUS OBSTRUCTION OF THE LOWER LIMB.

Class Description of criteria Global Deficit (%)

I * Only occasionally is experienced edema. 1 - 4.9%

II · There ulcer healed • There is a persistent moderate edema are not fully controlled with pressure gradient stockings. 5.0 - 11.9

III · There is a persistent superficial ulceration. · There is marked edema, partially controlled pressure gradient stockings. 12.0-22.4

IV · There is marked edema that is not controlled by average gradient Pressure and trophic disorders occur in one or both ends. • And, there are persistent and widespread ulceration or deep in a · the two ends. · Failure of revascularization extremity arterial compromised. • O, no recurrent ulceration and failure of surgical procedures indicated and well made, considering the pathogenesis of the lesion. 22.5 - 37.5

Examples of Vascular Diseases Affecting the Extremities and produce a higher overall deficiency of 40%.

a) Chronic Venous Insufficiency of Lower Limbs, failure or obstruction of deep venous varicose veins associated with superficial, with large hard swelling with stasis dermatitis and ulceration persistent or recurrent non-healing after 6 months of medical therapy or Surgical prescribed and well run.

b) ulceration of one or both legs that does not heal well run treatment after 6 months.

CHAPTER VIII8. NEOPLASTIC DISEASE8.1 General

It should be noted that with new knowledge of these pathologies, the bearer of a neoplasia or a history of having it is not synonymous with disability. It must meet the requirements and conditions specified in this chapter to consider the patient's debilitating cancer.

Determining the percentage of impairment resulting from malignant tumors based on:

• The location and size of tumor,

• The tumor invasion to neighboring organs,

• The extension to regional lymph nodes

· The Distant metastases

• The histology

• The degree of response to treatment (surgery, radiation, hormones, chemotherapy), and

• The magnitude of the consequences post-treatment.

8.2 CONSIDERATIONS FOR ASSESSMENT

In malignant diagnosis should be established based on the signs and symptoms, reports of examinations and diagnostic aid pathology, among others. You should also consider:

a) The site of the primary lesion, recurrent or metastatic disease should be documented in all cases of malignant neoplasm. If surgery was performed should include a reliable copy of the protocol and surgical pathology report of the part or biopsy. If you can not obtain these documents, the hospitalization epicrisis the physician's report should include details of the surgical findings and results of examinations (gross and microscopic) made by the pathologist.

b) If there is disease progression by the treating physician, it must send an updated medical report including recent surveys specifically aimed at determining local recurrence, lymph node, metastasis to other organs and probable sequelae after treatment.

c) For purposes of qualifying or opinion, the concept of lymph node metastases distance refers to the node tumor invasion beyond the limits of radical en bloc resection.

d) local or regional recurrence after radical surgery or anatomo-pathological evidence of incomplete excision in radical surgery is considered equal to the injury "inoperable" and for purposes of the rating should be evaluated as such, except for breast cancer.

e) The local or regional recurrence after complete removal of a tumor located, should not be considered equal to the recurrence after radical surgery.

f) The histological diagnosis of cancer is and should be documented with the original submission of the report issued by a pathologist, in case of no agreement between what was reported and the clinical, laboratory examinations, should be resorted to interconsultation pathologist requesting another shipment of plates and blocks shows that originated the diagnosis. The cytology report of either liquid or bodies shall be considered when dealing with

patients with disseminated disease, such as neoplastic cells in ascites, pleural, etc.

It is essential that the assessor also has the spread of cancer studies, such as imaging (RX, ECO, TAC, etc..) And radionuclides in asymptomatic patients. Moreover, in a patient with gastric cancer and a palpable mass at the level of right upper quadrant enough just endoscopy and histological report for finding a deficiency of 40%. In lymphomas, histological type and the compromised sites are not necessarily indicative of total disability. When the tumor involvement extends beyond the regional lymph nodes, the damage will generally be considered as severe.

8.3 Evaluation of neoplastic disease

These guidelines provide criteria to evaluate and quantify the deficiency caused by the presence of a neoplastic disease, the consequences that may arise from the treatment, or both.

a) In cases where a tumor and / or its metastases are hormone dependent, isótoposensibles, or both, or there is disappearance of the primary tumor or its metastases in a follow-up period of at least 3 years, the deficiency is determined in accordance with assessment of the damage to the corresponding organ system. Example: In a seminoma operated and treated, the deficiency is defined based on the presence or absence of sexual problems, must be cataloged in accordance with the provisions of Chapter VI.

b) When the malignancy is localized or regional lymph nodes involves only apparently were completely removed with or without radiotherapy, and is not expected metastasis or recurrence in the short term, the deficiency should be considered as described in the paragraph a), evaluating the resulting damage to the organ system involved by the tumor. The exceptions to these cases are outlined in section 8.4.

c) Effects of surgical therapy, significant postoperative sequelae must be evaluated according to the state of the organ system affected. If you made an extended gastrectomy, a colostomy or nephrectomy, gastrectomy deficiency depend on its own or its complications, such as dumping syndrome, malnutrition, etc., The colostomy should be considered with the percentage of disability resulting from an ostomy and nephrectomy the percentage given in the chapter for this disease. .

d) Effects of chemotherapy and radiation therapy: The impact caused by these types of procedures should be considered the treatment outcome and adverse response to therapy. These may vary greatly, so that each case must be studied individually. It is important to get the attending physician complete the treatment plan, including medication, dose, frequency of administration and duration. Obtain a description of complications or adverse responses to therapy, such as nausea, vomiting, diarrhea, weakness, skin disorders or reactive mental disorders and the severity of these effects in anticancer chemotherapy may change during the period of administration drug. Evaluation of patients with regard to the impact of therapy

with drugs or radiation, should be based on observation during a period sufficient to allow a proper determination of the deficiency on this ground.

e) There may be a patient with a history of being a carrier of a cancer, which at the time to evaluate it is only periodic checks and no evidence of active tumor disease. In this case, the failure rate is given by the aftermath of treatment, if any, such as total laryngectomy, nephrectomy, amputation, total gastrectomy, etc., And not by the statistical forecast.

f) When a cancer patient refused any treatment, you should inform the patient of the risk of your decision, you should rate the current state and to conduct periodic reviews in accordance with the clinical course of cancer to alter the percentage of deficiency, when be the case.

g) In the case of patients considered curative treatment, it was ruled under "Monitoring and Treatment" and will be periodic reviews in accordance with the clinical course of cancer to alter the percentage of impairment, when appropriate.

8.4 CHARACTERISTICS OF CANCERS WITH DEFICIENCY OF 40%

Neoplasms by histologic type, location and extent of the injury are inoperable or are out of control for other therapies, have an overall deficit of 40.0%.

8.4.1 Head and Neck

The head and neck tumors other than salivary glands, thyroid, upper and lower jaw, orbit and temporal fossa, corresponding to this classification when:

a) Inoperable

b) Not controlled by the therapy given.

c) Recurrences after surgery, radiation, or both.

d) They have distant metastases.

e) Squamous cell carcinoma of the pyriform sinus or posterior third of tongue (not included carcinoma of the tonsil).

8.4.2 Skin Sarcoma

a) Angiosarcoma with regional lymph node metastases.

b) systemic fungal infections with liver involvement or visceral.

8.4.3 Soft Tissue Sarcoma

a) Inoperable.

b) Distant metastasis.

c) recurrent cancer after radical surgery followed by radiation therapy or not.

8.4.4. Malignant Melanoma

a) recurrence after radical surgery.

b) Metastasis to the adjacent skin or other organs.

8.4.5. Lymphoma

Hodgkin's and non-Hodgkin's lymphoma with progressive disease despite treatment.

8.4.6 Lymph Nodes

a) metastatic adenopathy of unknown primary.

b) Squamous cell carcinoma of lymph node in the neck that does not respond to treatment.

8.4.7. Salivary glands

a) carcinoma or sarcoma with metastases beyond the regional lymph nodes.

b) recurrence after radical treatment.

8.4.8. Thyroid

a) Carcinoma with metastases beyond the regional lymph nodes, not controlled by treatment

made.

b) local recurrence not controlled by prescribed therapy.

8.4.9. Mama

a) Cancer inoperable.

b) Cancer inflammatory.

c) local and regional recurrence uncontrolled.

d) Distant metastasis or bilateral breast cancer.

e) Sarcoma with metastases anywhere.

04/08/1910. Bone System (excluding the mandible)

a) Primary malignant tumors with evidence of metastasis or uncontrolled therapy

prescribed.

b) bone metastases of unknown origin after an adequate search.

08/04/1911. Upper and lower jaw, orbit or temporal fossa

a) Sarcoma of any type with metastases.

b) Carcinoma of the cavity with extension into the orbit or ethmoid or sphenoid, with or without metastasis

regional.

c) orbital tumors with intracranial extension.

d) tumor of the temporal fossa with perforation of the skull or meningeal complications.

e) Adantinoma with intracranial and orbital infiltration.

f) Rathke sac tumors with infiltration of the base of the skull or metastases.

08/04/1912. Brain Tumor and Spinal Cord

a) malignant gliomas, grade III-IV astrocytomas, glioblastoma multiforme, medulloblastoma,

ependymoblastoma and primary sarcoma;

b) O, grade I-II astrocytomas, meningioma, pituitary tumors, oligodendroglioma, ependymoma

and benign tumors. These should be evaluated by the collateral damage that occur as:

epilepsy, organic brain damage or neurological deficits.

08/04/1913. Lungs

a) ineradicable.

b) Metastasis.

c) relapse after treatment.

d) incompletely excised tumor.

e) small cell carcinoma.

08/04/1914. Pleura and Mediastinum

a) Malignant mesothelioma of the pleura.

b) Malignant tumor with metastasis to the pleura.

c) primary malignant tumor of the mediastinum not controlled by prescribed therapy.

04/08/1915. Abdomen

a) peritoneal carcinomatosis.

b) retroperitoneal malignant tumor not controlled by prescribed therapy.

c) Ascites with demonstrated malignant cells.

04/08/1916. Esophagus

a) Carcinoma or sarcoma of the upper two thirds of the esophagus.

b) Carcinoma or sarcoma of the distal esophagus with regional node metastases or infiltration of neighboring structures.

08/04/1917. Stomach

a) Carcinoma of stomach with metastasis to regional lymph nodes or tumor invasion to adjacent organs.

b) Kaposi not controlled by adequate therapy.

c) Inoperable.

d) recurrence or metastasis after radical surgery.

e) lymphomas according to the progression of disease.

04/08/1918. Small Intestine

a) carcinoma, sarcoma, or carcinoid tumor with metastases beyond the regional lymph nodes.

b) Recurrence after previous excision.

c) Kaposi not controlled by the described therapy.

08/04/1919. Intestine

a) unresectable

b) metastases beyond the regional lymph nodes.

c) recurrence or metastasis after excision.

04/08/1920. Liver and Gallbladder

a) primary or metastatic malignant tumors.

b) invasive carcinoma of the gallbladder.

c) unresectable bile duct carcinoma or metastases.

04/08/1921. Pancreas

a) Carcinoma, except cel Cancer. islet.

b) Carcinoma of the islet cell in unresectable or physiologically active.

04/08/1922. Kidneys, adrenal or Ureters Pigeon

a) ineradicable.

b) With metastases

08/04/1923. Bladder

a) Infiltration beyond the bladder wall.

b) ineradicable.

c) Metastasis

d) Evaluate renal impairment after total cystectomy according to the criteria applied in that chapter.

08/04/1924. Prostate

Carcinoma not controlled by prescribed therapy and well run.

08/04/1925. Testicle

a) Choriocarcinoma, not controlled by adequate therapy.

b) Other primary malignant tumors with progressive disease not controlled with therapy

indicated.

08/04/1926. Uterus Carcinoma - Adenocarcinoma and Sarcoma.

a) Inoperable and not controlled with proper treatment.

b) recurrence after radical hysterectomy or radiotherapy.

c) total pelvic exenteration.

04/08/1927. Ovary

a) Ascites with demonstrated malignant cells.

b) Tumor unresectable or partially removed.

c) unresectable metastases of the abdominal cavity.

d) Distant metastasis.

04/08/1928. Fallopian tube

Carcinoma or unresectable or metastatic sarcoma.

04/08/1929. Leukemia

a) acute lymphocytic leukemia or nonlymphocytic completely unresponsive, refractory to initial treatment.

b) acute leukemia relapses during the maintenance period of therapy or treatment while outside.

c) chronic myeloid leukemia unresponsive to treatment or is in the stage of transformation or blast crisis.

d) chronic lymphocytic leukemia in advanced stage with symptoms of anemia and thrombocytopenia or unresponsive to treatment.

08/04/1930. Myeloma

Confirmed by electrophoresis of proteins in urine or serum and bone marrow examination appropriate. With:

a) radiological evidence of bone disease with intractable osteoalgias or pathologic fractures;

b) Or, evidence of kidney damage;

c) Or, Hypercalcemia with persistent serum levels of 11 mg/100 ml for at least 1 month despite prescribed therapy;

d) O, plasma cells, 100 or more cells per ml in peripheral blood.

8.5 ACQUIRED IMMUNODEFICIENCY SYNDROME

The criteria for evaluation of patients infected with HIV or AIDS patient are given in terms of the restriction, absence or functional deficiencies. Should consider three criteria to reach a diagnosis of HIV and AIDS, as follows:

1.    Epidemiological approach: The epidemiological approach is the starting point of diagnosis and includes various forms of transmission and risk history and positive contacts.

2.    Laboratory criteria: The laboratory approach based on the demonstration of the virus, its products or antibodies produced against different viral proteins. Diagnostic methods are categorized into:

a) Detection of antibodies presumptive tests (ELISA), additional evidence (Western-Blood, immunofluorescence, rapid test or immuno-blot), among others.

b) Detection of the virus or its products: Virus isolation, antigen P24 chain reaction (PCR), among others.

c) Additional laboratory tests, immune profile, blood count and erythrocyte sedimentation rate, lymphocyte population, CD4/CD8 ratio, delayed hypersensitivity immunological tests, among others.

3. Clinical criteria: The clinical criteria is given by the detection of signs and symptoms in relation to AIDS. Always keep in mind that the incubation period can last several years and that not all clinical manifestations will occur in all patients, since the same change can have different characteristics in people. HIV may directly affect the agency to significantly reduce the level of immune defenses and may trigger a series of diseases secondary to this. For the evaluation of impairment classification is used HIV / AIDS CDC/Atlanta/93, which includes consideration of a parameter for clinical evaluation and other laboratory, based on the T4 cell count or CD4 cells. The rating applies to those who already have tested positive for HIV (2 presumptive tests and an additional positive). The percentage of overall deficit generated by infection with HIV, is defined according to CDC classification for Adolescents and Adults, 1993, at three clinical categories (A, B, C) with ranges of CD4, 1, 2 and 3, as illustrated in Table No. 8. 1.

TABLE No. 8.1: CDC CLASSIFICATION FOR TEENS AND ADULTS.

CD4 range of clinical categories A B C

Symptomatic acute infection Asymptomatic lymphadenopathy no condition (A) or (C) AIDS-indicator conditions

1)> 500 / mm3 A1 B1 C1

2) A2 B2 C2 200-499/mm3

3) <200 / mm3 A3 B3 C3

For better orientation of the qualifiers, it is recommended to carefully review the criteria for the classification of CDC/Atlanta/93 for Adolescents and Adults.

TABLE No. 8.2: GLOBAL IMPAIRMENT BY INFECTION WITH HIV / AIDS

Deficiency Category Global (%)

10.0 A1

15.0 A2

A3 20.0

27.0 B1

34.0 B2

B3 40.0

C1 44.0

C2 47.0

C3 50.0

CHAPTER IX9. ENDOCRINE
9.1 General

This chapter defines the criteria for assessing global deficiency diseases of the endocrine glands. Is divided into:

· Axis pituitary-hypothalamic

· Thyroid

Adrenal ·

· Gonads

Parathyroid ·

· Network of pancreatic islets.

9.2 CRITERIA FOR EVALUATION OF PERMANENT IMPAIRMENT HIPOFISIS HIPOTÁLAMO.

The hypothalamic-pituitary hormonal changes, are studied using baseline measurement of the hormones involved and try to encourage or cancellation thereof. We also study the hypothalamic-pituitary region by imaging of the skull and visual perimetry, among others, to determine the origin of the changes and their effect on adjacent structures.

9.2.1. Assessment of the deficiency of the anterior pituitary disorders.

TABLE No. 9.1: EVALUATION OF THE CHANGES CAUSED BY DEFICIENCY of the anterior pituitary. GLOBAL STANDARD CLASS GAP (%)

I-The disease is controlled by continuous treatment. In case of tumor, is classified in this class if you manage to control with medical treatment and / or surgery, and in terms of size and symptoms. 1 - 4.90

II When symptoms can not be adequately controlled with treatment. 5.0 - 14.9

III When symptoms and signs persist despite treatment. 15.0 - 25.0 Example: 51 year old woman gradually developed acromegaly since he was 16, also presenting amenorrhea, headache and acne. In recent months intensified concerns headaches and vision changes. Hyperglycemia with glucosuria was found, the visual fields showed a field tubular in the left eye and temporal defect in the right eye. Skull radiography showed growth of the sella. Partial excision was operated on a pituitary tumor. After the intervention showed changes of visual fields and required a strict diet and 40 units of lente insulin to control their diabetes. Additionally hypopituitarism require hormone replacement. It was a diagnosis of acromegaly and pituitary adenoma with high hypopituitarism, diabetes mellitus and altered visual fields secondary.

It is considered a deficiency of 15.0% for pituitary dysfunction. Combine Debiéndose 13.0.% For unstable diabetes and 17.0% by visual disturbances. Weighted these diseases pose a global deficiency of 25.53%.

9.2.2. Assessment of impairment by changes in the posterior pituitary.

9.2.2.1 Neurohipofisiaria failure or diabetes insipidus. The study of hypofunction of the posterior lobe of the pituitary gland include:

a) Diagnostic Imaging area hypothalamus - pituitary.

b) Determination of the visual field.

c) Determination of urinary density and osmolality of plasma and urine at baseline and during water deprivation test.

TABLE No. 9.2: EVALUATION OF IMPAIRMENT CAUSED BY ALTERATIONS OF PITUITARY DEFICIENCY POSTERIOR.CLASE GLOBAL APPROACH (%)

I-The condition can be effectively controlled with continuous treatment. 1 - 4.90

II Continuous treatment partially control the symptoms and signs of enfermedad.5.0 - 14.9

III Despite appropriate treatment and well run the signs and symptoms persist. 15.0 - 25.0

9.2.2.2 Assessment of the deficiency pituitary dwarfism. For the assessment of such deficiency should be considered that almost all cases of pituitary dwarfism in Class III of hypothalamic-pituitary deficiency, which corresponds to 15 to 25% when symptoms persist despite treatment.

9.3 CRITERIA FOR THE ASSESSMENT OF THYROID DEFICIENCY.

Hyperthyroidism is not considered a cause of deficiency because the hypermetabolic state can be corrected permanently by treatment in most patients. After remission of hyperthyroidism may be deficient in the visual system or cardiovascular disease, which should be evaluated according to standards. Also, hypothyroidism in most cases can be managed successfully with thyroid hormone administration.

For the evaluation of thyroid function tests should be performed to determine thyroid endocrinologist.

9.3.1 Assessment of the deficiency Hyperthyroidism.

As mentioned hyperthyroidism in itself does not cause impairment, malignant thyrotoxicosis sometimes leads to the emergence of a progressive exophthalmos, which can reach the ophthalmoplegia, which is evaluated in the chapter on ophthalmology.

9.3.2 Assessment of the deficiency hypothyroidism.

TABLE No. 9.3: EVALUATION OF IMPAIRMENT OF HYPOTHYROIDISM. GLOBAL STANDARD CLASS GAP (%)

I-             Just a continuous therapy for the correction of an underactive thyroid, and · no physical or laboratory contraindications for this therapy. 1 - 4.9

II-            There are symptoms of thyroid disease or anatomical abnormalities; • It is necessary continuous thyroid therapy · But you have other diseases that allow the replacement of thyroid hormone only partially. 5.0 - 15.0

NOTE: When the thyroid substitution was started later and permanent sequelae of hypothyroidism occurred that make up the picture of cretinism, the deficiency shall be calculated in accordance with the chapter on mental deficiency.

9.4 CRITERIA FOR EVALUATION OF DEFICIENCY DISORDERS OF THE ADRENAL GLANDS.

9.4.1 Alterations in the adrenal cortex.

The hyper or hyposecretion of this portion of the adrenal deficiency can occur. It is sometimes associated with other endocrine disorders or other organ systems, which requires combining these anomalies according to the provisions in other chapters. Hypersecretion may be caused by hyperplasia of the cortex, or pituitary ACTH excess ectopias either benign or malignant. Among the diseases caused by hypersecretion is Cushing syndrome, adrenogenital syndrome and primary aldosteronism.

Hyposecretion adrenal may be primary, due to destruction or absence of these glands, or secondary as a result of decreased secretion of Corticotrophins. One adrenal gland can compensate for the absence or dysfunction of the other.

For the evaluation of adrenal gland function tests should be performed to determine functional and hormonal endocrinologist.

9.4.1.1. Assessment of the deficiency of the adrenal cortex disorders.

TABLE No. 9.4: EVALUATION OF THE ALTERATIONS Poor adrenal cortex. GLOBAL STANDARD CLASS GAP (%)

I-             • There are anomalies in the discharge and requires prolonged administration of cortical hormones, for loss of the two adrenal; • And you need continuous treatment. 1 - 9.9

II-            • There are an anomaly in the discharge and requires prolonged administration of cortical hormone by loss of the two gland; • And you need continuous treatment. • O is the case of a patient who requires large amounts of cortical hormones to treat another illness base and these will cause Cushing syndrome secundario.10.0 - 19.9

III-           · There is an anomaly in the secretion and requires cortical hormone administration on an ongoing basis. • There are florid Cushing's syndrome not due to the battery therapy currently exists. • There are a Nelson syndrome secondary to resection and the Adrenal Gland Battery is not due to treatment that currently exists. 20.0 - 30.0

9.4.2 Alterations in the adrenal medulla.

The adrenal medulla is not essential to the life or welfare of the individual, and therefore, the lack of it is 0% of overall deficit. The overactivity of the bone marrow can cause alterations in cell hypertrophy whether by tumor or not. The existence of this hyperfunction leads to hypertension in the form of crisis or maintained.

9.4.2.1 Assessment of the deficiency disorders of the adrenal medulla

TABLE No. 9.5: EVALUATION OF THE DEFICIENCY FOR SPINAL ABNORMALITIES Adrenal.

GLOBAL STANDARD CLASS GAP (%)

I-• There are anomalies in the secretion of hormones from the adrenal medullary;

Do not need continuous treatment · can carry out all or almost all activities of daily living. 1 - 9.9

II • There are an anomaly in the secretion of hormones from the adrenal medulla; • The continuous treatment does not control the symptoms and signs completely. 10.0 - 20.0

9.5 CRITERIA FOR EVALUATION OF PERMANENT IMPAIRMENT OF CHANGES IN PRODUCT GONADS.

A person with anatomical loss or impairment of the gonads resulting in abnormalities of hormone secretion have a global deficiency of 1 - 5.0.%, Provided that the alteration of gonadal function is permanent and irreversible. The deterioration of reproduction and sexual functions should be evaluated with the rules contained in Chapter VI.

9.6 CRITERIA FOR EVALUATION OF PERMANENT IMPAIRMENT BY PROBLEMS IN THE MAMMARY GLANDS.

A woman of childbearing age without breast or excessive galactorrhea, gynecomastia, or male with pain that interferes with daily activities, have an overall deficit between 1 and 5.0%. Breast cancers are evaluated according to the criteria of Chapter VIII.

9.7 CRITERIA FOR EVALUATION OF PERMANENT IMPAIRMENT OF PARATHYROID DISORDERS.

Hyperparathyroidism with hypercalcemia, unless caused by an inoperable carcinoma is generally considered a disease that can be corrected, although sometimes this correction can be difficult. Persistent hypercalcemia whether or not due to this disease, may require prolonged treatment. Deformities of the bones or kidney damage may persist after treatment and for evaluation of these conditions should be used standards for each chapter of the system involved.

When hypercalcemia with symptoms requiring prolonged treatment, assessment of deficiency must be based on the interference of the disease with the patient's daily activities can vary from 0 to 5.0% of overall deficit. This value must be combined with any other value relevant to the case of deficiency.

TABLE No. 9.6: EVALUATION OF IMPAIRMENT BY Hypoparathyroidism. GLOBAL STANDARD CLASS GAP (%)

I-             • The functioning of the parathyroid gland is deficient, calcium levels are maintained through the treatment, and no symptoms. 1 - 4.9

II-            Absence of the parathyroid calcium level rises and falls intermittently despite adequate treatment. Symptoms may or may not, due to abnormal levels of calcium in the blood. 5.0 - 9.9

III-           · Decrease in plasma calcium below 8 mg/100 ml. despite treatment.

IV-          · Severe recurrent tetany; ° or recurrent generalized convulsions; • O, lenticular cataract, which should be evaluated according to criteria developed in Chapter XIII of the sense organs. 10.0 - 15.0

9.8 ASSESSMENT OF DEFICIENCY OF METABOLISM OF CARBOHYDRATES.

9.8.1 Assessment of impairment caused by diabetes mellitus.

The long-standing diabetes may be associated with other diseases that lead to major deficiencies that diabetes itself. These conditions are referred to the cardiovascular system, neurological, urogenital, renal and visual, with specific degenerative complications such as coronary artery disease, neuropathy, retinopathy and nephropathy. Women of childbearing age may have difficulty completing the pregnancy and men sexual impotence. All these changes should

combined according to the assessment of deficiency issued in the chapter on the changes involved.

TABLE No. 9.7: EVALUATION OF IMPAIRMENT OF DIABETES MELLITUS. GLOBAL STANDARD CLASS GAP (%)

I-             Patient with Diabetes Mellitus, that properly controlled with diet. No evidence of diabetic microangiopathy (retinopathy and / or albuminuria> 30 mg/100 ml). 1 - 4.9

II-            Patient with Diabetes Mellitus, which requires restrictive diet and oral hypoglycemic agents, achieving satisfactory control of glycemia. Has any evidence of microangiopathy (retinopathy and / or albuminuria> 30 mg/100 ml) and the subsequent involvement of other organ systems. 5.0 - 9.9

III-           Patient with Diabetes Mellitus, which requires restrictive diet and oral hypoglycemic agents or insulin, achieving a satisfactory control of glycemia. Has any evidence of microangiopathy (retinopathy and / or albuminuria> 30 mg/100 ml) and the subsequent involvement of other organ systems. 10.0 - 19.9

IV-          Like the previous class, but despite the dietary management and insulin Frequent episodes of hyper or hypoglycemia, without satisfactory control that require hospital management and / or severe disease of other organ systems. 20.0 - 30.0 Example Class I: Man, 45 years on a review of present control glycemia of 190 mg and moderately overweight. Prescribed diet. Three months later his weight and blood glucose levels are normal. Diagnosis = Diabetes mellitus controlled by diet. = 1% overall deficit. Example class II: Man of 66 years in a test, glycemia has 300 mg, moderate overweight and hypertension. Prescribed diet, oral hypoglycemic and hypertensive therapy. Three months later his weight, blood glucose and blood pressure is controlled. Diagnosis = Diabetes Mellitus controlled. Global deficiency = 5%. Example Class III: Patient 25 years suffering from diabetes since age 15. Physical activity can develop varies greatly from day to day. Follows a strict diet and insulin therapy 2 times a day to control blood glucose and urine normal continuous. Lose weight without exceeding the normal range, but no further complications. Diagnosis = Diabetes Mellitus Type I, adequately controlled Deficiency = 15%.

Examples of Class IV: specific situations that fall in this case:

a) Neuropathy demonstrated by a persistent or significant impairment of motor function in two extremities and resulting in movement disorders, gait, postural attitude of the individual, or the last two, or there are changes in sensitivity consequences.

b) total or partial amputation of a limb due to diabetic necrosis or peripheral vascular obstructive disease.

c) severe retinopathy with significant loss of visual acuity and visual field, assessing visual impairment according to the criteria set forth in the chapter on organ of vision.

d) severe nephropathy with renal insufficiency (see corresponding chapter).

9.8.2 Assessment of impairment caused by hyperinsulinism (hypoglycemia Permanente).

Occasionally hyperinsulinism can result from an excess production of insulin, which induces hypoglycemia, which prolonged and repeated or severe attacks of which can lead to brain damage. Depending on the extent of brain damage, a person may suffer a deficiency hypoglycemic global assessment according to the Central Nervous System as defined in that chapter. Only in cases in which the metabolic damage is not controlled despite diet and appropriate medication, will be granted a deficiency of 10.0%.

9.9 EVALUATION OF IMPAIRMENT OF OTHER METABOLIC DISORDERS.

9.9.1 Assessment of the deficiency for metabolic bone diseases.

The metabolic bone diseases such as osteoporosis, osteomalacia resistant to vitamin D and Paget's disease, may require ongoing therapy and when they have symptoms and signs such as pain, skeletal deformities or condition of the peripheral nerves The overall deficit will be 0%. Where are the signs and symptoms mentioned above but get a complete remission of them through continued therapy based on hormones and minerals, the overall deficit can be 1-5%. When therapy is required to relieve the pain continues without achieving complete remission and the subject's daily activities are affected by it or from complications such as fractures,

may be an overall deficit of 5 - 10.0%.

In case of osteoporosis of the spine, should be evaluated with the parameters defined in Chapter I. For more general information about osteoporosis should be reviewed in Chapter III.

9.9.2 Multiple Endocrine Disease

Multiglandulares of autoimmune syndromes, is of particular interest is the association of hypothyroidism, Hashimoto's thyroiditis most adrenal insufficiency, or Addison's disease. Deficiencies are graded according to the provisions of sections that refer to each of the involved hormonal dysfunctions, by combining the

respective values. The multiple endocrine neoplasia (MEN), often generate various glands overactive simultaneously and continuously. The association of medullary thyroid carcinoma with pheochromocytoma is of particular interest. Exhausted the means of treatment, surgical and pharmacological deficiency is calculated according to the pathology of each gland.

CHAPTER X10. SKIN10.1 General

In this chapter we assess the pathology of chronic course I relapsed or which by their nature are irreversible and impossible to eradicate, that cause permanent impairment of the skin and affect performance in all activities of the individual. For skin lesions associated with systemic diseases are assessed to be

be carried out in that chapter.

10.1.1.CLASIFICACIÓN

a) For all skin conditions

b) To burn.

c) To scars.

d) To skin malignancies.

10.2 EVALUATION OF IMPAIRMENT BY SKIN CONDITIONS

The following are the criteria for evaluation of the deficiency of skin diseases:

· Anamnesis

· Consideration physical and mental

· Studies specific additional (test skin biopsies, immunology, smear etc.)

10.3 Criteria for evaluation of global deficiency diseases of the skin to the evaluation of skin lesions should be taken into account:

· The affected areas

• The depth

• The extent of injury

• The degree of difficulty caused labor

TABLE No. 10.1: CRITERIA FOR GLOBAL GAP Assessment of the skin pathology

Global% Class Deficiency Criteria

I • There are symptoms and signs of skin disorder · Limitation on tasks in daily life: none or minimal treatment, or in more extensive physical, chemical agents, temporarily. • Need for treatment: 1.0-2.4 Temporary

II • There are symptoms and signs of skin disorder · Limitation on tasks in daily life: Some tasks • Need of Treatment: Intermittent 2.5 - 7.4

III • There are symptoms and signs of skin disorder · Limitation on tasks in daily life: Many tasks • Need for treatment: Continuous 7.5 - 19.9

IV • There are symptoms and signs of skin disorder · Limitation on tasks in daily life: Many tasks • Need for treatment: Continuous • The confinement to home or other residence is optional 20 - 29.9

V • There are symptoms and signs of skin disorder · Limitation on tasks in daily life: limited • Need Intense Treatment: Continuous • The home confinement or other pathologies residence necesario30% belonging to the class V: exfoliative dermatitis , ichthyosis, erythroderma, pemphigus, mulrigorme exudative erythema, exudate pemphigoid, dermatitis herpetiformis, deep fungal infection, psoriasis, atopic dermatitis, dyshidrosis, Hidradenitis suppurativa, acne comglobata. Pathologies such as vitiligo, herpigmentaciones, pigmented nevus angiomas, per se do not cause damage to the function, but if they occur in the performance of the individual in activities of daily living, so they are evaluated there.

10.4 Criteria for evaluation of the overall deficit from burns. To determine the degree of disability caused by a burn, be taken into account:

a) Extension

b) Depth

c) Undertaking of joint mobility

d) aesthetic sequelae.

a)    Length: to quantify the extent of the injury will apply the "rule of nine", which is assigned 36% of body surface to the chest and back, 36% to the lower extremities, 18% of both upper limbs , 9% to 1% of head and the genitals (male or female).

b)    The depth of the burn is evaluated as follows:

TABLE No. 10.2: CRITERIA FOR THE EVALUATION OF THE GLOBAL IMPAIRMENT BY BURNS. TYPE ASSIGNED AREA INVOLVED%

A Superficial or epidermal 25% of the percentage of body surface area injured dermis50% AB Epidermis and percentage of body surface area injured

B dermis to fascia or bone Just to the affected area

c) Undertaking of joint mobility: assessed in the chapter.

d) aesthetic sequelae: assessment, insofar as it affects the ability to perform a job or occupational disability.

e) superficial lesions heal without scarring or sequelae, are not being evaluated.

10.5 Criteria for evaluation of the overall deficit by scars.

For purposes of qualifying for the loss of earning capacity, scars as such do not generate skin deficiency, except those with a residual occupational disability, to which is assigned a value of 2% of overall deficit. The aftermath or commitment of structures located in the affected area (eg, eye or joint) will be assessed in the chapters.

10.6. Criteria for evaluating the overall deficit for skin malignancies. These are assessed in the chapter on neoplasms.

CHAPTER XI11. CENTRAL NERVOUS SYSTEM11.1 GENERAL

Inducement or simulation of signs and symptoms of the patient is critical for the assessment of disability, it tends to mask, magnify or replace real underlying pathologies. Keep in mind that the degree of deficiency in the nervous system is not static so often we are faced with an evolutionary process. In this chapter you should analyze the following:

a) Brain

b) Spinal Cord

c) Cranial Nerves

11.2 Brain

11.2.1 Evaluation criteria for the deficiency of brain pathology.

For purposes of classifying the deficiency of brain pathology, will take into account the following criteria:

1. Sensory and motor disturbances.

2. Alterations in communication.

3. Alterations of complex and integrated functions of the brain.

4. Emotional disturbances.

5. Altered consciousness.

6. Episodic neurological disorders.

There may be more than one type of deficiency manifestations of pathology in the brain. In these cases, various degrees of deficiency are not added or combined, making the largest value of failure to represent the overall deficit.

Example: communication Altered brain damage (aphasia) = 18.0%. Alteration of the complex functions = 8.0%. = 0% emotional disturbance, altered consciousness = 25.0%. The overall deficit would be 25.0% and not 51.0% or 26.9% combined by the combination of values.

11.2.1.1 sensory and motor disturbances.

The muscle disorders, and some deformities secondary to neurologic injury, are reflected in loss of function and are not measured separately. Are rated according to defined criteria for restriction of movement and loss of muscle strength in Chapter I of Book I of this Manual. To evaluate the spasticity will take into account the criteria contained in Table 11.5 as follows: If it's upper extremities, are assigned a value according to the parameters set for "use of upper extremity" and if it is assigned lower extremities a value according to the parameters established for "poise and posture." Pain is individual, unmeasurable and variable according to the attention it gets dark. We can only assess the dermatome that point, the limitations it causes, antalgic positions and responses in pursuit of improvement. To get more background on pain should be reviewed in Chapter II, Peripheral Nervous System.

11.2.1.2. Communication Disorders

To qualify for the deficiency of communication disorders, will be considered disturbing the central mechanism of language including comprehension, storage and production thereof, which manifest as aphasia, dysphasia, agraphia, alexia or acalculia. Be considered for purposes of classifying not only the comprehension and understanding of

language of the patient but also the ability to produce a symbolic language intelligible and appropriate.

TABLE No. 11.1. Global DEFICIENCY DISORDERS OF COMMUNICATION.

Deficiency Disorders global communication (%)

You can understand the language and expression, but does so with difficulty. 0.0 - 9.9

You can understand the language but can not speak properly. 10.0 - 24.9

You can not understand the language and therefore is expressed as unintelligible or inappropriate. 25.0 - 44.9 can not understand or use language. 45.0 - 50.0

11.2.1.3. Alterations of complex and integrated functions of the brain These alterations are organic brain syndrome, with defects in orientation, comprehension, memory and behavior, then there are the criteria for assessment of deficiency:

TABLE No. 11.2 DEFICIENCY BY GLOBAL CHANGES OF COMPLEX FUNCTIONS OF THE BRAIN AND INCORPORATED.

Criteria of the whole person impairment (%)

You can perform the tasks of daily living. 1 - 9.9

Need of supervision 10.0 - 24.9

Need confinement 25.0 - 39.9

I could not take care of yourself 40.0 - 50.0

11.2.1.4. Emotional disturbances.

Emotional disturbances were graded according to the criteria set out in Chapter XII.

11.2.1.5. Altered consciousness.

TABLE No. 11.3 DEFICIENCY BY GLOBAL CHANGES OF CONSCIOUSNESS.

Altered consciousness of the whole person impairment (%)

Drowsiness 15.0 - 29.9

Stupor 35.0 - 45.0

50.0 Coma

11.2.1.6. Episodic Neurological Disorders.

These alterations may be mentioned, syncope, epilepsy, catalepsy and narcolepsy. The criteria for assessment of deficiency is given by the frequency and severity of attacks for each case described in the previous paragraphs.

TABLE No. 11.4. NEUROLOGICAL IMPAIRMENT BY GLOBAL Episodes.

Class Description of criteria Global Deficit (%)

I controlled disease treatment or occasional occurrence (1 to 2 episodes per year).

1.0 - 9.9

II disease that causes episodes occurring frequently (more than two episodes per year), despite receiving appropriate treatment and no evidence of sequelae of brain function. 10.0-24.9

III disease that causes the occurrence of frequent episodes (more than two episodes per year), despite receiving appropriate treatment and evidence of sequelae of brain function. 25.0 - 34.9

IV disease that causes episodes occurring more than once per month, despite receiving appropriate treatment and evidence of impairment of brain function. 35.0 - 45.0

Note: For evaluation of neurological deficiency and episodic is important to note that the treatment has been well run and in sufficient doses as specialized concept.

11.2.2. Criteria for the assessment of impairment of skull trauma - Brain Injury (TBI). Deficiency caused by the aftermath of a traumatic brain injury is assessed according to criteria established in paragraph 11.2.

11.2.3. Disorders of movement and posture. Within this group of diseases include disorders that involve disorder of posture and movement such as Parkinson's syndrome, ataxia, dyskinesias, tremor, rigidity and dystonia. In the case of Parkinson's, significant rigidity, bradykinesia or tremor in two extremities alone or in combination, result in a continuous alteration of the movement, gait or posture of the individual. It must prove conclusively that the patient is well-run treatment with sufficient doses and treatment time of not less than six (6) months, to proceed to qualify.

11.2.4. Brain tumors. Will be assessed according to the criteria set out in Chapter VIII.

11.2.5. Brain lesions that cause a deficiency of 40% However the above values, the following describes some neurological damage that cause a deficiency of 40%.

11.2.5.1. Stroke and central nervous system sequelae of head trauma. With one of the following characteristics after three months of the stroke occurred

a) motor or sensory aphasia resulting in ineffective speech or communication;

b) O, significant and persistent disturbance of motor function in two extremities, resulting in an alteration of movement or gait and posture of the individual.

11.2.5.2 Parkinson syndrome.

When involving two or more limbs with impaired movement continues, being treated well run, with the proper dosage and therapy for a while at least six months without improvement.

11.3. SPINAL CORD

In the course of the diseases of the spinal cord, autonomic autonomic disturbance may occur, such as sweating, circulatory phenomena and disorders in the regulation of body temperature and trophic injuries, urinary tract stones, osteoporosis, nutritional disorders and states psychological items, which are valued according to the relevant chapters.

11.3.1 Evaluation criteria for the deficiency of spinal cord pathology. For purposes of assessing impairment due to abnormalities of the spinal cord, is taken into account the following criteria:

1. Poise and posture.

2. Using upper extremities.

3. Breathing.

4. Bladder function.

5. Anorectal function.

6. Sexual function.

There may be more than one type of manifestations of deficiencies by spinal cord pathology in these cases, to determine the overall deficit will be made combination of values.

TABLE No. 11.5 global deficiency disorders Spinal Cord

Criteria of the whole person impairment (%)

Posture and poise:

Stands upright but with difficulty walking 5.0 - 9.9

Stands upright and walks alone on the flat 10.0 - 19.9

Stands upright but can not walk 20.0 - 30.0

Can not stand or walk 50.0 feet

Breathing:

Difficulty with exertion 5.0 - 9.9

You have to limit ambulation 10.0 - 24.9

Has to be in bed 25.0 - 40.0

Has no spontaneous breathing 50.0

Bladder function:

Can not be contained when it urgent 1.0 - 4.9

Reflexes without voluntary control 5.0 - 9.9

Poor reflexes without voluntary control 10.0 - 17.4

No reflection and no voluntary control 17.5-30.0

Anorectal function:

Limited voluntary control 1.0-2.4

Reflex regulation without voluntary control 2.5 - 7.4

Without regulation of reflexes and voluntary control 7.5 - 12.5

Sexual Function:

Mild difficulty 2.5 - 4.9

Reflex function but not seen 5.0 - 7.4

Unable to sexual function 7.5 -10.0

Using upper extremities:

Parent Tip Tip No Extra Both dominant deficiency. Some difficulty in hand and finger dexterity. 1.0 - 4.9 1.0 -2.4 2.5 - 9.9

You do not have in hand and finger dexterity. -14.9 5.0 2.5 - 9.9 10.0 -19.9

It serves only as auxiliary limb. 15.0 -19.9 10.0 -14.9 25.0 - 35.0

It has no functionality. 20.0 - 30.0 15.0 -20.0 40.0

11.3.2. Spinal Cord Injury with a 40% deficiency

The following are diseases of the spinal cord by their severity and complexity are given a 40% deficiency

11.3.2.1 Spinal Cord Injury. Complete spinal section due to any cause.

11.3.2.2 Multiple Sclerosis with:

a) When there is engine damage two or more limbs.

b) Or, visual or mental harm, according to the criteria applied in the chapters on organs of vision or psychiatric disorders.

11.3.2.3. Amyotrophic Lateral Sclerosis with:

a) Evidence of significant bulbar commitment;

b) Or, impaired motor function of two or more limbs.

11.3.2.4. Polio Back to:

a) persistent difficulty swallowing or breathing;

b) Or, slurred speech;

c) O, impaired motor function of two or more limbs.

11.3.2.5. Myasthenia Gravis with:

a) major difficulty speaking, swallowing and breathing despite adequate treatment.

b) major weakness of limb muscles despite being under treatment

properly controlled and properly managed.

11.3.2.6. Muscular dystrophy with:

When there is impairment of motor function of two or more limbs.

11.3.2.7. Tabes Dorsal with:

a) Crisis tabeta that occurs more than once per month;

b) O, or ataxic gait causing significant restriction hesitant motion, verified

by persistent signs of alteration of the posterior columns of the spinal cord.

11.3.2.8. Syringomyelia with:

a) Evidence of significant bulbar disorders;

b) Or, impaired motor function of two or more limbs.

11.4 Cranial Nerves

TABLE No. 11.6: VALUE OF DEFICIENCY FOR CRANIAL NERVE ABNORMALITIES

Criteria global deficiency (%)

I. Olfactory

Unilateral complete loss 0

3.0 bilateral complete loss

II. Optical

Unilateral complete loss 17.0

Bilateral complete loss 50.0

III-IV-VI-oculomotor. Abducens pathetic (alone or in combination)

Diplopia in the highlands of sight. 4.0

Diplopia in the bottom of the field. 9.0

Diplopia on lateral gaze. 7.5

Diplopia in all gaze positions (not compensable and that force to occlude one eye). 11.5

V. Trigeminal

5.0 unilateral complete sensory loss

Complete bilateral sensory loss 17.5

Trigeminal neuralgia typically intractable tic douloureux or 5.0 - 25.0

Atypical facial neuralgia 10.0

Motor lost 2.5 unilateral complete

22.5 Motor complete bilateral loss

VII. -Facial

Complete loss of taste (very rare) 3.0

7.5 Unilateral paralysis

Bilateral paralysis 22.5

VIII. Auditory

Cochlear:

Complete unilateral hearing loss 4.2

Complete bilateral hearing loss 25.0

Buzz 0.0

Vestibular:

Unilateral complete loss 0.0

Bilateral complete loss 1.0-15.0

Vertigo with imbalance

1) Do not interfere with activities 1.0

2) Do not interfere with the activities except those that cause danger to personnel or for other

like driving a car or take a bike 5.0

3) Do not interfere with activities of daily living, need help very activities

simple as caring for oneself, the house, walking down the street or ride in a vehicle

driven by someone else. 15.0

4) It is possible to carry out activities of daily living without assistance other than personal care 25.0

5) It is possible to carry out activities of daily living without assistance other than personal care and home confinement is necessary 35.0

IX - X - XI Glossopharyngeal, Vago or vagus, Espinal. Alterations in one or more of these nerves, which produce deficiency in swallowing and requires:

a) semi-sólidab Diet) Diet 10.0 15.0 liquid

c) tube feeding or gastrostomy. 30.0

Alterations in one or more of these nerves that causes weakness in the speech:

a) You can speak most of the time required 2.0

b) You can tell a lot about many times. 5.0

c) You can talk about some of the time required. 10.0

d) Few can speak many times .. 15.0

e) Can not speak 20.0

XII Hypoglossal

Unilateral paralysis 0.0 While the optic nerves (I) olfactory (II) and ocular motor (III-IV-VI) are mentioned in the chapter on Sense Organs, like the eighth or auditory, for clarity of text values ​​are repeated in this chapter deficiency allowing greater ease in the studies of various pathologies.

CHAPTER XII12. MENTAL AND BEHAVIORAL DISORDERS2.1 GENERAL

This chapter has been prepared based on the fifth chapter of the Tenth International Classification of Diseases (ICD - 10) and fourth version of the Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Society (DSM IV) .

In ICD-10 are proposed either 11 groups of mental disorders, the DSM IV, in turn, these groups of disorders located in two different axes of multiaxial classification: the pictures or Axis I clinical syndromes and Axis II personality disorders and mental retardation.

The classification of mental disorder based on clinical characteristics of the respective disorder, however, to specify the severity of it, and its forecast, the assessor need additional information about the different areas of activity of the person (family, social, academic, work, recreation, etc.).

To qualify axis I disorders is of particular importance to know the person's functioning in different areas of activity, especially during pre-qualification, to proceed to describe personality disorders and axis II, is necessary to have information on areas of activity of the person throughout his life, in order to clarify the

existence of jet or impairment in social, occupational, or otherwise. Also, this information will facilitate the quantification of disability and handicap, which in the case of mental disorder has unique characteristics.

12.2 CLASSIFICATION

For the purposes of this manual of mental disorders are divided into two groups: axis I and axis II, as follows:

Axis I Disorders Axis II disorders

1. Organic mental disorders, including symptomatic.

2. Mental and behavioral disorders due to psychoactive substance use.

3. Schizophrenia, schizotypal and delusional disorders.

4. Mood (affective).

5. Neurotic, stress-related disorders and somatoform disorders.

6. Mental retardation

7. Psychological development

1. Personality disorders and behavior in adults.

· Paranoid · Schizoid · schizotypal · histrionic · Asocial · From unstable personality (border) · Narcissistic · Anxious (avoidant) · Per dependence · anancastic (obsessive compulsive) • Changes

enduring personality

12.3. SCORING PROCEDURE

12.3.1 Quantification of impairment

In determining the deficiency resulting from clinical (Axis I) is taken into account only the disorder of major deficiency and this is quantified. For the rating of impairment resulting from personality disorder (axis II), is also considered a single disorder, but a person may have traits from more than one. Where relevant, each patient was graded on the deficiency of each of the axes, and their percentages are added together in a simple arithmetic, according to what is noted below.

In the case of deficiency is found only in one axis, this is the unique value of the overall deficit. For personality disorders (axis II) has been considered a unique category, whose value will vary depending on whether or not a deficiency in the axis, as explained in the following table:

DEFICIENCY IN THE AXIS I AXIS II DEFICIENCY VALUE

No 20% deficiency

If 10% deficiency

40% failure is not qualified

12.3.2 Criteria for classifying the deficiency arising from the Clinical Mental Syndromes (Axis I) For the classification of the deficiency arising from the different clinical syndromes or will be taken into account the following criteria:

Clinical diagnostic · Printing: Refers to the type of alteration (or disorganization) of mental activity characteristic of each clinical.

· Forms of Evolution: The clinical evolve in an episodic (with or without relapses) or persistently, taking the form of state, posing significant differences in the definition of the deficiency.

Current clinical · Assessment: At this point you consider the time period preceding qualifying, and in which there are clinical manifestations of the disorder. Includes assessing the duration of the last episode intercritical period that precedes or follows, in order to determine the presence or absence of residual symptoms, partial remission, symptoms, or behaviors resulting from alterations. In the case of non-episodic disorders, including evaluation of the state (persistent) current in order to determine the severity of the findings. In addition to the clinical features that occur in this time period, determine its duration.

· Evolution of the disorder: one takes into account the time between the onset of clinical changes characteristic of the first and the time of qualification. Includes the definition of the number of previous episodes and / or quantification of the total time of evolution. The definition of the number of previous episodes is a measure of the complications in the overall adaptation of the individual during the course of his life and, moreover, its prognosis, then, in general, a greater number of episodes greater the chance of recurrence.

· Assessment of the current findings: seeking to clarify the severity of the disorder itself the clinical and deficiencies arising therefrom in relation to the different areas of activity of the person (family, work, social, etc.).. The significance of these criteria will vary according to the clinical picture.

12.3.3 Criteria for rating the impairment resulting from personality disorders (axis II) For the rating of impairment resulting from personality disorders will be considered:

· Diagnosis: ie the clinical features of these disorders, or personality change lasting. These characteristics are defined by traits or behavior patterns prevalent.

· Disorder severity or intensity, determined by the persistence and rigidity of these features, as well as the difficulty in adapting resulting therefrom.

12.3.2.1. Diagnostic tests: psychological and neuropsychological studies A wide range of psychological tests that are not only useful for the diagnosis of a mental disorder, but also to determine the severity, prognosis and personal characteristics, work and family member of a particular case . Among the psychological tests that may be useful for the characterization of the loss of earning capacity, is the evidence on personality traits, scales of depression and anxiety, the stress level assessment and intelligence tests, for its part, evaluation of psychosocial factors at work and outside work is of paramount importance in qualifying origin of diseases and to quantify disability and handicap.

On the other hand, neuropsychological studies are useful for determining the location of brain injury, mental functions and processes altered the prognosis and the level at which occupational performance is affected, according to the characteristics of the subject, education level and occupation.

12.4 Mental Disorders Axis I (Clinical Syndromes)

12.4.1. Organic mental disorders, including symptomatic.

Includes a variety of disorders in which it has been established as an etiological factor the presence of "brain disease, injury, or other disturbance of the brain leading to brain dysfunction." The resulting brain dysfunction may be primary or secondary, as it results from direct and selective brain disorder or systemic disease that attacks various organs or systems, including the brain, also can be induced by substance use psychodysleptics. Here we consider the following syndromes:

• The amnestic syndrome and dementia;

Homepage More organic mental disorders (delusional or schizophreniform hallucinosis, organic mood disorder, organic anxiety disorder, dissociative, emotional lability, mild cognitive, other specified and unspecified).

· The personality disorders and behavioral disorders due to organic disease (organic personality disorder, postconfusional syndrome, emotional right hemisphere syndrome and organic personality disorder not otherwise specified.

12.4.1.1. Dementia and amnestic syndrome

Dementia may be primary and dementia in Alzheimer's disease or vascular dementia caused by strokes associated with vascular disease and those associated with other diseases. For these conditions, the deficiency is given by the alteration of different cognitive processes, and consequently by the disorganization of the conscious and voluntary. Its course is usually chronic. To assess the impairment caused by dementia and amnestic syndrome must meet two conditions: first, to clarify the existence of brain damage found, secondly, that the disorders have more than one year later. The disorders listed in this classification are: Alzheimer's disease, vascular dementia, dementia in other diseases classified elsewhere, dementia unspecified organic amnesic syndrome not induced by alcohol or other psychoactive substances, alcohol-induced delirium or other substances psychoactive and other mental disorders due to injury and brain dysfunction and physical illness.

TABLE No. 12.4.1 DEMENTIA AND CRITERIA% amnesic syndrome DEFICIENCY CATEGORY

I Presence of mild deficits in attention, concentration, memory or other mental functions, which can be offset with adequate support. 10%

II moderate addition to the above, there are changes in orientation, cognitive and sensorimotor disturbances (aphasia, apraxia, agnosia). 20%

III Grave addition to the previous deficits, the person has altered the organization of behavior, intellectual operations, decreased level of abstraction, learning ability, which hinder the conscious and voluntary organization of behavior. 30%

IV severe major presence of some or all of the above changes and marked deterioration of sensory-motor automatisms which are the basis of self-care. 40%

12.4.1.2. Other mental disorders due to injury and brain dysfunction and physical illness

This group consists of variety of diseases caused by primary brain disorders or systemic disease secondarily affecting the brain also can be caused by hormonal changes or exogenous toxic substances.

It includes organic hallucinosis or organic delusional disorder schizophreniform (organic psychosis for DSM IV), organic mood disorders (affective), organic anxiety disorder and dissociative disorder organic.

To qualify for the deficiency by organic hallucinosis and organic delusional disorder should be considered below the criteria for schizophrenia, schizotypal and delusional disorders (Table 12.3.3), to qualify organic mood disorders, are taken into account the criteria for major mood disorders (Table 12.3.4), and finally, the classification of anxiety disorders and organic dissociative will take into account the criteria for neurotic and somatoform disorders (Table 12.4.7 .)

12.4.1.3. Organic personality disorder and behavior

For ICD-10 disorder may take the form of "personality seudorretrasada pseudopsicopática or organic," which may be related to frontal lobe damage (frontal lobe syndrome, postleucotomía, lobotomy), limbic epilepsy (limbic epilepsy personality) or injured in the right hemisphere. In this group of disorders of deficiency is given by the deterioration of the consent and voluntary organization of behavior, either by altering cognitive processes, and consequently the programming itself, or by altering the organization of impulses under

Interests and values ​​of culture.

The rating of impairment caused by these disorders is done for diseases with more than a year later.

TABLE No.12.4.2 ORGANIC PERSONALITY DISORDER SEVERITY CLASS ALTERATION AND FINDINGS CURRENT GLOBAL GAP (%)

Class I (Mild) Especially reactive, episodic emotional lability, impaired impulse control and / or incipient cognitive impairment temporary difficulty in memory and concentration. In the interview situation presents distractibility. 10%

Class II (Moderate) Highly reactive, emotional lability, marked and frequent failures of impulse control and / or established cognitive deficits, especially perceptual level, alterations in the praxia and poor concentration. 20%

Class III (Severe) Apathy, indifference, depression or euphoria unrelated to specific events and / or difficulty maintaining consent and voluntary organization of behavior, deficits in higher cognitive processes. 30% Class IV (Severe) loss in the conscious and voluntary organization of behavior to serious disruption of the system of values ​​and interests sensorimotor dominance and impulsive activities, loss of own habits of everyday life, marked deficit of cognitive processes higher. 40%

12.4.2 Mental and behavioral disorders due to psychoactive substance use disorders include these components: intoxication, harmful use (or abuse) and dependence. It also includes consumer-related complications (usually long) of these substances, particularly those characterized by damage to brain structures or formations.

For the purposes of classifying the deficiency is taken into account the dependency syndrome, which will be assessed in cases in which the last period of dependency has a duration of at least two years. If coexisting deficiency resulting from the dependency syndrome resulting from impaired brain damage secondary to substance use

Psychodysleptics, will take the major deficiency in accordance with the statements in the general. Deficiency syndrome own dependence is given by the change in the organization and voluntary consent of the different types of activity, in this case, difficulty in managing what drives the consumption, which is manifested by different types of conduct .

TABLE No. 12.4.3 DEPENDENCY DISORDER DUE TO USE OF CATEGORY SUSTANCIASPSICOATIVAS GLOBAL OVERVIEW OF SIGNIFICANT DEFICIENCY (%) DISTURBANCE SEVERITY TIME EVOLUTION OF DISORDER

Class I (Mild) Loss of control over the use of substances. Increase in the number or frequency of use. Persistent use despite harmful consequences. Abandonment of family work and social responsibilities. Time-consuming in the acquisition and consumption of the substance. Sometimes physiological dependence (withdrawal)

Up to 10 years and / or less than four periods of dependency. The duration of the last period of dependency is up to two years including the period of partial remission. 10% Class II (Moderate) Loss of control over the use of substances. Increase in the number or frequency of use. Persistent use despite harmful consequences. Abandonment of job responsibilities, family and social. Time-consuming in the acquisition and consumption of the substance. Sometimes physiological dependence (withdrawal).

More than ten years and / or more than four periods of dependency The duration of the last period of dependency is more than two years, including partial remission period. . 20%

12.4.3. Schizophrenia, schizotypal and delusional disorders included in this group of schizophrenia, persistent delusional disorder, the acute and transient psychotic disorder and schizoaffective disorder. Schizotypal disorder and its clinical features will be considered with personality disorders, according to the issues raised by the DSM - IV deficiency in this group of disorders is characterized by severe disturbances in thought processes (delusions, hallucinations, affective disorders , motor, etc.) affecting conscious and voluntary organization of the different aspects of behavior, can evolve in an episodic, with or without recurrence, or persistent (psychotic state). In some cases the evolution is episodic to the onset and then becomes persistent.

There are two different types of episodes: acute, up to a month-long and subacute from one to six months, the psychotic state lasts longer than six months. Acute psychotic disorder and transitional by nature brief, not be taken into account for purposes of qualifying.

TABLE No. 12.4.4 Schizophrenia, schizotypal and delusional disorder CRITERIA CATEGORY DESCRIPTION OF DEFICIENCY (%)

Class I (mild) • The duration of the last episode and / or current is less than 6 months, and • In the intercritical period related to the last episode or the current state has been complete remission even without treatment, and • The individual has presented four episodes and / or the disorder is under 10 years of total duration, and • Current Finding: no significant signs and symptoms. Mental functions are preserved. 10% Class II (Moderate) • The duration of the last episode and / or current is up to 6 months, including the intercritical period, and • In the intercritical period the patient has difficulty maintaining the test of reality and • The individual has filed more than four episodes and / or disorder has more than 10 years of total duration, and • Find Current trends are in loss of reality testing. Other mental functions can be altered.

20%

Class III (severe) • The duration of the last episode and / or current is more than 6 months, and • In the intercritical period is persistent delusional content and / or negative symptoms, and • The person may have had or no previous episodes (number not relevant), and • Current Finding: delirium tends to be systematic and / or referral to various situations (delusional disorder). Negative psychotic symptoms and / or positive (schizophrenia and schizoaffective disorder). The person has trouble voluntary conscious development of their activities. There is a formal psychotic state. 30% Class IV (severe) • The duration of the last episode and / or current status is one year or more, and • In the intercritical period all areas of conscious and voluntary activity are deeply affected, and • Find now structured delusional disorder. Negative psychotic symptoms and / or persistent positive. The person has a deep deficit for the conscious development and volunteer activities. Presence of a schizophrenic process or a chronic delirium. 40%

12.4.4 Mood (affective)

Are characterized by an alteration of humor that tends to depression or euphoria. These disorders differ in major ways, which are generally episodic and recurrent (cyclic) and lesser forms, usually persistent (several years of evolution). Episodic forms include two types of mood disorders: bipolar disorder and recurrent depressive disorder. Persistent disturbances of mood, in turn, comprise two types of disorder, cyclothymic disorder and dysthymia. Two groups are established for the classification of the deficiency resulting from these disorders, a first group consisting of major mood disorders associated with minor alterations thereof and a second group consisting exclusively of minor mood disorders. Deficiency disorders resulting from the first group is given by the characteristics of its evolution and the total time of it.

TABLE No. 12.4.5 MAJOR DISORDERS OF MOOD (AFFECTIVE) DISORDERS ASSOCIATED OR NOT WITH JUVENILE HUMOR CATEGORY DESCRIPTION OF CRITERIA% DEFICIENCY

Class I (mild) • The duration of episodes is at least one to two weeks, and • In the intercritical period is complete remission, and • The person has made up to four episodes, or total time of evolution of the disorder be up to 10 years and • Current Finding: no significant symptoms. Mental functions are preserved. 10%

Class II (moderate) • The duration of episodes is at least one to two weeks, or the state lasts at least 6 months, including the intercritical period, and • In the intercritical period is complete remission or partial remission is greater disorder in the presence of minor alterations of humor, and • The individual has filed more than four episodes, or the total time course of the disorder is more than 10 years and • Current Finding: There is presence of some major symptoms of affection only, or there is moderate their intensity. 20%

Class III (severe) • The disorder lasts at least two years, including the intercritical period, and • In the intercritical period is partial remission of major episodes in the presence of minor alterations of humor, and • Find Current disturbances are present humor, of varying intensity. They are problems at the mental functions or some alteration of perception, thinking, reasoning or language. WITH RAPID CYCLING BIPOLAR DISORDER: • The disorder has a duration of one year or more, and • The person has submitted four or more episodes, and • Current Finding: There are major symptoms of mood (manic or depressive) with great severity, which interfere with mental function or alter perception, thought, motivation and / or language. 30% The following table qualify under mood disorders (persistent) and dysthymia or cyclothymia, which are defined by the absence of major alterations of mood, and only eligible cases whose duration is more than two years.

TABLE No. 12.4.6: MOOD DISORDERS UNDER THE CATEGORY CRITERIA% DEFICIENCY

Findings single class today: clinically significant distress, especially difficulties in motivational aspects and decision making. 10%

12.4.5. Neurotic, stress-related disorders and somatoform disorders differ order to classify three groups formed based on the characteristics of the deficiency involved, and not because they have similar characteristics from the descriptive point of view.

a) Group one: phobic disorders, panic disorder and posttraumatic stress disorder.

b) Group two: generalized anxiety disorder, neurasthenia, somatization disorder, hypochondriacal disorder, somatoform autonomic dysfunction and persistent somatoform pain. c) Group three: conversion disorder and obsessive-compulsive disorder.

In the corresponding table defines two types of deficiency for each of the three groups, according to the total duration of the disorder. On the other hand, sets out the clinical characteristics or severity that should have each of the groups of disorders to be awarded. In fact with mild disorders do not lead to any degree of impairment. For the purposes of impairment rating is only taken into account the post-traumatic stress disorder.

TABLE No. 12.4.7: Neurotic, Stress Related Disorders and Somatoform Disorders

Class I (mild): The duration of current symptoms and behaviors is high over a year, and total time of evolution of the disorder may be one to five years.

DIAGNOSTIC CRITERIA DESCRIPTION OF DEFICIENCY% severe or intense current symptoms GROUP ONE PRESENT FINDINGS

Phobias Posttraumatic Stress Disorder Panic Disorder · The symptoms may be related to different situations, or situations that the person must face daily (difficult avoidance), or symptoms may be multiple and of great severity, and • The anticipatory anxiety can be occupied by thinking much of the day, and / or lead to severe avoidance behaviors.

Concern about the possibility of occurrence of acute symptoms may be marked and / or isolation may be important. Symptoms during the past year can be significant and frequent. GROUP TWO-10% generalized anxiety disorder, neurasthenia symptoms (physiological and / or cognitive impairments can be many, or few but very intense and take thought for several hours a day, and / or hinder many of the activities person. The physiological and cognitive manifestations can be severe and affect both motivational and operational aspects of behavior. hypochondriacal disorder or dysmorphic. "somatization disorder Concern for the health and appearance can be consistent and present with structured content without constitute delusions.

Somatoform autonomic dysfunction, persistent somatoform pain, symptoms can be intense and motivating different laboratory examinations and treatments. GROUP THREE-conversion disorder · Can be very functional limitation or compromise of basic body systems (paralysis, anesthesia, muteness and blindness), and • There may be behaviors of indifference to the symptom. There is limited functional body system involved. Obsessive compulsive · The symptoms can be structured, persistent and cause great discomfort, and • The person may occupy much of the day in addressing the symptoms. The different areas of activity of the (motivational, cognitive and motor) may be committed to the symptoms of the disease and coping strategies.

Class II (moderate): The duration of current symptoms and behaviors is high over a year and the total time of evolution of the disorder is more than five years.

DIAGNOSTIC CRITERIA% DESCRIPTION OF DEFICIENCY SEVERITY OF SYMPTOMS OR CURRENT CURRENT CURRENT FINDINGS ONE GROUP

Phobias Posttraumatic Stress Disorder Panic Disorder · Symptoms related to wide range of situations, or situations that the person must face daily (difficult avoidance), or multiple symptoms of great severity, and Presence of anticipatory anxiety that takes the content thought much of the day, and / or leads to marked avoidance behavior. · Marked concern over the possibility of occurrence of acute symptoms and / or isolation important or Existence of significant and frequent symptoms during the past year. GROUP TWO-20% generalized anxiety disorder, neurasthenia symptoms (physiological and / or cognitive), many, or few but of great intensity that occupy the mind for several hours a day and / or hinder many of the activities of the individual. Cognitive and physiological manifestations are of such intensity that affects the motivational aspects of behavior and operational hypochondriacal disorder or somatization disorder dismórfico. "The concern for health or appearance is permanent, structured content manifests itself, without being delusions .

Somatoform autonomic dysfunction, pain, persistent somatoform symptoms are intense to the point that motivate different laboratory examinations and treatments.

GROUP THREE-conversion disorder · Great functional limitation or compromise of basic body systems (paralysis, anesthesia, muteness and blindness), and • Sometimes behaviors presence of indifference to the symptom. Apparent functional limitation compromised system. Obsessive compulsive · Symptoms clearly structured and persistent that produce great discomfort, and • In the clash of symptoms the person occupies much of the day. All or almost all areas of activity of the person (cognitive systems, motivational and motor) are committed to the symptoms of the disease, or conflict

12.4.6. Mental retardation is a state of incomplete or arrested mental development, characterized by deficiency in organizing skills that contribute to the overall level of intelligence such as cognitive function, language and motor skills or social. May be associated or not with other mental or physical impairment such as autism, other developmental disorders, conduct disorders, epilepsy or severe physical disability. Consequently, the resulting impairment of mental retardation is given mainly by the detention level of cognitive development.

TABLE No. 12.4.8 MENTAL RETARDATION APPROACHES% CATEGORY DESCRIPTION CURRENT DEFICIENCY DISORDER: DISORDER FEATURES:

Class I (mild) IQ of 50 to 69 (adult mental age of 9 to 12 years) I can present some difficulties in school learning, you can develop skills to perform everyday tasks without supervision. With appropriate stimuli can develop unskilled 
work and maintain appropriate social relationships. • With weak stimulation can only develop simple activities that require practical intelligence, with a minimum of abstraction. In this case, require continuous monitoring for work activities and even personal care.

10% Class II (moderate) IQ of 35 to 49 (adult mental age of 6 to 9 years) can take charge of their care under supervision. Moves only in a family environment. You can receive training in unskilled or semiskilled work (always with supervision) that imply the presence of organization in their body schema and motor to sensory manipulation.

20% Class III (severe) IQ of 20 to 34 (adult mental age of 3 to 6 years) can purchase a communicative language and little or no skills can be trained in basic care. In adulthood can perform simple tasks in closely supervised institutions. It can also adapt well to life of community, either in group homes or with their families.

30% Class IV (severe) IQ below 20. Severe restriction of personal care, continence, communication and mobility. Usually associated with neurological disease. Require continued assistance in all activities of daily living, including personal care

40% 12.4.7. Psychological development disorders

Includes conditions that a) invariably begin during infancy or childhood, b) there is deterioration or delay the development of functions closely related to biological maturation of the central nervous system are progressive course without remission or relapse. Within the developmental disabilities are two groups: pervasive developmental disorders and specific developmental disorders. This latter group will be considered for qualification for the loss of working capacity.

The group includes pervasive developmental disorders: infantile autism, Rett syndrome, childhood disintegrative disorder, Asperger disorder and other pervasive unclear. For these disorders are treated as such and qualifying requires that started before the three years of age.

This group of disorders should not be classified before making a comprehensive rehabilitation process.

Table 12.4.9 Pervasive Developmental Disorders DEFICIENCY CATEGORY CRITERIA%Severity of ED

Class I (Mild) Little interest in establishing interpersonal relationships, difficulty in establishing communication, little development of interests and activities.

10% Class II (Moderate) Defect in establishing interpersonal relationships, poor communication with others, poor communication on behavior.

20% Class III (Severe) Apparent failure to establish interpersonal relationships, poor development of communication with others, poor organization of behavior.

30% Class IV (Severe) Lack notorious for the establishment of interpersonal relationships; obvious deficiency in the communication (intelligible), not knowing and voluntary organization of behavior.

40% 12.5 Axis II mental disorders, personality disorders, and behavior in adults This group includes a variety of conditions and clinically significant behavioral traits (ie, individual produce discomfort or difficulty in social adaptation to the DSM IV -), which tend to be persistent and appear to be the expression of the typical lifestyle of the person and their way of relating to oneself and others.

For purposes of qualifying for disability consider the specific personality disorders, mixed disorders of personality and enduring personality changes, not attributable to brain injury or disease. To be considered as such and by the end of qualifying, personality disorders should have arisen at least since adolescence, and enduring personality change should be more than two years as a total evolution time. Also, in order to qualify these conditions must be evident in different life situations and at different stages of life.

Based on the DSM IV the specific personality disorders are classified into three groups:

· Group A (odd, eccentric) comprises the schizoid, paranoid, and schizotypal personality.

· Group B (dramatic, emotional): Includes histrionic, antisocial (or psychotic), emotionally unstable (borderline or borderline) and narcissistic personality. · Group C (anxious, fearful) includes anxiety disorders (or evasive)), dependent and anancastic (or obsessive compulsive disorder).

Lasting changes of personality, not attributable to brain injury or disease, however, appear not in relation to the development process, but "after exposure to prolonged stress, catastrophic or excessive" (sometimes post a picture posttraumatic stress disorder) or after a severe mental illness. It is important to consider behavioral disorders in the assessment of impairment of different personality disorders.

TABLE No. 04/12/1910: DISORDERS OF PERSONALITY AND ENDURING PERSONALITY CHANGES

(Axis II) CATEGORY DESCRIPTION OF DIAGNOSTIC CRITERIA% DEFICIT DISORDER SEVERITY OR INTENSITY OF GROUP A SINGLE CLASS

· Disorder Schizoid paranoid · Schizotypal Poverty · links interpersonal distrust major fantasy threat, or magical character. 20% (when only going to rate this axis) 10% (if it is also going to rate the axis I) 0% (when going to score a 40% deficiency in the axis I)

GROUP B Histrionic · asocial disorder (psychopathy) · personality disorder emotionally unstable (border or borderline) · narcissistic disorder impulsivity, or strong or particularly labile emotionality, low frustration tolerance, poor organization of the system of interests and values ​​and interest notorious in his own person and disregard of others, expressed in fantasies, attitudes and behaviors.

GROUP C ¢ anxious personality disorder (avoidant) · disorder dependence · anancastic Disorder (OCD) Markedly concern about interpersonal relationships and attitudes associated with anxiety and / or avoidance behavior, submission and control.

ENDURING PERSONALITY CHANGES Marked hostility and mistrust, isolation notorious, anxiety and depression, or severe dependency and others demand to inability to maintain interpersonal relationships, notorious passivity and decrease in interest, attitude and behavior marked unhealthy.

CHAPTER XIII13. SENSES: vision, hearing and balance, speech, smell, taste

13.1 VISUAL SYSTEM

Overview 13.1.1 For purposes of qualifying for the deficiency by alterations in the vision system should be taken into account the following criteria:

a) Assessment of visual acuity

b) Assessment of visual field, and

c) Assessment of ocular motility.

In cases of impaired visual acuity and / or visual field, should make the assessment of impairment after refractive correction of the defect presented by the individual. When changes are more than one of the above criteria should be combined deficiency values ​​assigned to each of them, for the overall deficit by altering the visual system.

13.1.2. Criteria for the assessment of impairment by changes in central visual acuity. Under the specialist system used for detecting disorders of visual acuity, using the English or the metric system, will use the following conversion table to convert decimal values ​​measures.

TABLE No.13.1 Table of equivalences for visual acuity measurements metric Measures Measures Measures English decimal 20/20 5 / 5 - 6 / 6 0.80

20/25 5/7.5 - 6/7.5 0.70

20/32 6/10 0.60

20/40 5/10 - 6/12 0.50

20/50 6/15 0.40

20/64 5/15 - 6/20 0.30

20/100 5/20 - 6/30 0.20

20/125 5/40 - 6/48 0.10

20/200 5/50 - 6/60 0.10

20/400 5/100 - 6/120 0.05

20/800 6/240 0.00

The following table shows the overall deficit as percentage of decrease in visual acuity.

TABLE No. 13.2 Deficiency Global changes in visual acuity

Visual acuity (Decimal) 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.05 0.0 (Ojo

Blind) Enucleation

0.8 0 2 3 4 5 6 8 9 11 12 15

0.7 2 3 4 5 6 8 10 11 13 15 20

0.6 3 4 5 6 8 10 12 14 15 17 25

0.5 4 5 6 8 10 12 15 16 18 20 27

0.4 5 6 8 10 12 15 18 20 23 25 33

0.3 6 8 10 12 15 18 20 23 25 30 35

0.2 8 10 12 15 18 20 23 27 30 33 37

0.1 9 11 14 16 20 23 27 30 33 35 40

0.05 11 13 15 18 23 25 30 33 35 38 45

0.0 (Eye Blind) 12 15 17 20 25 30 33 35 38 45 50

Enucleation 15 20 25 27 33 35 37 40 45 50 50

Explanation of Table 13.2:

a)    In case of loss or decrease in visual acuity of one eye, while the healthy one, the deficiency is determined by the percentage of visual acuity in the first horizontal line of the table.

b)    In cases of loss or bilateral decrease of visual acuity, impairment is determined at the intersection of the horizontal to the vertical column of the visions for the left and right eye.

c)    In case of a single eye, the deficiency will be determined at the intersection of the vertical levels of visual acuity in the first row of the table with the column horizontal blind eye.

d)    If there enucleation of an eye, the percentage of impairment shall be determined at the intersection of the vertical to the horizontal that says enucleation.

13.1.3. Criteria for evaluation of visual field alterations.

For the determination of visual field loss is required to have a study that includes central or peripheral visual field, which must be performed with best corrected visual acuity.

Extension Table No.13.3 minimum degree of each of the axes taken from the point of attachment.

Grade Area

Temporary 85

85 inferior temporal

Bottom 65

Inferior nasal 50

Nasal 60

Superior nasal 55

Top 45

55 superior temporal

Total 500

Inferior hemianopsia axes then undertake inferior, nasal and inferior temporal inferior, recording each kept freezing and the rest of axes its maximum value.

FIGURE 5: MAXIMUM EXTENT OF EACH OF THE LINES IN THE VISUAL FIELD

To calculate the overall deficit for visual field loss should be:

1) Calculate the magnitude of the field by the sum of the loss in degrees in each axis for each eye. Check the maximum normal values ​​in Table 13.3.

2) The magnitude of the field must be converted to the percentage of visual field loss of the eye, according to Table 13.4. If it comes to alterations in the central visual field, previously multiplied by two, taking into account that the maximum magnitude of the visual field is 270 °. In all cases, must obtain the percentage of visual field loss in both eyes.

3) To calculate the overall deficit for visual field loss, apply the following formula:

"% Loss worse eye x 0.25 +% loss better eye x 0.75" That is, the major deficiency is multiplied by 0.25 and reduced by 0.75 and then added, resulting in impairment of the whole person impairment of bilateral visual field.

TABLE No.13.4 visual impairment visual field loss in one eye Grades Grades Grades

Conserv% Lost Lost Lost Conserv Conserv%%

0 500 0 170 330 17 340 160 34

10 490 1 180 320 18 350 150 35

20 480 2 190 310 19 360 140 36

30 470 3 200 300 20 370 130 37

40 460 4 210 290 21 380 120 38

50 450 5 220 280 22 390 110 39

60 440 6 230 270 23 400 100 40

70 430 7 240 260 24 410 90 41

80 420 8 250 250 25 420 80 42

90 410 9 260 240 26 430 70 43

100 400 10 270 230 27 440 60 44

110 390 11 280 220 28 450 50 45

120 380 12 290 210 29 460 40 46

130 370 13 300 200 30 470 30 47

140 360 14 310 190 31 480 20 48

150 350 15 320 180 32 490 10 49

160 340 16 330 170 33 500 0 50

Note: In cases which go unreported in the visual field grades lost but the percentage of visual field loss is equivalent to search for missing grades in Table 13.4, taking into account that 100% loss corresponds to 500 ° we lose. Example: We report a 60% loss of sight of his right eye and normal visual field for the left eye: Its equivalence according to Table 13.4 for the right eye is 300 ° lost his left eye and lost 0 °, therefore visual impairment of the right eye is then 30% and the left eye from 0% to find the overall deficit for bilateral visual field loss formula is applied, resulting in 22.5%.

13.1.4. Diplopia (oculomotor function disorders).

Table 13.5. Global deficiency diplopia.

Global Deficiency Criteria (%)

Diplopia in the highlands of sight. 4.0

Diplopia in the bottom of the field. 9.0

Diplopia on lateral gaze. 7.5

Diplopia in all gaze positions (not compensable and that force to occlude one eye). 11.5

13.1.5. Deficiencies of other unilateral eye injury.

Table 13.6 Global Deficiency unilateral ocular injures.

Criteria of the whole person impairment (%)

Total internal ophthalmoplegia, unilateral (accommodation) 11.5

Mydriasis and iris damage when they cause functional impairment, unilateral. 2.5

Ptosis or blepharospasm, unilateral pupil covered. 10.0

Eyelid deformities, unilateral. 5.0

Unilateral epiphora. 5.0

Unilateral lacrimal fistulas 5.0

5.0 bilateral glaucoma

These percentages of impairment, should be added in combination with other concepts found by other alterations, without exceeding the equivalent total eye loss.

EAR 13.2

13.2.1 General.

Within this system we consider the functions of hearing and balance. The hearing capacity of a person shall be evaluated according to language comprehension and speech discrimination hearing. For purposes of the classification of hearing loss is taken into account the frequencies 1000, 2000, 3000 and 4000 Hz must perform three audiometry using the same computer, using the techniques that ensure quality of output, such as idle listening of at least 12 hours, the examination during the first hours of the day, among others.

To determine the loss of working capacity of auditory origin, are required together: auditory evoked potentials, audiometry logo and bone conduction audiometry. The interpretation and overview of the results should be consistent. The bone conduction audiometry were taken as reference to describe this loss. If evoked potentials are reported as normal, although hearing tests are altered the overall deficit was taken as 0%.

13.2.2 Criteria for assessing the deficiency hearing impairment.

Audio evaluation metric must be performing the following calculations:

a) The calculation of the sum of decibel thresholds (SDU) for each ear.

b) The calculation of the binaural impairment.

c) The calculation of the overall deficit.

13.2.2.1. Calculating Decibel Sum Threshold (SDU) for each ear.

To make the calculation of the deficiency mono Follow these steps:

1) For purposes of the qualification will take into account the values ​​of 1000, 2000, 3000 and 4000 Hz for each of the three hearing tests for each ear.

2) To determine the average hearing thresholds of each of the above frequencies, align the thresholds found in the three hearing tests for each frequency and divided by three, finding the average. If the sum of the thresholds is less than 100 dB to 100 dB is approaching. When no hearing at a certain frequency, it is assigned a maximum value of 92 dB.

3) Then add these mean values ​​of the four frequencies for each ear. This represents the SDU of each ear.

13.2.2.2. Calculation of binaural impairment.

Once the SDU for both ears, calculate the binaural impairment as follows:

(% Better ear x 5) + (worst Ear x 1) x 0.5 =% binaural impairment. 6 Remember that the better ear is one whose SDU is about 100. Table 13.7 shows the binaural hearing impairment and include the two above calculations. With the result of binaural loss is estimated the overall deficit.

13.2.2.3 Calculation of the overall deficit.

After obtaining the binaural impairment, calculate the overall deficit as follows:

Overall deficit binaural impairment =% x 0.5

TABLE No. 13.7. Binaural Hearing Impairment

100 0.0 ear

105 0.2 1.0 worse

SDU 110 0.3 1.1 1.9

115 0.5 1.3 2.1 2.8

120 0.7 1.4 2.2 3.0 3.8 SDU better ear

125 0.8 1.6 2.4 3.2 3.9 4.7

130 1.0 1.7 2.5 3.3 4.1 4.9 5.7

135 1.1 1.9 2.7 3.5 4.2 5.0 5.8 6.6

140 1.3 2.1 2.8 3.6 4.4 5.2 6.0 6.7 7.5

145 1.4 2.2 3.0 3.8 4.6 5.3 6.1 6.9 7.7 8.5

150 1.6 2.4 3.2 3.9 4.7 5.5 6.3 7.1 7.8 8.6 9.4

155 1.7 2.5 3.3 4.1 4.9 5.7 6.4 7.2 8.0 8.8 9.6 10.3

160 1.9 2.7 3.5 4.2 5.0 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3

165 2.1 2.8 3.6 4.4 5.2 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2

170 2.2 3.0 3.8 4.6 5.3 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2

175 2.4 3.2 3.9 4.7 5.5 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1

180 2.5 3.3 4.1 4.9 5.7 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0

185 2.7 3.5 4.2 5.0 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0

190 2.8 3.6 4.4 5.2 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9

195 3.0 3.8 4.6 5.3 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1

200 3.2 3.9 4.7 5.5 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2

205 3.3 4.1 4.9 5.7 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4

210 3.5 4.2 5.0 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5

215 3.6 4.4 5.2 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7

220 3.8 4.6 5.3 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8

225 3.9 4.7 5.5 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0

230 4.1 4.9 5.7 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2

235 4.2 5.0 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3

240 4.4 5.2 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5

245 4.6 5.3 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8 18.6

250 4.7 5.5 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0 18.8

255 4.9 5.7 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2 18.9

260 5.0 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3 19.1

265 5.2 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5 19.2

270 5.3 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8 18.6 19.4

275 5.5 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0 18.8 19.6

280 5.7 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2 18.9 19.7

285 5.8 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3 19.1 19.9

290 6.0 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5 19.2 20.0

295 6.1 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8 18.6 19.4 20.2

300 6.3 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0 18.8 19.6 20.3

305 6.4 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2 18.9 19.7 20.5

310 6.6 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3 19.1 19.9 20.7

315 6.7 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5 19.2 20.0 20.8

320 6.9 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8 18.6 19.4 20.2 21.0

325 7.1 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0 18.8 19.6 20.3 21.1

330 7.2 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2 18.9 19.7 20.5 21.3

335 7.4 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3 19.1 19.9 20.7 21.4

340 7.5 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5 19.2 20.0 20.8 21.6

345 7.7 8.5 9.2 10.0 10.8 11.6 12.4 13.2 13.9 14.7 15.5 16.3 17.1 17.8 18.6 19.4 20.2 21.0 21.7

350 7.8 8.6 9.4 10.2 11.0 11.7 12.5 13.3 14.1 14.9 15.7 16.4 17.2 18.0 18.8 19.6 20.3 21.1 21.9

355 8.0 8.8 9.6 10.3 11.1 11.9 12.7 13.5 14.2 15.0 15.8 16.6 17.4 18.2 18.9 19.7 20.5 21.3 22.1

360 8.2 8.9 9.7 10.5 11.3 12.1 12.8 13.6 14.4 15.2 16.0 16.7 17.5 18.3 19.1 19.9 20.7 21.4 22.2

365 8.3 9.1 9.9 10.7 11.4 12.2 13.0 13.8 14.6 15.3 16.1 16.9 17.7 18.5 19.2 20.0 20.8 21.6 22.4

368 8.4 9.2 10.0 10.7 11.5 12.3 13.1 13.9 14.7 15.4 16.2 17.0 17.8 18.6 19.3 20.1 20.9 21.7 22.5

100 105 110 115 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190

TABLE No. 13.7. Binaural Hearing Impairment "Continuation"

190

195 17,8

200 18,0 18,8

205 18,2 18,9 19,7

210 18,3 19,1 19,9 20,7

215 18,5 19,2 20,0 20,8 21,6

220 18,6 19,4 20,2 21,0 21,7 22,5

225 18,8 19,6 20,3 21,1 21,9 22,7 23,5

230 18,9 19,7 20,5 21,3 22,1 22,8 23,6 24,4

235 19,1 19,9 20,7 21,4 22,2 23,0 23,8 24,6 25,3

240 19,2 20,0 20,8 21,6 22,4 23,2 23,9 24,7 25,5 26,3

245 19,4 20,2 21,0 21,7 22,5 23,3 24,1 24,9 25,7 26,4 27,2

250 19,6 20,3 21,1 21,9 22,7 23,5 24,2 25,0 25,8 26,6 27,4 28,2

255 19,7 20,5 21,3 22,1 22,8 23,6 24,4 25,2 26,0 26,7 27,5 28,3 29,1

260 19,9 20,7 21,4 22,2 23,0 23,8 24,6 25,3 26,1 26,9 27,7 28,5 29,2 30,0

265 20,0 20,8 21,6 22,4 23,2 23,9 24,7 25,5 26,3 27,1 27,8 28,6 29,4 30,2 31,0

270 20,2 21,0 21,7 22,5 23,3 24,1 24,9 25,7 26,4 27,2 28,0 28,8 29,6 30,3 31,1 31,9

275 20,3 21,1 21,9 22,7 23,5 24,2 25,0 25,8 26,6 27,4 28,2 28,9 29,7 30,5 31,3 32,1 32,8

280 20,5 21,3 22,1 22,8 23,6 24,4 25,2 26,0 26,7 27,5 28,3 29,1 29,9 30,7 31,4 32,2 33,0 33,8

285 20,7 21,4 22,2 23,0 23,8 24,6 25,3 26,1 26,9 27,7 28,5 29,2 30,0 30,8 31,6 32,4 33,2 33,9

290 20,8 21,6 22,4 23,2 23,9 24,7 25,5 26,3 27,1 27,8 28,6 29,4 30,2 31,0 31,7 32,5 33,3 34,1

295 21,0 21,7 22,5 23,3 24,1 24,9 25,7 26,4 27,2 28,0 28,8 29,6 30,3 31,1 31,9 32,7 33,5 34,2

300 21,1 21,9 22,7 23,5 24,2 25,0 25,8 26,6 27,4 28,2 28,9 29,7 30,5 31,3 32,1 32,8 33,6 34,4

305 21,3 22,1 22,8 23,6 24,4 25,2 26,0 26,7 27,5 28,3 29,1 29,9 30,7 31,4 32,2 33,0 33,8 34,6

310 21,4 22,2 23,0 23,8 24,6 25,3 26,1 26,9 27,7 28,5 29,2 30,0 30,8 31,6 32,4 33,2 33,9 34,7

315 21,6 22,4 23,2 23,9 24,7 25,5 26,3 27,1 27,8 28,6 29,4 30,2 31,0 31,7 32,5 33,3 34,1 34,9

320 21,7 22,5 23,3 24,1 24,9 25,7 26,4 27,2 28,0 28,8 29,6 30,3 31,1 31,9 32,7 33,5 34,2 35,0

325 21,9 22,7 23,5 24,2 25,0 25,8 26,6 27,4 28,2 28,9 29,7 30,5 31,3 32,1 32,8 33,6 34,4 35,2

330 22,1 22,8 23,6 24,4 25,2 26,0 26,7 27,5 28,3 29,1 29,9 30,7 31,4 32,2 33,0 33,8 34,6 35,3

335 22,2 23,0 23,8 24,6 25,3 26,1 26,9 27,7 28,5 29,2 30,0 30,8 31,6 32,4 33,2 33,9 34,7 35,5

340 22,4 23,2 23,9 24,7 25,5 26,3 27,1 27,8 28,6 29,4 30,2 31,0 31,7 32,5 33,3 34,1 34,9 35,7

345 22,5 23,3 24,1 24,9 25,7 26,4 27,2 28,0 28,8 29,6 30,3 31,1 31,9 32,7 33,5 34,2 35,0 35,8

350 22,7 23,5 24,2 25,0 25,8 26,6 27,4 28,2 28,9 29,7 30,5 31,3 32,1 32,8 33,6 34,4 35,2 36,0

355 22,8 23,6 24,4 25,2 26,0 26,7 27,5 28,3 29,1 29,9 30,7 31,4 32,2 33,0 33,8 34,6 35,3 36,1

360 23,0 23,8 24,6 25,3 26,1 26,9 27,7 28,5 29,2 30,0 30,8 31,6 32,4 33,2 33,9 34,7 35,5 36,3

365 23,2 23,9 24,7 25,5 26,3 27,1 27,8 28,6 29,4 30,2 31,0 31,7 32,5 33,3 34,1 34,9 35,7 36,4

368 23,2 24,0 24,8 25,6 26,4 27,2 27,9 28,7 29,5 30,3 31,1 31,8 32,6 33,4 34,2 35,0 35,7 36,5

195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280

TABLE No. 13.7. Binaural Hearing Impairment "Continuation"

280

285 34,7

290 34,9 35,7

295 35,0 35,8 36,6

300 35,2 36,0 36,7 37,5

305 35,3 36,1 36,9 37,7 38,5

310 35,5 36,3 37,1 37,8 38,6 39,4

315 35,7 36,4 37,2 38,0 38,8 39,6 40,3

320 35,8 36,6 37,4 38,2 38,9 39,7 40,5 41,3

325 36,0 36,7 37,5 38,3 39,1 39,9 40,7 41,4 42,2

330 36,1 36,9 37,7 38,5 39,2 40,0 40,8 41,6 42,4 43,2

335 36,3 37,1 37,8 38,6 39,4 40,2 41,0 41,7 42,5 43,3 44,1

340 36,4 37,2 38,0 38,8 39,6 40,3 41,1 41,9 42,7 43,5 44,2 45,0

345 36,6 37,4 38,2 38,9 39,7 40,5 41,3 42,1 42,8 43,6 44,4 45,2 46,0

350 36,7 37,5 38,3 39,1 39,9 40,7 41,4 42,2 43,0 43,8 44,6 45,3 46,1 46,9

355 36,9 37,7 38,5 39,2 40,0 40,8 41,6 42,4 43,2 43,9 44,7 45,5 46,3 47,1 47,8

360 37,1 37,8 38,6 39,4 40,2 41,0 41,7 42,5 43,3 44,1 44,9 45,7 46,4 47,2 48,0 48,8

365 37,2 38,0 38,8 39,6 40,3 41,1 41,9 42,7 43,5 44,2 45,0 45,8 46,6 47,4 48,2 48,9 49,7

368 37,3 38,1 38,9 39,7 40,4 41,2 42,0 42,8 43,6 44,3 45,1 45,9 46,7 47,5 48,2 49,0 49,8 50,0

285 290 295 300 305 310 315 320 325 330 335 340 345 350 355 360 365 368

13.2.2.4. Special Situations

a) In case of individuals who have a cochlear implant, audiometry should be performed with the implant operation.

b) A cosmetic defects that do not cause functional impairment are not given deficiency.

13.2.3 Criteria for assessment of deficiency and balance disorders.

The evaluation of the auditory system deficiency balance disorders are considered only the problems resulting from defects of the labyrinth, the vestibule and its ways. Not included in this chapter, the dizziness caused by central nervous system disorders, which are described in the chapter on the Central Nervous System.

13.2.3.1. Complete Loss of Vestibular Function

This loss may be unilateral or bilateral. When the loss is unilateral balance has not been permanently altered, so should not be granted a percentage of disability for this condition. When the loss is bilateral can expect some degree of compensation for the kinesthetic and visual mechanisms, so depending on the degree of this compensation the rate will be evaluated in Table 13.8.

13.2.3.2. Criteria for evaluating Global Gap Vestibular Vertigo

Class Description of criteria DeficiencyGlobal (%)

I "There are symptoms of peripheral vertigo," and can perform activities of daily living without any kind of help. 1.0

II "You have symptoms of peripheral vertigo," and can be carried out without assistance, activities of daily living, except those enclosing personal danger or others, like driving all types of vehicles, working at heights, working with management tools that is risky, and so on. 5.0

III "You have symptoms of peripheral vertigo," and can not perform activities of daily living without assistance, except personal care, housekeeping, travel in short distances down the street and go in a vehicle driven by other 15.0

IV "There are symptoms of peripheral vertigo," And, you can not perform activities of daily living, except to take care of itself. 25.0

V "There are symptoms of peripheral vertigo," You can not perform activities of daily living without help, except for personal care and must be homebound 35.0

13.3 SMELL AND TASTE

These rules give a single value of 3% of global impairment of the person when there is a complete loss of these senses.

SPOKEN 13.413.4.1 OverviewOrganic loss of speech.

Glossectomy, laryngectomy or cicatricial stenosis of the larynx result in a loss of voice production by its normal means. The evaluation of the organic waste includes language deficiency produce by any means, including rehabilitation phoniatric mechanical or electronic devices. If the condition is due to neurological damage it must be evaluated with the criteria of the chapter.

13.4.2 Evaluation of speech impairment.

TABLE No. 13.8 Global deficiency disorders in speech.

Class Description of criteria Global Deficit (%)

I · audibility. The patient can be heard as sufficient in most cases but sometimes have to make an effort and sometimes this will fail. · Intelligibility. The patient can articulate enough in most cases but sometimes have to repeat and sometimes unable to articulate certain sounds. · Functional efficiency. The patient can pronounce and articles in most cases with adequate speed and ease, but then hesitate or slow down. 2.0

II · audibility. The patient can be heard enough on many occasions, is understood in normal conditions but have difficulty in making himself understood in buses, trains, stations, restaurants etc. · Intelligibility. The patient can articulate enough on many occasions. Can understand anyone saying your name, address, etc. You can make many mistakes and sometimes have great difficulty in articulating the word. · Functional efficiency. El paciente puede pronunciar y articular en MUCHAS ocasiones con velocidad y facilidad adecuada, pero a veces da la impresión de encontrar dificultad y tiene interrupciones, dudas o lo hace despacio. 5.0

III · audibility. The patient can sometimes be heard talking closely with someone else, but have difficulty in noisy. Her voice is inaudible tired quickly and a few seconds. · Intelligibility. The patient can articulate in some cases, talking with family and friends. However, people can not find much difficulty trying to understand, often have to repeat the statement. · Functional efficiency. The patient can speak and articulate in some cases with adequate speed and ease, but at times can only sustain a continuous conversation for brief periods, giving the impression of rapid fatigue 10.0

IV · audibility. The patient can be heard only rarely, rarely hear him. Not listened on the phone, you can whisper but no voice. · Intelligibility. The patient can rarely be heard, it just may give some phonetic units can mumble some names not understand him. · Functional efficiency. The patient can speak and articulate appropriate speed on a few occasions, only short sentences and single words, but can not hold a conversation. She struggles to speak and does so very slowly. 15.0

V ‡ audibility. Can not be heard at all. · Intelligibility. You can not utter a word. · Functional efficiency. He can not pronounce or articulate 20.0

CHAPTER XIV

14. Hematopoietic System

14.1 General

This chapter contains the criteria for evaluating impairment caused by alterations in the hematopoietic system.

14.1.1 Rating:

a) Anemia

b) Erythrocytosis

c) Changes of leukocytes

d) Changes of the reticuloendothelial system

e) Bleeding disorders or coagulation

f) Changes of platelets

14.2 ANEMIA

Chronicity is indicated by a persistence of the condition of at least 3 months and with a hematocrit below 30% and requires at least a weekly transfusion.

14.2.1 Evaluation

Laboratory reports must match the values ​​obtained in more than one test, conducted over a period of 3 months prior to evaluation.

TABLE No. 14.2.1 Global related deficiency anemia

Symptomatology level in peripheral blood hemoglobin, g/100 ml of blood

Transfusion need global deficiency (%)

No 11 or more in adult females None 0

No 12 or more adult males None 0

None to minimal 9-11 No 3

Minimal to moderate 7 to 9 Average of 1 unit or less cada6 weeks. 10

Moderate 7 Average of 1 unit or more every two semanas20

Moderate to severe 5-7 Average of 1 or less every 2 weeks 30

Severe 5 Average of 1 or more every 2 weeks 40

Less severe than 5 1 or more every two weeks 50

14.3 erythrocytosis14.3.1 Criteria for the Evaluation of Permanent Impairment Related erythrocytosis:

TABLE No. 14.1. Global deficiency erythrocytosis.

Class Description of criteria Global Deficit (%)

I • The hemoglobin level is high, but remains at a level below 18 g/100 ml blood at sea level, with infrequent or no treatment. 5.0

II · need an intermittent treatment with phlebotomy myelosuppressive month to keep the level of peripheral blood hemoglobin less than 18 g/100 ml of blood at sea level. 20.0

III · myelosuppressive therapy is required with phlebotomy every two weeks or less to maintain the level of peripheral blood hemoglobin less than 20 g/100 ml of blood at sea level. 40.0

14.4 CHANGES OF LEUKOCYTES

For greater clarity in the exposition and to facilitate the search of the percentage of impairment is not included in this chapter leukemia in its different types or varieties which are described in the chapter that corresponds to malignant neoplasm.

14.4.1 Criteria for evaluating the impairment caused by disorders of leukocytes

TABLE No. 14.2. Global deficiency disorders of leukocytes

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of abnormality in leukocytes; Do not need any treatment or only needed sporadically; • And, you can perform all or most activities of daily living. 3.0

II • There are symptoms and signs of abnormality in leukocytes, and, • Although continuous treatment is necessary, can continue with most activities of daily living 10.0

III • There are symptoms and signs of abnormality in leukocytes · need continuous treatment; • And, there is interference in carrying out activities of daily living, occasionally requiring the assistance of others. 20.0

IV • There are symptoms and signs of abnormality in leukocytes · need continuous treatment; • And, they have difficulty performing everyday tasks, requiring continued assistance of others. 35.0

NOTE:

In general, all chronic granulocytopenia ANC repeatedly under 2,000 per mm3 and recurrent systemic bacterial infections, duly certified for at least 3 times within 5 months prior to filing for disability qualification under the class IV deficiency 35%.

14.5 ALTERATIONS the reticuloendothelial system.

Splenectomy or failure in the development of this body before 5 years of age may be associated with changes in other organ systems. Any failure on these grounds should be assessed according to the affected system. If splenectomy is traumatic origin is given a 10% overall deficit. Abnormalities of the thymus with hyperfunction should be assessed in the chapters on the aftermath, his overactive benign or malignant tumors or absence of the thymus only be assessed in relation to the difficulties of the individual to develop their activities.

14.5.1 Criteria for the evaluation of reticuloendothelial system deficiency

TABLE No. 14.3. Global deficiency disorders of the reticuloendothelial system. Class Description of criteria Global Deficit (%)

I • There are symptoms or signs of reticuloendothelial disease; • And, you can perform activities of daily living with little or no difficulty. 5.0

II • There are symptoms and signs of reticuloendothelial disease; • And, can perform most daily tasks with little help from others. 20.0

III • There are symptoms and signs of reticuloendothelial disease. · Need continuous treatment; • And, you can not perform activities of daily living. 30.0

14.6 bleeding disorders or coagulation

Since people with bleeding disorders should avoid activities that may cause trauma, there will be an overall deficit of 5.0%. Any complications or complications, should be evaluated individually according to the criteria in the standards, regardless of the cause. The percentage value assigned to the complication, must then be combined with that calculated for the disorder.

Hemophilia 14.6.1

Given that there is a deficiency of clotting factors and therefore the hemophilia should avoid activities that might cause injury, is taken as a criterion to assign a percentage of overall deficit of 17.0%. Deficiencies caused by the disease were evaluated in the relevant chapters.

14.7 ALTERATION OF PLATELET

Since platelets have impaired people need to avoid activities that could cause trauma and constant need for hemostasis, an individual who has an established disorder in platelets, have a deficiency of 10%. The complications that may arise as a result of disorder in platelets, such as bleeding or thrombosis should be evaluated according to the criteria for the assessment of impairment of the affected system and then combined with the value determined for the disorder platelets.

Article 13th. - Book Two: OF DISABILITY

1. General:

This book complements the First and Third, to achieve the rating of disability within the principle of comprehensiveness. It is therefore necessary that the doctors of the Functional Assessment Committees and the Boards of the Disability Rating, understand very clearly what the impact of a deficiency in the operation causes physio-psycho-social of a person or a worker.

2. Definition of disability:

In Health experience, a disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Their top rating in the sum total of disability is 20%.

3. Nature of the disability:

The disability is characterized by excesses or deficiencies in performance and behavior in a normal routine activity, which can be temporary or permanent reversible or irreversible and progressive or regressive. Disabilities may arise as a direct result of the deficiency, or a response of the individual himself, especially the psychological, physical disability sensory or otherwise. Disability represents the objectification of a deficiency and as such, reflects changes at the level of the individual.

4. General Criteria for the classification of disability.

To qualify for disability must be taken into account the following criteria:

4.1. Concept of integrity: to award the disability is considered the human being as an open system composed of three subsystems.

a) Subsystem will: Government, singles, motivates and initiates execution. The will determine the "why we do what we do."

b) Habituation Subsystem: Organize what we do in patterns (habits and routines) whereas when we do.

c) subsystem performance: "It is that with what you have to do" and includes structures used to produce occupational performance.

4.2. The damage occurred in any of these subsystems leads to a particular disability is qualified.

4.3. To qualify for disability of occupational performance, human processes regarding occupational (work, recreation, leisure and self care) must take into account not only the main executing agency for such activities as such, but also the systems, organs and functions that support, provide feedback and take part in the execution of the activity evaluated.

4.4. Each of the disabilities other than disabilities of the situation has a different severity depending on the type of pathology as follows:

TABLE No. 1. Severity rating

STANDARD RATE

0.0 nondisabled

0.1 Difficulties in implementing

0.2 Implementation aided

Assisted implementation dependent, increased. 0.3

In awarding the score should be used for the previous table in each of the disabilities, taking into account not exceed the maximum value assigned to each category of disability.

5. Classification of disability

For a better understanding and ease of type of disability can be an individual, they have been divided into categories, each category in turn has a maximum score qualifying under the weight of each category is within the normal performance of an individual. The following table condenses the categorization and individual scores for qualifying.

TABLE No. 2. Classification of disabilities

Relationship categories and their individual maximum scores for qualification

MAXIMUM PERCENTAGE ASSIGNED Category

Behavioral disabilities 3.0

3.0 Communication Disabilities

Personal care disabilities. 3.0

Disabilities of locomotion 3.0

Disabilities of the disposition of the body 3.0

3.0 dexterity disabilities

2.0 Disability status

TOTAL SCORE 20.0

TABLE No. 3. List of disability categories and double digit scores. Indivi Category SCORING TYPE OF DISABILITY. Sum Total

1. 3.0 BEHAVIORAL DISABILITIES

Disability Awareness (10-16) 2.1

10 Disability Awareness 0.3 I

11 Disability in relation to the location in time and space 0.3

12 Other disability 0.3 Identification

Disability 13 0.3 Personal Safety

14 Disability in relation to the conduct situational 0.3

15 Disability in the acquisition of knowledge 0.3

16 Other educational disability 0.3

Disabilities relations (17 - 19): 0.9

17 0.3 Disability of family role

18 0.3 Disability of occupational role

19 0.3 Disability of the social role

2. 3.0 COMMUNICATION DISABILITIES

Speech disability (20-22) 0.9

Disability 20 0.3 understanding speech

21 0.3 Disability talk

22 Another disability talk 0.3

Disability hearing (23 - 24) 0.6

Disability 23 0.3 hearing speech

24 0.3 Another hearing disability

Disabilities to see (25-27) 0.9

25 Disability visual tasks together 0.3

26 Disability for detailed visual tasks 0.3

27 Other disability to view and similar activities 0.3

Other communication disabilities (28-29) 0.6

28 0.3 Disability type

29 Another 0.3 communication disability

3. 3.0 PERSONAL CARE DISABILITIES

Disabilities excretion (30-32) 0.9

30 0.3 Difficulty controlled excretory

31 0.3 Difficulty uncontrolled excretory

32 Disability to move and make use of sanitary or other elements for excretion. 0.3

Disabilities personal hygiene 0.6

Disability 33 0.3 bath

34 Other personal care disability 0.3

Fixed Disabilities (35-36) 0.6

35 Disabilities to put clothes 0.3

36 Another 0.3 fixed disability

Disabilities for feeding and other personal care (37-39) 0.9

37 Disability in food preparations 0.3

38 Another 0.3 feed disabled

39 Other personal care disability 0.3

4. 3.0 DISABILITIES MOVEMENT

Disabilities of ambulation (40-45) 1.8

40 0.3 Disability walk

41 0.3 Disability save slopes

42 0.3 Disability stairs

43 Another disabilities to climb 0.3

Disability to run 0.3 44

45 Another 0.3 ambulation disability

Disabilities from leaving (46 -47) 0.6

46 Disability to change positions in bed or chair. 0.3

Disability 47 0.3 transport use

Other disability in locomotion (48-49) 0.6

Up 48 0.3 Disability

49 Another 0.3 locomotion disability

5. DISABILITIES OF THE DISPOSITION OF THE BODY 3.0

Domestic Disabilities (50-51) 0.6

50 Disability to provide subsistence 0.3

51 Disability 0.3 housework

Disabilities body movement (1952-1957) 1.8

Disability 52 0.3 pick

Disabilities to reach 0.3 53

54 Another disability of arm function 0.3

55 0.3 Disability kneel

Disability 56 0.3 Crouch

57 Another body movement disabilities 0.3

Other disabilities in the provision of the body (58-59) 0.6

58 Impaired postural 0.3

59 Another provision of the disability of the body 0.3

6. 3.0 SKILL DISABILITIES

Disabilities in daily life (60-61) 0.6

60 Disability regular 0.3 environment

61 Another disability of daily life 0.3

Disabilities manual activity (62-66) 1.5

Disability 62 fingers to handle 0.3

Disability to grab 63 0.3

Disability 64 0.3 hold

65 Disability hand use 0.3

66 Other disability manual activity 0.3

Other dexterity disabilities (67-69) 0.9

Disability 67 0.3 foot control

68 Another Body Control disabilities 0.3

69 Another 0.3 dexterity disability

7. 2.0 DISABILITY STATUS

Disabilities dependency and resistance (70-71) 0.4

Unit 70 0.2 circumstantial

71 0.2 Disability in the resistance

Environmental Disabilities (1972-1977) 1.4

72 Disability relating to tolerance of temperature 0.2

73 Disability relating to tolerance of other climatic 0.2

74 Disability relating to tolerance to noise 0.2

75 Disability relating to tolerance of 0.2 Lighting

76 Disability relating to tolerance to stress at work 0.3

77 Disability relating to tolerance of other environmental factors 0.3

Other disability status (78) 0.2

Another 78 0.2 Status disabled

CHAPTER IBEHAVIORAL DISABILITIES

Refers to the restriction or lack of the ability of individuals to behave, both in daily life activities and in relation to others, either because of problems of consciousness, loss of motivation or learning difficulties. Excludes: Communication Disabilities (2)

DISABILITIES AWARENESS (10-16)

Awareness refers to having knowledge.

10 AD DISABILITY AWARENESS OF SELF

Includes: disturbance of the ability to develop or maintain a mental representation of self-identity of the subject or body (body schema) and its continuity over time, and behavioral disturbance resulting from the interference with conscience or sense of identity and confusion (inappropriate interpretation and response to external events, which is expressed by means of agitation, restlessness and noise). This disability is scored when present on a temporary or permanent.

10.1 Disability in the orientation of the body schema

Includes: disturbance of the mental representation of the subject's body, such as inability to differentiate right and left, experiences "phantom limb" and other similar phenomena.

10.2 In personal appearance

Includes: Souci for shaving or hair care status and bring dirty clothes. Dress and makeup in a careless manner, physical appearance very strange or inconsistent with the circumstances and the socio - cultural.

10.3 Other disturbance of the presentation of self

Includes: disturbance of the ability to offer a favorable image in social situations, such as not paying attention to social support routines (eg, waving, partying, thank, apologize, apologize, and reciprocity of all it) and lack of "presence" (eg, total lack of originality or excessive conformity in behavior). Excludes: Intentional Behavior unconventional (not a disability).

11 AD DISABILITY IN RELATION TO THE LOCATION IN TIME AND SPACE

Includes: disturbance of the subject's ability to properly identify external objects, events and himself in relation to the dimensions of time and space. This disability is qualified even if this temporarily.

DISABILITY IDENTIFICATION AD 12

Includes: disturbance of the ability to correctly identify objects and people.

This disability is qualified even if this temporarily.

12.1 Conduct out of context

Inappropriate conduct to the place, time, degree of maturity at the prevailing circumstances.

13 SECURITY DISABILITY PERSONAL AD

Includes: disturbance of the ability to avoid risks to the integrity of the body of the subject as being at risk of injury, being unable to react to protect themselves from any risk.

13.1 tendency to cause injury

Includes: Risk of suicide or self-inflicted injury or injury from loss of sensitivity.

13.2 Disability to ensure personal safety in special situations.

Includes: To be in danger in special situations such as those related to travel, transport and leisure, including sport. Excludes: Disability occupational role (18)

13.3 Conduct irresponsible or potentially dangerous to the subject himself

Includes: Leave the gas on or off the fire, throwing burning matches on carpet

13.4 Loss

Another 13.5 madness.

14 AD DISABILITY IN RELATION TO THE CONDUCT SITUATIONAL

Includes: disturbance of the ability to record and understand the relationships between objects and people in daily life situations. Excludes: personal safety Disability in special situations (13.2)

14.1 Disability understand situations

Includes: disturbance of the ability to perceive, record and understand the relationships between things and people.

14.2 Disability in interpreting situations

Includes: False interpretation of the relationships between people, things and their meaning.

14.3 Disability to address the situation

Includes: disturbance of the ability to perform in specific situations, such as those made outside of the house or in the presence of certain animals or other objects. Excludes: Disability behavior in critical situations (18.7)

15 AD DISABILITY IN THE ACQUISITION OF KNOWLEDGE

Includes: general disturbance of the ability to learn, as can be caused by deficiencies of intellect or ability to learn new skills.

16 OTHER DISABILITIES OF CHARACTER EDUCATION

Includes: Another disabilities to take advantage of educational opportunities due to the disruption of specific individual skills to acquire, process and retain new information. Excludes: due to communication disabilities (2) and other disabilities (3-7) Includes: Decline in mental function.

DISABILITIES OF RELATIONS (17-19)

17 AD DISABILITY FAMILY ROLE

17.1 Disability in participation in household activities.

Includes: Impaired ability to develop common activities such as regular meals together, doing household chores, going out together to visit, play games and watch TV and conducted during these activities, as well as the difficulty and lack of interest in decision making household matters, such as decisions relating to the children and money.

17.2 Disability in the marital role emotional.

Includes: disturbance of the affective relationship continued with their regular partner and communication (well, talking about the children, news and events of everyday life), ability to show affection and warmth (but excluding regular outbursts of anger or culturally irritability) and generate the feeling of being a source of support for the other spouse.

17.3 Disability marital role

This disability may exist because of a physical or mental. Includes: Disruption of sex with regular partner (including the practice of sexual intercourse and whether the subject and your partner are satisfactory sexual intercourse)

17.4 Disability parental role.

This disability may exist because of a physical or mental. Includes: disturbance of the ability to assume and perform the tasks of caring for children that correspond to the position of the subject at home (well, feed, into bed or take to school, so that relates to young children, and addressing the needs of children, in the case of older children) and to express interest in children (well, play with them, read a story and interested in the problems of children or homework)

17.5 Other family role disability.

AD 18 DISABILITY OF OCCUPATIONAL ROLE

Includes: disturbance of the ability to organize and participate in occupational activities, leisure or recreational routine.

Excludes: Disabilities of the situation (70-78)

18.1 Disability in motivation.

Includes: Interference with the ability to work under a severe deficiency of momentum.

18.2 Disability in cooperation.

Includes: Inability to cooperate with others and to "give and take" in social interaction.

18.3 Disability in the work routine

Includes: disturbance of other aspects of adaptation to the routine work (such as going to work regularly and on time, and observe the rules).

18.4 Disability for managing daily routines.

Includes: disturbance of the ability to organize activities according to a temporal sequence, and difficulty making decisions on issues of everyday life.

18.5 Other disability in the performance of work

Includes: Other difficulties in the conduct and results of the work.

18.6 Disability in recreational activities.

Includes: Lack of interest in leisure activities (such as watching television, listening to the radio, read newspapers or books, play games and have hobbies) and events of local and global levels (including efforts to obtain information).

18.7 Disability behavior in critical situations.

Includes: unsatisfactory or inappropriate responses to events (illness, accident or other incidents affecting a family member or others), emergency (like fire) and other experiences that would normally require a quick decision and action.

18. 8 Another occupational role disability.

Includes: For subjects who do not work, the disturbance of interest in getting a job or return to the old position, and the steps taken to achieve this goal. Excludes: Other social role disability (19.2)

19 AD DISABILITY SOCIAL ROLE.

This disability can occur as a result of mental or physical disability in the latter case, people may lose interest in social interaction. Includes: impairment of interpersonal relationships outside the home (friends, coworkers and the general community). Excludes: Disability occupational role (18).

19.1 Disability social interaction.

Includes: Conduct of the subject that involves difficulties in social interaction, either by excess or defect (withdrawal, irritability defendant or other frictions arising in social situations outside the home.) Excludes: Disability Awareness I (10) and identification (11-12)

19.2 Indifference to social norms accepted.

Includes: Conduct that is embarrassing (such as making suggestions or sexual innuendo, or not contained in the genital scratching or noisy farts release), disrespectful (such as singing, making silly jokes or impertinent remarks or showing too much familiarity) or histrionic (as express feelings in an exaggerated way, dramatic) Excludes: Intentional conduct or when it is proper behavior is itself a cultural context, not being a disability. .

19.3 antisocial behavior.

Includes: Severely maladjusted, psychopathic and delinquent

19.4 Other social role disability

Includes: Another behavioral disturbance in excess or defect that presents control problems (such as aggressiveness, destructiveness, hyperactivity and extreme attempt to get attention or extreme passivity).

CHAPTER II

COMMUNICATION DISABILITIES

Refer to the restriction or lack of subject's ability to generate and deliver messages and to receive and understand messages.

Speech disability (20-22)

DISABILITY 20 AD to understand speech.

Includes: loss or restriction on the ability to understand the meaning of verbal messages. Excludes: Disabilities to hear (23) and economic difficulties such as lack of local language.

21 AD TO DISCUSS DISABILITY.

Includes: loss or restriction on the ability to produce audible and verbal messages to convey meaning through talk.

22 OTHER DISABILITIES TALK

22.1 Disability understand other audible messages.

Excludes: Disabilities to hear (24)

22.2 Disability to express through speech codes substitutes.

Includes: loss or restriction on the ability to transmit information through a sign language code.

22.3 Other disability with substitute language codes.

Includes: loss or reduction of the ability to receive information through a code based on sign language.

Another 22.4

LISTEN DISABILITIES (23-24)

DISABILITY 23 AD TO HEAR SPEECH

Includes: loss or reduction of the ability to receive verbal messages.

24 OTHER DISABILITIES TO LISTEN

Includes: loss or reduction of the ability to receive voice prompts other

SEE DISABILITIES (25-27)

25 AD DUTY DISABILITY VISUAL SET

Includes: loss or reduction of ability to perform tasks that require adequate distant or peripheral vision.

DISABILITY 26 AD DETAIL visual tasks.

Includes: loss or reduction of ability to execute tasks requiring adequate visual acuity, such as reading, recognizing faces, write and perform manipulations that require sight.

27 OTHER DISABILITIES TO SEE AND SIMILAR ACTIVITIES

Excludes: Disability on tolerance to enlightenment. (75)

27.1 Disability for night vision

27.2 Disability for color recognition

27.3 Disability understanding Posts

Includes: loss or reduction of the ability to decode and understand messages written

27.4 Other disability to read written language

Includes: Difficulty for speed or stamina in reading

27.5 Disability to read other notation systems

Includes: loss or reduction of the ability to read Braille by a subject near vision disabilities who previously had this ability, or difficulty in learning this system of notation for a disabled individual in near vision.

27.6 Disability speechreading

Includes: loss or reduction of the ability to read lips for a disabled individual to listen to that previously had this ability, or difficulty learning this skill by an individual with a disability to listen.

OTHER COMMUNICATION DISABILITIES (28-29)

28 AD WRITING DISABILITY

Includes: loss or reduction of the ability to encode speech into written words and to make written messages or do graphic signs. It also includes the deficiencies at the level of disability to make hand writing. Exclusions: The rehabilitated, those with prosthetics, orthotics and / or attachments and can be written using them.

29 OTHER DISABILITY COMMUNICATION

29.1 Disability symbolic communication

Includes: loss or restriction on the ability to understand signs and symbols associated with conventional codes (eg, traffic lights and traffic signs, pictograms) and to read maps, charts and other simple schematic representations of objects.

29.2 Other disability nonverbal expression

Includes: loss or restriction on the ability to convey information by gestures, expressions and similar procedures.

29.3 Other disability nonverbal communication

Includes: loss or restriction on the ability to receive information through gestures, expressions and similar procedures.

29.4 Other Includes: communication disability NOS

CHAPTER III

PERSONAL CARE DISABILITIES

Refer to the subject's ability to take care with regard to basic physiological activities such as feeding and excretion, self-care, hygiene and clothing.

EXCRETION DISABILITIES (30-32)

30 DIFFICULTY excretory CONTROLLED

Control refers to the mitigation of the consequences of the excretory difficulty by a certain degree of regulation either by adaptive mechanisms, electrical stimulators, special protective clothing or other procedures, so that it is possible to lead a normal life.

30.1 Control by adaptive mechanisms

30.2 Control by electrical stimulators

30.3 Derivation gastrointestinal

Includes: ileostomy and colostomy

Excludes: small internal circuit operations (70.5)

30.4 IUC.

30.5 Other urinary diversion.

Includes: With abnormal opening (as cystostomy)

Excludes: small internal circuit operations (70.5)

30.6 Control by special protective clothing.

July 30 Another difficulty controlling excretory

31 DIFFICULTY excretory UNCONTROLLED

31.1 Severe double incontinence.

Frequency: Every night and every day

Includes: fecal incontinence and urinary incontinence.

Moderate double incontinence 31.2

Frequently than once a week, night and day.

Another 31.3 incontinence

Include fecal or urinary incontinence.

32 DISABILITY AD FOR MOVING AND USE OF HEALTH AND / OR OTHER ITEMS FOR EXCRETION

32.1 Associated with the difficulty of travel in the difficulty of the individual household to the toilet

32.2 Associated with the difficulty of moving and / or using toilet facilities outside the home.

32.3 Another difficulty for the use of sanitary facilities and other elements for excretion.

GROOMING DISABILITIES (33-34)

33 Disability swimming

Includes: Taking a bath, wash your whole body and back and then dried.

33.1 Associated with the difficulty of travel

Difficulty of the subject to move to the bathroom and the bathroom.

33.2 Another difficulty using the bathroom

33.3 difficulty using the shower

Another 33.4 bathing disability

34 OTHER DISABILITIES GROOMING

34.1 Wash face

34.2 Washing your hair

Includes: Wash the neck and ears

34 3 Hand Care

Includes: Wash and nail care

34.4 Foot Care

Includes: Wash and nail care

34.5 Health post-excretion

34.6 menstrual hygiene

34.7 Dental Hygiene

34.8 gender-specific care

Includes: Brushing and combing hair and shaving

DISABILITIES IN THE DRESS (35-36)

35 DISABILITY TO WEAR CLOTHES AD

Excludes: Footwear

35.1 Underwear

35.2 Lower Body

Includes: Wear skirts and pants

35.3 Over the shoulders and arms

35.4 Above Head

Includes: Stand blouses, shirts and nightgowns

35.5 Outerwear

Includes: Wear work clothes, coats and outerwear

35.6 Buckling

Includes: Fasten buttons, hooks and zippers

DISABILITY 36 AD TO ARRANGE

36.1 Hosiery

Includes: Mount hosiery

36.2 Footwear

Includes: Stand and tying shoes

36.3 Hands Protective Cover

36.4 headgear

Cosmetics 36.5

36.6 Another aspect of personal adornment

EATING AND OTHER DISABILITIES PERSONAL CARE (37-39)

37 AD DISABILITY IN THE PREPARATION OF FOOD

Serve drinks 37.1

Hold 37.2 beverage jars

37.3 Food Deal

Includes: serving food

37.4 Preparing food

Includes: Cut food and spread on bread with butter

37.5 eating utensils

Includes: Hold the cutlery and other eating utensils

38 OTHER DISABILITIES TO EAT

Drink 38.1

Includes: Getting food to the mouth and eat them (eg. Take a sip).

Food 38.2

Includes: Getting food to the mouth and swallowed.

Chewing 38.3

Includes: Chewing

38.4 Deep

Gastrostomy 38.5

Poor appetite 38.6

39 OTHER PERSONAL CARE DISABILITY

39.1 Difficulty in making use of bed and sleep.

Includes: difficulty waking up, inability to make the decision to go to bed and have sleep disorders.

Excludes: travel Handicap (46)

39.2 Difficulty in bed

Includes: Difficulty managing bedclothes

CHAPTER IV

LOCOMOTION DISABILITY

Refer to the subject's ability to perform activities associated with the movement characteristics from one place to another, of self and objects.

DISABILITIES ambulation (40-45)

40 DISABILITY WALKING AD

Include: Ambulation in flat

Excludes: Ability to maneuver in uneven terrain (41-43).

DISABILITY 41 HEIGHT DIFFERENCE TO SAVE AD

Includes: Ability to maneuver on uneven terrain and occasional negotiate steps between different levels.

Excludes: Flights of stairs (42) and other aspects of the rise (43).

DISABILITY 42 AD TO CLIMB STAIRS

Includes: Save stretches of artificial obstacles such as stairs and ladders.

Excludes: Steps casual (41)

OTHER DISABILITY TOP 43

Includes: Natural Barriers

ADES 44 RUNNING DISABILITY

45 other disability of ambulation

DISABILITY TO CHANGE POSITIONS

DISABILITY 46 AD TO CHANGE POSITIONS IN BED AND / OR IN THE CHAIR.

Join lying down 46.1

Includes: Difficulty getting up and lying in bed

Excludes: Difficulties getting in and unrelated to the movement itself

(39.0)

Joining 46.2 sitting

Includes: Difficulty in sitting and rising from a chair

Excludes: Problems associated with entering or leaving the health services (32) or into or out of a car (47.0)

46.3 Reach a bed or chair

Includes: Difficulty in reaching a bed or chair

DISABILITY 47 AD TO USE THE TRANSPORT.

47.1 Personal transport

Includes: Difficulties such as entering or leaving a car or use other forms of personal transportation. (Bike, bicycle, horse or other).

47.2 Other Vehicles

Includes: Up and off public transport

47.3 Another difficulty shopping at remote locations

Includes: Inaccessibility of the place until you reach a means of transportation (well, impossible to park vehicles close enough).

Excludes: Make purchases in the neighborhood (50.0) and lack of availability of transportation (which is a handicap).

47.4 Other transportation disability

Other disability that prevents you leave home

LOCOMOTION OTHER DISABILITIES (48-49)

Disability to lift 48

Includes: Carrying

Excludes: Difficulty lifting and carrying related only to the disability to provide a living (50).

49 Other disability in locomotion

Excludes: body movement Disabilities (52-57)

CHAPTER VDISABILITIES OF THE DISPOSAL OF BODY

Refer to the disability of a person to carry out activities associated with the disposal of body parts, can be for physical disability and / or mental disability in this case to perform these activities properly, and they include downstream activities such as performing tasks associated with the subject's home

Includes: Disability skill (6)

DOMESTIC DISABILITIES (50-51)

DISABILITY 50 AD TO PROVIDE TO KEEP

Seek the support 50.1

Includes: Make shopping in the nearby vicinity

Excludes: Make purchases in remote areas coupled with transport disabilities (47).

Transporting 50.2 support

Includes: Provide supplies at home before transporting them (like carrying shopping).

Open containers 50.3

Includes: Open cans

Preparing meals 50.4

Includes: Cut and bucking

Food Mix 50.5

Includes: Beat

50.6 solids Cooking

Includes: Pick up and serve pots and pans

50.7 Liquid Cooking

Includes: Handle and pour hot liquid containers.

50.8 Serving food

Includes: Carry trays

Hygiene of food utensils 50.9

Includes: Washing utensils after meals

51 Disability housework

51.1 Care Bedding

51.2 Wash small quantities

Includes: hand wash delicate (eg. Small or delicate items)

51.3 Wash in large numbers

Includes: washing large items and linens

51.4 laundry Dry

Includes: Wash, hang and extend

51.5 Clean Hand

Includes: Cleaning, dusting, scrubbing and polishing

Clean with aids 51.6

Includes: Sweep up and use machines to clean the floor (eg. Vacuums)

51.7 Caring for dependents

Includes: To assist children or other dependents of a tasks such as eating and dressing

BODY MOVEMENT DISABILITIES (52-57)

Excludes: those classified as domestic disability (50-51)

Disability to collect 52

Includes: Pick up objects from the floor and bend

Excludes: Pick up and carry small objects (61.3)

53 disabilities to achieve

Includes: reaching or stretching to catch them

54 Another disability of arm function

Includes: The ability to push or pull with the upper extremities

55 Disability kneel

56 Crouch Disability

Includes: Slouching

57 Another body movement disability

Includes: Head movements and neck.

57 Impaired postural

Includes: Difficulty in getting or keeping positions (eg. Disturbance of balance).

Exclusions: Those related with limited resistance (71)

59 Another provision of the disability of the body

Includes: Other difficulties in maintaining the proper relationships between different parts of the body

CHAPTER VIDISABILITIES OF SKILL

Refer to the skill and ability of body movements, including the manual skills and the ability to regulate the mechanisms of control. Exclusions: The ability to write or graphic signs.

DISABILITIES OF EVERYDAY LIFE (60-61)

DISABILITY 60 AD TO REGULATE THE ENVIRONMENT

60.1 Security Disability

Includes: Management of bolts and other fasteners (eg, doorknobs) and use of keys.

60.2 Disability Access

Includes: Opening and closing doors

60.3 Fire

Includes: Setting fire and light matches

60.4 Domestic Devices

Includes: Use of taps, pumps and outlets

60.5 Ventilation

Includes: Opening windows

Another 60.6

61 OTHER DISABILITIES OF EVERYDAY LIFE

61.1 Using the phone.

61.2 Currency

Includes: Money Management

61.3 Other delicate movements

Includes: Winding wristwatches and wall

61.4 Moving Objects

Includes: Pick up and carry small objects and objects do not fall.

Excludes: Pick up items (52).

DISABILITIES OF THE ACTIVITY MANUAL (62 - 66)

Excludes: Disability to write (28)

DISABLED DRIVER AD 62 FINGERS

Includes: Ability to handle with fingers

63 AD DISABILITY GRAB

Includes: Ability to hold or grasp objects and to move

DISABILITY 64 AD TO HOLD

Includes: The ability to freeze objects by subjecting them

DISABILITY 65 AD THE USE OF THE HAND

Includes: Disability Culture in a predominantly left-handed right hand

66 OTHER ACTIVITIES DISABILITY MANUAL

Includes: Other difficulties in coordination.

OTHER SKILLS DISABILITIES (67-69)

AD DISABILITIES TO CONTROL 67 FOOT

Includes: Ability to use the foot control mechanisms.

68 DISABILITY OTHER BODY CONTROL

Includes: Ability to use other parts of the body to regulate the mechanisms of control.

69 OTHER DISABILITIES OF SKILL

CHAPTER VIIDISABILITY STATUS

Although some of the difficulties embedded in this section are not strictly disturbances activity undertaken (in fact, some could be considered failures), they are included here for practical reasons, in particular as regards mutual specification of the environment (see the Book of Deficiencies).

DISABILITIES UNIT AND RESISTANCE (70-71)

Unit 70 Circumstantial

Includes: Unit equipment for preservation of life and special procedures to continue life support or active.

70.1 Dependent external mechanical equipment

Includes: Unit of any form of external machine guarantor of survival, such as vacuum machines, respirators and artificial kidney (dialysis), or any form of electromechanical equipment for the maintenance or expansion of potential activity.

70.2 Dependent internal devices for the preservation of life.

Includes: Cardiac Pacemaker

70.3 Depending on other internal devices

Includes: artificial heart valves and joint prostheses.

70.4 Dependent organ transplant

Includes: State posttransplant

70.5 Depending on other environmental changes inside the body.

Includes: Surgical operations in short circuit and the existence of artificial holes.

Excludes: removal of organs without functional consequences (and appendectomy or cholecystectomy) and artificial openings related to excretion (30) or food (38).

70.6 Depending on a special diet

Includes: Inability to eat the traditional dishes of the individual's culture.

70.7 Depending on medications that cause side effects or causing a disability. Includes discontinued medications that produce the individual symptoms that will prevent or hinder you rest or sleep.

70.8 Depending on sleeping medications and / or rest.

70.9 Depending on other forms of special attention, such as reliance on medications with side effects that cause disability.

Excludes: Dependence on the help of a third party (see would combine degrees of disability).

71 AD DISABILITY IN THE RESISTANCE

71.1 Disability to maintain positions

Includes: Sitting and standing

71.2 Disability in exercise tolerance

71.3 Disability in other aspects of endurance

71.4 Other disability on the resistance.

DISABILITIES ENVIRONMENTAL (72 - 77)

72. DISABILITY ON THE TEMPERATURE TOLERANCE.

72.1 intolerance to cold.

72.2 Heat intolerance.

72.3 intolerance to another aspect of ventilation.

73. Dicapac ON THE TOLERANCE OF OTHER FEATURES WEATHER

73.1 intolerance to ultraviolet light.

Includes: sunlight.

Excludes intolerance intense lighting.

73.2 intolerance to moisture.

Intolerance to extremes in barometric pressure.

Includes: intolerance and associated pressurization flight.

73.3 Unspecified.

74. DISABILITY ON THE NOISE INTOLERANCE

75. DISABILITY ON THE TOLERANCE TO LIGHTNING.

75.1 intolerance to bright light.

75.2 intolerance fluctuation in lighting.

76. DISABILITY ON THE TOLERANCE TO STRESS AT WORK

Includes: disability to cope with the speed, to excesses or other aspects of work pressure.

Excludes: disability attributable to occupational role.

77. DISABILITY ON THE INTOLERANCE OF OTHER ENVIRONMENTAL FACTORS

77.1 intolerance dust.

77.2 intolerance to other allergens.

77.3 Susceptibility to chemical agents.

Includes: associated with liver disease and derived from prior exposure to tolerable levels of toxic chemicals.

77.4 susceptibility to other toxins,

77.5 susceptibility to ionizing radiation.

Includes: the derivative of a previous exposure to radiation tolerable limits.

77.6 intolerance to other environmental factors.

78. OTHER DISABILITY STATUS

Includes: widespread restrictions in activity resulting from causes such as poor health of the subject or likely to suffer trauma.

ARTICLE 14th. - Book Three: OF DISABILITIES

1. General.

This new book complements the first two, noting in it the component that has the performance of work activity, ie, giving great strength to the effect of impairment and disability can have on the individual's residual earning capacity. It is therefore necessary that the doctors of the Functional Assessment Committees and the Boards of the Disability Rating, understand very clearly what the method of assessment of disability is intended, understood as the evaluation of the impact of impairment and disability on operation physio-psycho-social of a person or a worker.

2. Definition

Within the health experience, disability is a disadvantage for a given individual, resulting from an impairment or disability that limits or prevents the fulfillment of a role that is normal for you (depending on age, sex, social and cultural factors). Their top rating in the sum total of disability is 30%.

3. Features

The disability is related to the value attributed to the situation or experience of an individual when it departs from the norm. It is characterized by the discrepancy between the performance or status of the individual and the expectations of the individual himself or the particular group to which it belongs. The disability is, therefore, the socialization of an impairment or disability, and as such reflects the cultural, social, occupational, economic and environmental for the individual arising from the presence of impairment and disability. The disadvantage arises from the failure or inability to meet the expectations or standards of the universe of the individual. Thus, the disability occurs when an obstruction in the ability to maintain what could be called "survival roles."

Relationship dimensions of disability survival Roles: A six key dimensions of experience that are expected to show the competence of the individual designated as the roles of survival. For each of these dimensions has made a scale based on the greater range of circumstances that can apply. In contrast to the impairment and disability classifications, for which individuals are identified only in the categories that apply to it, the classification of disability is desirable that the individual is always identified in each

Size or role of survival. This may be drawn a profile of their disadvantaged status.

4. Classification of disability

For a better understanding and ease of type of disability can be an individual, they have been divided into categories, each category in turn has a maximum score qualifying under the weight of each category is within the normal performance of an individual. In Table A, condenses this categorization and individual scores for qualifying.

TABLE No. 1. Classification of disability

Aspect ratio and individual scores for the grade:

MAXIMUM PERCENTAGE ASSIGNED Category

1 handicap orientación2.5

2 Physical Independence Handicap 2.5

3 2.5 Disability Travel

4 15.0 Occupational Disability

5 Handicap social2.5 integration

Economic self-sufficiency 6 Handicap 2.5

7 Handicap based on the Ages 2.5

TOTAL 30.0

General rules for the allocation of the disability:

1. If there is doubt about the category to be assigned to a person, should incluírsele in

Less favorable category. That is, one with a higher score.

2. A person must be assigned the category according to their actual situation and not according to what the appraiser thinks it may be able to perform.

Table No. 2: Summary of categories of disability by codes and rating scores:Category Score1. GUIDANCE DISABILITIES

10. 0.0 Fully oriented

11. Impediment to orientation, fully compensated (not in categories 2-9). 0.5

12. Impediment to orientation, offset but requires additional support 1.0

13. Impediment to the uncompensated orientation. 1.5

14. 2.0 Lack of guidance

15. 2.5 unconsciousness

2. PHYSICAL DISABILITIES OF INDEPENDENCE

20. 0.0 fully independent

21. Independence 0.5 support

22. Adapted Independence 1.0

23. Situation Unit 1.5

24. 2.0 Unit assisted

25. Special Care Unit and / or permanent 2.5

3 TRAVEL DISABILITIES

30. 0.0 full displacement

31. 0.5 intermittent movement restrictions

32. Displacement 1.0 poor

33. Displacement reduced the scope of the neighborhood 1. 5

34. Displacement reduced the scope of the home. 2.0

35. Confining the scope of the chair or bed. 2.5

4. OCCUPATIONAL DISABILITIES

40. Normally occupied 0.0

41. Occupation trimmed 2.5

42. Occupation adapted 5.0

43. 7.5 Change of occupation

44. Reduced occupancy 10.0

45. Occupancy restricted or confined protected 12.5

46. No possibility of occupying 15.0

5 DISABILITIES SOCIAL INTEGRATION

50. Socially integrated 0.0

51. 0.5 Participation inhibited

52. Decreased 1.0 Participation

53. Participation impoverished. 1.5

54. Reduced 2.0 Relations

55. 2.5 Social Isolation

6 MINUSVALIADE ECONOMIC SELF-SUFFICIENCY

60. Fully self-sufficient 0.0

61. 0.5 self

62. Self-sufficiency 1.0 adjusted

63. Self precariously 1.5

64. Economically weak 2.0

65. Economically inactive 2.5

7. DISABILITIES IN TERMS OF AGE

71. Under 18 years. 2.5

72. 18 to 29 years. 1.25

73. 30 to 39 years. 1.75

74. 40 to 49 years. 2

75. 50 to 54 years 2.25

76. 55 or more years. 2.5

Note: The share of disability on the basis of age, will be allocated according to age on the individual at the time of qualifying.

CHAPTER I

GUIDANCE DISABILITIES

1.1 DEFINITION

It is the disadvantage of the individual to manage their environment due to the alteration of the function of consciousness, which involves the notion of oneself, one's own body or the time and space in which it is. This disability can occur from a deficiency.

1.2 Features

1.2.1 Matters of scale

Guidance on the environment, including reciprocity or interaction with the environment. Includes: The reception of signals from the environment (for example, to see, hear, smell or touch), the assimilation of these signals and the formulation of responses to the assimilated, the impact of disabilities and behavior including communication plans of seeing, hearing, touching, talking and the assimilation of these functions by the mind.

1.2.2 Category of scale:

10 0.0 Fully oriented

11 Impediment to fully offset orientation 0.5

With the constant use of aid managed to compensate in full and always impediments to orientation, or once the crisis. Excludes: Aid or drugs used intermittently.

12 Impediment to 1.0 compensated orientation

Individuals who use aid though, need special environmental conditions.

13 Impediment to 1.5 uncompensated orientation

Despite the continued use of aids or medication in any event the person has some disorientation because they do not look good, do not listen well, you feel any numbness in touch, do not perceive pain, heat, cold, or recognize objects by touch or confused need help from another person to feel safe.

14 serious impediments 2.0 orientation

Impairment of orientation is not compensated despite their individual support and special environmental conditions.

15 Lack of guidance and unconsciousness 2.5

Cases in which the individual is unable to orient in their environment.

CHAPTER II

PHYSICAL INDEPENDENCE HANDICAP

2.1 DEFINITION

The disadvantage of the individual is caused by loss or decrease of physical autonomy, stemming from their difficulty or inability to perform activities of daily living.

2.2 Features

2.2.1 Field of the scale.

Independent of aid and other assistance.

Includes: Personal care and other activities of daily living.

Excludes: aid or assistance for orientation (loss of orientation, 1).

2.2.2 scale categories:

Fully Independent 20 0.0

Includes: Independence in personal care and without dependence on aid, devices, modifying the environment or assistance from other people, or less aid dependent not only essential for independence.

21 0.5 Physical independence using

Requires the use of aids and devices to be completely independent in their work environment, social and cultural.

Exclusions: The use of aids and devices for guidance.

1.0 22 Independence adapted physical

Requires: besides the use of aids and devices, changes in their environment.

Unit 23 situational 1.5

The individual in addition to requiring aid, devices and environmental modifications fails physical independence and requires occasional help from others to needs that arise at least every 24 hours.

24 2.0 Unit assisted

The individual depends on the continued availability of others to assist it in its basic activities of daily living.

25 Special Care Unit and / or permanent 2.5

The individual requires constant attention for 24 hours.

CHAPTER III

DISABILITY TRAVEL

3.1 Definitions

It is the disadvantage of the individual derived from the reduction or loss of ability to move effectively in their environment.

3.2 Features

3.2.1 Matters of scale

Scope of mobility from a reference point: the bed of the individual.

Includes: individual capabilities should be increased when using prostheses or other physical aids, including wheelchair (all must be identified in categories 1 or 2 of the handicap of physical independence.

3.2.2 Scale Categories

30 Full Displacement: 0.0

The individual can move freely and quickly.

31 Restriction Intermittent displacement: 0.5

The individual is restricted from moving intermittently by attack of the disease in the intercritical periods or phases of remission appear normal.

32 Displacement 1.0 poor

The individual due to their condition, make great efforts to fatigue, or experience insecurity which interferes with their movement.

33 Displacement reduced to 1.5 area neighborhood

The individual because of their condition, can only modest efforts that restrict their movement to areas of the neighborhood itself.

34 Displacement reduced the scope of the registered 2.0

The individual because of their condition can only make small efforts that restrict their movement, the scope of the home.

35 confined to the realm of the chair or bed 2.5

The individual because of their disease remains restricted to the area of ​​the bed or chair.

3.2.3 Rules for allocation

a) Include the individual in the category that you agree with each of their skills of independence, taking into account aids and devices and the modification or adaptation of their immediate environment, but without those gains due to the help of others. Thus, the questions to classify in categories 3 and 4 can be classified when the company gives other people, even though this dependence on others should rather be identified under the handicap of physical independence between categories 3 to 5 as be more appropriate.

.

b) The occasional reduction or restriction of mobility should not preclude the assignment of a category less disadvantaged (ie, with a lower score).

c) aids or adaptations are intended to provide or prescribe should not be taken into account.

Note 1. You may be having difficulties when it comes to opt for one or another category, such as when trying to choose between 2 and 3 in areas where there is no public transport system. In such cases the individual should be included in the category less favorable, as indicated by the rule d) and can only be included in Category 2 if there is a special vehicle. This criterion also applies even in cases in which the occupation or lifestyle of the individual does not require full mobility, this is only an effort that should be done to change its category when these events may affect it.

Note 2. The degree of disadvantage depends on cultural norms and this can clearly see a problem in urbanized societies. The attitude of bus drivers in an area may be an impediment for people with disabilities who live in it, to the point that they stop using public transport, whereas in another area where drivers have a more comprehensive, there will be people with the same type of disability such transport used without problems. This is a clash between a category semantic consistency means the same everywhere and the possibility that the classification reflects the individual's needs. The classification of disability is conceived primarily in relation to this objective, and only secondarily for cross-cultural comparisons.

CHAPTER IVOCCUPATIONAL DISABILITY4.1 DEFINITION

It is the disadvantage of the individual derived from the reduction or loss of their ability to perform gainful employment for which the individual has been trained and / or contracted.

4.2 Characteristics

To quantify this disability must be taken into account the following criteria:

a) Socio - demographic: gender, age, culture, level of education (formal and informal).

b) Results of the comprehensive rehabilitation of the worker understood as rehabilitation, resettlement, rehabilitation and conversion. The assessment of occupational disability requires judicious comparison between the characteristics and capabilities of workers (Profile) and characteristics and requirements of the job or task to perform (job evaluation). Occupation is the ability of an individual to spend time in the usual manner taking into account their sex, age, educational background and culture.

4.3 Category scale

Usually occupied 40 0.0

The individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation or not, is able to perform their regular work or other higher occupational status and economic competitive conditions, and can work throughout the workday. The individual occupying the whole of their days a week, without presenting any trouble that develops specific occupation, such as study, work and household tasks.

41 Occupation trimmed 2.5

The individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation, is capable of performing his regular work, one performing the basic tasks and not some secondary without affecting competitiveness, working for throughout the workday.

42 Occupation adapted 5.0

The individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation, is able to perform their regular work, with job changes and / or attachments, or occupation similar tasks under competitive conditions, and can work throughout the workday.

43 7.5 Change of occupation

EI individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation, can not perform to their usual work or other similar nature and necessarily must be trained to develop competencies and skills that will enable it to implement a new trade. This new occupation can maintain their occupational status and socioeconomic status.

Guests 10 44 Occupation

The individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation, can not recover or acquire skills and abilities that allow them to develop or practice a new skill with which it can maintain its status occupational and socioeconomic status. Implies decrease in working hours and non-competitive.

45 Occupation restricted or confined protected 12.5

The individual is in a state in which, as a result of illness or accident and after comprehensive rehabilitation, their limitations are so severe that only allow you to develop work at home or in an institution. You may have some compensation, but its purpose is to occupy the time.

46 No 15 job possibilities

The individual is in a state as a result of illness or accident and after full rehabilitation, which is not able to develop or work activities to occupy their time.

4.2.3 Rules for allocation

a) The fact that occasionally give less favorable experiences should not be precluded from assignment to a category that represents a lesser degree of disadvantage (ie with a lower score).

CHAPTER VDISABILITY SOCIAL INTEGRATION5.1 Definition

It is the disadvantage of the individual derived from the reduction or loss of their ability to participate and maintain social relations that correspond to the basis of their socio - cultural.

5.2 Features

5.2.1 Matters of scale

Contact the individual level with a widening circle, taking as reference the individual.

5.2.2 Categories Socially integrated scale 50 0.0 The individual participates in all the usual social relationships.

51 0.5 The Individual Participation inhibited due to its pathology is inhibited from participating in the full range of social activities that correspond to their sociocultural context (including shyness, embarrassment and other cases arising from image problems because of a disfigurement or other deficiencies and disabilities) and some deficiencies in personality or behavior disabilities mild.

52 share declined 1.0

The individual because of his pathology is inhibited from participating in the full range of social activities involving strangers, but the situation may experience improvement.

53 Participation Impoverished 1.5

The individual because of his condition only has relationships with parents, spouse, or children with no signs of improvement.

54 small 2.0 Relations

The individual because of their disease, has serious difficulties to interact even with their parents, spouse, children or siblings.

55 2.5 Social Isolation

The individual because of his disease has severe difficulties in relating to any person which is required permanent institutional care.

5.2.3 Rules for assignment:

a) The occasional loss of social contact should not prevent the assignment of a category that represents a lesser degree of disadvantage (ie that has a lower number).

CHAPTER VIEconomic Self-Sufficiency DISABILITIES6.1 Definition

It is the disadvantage of the individual derived from the reduction or loss of its ability to meet their needs and expenses incurred by the pathology directly related to the loss of working capacity.

6.2 Characteristics

6.2.1 Matters of scale

Refers mainly to economic self-sufficiency, from the point of reference for the total absence of economic resources, but unlike other disability scales, matter has expanded here to take into account the possession or control of a number of resources higher than normal, this expansion is done taking into account the abundance of resources may enlarge or reduce the disadvantage experienced in other dimensions.

Includes: Self-sufficiency of individuals to fulfill their obligation to support others, such as members of their family economic self-sufficiency achieved through compensation or disability pension, disability or retirement, but excluding special allowances received to relieve a poverty, economic self-sufficiency based on income (the result of work or any other source) or material possessions, such as natural resources, livestock or crops, and poverty situations produced or increased by an impairment or disability.

Excludes: economic difficulties are not caused by a deficiency or disability.

6.2.2-scale categories:

0.0 The 60 fully self-sufficient individual has sufficient resources to meet all your needs.

0.5 Self-Sufficiency 61

The individual regardless of their pathology is little affected the substitution of their needs and can easily cover their costs of their pathology.

62 Self-sufficiency 1.0 adjusted

The individual as a result of their disease significantly affected their economic situation, requiring the input of other household members to meet all your needs and costs of their pathology.

63 1.5 precariously self

The individual as a result of their condition severely affected their financial situation, so depending on family income to meet personal and family needs and expenses arising from their condition.

Economically weak 2.0 64

The individual as a result of their condition can only meet their basic needs (housing, food and clothing).

Economically Inactive 65 2.5

The individual as a result of their condition can not cover any of your needs or have family support, or others.

6.2.3 Rules for assignment:

a) Assign a category to the individual considering the sufficiency of their families, regardless of their situation dependent.

b) An occasional decrease in economic self-sufficiency should not be inconvenient for the allocation of a category that represents a lesser degree of disadvantage (ie, one with a lower number).

c) not be taken into account pensions and other fringe benefits that he receives in the future.

ARTICLE 15. REVIEW AND UPDATING OF THE MANUAL.

This Unique Handbook of Disability Qualification is subject to review and update its content, in part by chapters or books, or all, according to the scientific and technological development of the health sciences and like the baremología worldwide.

ARTICLE 16. EFFECTIVE DATE AND REPEAL. 

This decree from the date of publication and repeals Decree 692 of 1995 and all rules that are contrary.

PUBLISHED AND ENFORCED

As in Santafe de Bogota, the

HERNANDO ASILAH YEPES

Minister of Labour and Social Security

Virgilio Galvis Ramirez

Minister of Health