A-25, r. 2 - Regulation respecting permanent impairments

Table of contents
Full text
chapter A-25, r. 2
Regulation respecting permanent impairments
AUTOMOBILE INSURANCE — PERMANENT IMPAIRMENTS
Automobile Insurance Act
(chapter A-25, s. 195, par. 12)
A-25
September 1 2012
This Regulation remains in force and continues to apply to accidents and deaths having occured between 1 January 1990 and 31 December 1999. (1999, chapter 22, s. 44)
DIVISION I
SCHEDULE OF PERMANENT IMPAIRMENTS
1. The schedule of permanent impairments and the percentages assigned for each impairment appear in Schedule I.
O.C. 1921-89, s. 1.
DIVISION II
ENHANCEMENT FOR SYMMETRICAL ORGANS
1.1. Where permanent anatomicophysiological deficits affect internal organs or organs controlling vision, balance and hearing, an enhancement factor taking bilaterality into account is already included in the percentages set forth in Schedule I.
O.C. 766-96, s. 1.
1.2. Where permanent impairment of organs or symmetrical limbs is the result of damage to the central nervous system, an enhancement factor taking inherent bilaterality into account is already included in the percentages set forth in Schedule I.
O.C. 766-96, s. 1.
2. Where permanent anatomicophysiological deficits affect symmetrical limbs or a limb symmetrical to one that is already impaired, the average of the percentages of the anatomicophysiological deficits for both limbs is multiplied by an enhancement factor of one-quarter, up to the sum of percentages of the lesser damaged limb.
The average is obtained by adding together the percentage of anatomicophysiological deficit of each of the two symmetrical limbs and dividing the sum by 2.
The percentage so obtained is added to the percentages of anatomicophysiological deficits resulting from the accident.
Symmetrical deficits are established on a limb-to-limb basis: the upper right limb with the upper left limb and the lower right limb with the lower left limb. The upper limb includes the scapula and clavicle. The lower limb includes the pelvis.
O.C. 1921-89, s. 2; O.C. 766-96, s. 2.
3. (Revoked).
O.C. 1921-89, s. 3; O.C. 766-96, s. 3.
4. The percentage of a deficit prior to the accident is fixed, for purposes of applying section 2, according to the schedule appearing in Schedule I, or, if this deficit is not mentioned in the schedule, according to deficits of the same type mentioned therein.
O.C. 1921-89, s. 4.
DIVISION III
COMPUTATION ON SUCCESSIVE REMAINDERS
5. Where a victim has several permanent impairments, the percentage of the most important impairment is computed on the basis of 100% and the percentages of the other impairments, starting with the highest, are computed on the successive remainders, in accordance with Schedule II.
O.C. 1921-89, s. 5.
6. The method for computing provided in section 5 does not apply to a percentage of 5% or less attributed to a permanent impairment, as such percentage must be added in full to the other percentages.
It does not apply either to the percentage obtained by applying the enhancement factor referred to in section 2.
O.C. 1921-89, s. 6.
DIVISION IV
COMBINATION OF THE COMPUTATION ON SUCCESSIVE REMAINDERS AND THE ENHANCEMENT FOR SYMMETRICAL ORGANS
7. Where Divisions II and III both apply to a victim, the percentage resulting from the enhancement factor is first computed, but is only added to the other percentages of deficits once the computation on successive remainders has been made.
O.C. 1921-89, s. 7.
8. (Omitted).
O.C. 1921-89, s. 8.
SCHEDULE I
(ss. 1, 1.1, 1.2 and 4)
SCHEDULE OF PERMANENT IMPAIRMENTS
PART I
ANATOMICOPHYSIOLOGICAL DEFICITS
TITLE I
MUSCULO-SKELETAL SYSTEM
DIVISION I
UPPER LIMB AND SCAPULA
(1) Amputation:
(1) Inter-scapulo-thoracic disarticulation: 60%
(2) Disarticulation at the shoulder: 56%
(3) Amputation near the shoulder: 54%
(4) Amputation at the middle third of the arm: 52%
(5) Disarticulation at the elbow or amputation near the elbow: 50%
(6) Amputation at the middle third of the forearm: 47%
(7) Disarticulation at the wrist: 45%
(2) Clavicle, scapula and thoracic cage:
(1) Clavicle and scapula:
(a) acromioclavicular or sternoclavicular dislocation requiring or not requiring resection: 2%
(b) partial acromioclavicular or sternoclavicular dislocation: 1%
(c) pseudarthrosis or faulty consolidation: 1%
(2) Sternum:
(a) pseudarthrosis or faulty consolidation: 1%
(b) loss of xiphoid process: 0.5%
(3) Rib fractures:
— pseudarthrosis or faulty consolidation: 0.5%
(3) Humerus:
(1) Axial deviation:
(a) of more than 15°: 3 to 5%
(b) between 10° and 15°: 2.5%
(c) between 5° to 10°: 1.5%
(2) Shortening:
(a) of more than 4 cm: 5%
(b) between 2 and 4 cm: 3%
(c) of less than 2 cm: 1.5%
(4) Shoulder:
(1) Functional limitations: depending on the degree of ankylosis
(2) Rupture of the rotator cuff, including reduction of muscular strength and atrophy, if applicable: depending on the degree of ankylosis
(3) Complete ankylosis, including the loss of the head of the humerus and shortening, if applicable:
(a) with complete ankylosis of the scapula: 25%
(b) in a faulty position with the scapula being functional: 20%
(c) in functioning position with the scapula being functional: 15%
(4) Incomplete ankylosis:
(a) from reduction to loss of abduction: 0.5 to 6%
(b) from reduction to loss of front elevation: 0.5 to 3%
(c) from reduction to loss of external rotation: 0.5 to 2%
(d) from reduction to loss of internal rotation: 1%
(e) from reduction to loss of abduction or extension: 0.5%
(5) Loss of the head of the humerus, including its prosthetic replacement and any shortening: 5%
(5) Biceps:
— Musculo-tendinous rupture, including any reduction of muscular strength and atrophy: 2%
(6) Elbow:
(1) Functional limitations: depending on the degree of ankylosis
(2) Complete ankylosis in a faulty position, including loss of the radial head and any shortening: 14%
(3) Complete ankylosis in functioning position between 60° and 110°, including loss of the radial head and any shortening: 12%
(4) Incomplete ankylosis:
(a) extension:
i. reduction of more than 100°: 6%
ii. reduction between 75° and 100°: 5%
iii. reduction between 50° and 74°: 3%
iv. reduction between 25° and 49°: 2%
v. reduction of less than 25°: 1%
(b) flexion:
i. reduction of more than 100°: 6%
ii. reduction between 75° and 100°: 5%
iii. reduction between 50° and 74°: 3%
iv. reduction between 25° and 49°: 2%
v. reduction of less than 25%: 1%
(5) Loss of the radial head, including its prosthetic replacement if applicable: 2%
(7) Forearm:
(1) Functional limitations: depending on the degree of ankylosis
(2) Ankylosis:
(a) loss of pronation and supination in a faulty position: 9%
(b) loss of pronation and supination in functioning position: 8%
(c) reduction of pronation down to loss of movement: 1 to 4%
(d) reduction of supination down to loss of movement: 1 to 4%
(3) Axial deviation: 1 to 3%
(4) Loss of the distal end of the cubitus: 2%
(8) Wrist:
(1) Functional limitations: depending on the degree of ankylosis
(2) Complete ankylosis:
(a) complete ankylosis, in a faulty position with more than 10° of cubital or radial inclination or with more than 30° of dorsiflexion or palmar flexion: 8%
(b) complete ankylosis, in functioning position from 0 to 20° of dorsiflexion and in neutral position of radial or cubital inclination: 6%
(3) Incomplete ankylosis:
(a) from reduction to loss of flexion: 0.5 to 2%
(b) from reduction to loss of extension: 0.5 to 2%
(c) from reduction to loss of cubital laterality: 0.5%
(d) from reduction to loss of radial laterality: 0.5%
(4) Loss of scaphoid or lunate, including its prosthetic replacement, if applicable: 1%
(5) Pseudarthrosis or avascular necrosis of the scaphoid or lunate: 1%
(6) Alteration of tissue following a decompression of the median nerve in the Carpal tunnel: 0.5%
(9) Hand:
(1) Amputation, including the loss or reduction of dexterity, as the case may be:
(a) of the hand: 45%
(b) of the last 4 fingers: 30%
(c) of the thumb:
i. 2 phalanges: 15%
ii. 1 phalanx: 10%
(d) of the metacarpus:
i. first metacarpus: 10%
ii. 2nd or 3rd metacarpus: 4%
iii. 4th or 5th metacarpus: 3%
(e) of fingers other than the thumb: according to Tables 1, 2 and 3
(2) Ankylosis, including the loss or reduction of dexterity, as the case may be:
(a) of the thumb: 1 to 7.5%
i. ankylosis of the 2 joints: 1 to 7.5%
ii. ankylosis of the metacarpophalangeal joint: 1 to 3%
iii. ankylosis of the interphalangeal joint: 1 to 2.5%
(b) of a finger other than the thumb: according to Tables 1, 2 and 3
TABLE 1
(s. 9)
VALUE OF EACH OF THE PHALANGES WHEN A FINGER, OTHER THAN THE THUMB, IS ANKYLOSED IN A FAULTY POSITION OR IS PARTIALLY OR TOTALLY AMPUTATED (whether or not due to the accident).
Value of each of the phalanges when a finger, other than the thumb, is ankylosed in a faulty position or is partially or totally amputated (whether or not due to the accident).
NOTE: When the thumb is also impaired, the lesser of the 2 percentages anatomicophysiological deficit is multiplied by 2.
TABLE 2
(s. 9)
VALUE OF EACH OF THE PHALANGES WHEN 2 OR 3 FINGERS, OTHER THAN THE THUMB, ARE ANKYLOSED IN A FAULTY POSITION OR ARE PARTIALLY OR TOTALLY AMPUTATED (whether or not due to the accident).
Value of each of the phalanges when 2 or 3 fingers, other than the thumb, are ankylosed in a faulty position or are partially or totally amputated (whether or not due to the accident).
TABLE 3
(s. 9)
VALUE OF EACH OF THE PHALANGES WHEN 4 FINGERS, OTHER THAN THE THUMB, ARE ANKYLOSED IN A FAULTY POSITION OR ARE PARTIALLY OR TOTALLY AMPUTATED (whether or not due to the accident).
Value of each of the phalanges when 4 fingers, other than the thumb, are ankylosed in a faulty position or are partially or totally amputated (whether or not due to the accident).
DIVISION II
PELVIS AND LOWER LIMB
(10) Pelvis:
(1) Deformity, pubic disjunction or sacro-iliac injury, including dystocia, if applicable:
(a) severe: 2 to 4%
(b) minor: 1%
(2) acetabular impairment: according to the ankylosis of the hip
(11) Amputation and shortening:
(1) Hemipelvectomy: 50%
(2) Disarticulation at the hip or amputation near the hip, within 10 cm of the end of the greater trochanter: 45%
(3) Amputation at the middle third of the thigh: 40%
(4) Disarticulation of the knee, supra-condyler amputation, or amputation below the knee, not permitting the wearing of a prosthesis with patellar support: 35%
(5) Amputation below the knee permitting the wearing of a prosthesis with pattelar support: 30%
(6) Amputation at the ankly (Symes): 20%
(7) Mediotarsal amputation (Chopart): 18%
(8) Tarsometatarsal amputation (Lisfranc): 12%
(9) Transmetatarsal amputation: 10%
(10) Amputation of all 5 toes: 7%
(11) Amputation at the distal end of the 1st metatarsal bone: 5%
(12) Amputation of the big toe: 3%
(13) Amputation of the distal end of the 5th metatarsal bone: 2%
(14) Amputation of a phalanx of the big toe: 2%
(15) Total or partial amputation of the 2nd, 3rd, 4th and 5th toes, per toe: 1%
(16) Shortening:
(a) shortening by 7.5 cm or more: 10%
(b) shortening by 6.5 cm but less than 7.5 cm: 8%
(c) shortening by 5.5 cm but less than 6.5 cm: 6%
(d) shortening by 4.5 cm but less than 5.5 cm: 5%
(e) shortening by 3.5 cm but less than 4.5 cm: 3%
(f) shortening by 2.5 cm but less than 3.5 cm: 2%
(g) shortening by more than 1 cm but less than 2.5 cm: 1.5%
(17) Atrophy of the thigh or leg:
(a) Muscular atrophy of the thigh of 2 cm or more, measured 15 cm above the upper pole of the patella, including any resulting muscular weakness: 2%
(b) Muscular atrophy of the leg of 1.5 cm or more, measured 15 cm below the lower pole of the patella, including any resulting muscular weakness: 2%
(12) Hip:
(1) Loss of the head and neck of the femur without a replacement prosthesis, including ankylosis and shortening of the lower limb: 30%
(2) Loss of the hip or the head of the femur replaced by a total prosthesis, including any shortening of the lower limb: 15%
(3) Loss of the head of the femur replaced by a cephalic prosthesis, including any shortening of the lower limb: 10%
(4) Total ankylosis:
(a) in faulty position: 25%
(b) in functioning position: 20%
(5) Partia ankylosis:
(a) from reduction to loss of flexion: 1 to 8%
(b) from reduction to loss of abduction: 1 to 4%
(c) from reduction to loss of external rotation: 1 to 3%
(d) from reduction to loss of internal rotation: 0.5 to 2%
(e) from reduction to loss of extension: 0.5 to 2%
(f) from reduction to loss of abduction: 1%
(6) Deformity of the head or neck of the femur, without acetabular impairment: 0.5 to 2%
(13) Femur:
(1) Single or multiple axial angulation:
(a) more than 20°: 4%
(b) from 10° to 20°: 2%
(2) Faulty rotation:
(a) more than 20°: 4%
(b) from 10° to 20°: 2%
(14) Knee:
(1) Complete ankylosis:
(a) in a faulty position, including any loss of the patella, shortening, recurvatum, varus, valgus, rotation as well as muscular atrophy and muscular weakness of the thigh: 20%
(b) in functioning position, including any loss of the patella, shortening by 3 cm or less, recurvatum, varus, valgus, rotation as well as muscular atrophy and muscular weakness of the thigh: 15%
(2) Incomplete ankylosis:
(a) from reduction to loss of extension:
i. over 35°: 9 to 18%
ii. from 20° to 35°: 5 to 8%
iii. under 20°: 1 to 4%
(b) from reduction to loss of lexion:
i. over 80°: 6 to 12%
ii. from 20° to 80°: 2 to 5%
iii. under 20°: 0.5 to 1.5%
(3) Knee impairment, including any shortening of the lower limb:
(a) requiring a total prosthesis: 8%
(b) requiring a partial prosthesis: 3%
(4) instability:
(a) severe, requiring the regular wearing of an orthosis: 7%
(b) moderate, requiring the occasional wearing of an orthosis: 4%
(c) minor, not requiring the wearing of an orthosis: 2%
(5) Functional limitations following a tendinous rupture, including muscular weakness and muscular atrophy of the thigh of less than 2 cm: 0.5 to 2%
(6) Recurvatum of more than 10°: 2%
(7) Varus of more than 10°: 2%
(8) Valgus of more than 10°: 2%
(9) Rotation of more than 10°: 2%
(15) Patella and meniscus:
(1) Loss of the patella, including muscular atrophy of the thigh: 5%
(2) Rotular or femoropatellar syndrome: 1%
(3) Alteration of the patella, including any muscular atrophy of the thigh of less than 2 cm: 0.5 to 2%
(4) Alteration of the internal or external meniscus up to its loss, including any muscular atrophy of the thigh of less than 2 cm: 0.5 to 2%
(16) Leg:
(1) Single or multiple axial angulation:
(a) of more than 15°: 3%
(b) from 10° to 15°: 2%
(2) Faulty rotation:
(a) of more than 20°: 3%
(b) from 10° to 20°: 2%
(17) Ankle and foot:
(1) Ankylosis of the ankle or foot:
(a) complete ankylosis:
i. subastragal, mediotarsal, tibiotarsal (panarthrodesis): 12%
ii. tibio-tarsal up to 10° of plantar flexion, without inversion or eversion: 8%
iii. subastragal and mediotarsal (triple arthrodesis): 4%
iv. subastragal: 3%
v. tarsal-metatarsal: 2.5%
vi. metatarso-phalangeal:
— big toe: 1.5%
— any other toe: 0.5%
vii. inter-phalangeal:
— big toe: 0.5%
— any other toe: 0.25%
(b) incomplete ankylosis:
i. tibiotarsal: 1 to 7%
ii. subastragal: 2%
iii. mediotarsal: 1%
(2) Impairment requiring the presence of an ankle prosthesis, including osteo-articular shortening required for fitting the prosthesis: 5%
(3) Chronic instability of the ankle: 1.5%
(4) Alteration of the calcaneum or other bones of the forefoot making it necessary to wear a custom-fitted shoe due to this pathological condition: 0.5%
DIVISION III
SPINE
(18) Cervical spine:
(1) Complete ankylosis from the occiput to C2 or C3, including bone alterations: 18%
(2) Complete ankylosis at C1 and C2, including bone alterations: 12%
(3) Complete ankylosis of other vertebrae, including bone alterations if applicable; per space: 4%
(4) Pseudarthrosis of the odontoid:
(a) with instability: 6%
(b) without instability: 3%
(5) The compression of a vertebral body with instability, including any incomplete ankylosis:
(a) compression of over 50%: 6%
(b) compression between 25 and 50%: 4%
(c) compression under 25%: 3%
(6) The compression of a vertebral body without instability, including any incomplete ankylosis:
(a) compression of over 50%: 4%
(b) compression between 25 and 50%: 3%
(c) compression under 25%: 2%
(7) Functional limitations by alterations of the atlas or axis, including any incomplete ankylosis and instability: 1 to 4%
(8) Functional limitations following a sprain, including any instability: 2%
(9) Bone alterations following a compartment fracture of a vertebral body: 0.5%
(19) Thoracic spine, excluding T12:
(1) The compression of a vertebral body with instability, including any incomplete ankylosis:
(a) compression of over 50%: 5%
(b) compression between 25 and 50%: 4%
(c) compression under 25%: 2%
(2) The compression of a vertebral body without instability, including any incomplete ankylosis:
(a) compression of over 50%: 4%
(b) compression between 25 and 50%: 3%
(c) compression under 25%: 1%
(3) Complete ankylosis of vertebrae, including any compression; per space: 3%
(4) Bone alterations following a compartmented fracture of a vertebral body: 0.5%
(20) Lumbar spine, including T12:
(1) The compression of a vertebral body with instability, including any incomplete ankylosis:
(a) compression of over 50%: 6%
(b) compression between 25 and 50%: 5%
(c) compression under 25%: 3%
(2) The compression of a vertebral body without instability, including any incomplete ankylosis:
(a) compression of over 50%: 5%
(b) compression between 25 and 50%: 4%
(c) compression under 25%: 2%
(3) Complete ankylosis of vertebrae, including any compression; per space: 4%
(4) Functional limitations following a sprain, including any instability: 2%
(5) Bone alterations following a compartmented fracture of a vertebral body: 0.5%
(21) Other spinal impairments:
(1) Alteration an intervertebral disk:
(a) with discoidectomy, including any compete ankylosis following a graft, functional limitations and chemonucleolysis; per space: 6 to 8%
(b) with discoidectomy but without complete ankylosis, including any functional limitations and chemonucleolysis; per space: 5%
(c) without discoidectomy or chemonucleolysis, including any functional limitations, per space: 3 to 5%
(d) with chemonucleolysis, including any functional limitation; per space: 2%
(2) Instability without fracture: 1%
(3) Loss of 2 lamina of a vertebra following a laminectomy, including loss of the spinous process: 2%
(4) Loss of a vertebral lamina following a unilateral laminectomy: 1%
(5) Alteration of the coccyx with or without coccygectomy: 1%
(6) Alteration of a spinous process, a transverse process or of a lamina following a fracture, a chip fracture or pseudarthrosis: 0.5%
TITLE II
CENTRAL AND PERIPHERAL NERVOUS SYSTEM
DIVISION I
SKULL, BRAIN AND CAROTIDS
(1) Hydrocephalus justifying a derivation of the cerebrospinal fluid: 15%
(2) Occlusion of the inner carotid: 10%
(3) Stenosis of the inner carotid:
(1) Over 70%: 8%
(2) Between 50% and 70%: 5%
(3) Under 50%: 2%
(4) Bone alteration following a skull fracture:
(1) With recess but without dura mater laceration:
(a) requiring a craniectomy and plasty, including elevation: 3 to 5%
(b) requiring elevation: 1 to 3%
(c) not requiring elevation: 1%
(2) With or without recess but with dura mater laceration:
(a) leading to a carotidocavernous fistula:
i. treated unsuccessfully or not treated: 15%
ii. treatment requiring the occlusion of one or more carotids: 10%
iii. treatment not requiring the occlusion of one or more carotids: 5%
(b) leading to a subarachnoidal fistula via one of the paranasal sinuses or via the external auditory duct, including any elevation, craniotomy, craniectomy and plasty, if applicable: 3 to 7%
(c) with one or more cortical lacerations, whether or not complicated by sinocuricular lacerations and extrusion of brain matter, including any elevation, craniectomy and plasty, if applicable: 3 to 7%
(5) Alteration of cerebral tissue following a concussion, contusion, laceration or intracerebral haematoma:
(1) Severe: 3 to 5%
(2) Minor: 0.5 to 2%
(6) Alteration of tissue:
(a) Following a craniotomy or a craniectomy: 2%
(b) Following trephination, per incision: 0.5%
(7) Bone alteration following a linear skull fracture:
(1) of the base: 2%
(2) of the calvarium: 1%
DIVISION II
CRANIAL NERVES
(8) Olfactory nerves:
— Complete anosmia: 4%
(9) Trigeminal nerve:
(1) Unilateral motor loss: 4%
(2) Unilateral sensory loss: 8%
(3) Sensory loss of the ophthalmic branch:
(a) ophtalmic division: 2%
(b) supraorbital division: 1%
(4) Sensory loss of the superior maxillary branch:
(a) affecting the hard palate, dental arch and lip: 2%
(b) affecting the dental arch and lip: 1%
(c) affecting the lip: 0.5%
(d) affecting the sub-orbital area: 1%
(5) Sensory loss of the inferior maxillary branch affecting the dental arch and lip: 3%
(10) Facial nerve:
(1) Temporofacial branch:
(a) paralysis: 6%
(b) paresis: 1 to 5%
(2) Cervicofacial branch:
(a) paralysis: 3%
(b) paresis: 1%
(11) Glossopharangeal, vagal, hypoglossal nerve:
(1) Dysphagia:
(a) requiring permanent tube feedng: 20%
(b) liquids and solids, occasionally requiring tube feeding: 15%
(c) liquids and solids, not requiring tube feeding: 10%
(d) liquids or solids, not requiring tube feeding: 5%
(2) dysphonia with or without dysarthria or inversely, according to the reduction of functional efficiency resulting from audibility and intelligibility:
(a) severe, totally preventing articulated language: 15%
(b) moderate, entailing serious restrictions and limiting the expression of essential needs: 10%
(c) minor, allowing the expression of most needs: 5%
(12) Spina-accessory nerve:
(1) sterno-cleido-mastoid or trapezius paralysis: 4%
(2) sterno-cleido-mastoid or trapezius paresis: 1 to 3%
DIVISION III
SPINAL CORD AND BRAIN
(13) Spinal cord or brain:
(1) Quadriplegia, including all anatomicophysiological deficits inherent in this pathology and any osseous or discal impairments and grafting, if applicable:
(a) C4 or C5 medullary level: 100%
(b) C6 medullary level: 95%
(c) C7 medullary level: 90%
(d) C8 or T1 medullary level: 85%
(2) paraplegia, including all anatomicophysiological deficits inherent in this pathology and any osseous or discal impairments and grafting, if applicable:
(a) upper motor neuron between T2 and T7: 80%
(b) upper motor neuron under T7: 75%
(c) lower motor neuron: 70%
(3) Impairment affecting use of an upper limb, excluding quadriplegia, causing:
(a) inability to use either limb for self care: 80%
(b) inability to use one limb for self care: 60%
(c) difficulty in using both limbs for self care: 40 to 60%
(d) difficulty in using one limb for self care: 25 to 40%
(e) difficulty in handling nonetheless allowing the use of both limbs for grasping and holding, but without problems for self care: 25 to 35%
(f) difficulty in handling nonetheless allowing the use of one limb for grasping and holding, but without problems for self care: 15 to 20%
(g) a degree of awkwardness nonetheless allowing the use of both limbs for grasping and holding, but without problems for self care: 8 to 15%
(h) a degree of awkwardness nonetheless allowing the use of one limb for grasping and holding, but without problems for self care: 5 to 10%
(4) Impairment affecting posture and ability to walk, excluding quadriplegia and paraplegia, resulting in:
(a) inability to stand or walk: 50%
(b) ability to stand, but great difficulty or inability to walk: 20 to 40%
(c) moderate difficulty in walking as seen or irregular surfaces, stairways and uneven terrain: 10 to 15%
(d) slight difficulty in walking: 5%
(5) Functional alteration of breathing: According to Title V
(6) Bladder impairment: According to Title IV
(7) Anorectal impairment: According to Title VI
(8) dysphasis, aphasia, alexia, agraphia, acalculia and other communication disturbances:
(a) disturbances leading to inability to understand and use language: 100%
(b) disturbances not affecting the ability to understand linguistic symbols, but severely or totally disturbing the ability to use sufficient or appropriate language: 50 to 70%
(c) disturbances not affecting the ability to understand linguistic symbols, but moderately disturbing the ability to use sufficient or appropriate language: 10 to 15%
(d) disturbances entailing minor communication difficulties: 1 to 15%
(9) Posttraumatic epilepsy, syncope, cataplexy, narcolepsy and other neurological disorders and disturbances of consciousness:
(a) stupor, coma or other disorders or disturbances that prevent the performance of the activities of daily living and/or require constant supervision for the performance of such activities or confinement, including the side effects of medication: 100%
(b) disorders or disturbances that severely disrupt the performance of the activities of daily living and require an almost constant supervision for the performance of such activities, including the side effects of medication: 50 to 80%
(c) disorders or disturbances that moderately disrupt the performance of the activities of daily living and require occasional supervision for the performance of such activities, including the side effects of medication: 20 to 45%
(d) disorders or disturbances that hinder the performance of the activities of daily living, including the side effects of medication: 1 to 15%
(10) Disturbances of vision: According to Title III
(11) Organic cerebral syndrome: According to Title IX
DIVISION IV
PERIPHERAL NERVOUS SYSTEM
(14) Motor and sensory impairments:
Motor impairments and sensory impairments are assessed according to Table 4 by taking into account the following classes:
(1) Motor impairment:
(a) class I:
no loss of motor function and absence of weakness;
(b) class II:
weakness against strong resistance (25% loss of function), including any muscular atrophy;
(c) class III:
weakness against minor resistance (50% loss of function), including any muscular atrophy;
(d) class IV:
weakness against gravity (75% loss of function), including any muscular atrophy;
(e) class V:
no motor strength (100% loss of function), including muscular atrophy;
(2) Sensory impairment:
(a) class I:
no sensory impairment;
(b) class II:
hypoaesthesia including dysesthesia, paresthesia, hyperesthesia and pain (25% loss of function):
(c) class III:
anesthesia including pain (100% loss of function).
TABLE 4
(s. 14)
TABLE OF ANATOMICOPHYSIOLOGICAL DEFICITS OF THE PERIPHERAL NERVOUS SYSTEM IN RELATION WITH THE CLASSES OF MOTOR AND SENSORY IMPAIRMENTS.
A. BRACHIAL PLEXUS

Brachial plexys complete motor and sensory impairment: 60%

Upper trunk
C-5, C-6,
Erb-Duchesne
syndrome complete motor and sensory impairment: 35%

Middle trunk C-7 complete motor and sensory impairment: 20%

Lower trunk C-8
T-1, Klumpke-
Dejerine syndrome complete motor and sensory impairment: 45%


Motor impairments Sensory impairments
(classes) (classes)


Impaired structures I II III IV V I II III


B. ROOT NERVES

C-5 N/A 3% 6% 9% 12% N/A 1% 2%
C-6 N/A 4% 8% 12% 16% N/A 2% 5%
C-7 N/A 4% 8% 12% 16% N/A 1% 4%
C-8 N/A 5% 10% 15% 20% N/A 1% 5%
T-1 N/A 3% 6% 9% 12% N/A 1% 3%
L-2 N/A 3% 5% 8% 10% N/A 1% 3%
L-3 N/A 3% 5% 8% 10% N/A 1% 3%
L-4 N/A 3% 5% 9% 12% N/A 1% 3%
L-5 N/A 4% 8% 12% 16% N/A 1% 3%
S-1 N/A 4% 8% 12% 16% N/A 1% 3%

C. PERIPHERAL NERVES

1. Head and neck

Greater occipital - - - - - N/A 0.25% 1%
Lesser occipital - - - - - N/A 0.25% 1%
Auricular ramus
C-2, C-3 - - - - - N/A 0.50% 2%

2. Upper limbs

Anterior thoracic
nerves N/A 1% 2% 3% 4% - - -
Circumflex (axillary) N/A 3% 6% 9% 12% N/A 1% 2%
Dorsal scapular N/A 1% 2% 3% 4% - - -
Long thoracic (serratus
anterior nerve) N/A 2% 4% 6% 8% - - -
Medial brachial cutaneous
internal accessory - - - - - N/A 1% 3%
Median (above middle
forearm) N/A 6% 12% 18% 24% N/A 4% 16%
Median (below the
junction of the middle
and distal thirds of
the forearm) N/A 4% 8% 12% 16% N/A 4% 16%
Median (digital branches)
. Radial side of thumb N/A 0.5% 1%
. Ulnar side of thumb N/A 1.2% 5%
. Radial side of index finger N/A 1.2% 5%
. Ulnar side of index finger N/A 0.5% 1%
. Radial side of middle finger N/A 1% 2%
. Ulnar side of middle finger N/A 0.25% 1%
. Radial side of ring finger N/A 0.5% 1%
Musculocutaneous N/A 4% 7% 10% 16% N/A 1% 3%
Radial (triceps lost) N/A 7% 15% 22% 29% N/A 1% 3%
Radial (triceps spared) N/A 5% 10% 15% 20% N/A 1% 3%
Subscapular nerve
(subscapularis) N/A 1% 2% 3% 4% - - -
Suprascapular nerve
(suprascapularis) N/A 2% 4% 6% 8% N/A 0.5% 1%
Thoracodorsal nerve
(thoracodorsalis) N/A 2% 3% 5% 7% - - -
Ulnar (above the middle
and distal thirds)
(ulnaris) N/A 5% 10% 15% 20% N/A 1% 3%
Ulnar (below the junction
of the middle and distal
thirds) (ulnaris) N/A 4% 8% 12% 16% N/A 1% 3%
Ulnar (digital branches)
. Ulnar side of ring finger N/A 0.25% 1%
. Radial side of ring finger N/A 0.25% 1%
. Ulnar side of auriculair finger N/A 0.25% 1%

3. Inguinal region

Greater abdominogenital
(iliohypogastricus) - - - - - N/A 1% 4%
Lesser abdominogenital
(ilioinguinalis) - - - - - N/A 1% 4%

4. Lower limbs

Femoral (cnemial) N/A 4% 7% 10% 13% N/A 1% 3%
Genitocnemial
(genitofemoralis) - - - - - N/A 1% 4%
Inferior gluteal N/A 2% 4% 5% 7% - - -
Lateral cutaneous
nerve of thigh - - - - - N/A 1% 4%
Obturator nerve N/A 2% 4% 5% 7% N/A 1% 4%
Posterior cutaneous
nerve of thigh - - - - - N/A 1% 4%
Superior gluteal N/A 3% 5% 8% 10% - - -
Large sciatic, above
rami to ischiotibial
muscles N/A 8% 16% 24% 32% N/A 4% 16%
External popliteal
sciatic (common
peroneal) N/A 4% 7% 10% 13% N/A 1% 3%
Deep peroneal above
mid-leg (peroneus
profundus) N/A 3% 5% 8% 10% - - -
Deep peroneal below
mid-leg (peroneus
profundus) N/A 1% 2% 3% 4% - - -
Superficial personeal
(peroneus superflicialis) N/A 1% 3% 4% 5% N/A 1% 3%
Internal popliteal nerve
above knee N/A 4% 7% 10% 13% N/A 2% 7%
Posterior tibia in the
annular soleus region N/A 2% 4% 5% 7% N/A 2% 7%
Posterior tibial at
mid-calf N/A 2% 4% 5% 7% N/A 1% 3%
Internal plantar
(medial plantaris) N/A 1% 2% 3% 4% N/A 0.5% 2%
External plantar
(lateral plantaris) N/A 1% 2% 3% 4% N/A 0.5% 2%
External sapheneus
(cutaneous sural) - - - - - 0 0.5% 2%
TITLE III
MAXILLOFACIAL SYSTEM AND VISION
DIVISION I
TEMPORO-MANDIBULAR ARTICULATIONS
(1) Temporo-mandibular articulations:
(1) Complete ankylosis of the 2 articulations: 30%
(2) Incomplete ankylosis:
(a) reduction of opening according to the distance measured between free edge of the upper and lower incisors:
i. 40 mm of lost movement: 9%
ii. 30 mm of lost movement: 7%
iii. 20 mm of lost movement: 5%
iv. 10 mm of lost movement: 3%
(b) lateralization:
i. 50% reduction or more: 8%
ii. reduction under 50%: 1 to 4%
(c) propulsion (protrusion):
i. 50% reduction or more: 8%
ii. reduction under 50%: 1 to 4%
(2) Maxilla:
(1) Loss of hard palate and dental arch: 20%
(2) Loss of hard palate: 10%
(3) Loss of soft palate:
(a) with rhinolalia:
i. severe: 10%
ii. minor: 3%
(b) with tubal dysfunction: 3%
(c) without rhinolalia or tubal dysfunction: 1%
(4) Loss of dental arch:
(a) allowing a complex prosthesis to be worn: 5%
(b) allowing a simple prosthesis to be worn: 3%
(5) Faulty consolidation of the palate and dental arch:
(a) with serious malocclusion and temporo-mandibular dysfunction: 5%
(b) with obstruction to the rhinopharynx and tubal dysfunction: 3%
(c) with minor malocclusion: 2%
(6) Periodontal problems despite adequate consolidation of the palate and dental arch: 5%
(7) Pseudarthrosis of the palate and dental arch: 4%
(3) Mandible:
(1) Horizontal portion:
(a) loss of tissue with severe pseudarthrosis: 10%
(b) faulty consolidation:
i. with malocclusion and temporo-mandibular dysfunction: 3 to 10%
ii. with malocclusion, but without temporo-mandibular dysfunction: 2%
(2) Ascending portion:
(a) faulty consolidation:
i. with malocclusion and temporo-mandibular dysfinction: 3 to 5%
ii. with malocclusion, but without temporo-mandibular dysfunction: 2%
(b) loss of tissue with severe pseudarthrosis: 5%
(c) loss of tissue without solution of continuity of mandibular arch: 2%
(3) Collum of condyle:
(a) faulty consolidation: According to ankylosis of temporo-mandibular articulations
(b) pseudarthrosis: According to ankylosis of temporo-mandibular articulations
(c) loss of tissue resulting in unilateral or bilateral temporo-mandibular dysfunction: 1 to 3%
(4) Alteration or loss of teeth:
(1) Healthy teeth:
(a) central incisor: 1%
(b) lateral incisor: 0.75%
(c) canine: 1.5%
(d) first premolar: 1%
(e) second premolar: 1%
(f) first molar: 1.25%
(g) second molar: 1%
(h) third molar: 1%
(2) Damaged teeth:
(a) central incisor: 0.5%
(b) lateral incisor: 0.375%
(c) canine: 0.75%
(d) first premolar: 0.5%
(e) second premolar: 0.5%
(f) first molar: 0.75%
(g) second molar: 0.5%
(h) third molar: 0.5%
DIVISION II
FRONTO-ORBITO-NASAL AREA
(5) Orbit:
(1) Impairment of orbital walls, including any displacement of the eyeball: 1 to 4%
(2) Impairment of canthus, including any change in palpebral fissure: 1 to 3%
(3) Modification of the palperbral fissure: 1%
(4) Blocage of a lacrimal duct: 1%
(6) Malar bone and zygoma:
— Functional limitations: 0.5 to 2%
(7) Nose:
(1) Alteration of air flow: 0.5 to 2%
(2) Trophic problems: 1%
(3) Hypertelorism: 1%
(4) Perforation of the nasal septum: 0.5%
(8) Sinus:
(1) Alteration of the walls and mucosa of an ethmoid or spenoidal sinus: 1.5%
(2) Alteration of the walls and mucosa of a frontal or maxillary sinus: 1%
DIVISON III
SALIVARY GLANDS
(9) Hyposalivation: 1 to 2%
DIVISION IV
TONGUE
(10) Anatomic loss:
(1) Loss of the tongue: 5%
(2) Alteration of the tongue due to loss of the lateral edge and tip: 1 to 3%
DIVISION V
VISION
(11) Bilateral loss of vision: 80%
(12) Alteration of vision:
(1) homonymous or bitemporal quadrantanopsia or hemianopsia: 20 to 50%
(2) aphakia: 12%
(3) pseudoaphakia: 6%
(13) Unilateral loss of vision with or without enucleation: 25%
(14) Paralysis of accommodation or loss of close-up vision: 3%
(15) Iridoplegia or fixed mydriasis based on photophobia, disturbance of close-up vision or dizziness: 1 to 3%
(16) Problems with colour vision: 0.5%
(17) Other impairments to vision:
— Other impairments to vision are evaluated in accordance with the evaluation process appearing in the schedule to this title.
PROCESS FOR EVALUATING VISION
(1) Criteria for evaluating vision
A deficit of the visual system occurs where there is a deviation from normal in one or more functions of the eye. Visual integrity requires:
(a) Integrity of corrected visual acuity for distance and close-up,
(b) integrity of the field of vision, and
(c) ocular motility without diplopia.
The evaluation of these 3 functions is necessary in determining the visual deficit. Although not of equal importance, their coordinated action is essential to optimal sight.
Other ocular functions or problems that affect the coordinated functions of the eye are awarded percentages of deficit in accordance with the scale prescribed for those functions.
(2) Methods for evaluating vision
(a) Determination of central visual acuity
Central vision is measured with the best corrected vision possible for distance and close-up, based on Tables 5 and 6.
(b) Determination of the extent of visual fields
The extent of the visual field is determined by use of the usual perimetric methods with a white target which subtends a 0.5° angle, i.e., a 3 mm white disk at a distance of 330 mm under illumination of not less than 7 f-c. A 6/330 white disk should be used for aphakia. The target is brought from the periphery to the field of vision, or from the unseen to the seen.
At least 2 peripheral fields should be obtained agreeing within 15° in each meridian.
The result is plotted on an ordinary visual field chart on each of the eight principal meridians separated from one another by 45°, as shown in Table 7.
The minimum normal extent of the visual field from the point of fixation is indicated in Table 7.
The percentage of retained visual field in one eye is obtained by adding the number of degrees of the eight principal meridians shown in Table 7 for the 3/330 isopter - which for the normal 500 degrees - and by dividing the total by 5; conversely, the percentage of deficit of visual field is obtained by adding the degrees lost, as measured according to the norms in Table 7, in each of the eight principal meridians and dividing the total by 5.
Where there is a deficit of a quadrant or a half field, the total of the deficit in each meridian must be added to half the sum of the tow adjacent meridians. The deficit of visual field can be calculated for other defects in the same way.
Table 8 shows percentages of deficit of visual field, calculated on the basis of degrees lost, expressed in increments of 5 degrees.
(c) Determination of ocular motility
Unless diplopia is present within 30 degrees of the centre of fixation, it rarely causes a visual deficit except on looking downward. The extend of the diplopia when the patient looks in various directions is determined on the perimeter at 330 mm or on any campimeter at a distance of 1 m from the patient in each of the eight principal meridians, using a small test light and without coloured lenses or correcting prisms.
The Hess Lancaster diplopia screen may also be used with the patient 1 m distance and using lenses coloured red, green, etc.
To determine loss of ocular motility:
· plot the results of the separation of 2 images on an ordinary visual field chart;
· add the corresponding percentages of loss of ocular motility caused by diplopia when the patient looks in various directions as given in Table 9.
(d) Determination of the visual efficiency of an eye
The methods described in a, b, and c above were used to evaluate:
· visual acuity,
· the field of vision, and
· ocular motility.
The percentage of visual efficiency of an eye is obtained by multiplying the percentage of visual acuity retained by the percentage of the visual field retained and by the percentage of ocular motility retained.

% of visual % of visual % of ocular % of efficiency
acuity retained field retained motility retained of eye

Right
eye ________________ × _____________ × _________________ = ______________

Left
eye ________________ × _____________ × _________________ = ______________
(e) Determination of efficiency of entire visual system
Multiply the percentage of efficiency of the better eye by 3, add the percentage of efficiency of the other eye and divide the sum obtained by 4 to obtain the percentage of function of the entire visual system or efficiency of binocular vision. Subtract the percentage of efficiency of binocular vision from 100% (normal vision) to obtain the percentage of deficit for the entire visual system.
% of efficiency % of efficiency % of efficiency
of better eye of other eye of binocular vision

( x 3) + =
_________________ ___________________ ______________________
4
% of efficiency % of deficit of the
of binocular vision entire visual system
100 - ___________________ = ______________________
TABLE 5
RATING OF CENTRAL VISUAL ACUITY
(A) DISTANCE VISION
Snellen Snellen % of deficit of
English metric central vision


20/16 6/5 0


20/20 6/6 0


20/25 6/7.5 5


20/32 6/10 10


20/40 6/12 15


20/50 6/15 25


20/64 6/20 35


20/80 6/24 40


20/100 6/30 50


20/125 6/38 60


20/160 6/48 70


20/200 6/60 80


20/300 6/90 85


20/400 6/120 90


20/800 6/240 95

(B) CLOSE-UP VISION


Snellen Jaeger Point % of deficit of
central vision


14/14 1- 3 or 0.35 0


14/18 2- 4 0.46 0


14/22 ... 5 0.56 5


14/28 3- 6 0.71 10


14/35 6 6 0.89 50


14/45 7- 9+ 1.14 60


14 56 8 12 1.42 80


14/70 11 14 1.78 85


14/87 ... ... 2.21 90


14/112 14 22 2.34 95


14/140 ... ... 3.56 98

TABLE 6
DEFICIT OF CENTRAL VISION
(Snellen’s scale)
Distance 14* 14 14 14 14 14 14 14 14 14 14
vision 14** 18 22 28 35 45 56 70 87 112 140

20* 0 0 3 5 25 30 40 43 45 48 49
16** 50 50 52 53 63 65 70 72 73 74 75

20 0 0 3 5 25 30 40 43 45 48 49
20 50 50 52 53 63 65 70 72 73 74 75

20 3 3 5 8 28 33 43 45 48 50 52
25 52 52 53 54 64 67 72 73 74 75 76

20 5 5 8 10 30 35 45 48 50 53 54
32 53 53 54 55 65 68 73 74 75 77 77

20 8 8 10 13 33 38 48 50 53 55 57
40 54 54 55 57 67 69 74 75 77 78 79

20 13 13 15 18 38 43 53 55 58 60 62
50 57 57 58 59 69 72 77 78 79 80 81

20 18 18 20 23 43 48 58 60 63 65 67
64 59 59 60 62 72 74 79 80 82 83 84

20 20 20 23 25 45 50 60 63 65 68 69
80 60 60 62 63 73 75 80 82 83 84 85

20 25 25 28 30 50 55 65 68 70 73 74
100 63 63 64 65 75 78 83 84 85 87 87

20 30 30 33 35 55 60 70 73 75 78 79
125 65 65 67 68 78 80 85 87 88 89 90

20 35 35 38 40 60 65 75 78 80 83 84
160 68 68 69 70 80 83 89 89 90 91 92

20 40 40 43 45 65 70 80 83 85 88 89
200 70 70 72 73 83 85 90 91 93 94 95

20 43 43 45 48 68 73 83 85 88 90 92
300 72 72 73 74 84 87 91 93 94 95 96

20 45 45 48 50 70 75 85 88 90 93 94
400 73 73 74 75 85 88 93 94 95 97 97

20 48 48 50 53 73 78 88 90 93 95 97
800 74 74 75 77 87 89 94 95 97 98 99
* Higher number: percentage of deficit of central vision without allowance for monocular aphakia.
** Lower number: percentage of deficit of central vision with allowance for monocular aphakia.
Add any percentage of deficit prescribed of pseudoaphakia.
TABLE 7
VISUAL FIELDS
Visual fields
LEFT EYE RIGHT EYE
TABLE 8
DEFICIT OF VISUAL FIELD


Degrees Degrees Degrees Degrees Degrees Degrees
lost retained Deficit lost retained Deficit lost retained Deficit
(total) (total) % (total) (total) % (total) (total) %


0 500* 0 170 330 34 340 160 68
5 495 1 175 325 35 345 155 69
10 490 2 180 320 36 350 150 70
15 485 3 185 315 37 355 145 71
20 480 4 190 310 38 360 140 72
25 475 5 195 305 39 365 135 73
30 470 6 200 300 40 370 130 74
35 465 7 205 295 41 375 125 75
40 460 8 210 290 42 380 120 76
45 455 9 215 285 43 385 115 77
50 450 10 220 280 44 390 110 78
55 445 11 225 275 45 395 105 79
60 440 12 230 270 46 400 100 80
65 435 13 235 265 47 405 95 81
70 430 14 240 260 48 410 90 82
75 425 15 245 255 49 415 85 83
80 420 16 250 250 50 420 80 84
85 415 17 255 245 51 425 75 85
90 410 18 260 240 52 430 70 86
95 405 19 265 235 53 435 65 87
1O0 400 20 270 230 54 440 60 88
105 395 21 275 225 55 445 55 89
110 390 22 280 220 56 450 50 90
115 385 23 285 215 57 455 45 91
120 380 24 290 210 58 460 40 92
125 375 25 295 205 59 465 35 93
130 370 26 300 200 60 470 30 94
135 365 27 305 195 61 475 25 95
140 360 28 310 190 62 480 20 96
145 355 29 315 185 63 485 15 97
150 350 30 320 180 64 490 10 98
155 345 31 325 175 65 495 5 99
160 340 32 330 170 66 500 0 100
165 335 33 335 165 67
*or more

When the central visual field is impaired, the percentage of deficit is that of the concomitant loss of visual acuity. If the visual acuity is normal, the percentage of deficit is calculated on the basis of the degrees lost.
TABLE 9
PERCENTAGE OF DEFICIT OF OCULAR MOTILITY
Percentage of deficit of ocular motility
Percentage of deficit of ocular motility of an eye in the field of diplopia
TITLE IV
GENITO-URINARY SYSTEM AND FOETUS
(1) Impairment of the bladder:
(1) Loss of the bladder, including absence of control over the functioning of the bladder and urinary by-pass: 35%
(2) Incontinence or retention:
(a) from reduction to loss of control: 10 to 30%
(b) dysfunction in the form of precipitant urination: 1 to 5%
(3) alteration of the bladder with enterocystoplasty: 10%
(4) alteration of the bladder without enterocystoplasty: 1 to 5%
(2) Impairment of renal functions:
(1) loss of both kidneys, including loss of renal function: 40%
(2) loss of one kidney: 10%
(3) reduction or loss of renal functions:
(a) reduction of more than 50% or loss: 21 to 30%
(b) reduction of 25 to 50%: 11 to 20%
(c) reduction of less than 25%: 1 to 10%
(3) Male genital organs:
(1) Loss of penis: 15%
(2) Alteration of penis: 1 to 15%
(3) Loss of both testicles:
(a) before the end of puberty: 20%
(b) after puberty: 10%
(4) Loss of a testicle: 5%
(4) Female genital organs:
(1) Internal genital organs:
(a) loss of 2 ovaries:
i. before the end of puberty: 20%
ii. after puberty: 10%
(b) loss of the uterus:
i. before the end of menopause: 10%
ii. after menopause: 5%
(c) loss of an ovary with or without connecting fallopian tube: 5%
(d) alteration of tissue following a caesarian section: 2%
(2) External genital organs:
(a) loss of clitoris: 5%
(b) loss of vagina: 5%
(c) loss of vulva: 5%
(d) alteration of vagina: 1 to 4%
(e) alteration of vulva: 1 to 4%
(5) Urinary by-pass: 12%
(6) Impairment of the urethra:
(1) Surgically incurable fistula: 5 to 10%
(2) Contraction requiring monthly treatments: 6%
(3) Contraction requiring quarterly treatments: 3%
(7) Loss of foetus: 7%
(8) Alteration of tissue following a posterolumbar incision or a laporotomy: 2%
TITLE V
RESPIRATORY APPARATUS
(1) Absence of spontaneous respiration: 100%
(2) Restrictive functional alteration, with regard to vital capacity, respiratory volume and other pulmonary volumes, the percentage of functional alteration corresponding to the percentage of the deficit, a percentage of alteration of 60% or more corresponding, however, to a deficit of 80%: 20 to 70%
(3) Stenosis of the trachea:
(1) requiring a permanent tracheostomy, depending on phonetic alterations: 10 to 20%
(2) without permanent tracheostomy: 1 to 3%
(4) Loss of a lung: 20%
(5) Paralysis of the phrenic nerve:
(1) with restrictive functional alteration: depending on the restrictive functional alteration
(2) without restrictive functional alteration: 15%
(6) Pleural impairment:
(1) with respective functional alteration: depending on the restrictive functional alteration
(2) without restrictive functional alteration: according to Table 10
(7) Loss of 2 pulmonary lobes: 6%
(8) Loss of a pulmonary lobe: 3%
(9) Alteration of tissue following a thoracotomy: 2%
(10) Alteration of tissue following thoracic drainage: 0.5%
(11) Alteration of tissue following a tracheotomy: 1%
TABLE 10
ASSESSEMENT OF PLEURAL IMPAIRMENT
Pleural impairment is assessed in accordance with the 1980 ILO classification as follows:
(A) PLEURAL THICKENING:
Thickness
For pleural thickening visible along the thoracic wall, maximum thickness is measured from the osseous line of the thorax to the internal limit of the pleural opacity, as most clearly delimited:
(a) maximum thickness of under 5 mm: 1%
(b) maximum thickness of between 5 mm and 10 mm: 2%
(c) maximum thickness of over 10 mm: 3%
Front view
The presence of pleural thickening observed by a font view is notable even if it can also be seen from a side view. In the event that it is only visible by a front view, usually the thickening cannot be measured.
Extent
The extent of pleural thickening is defined in terms of maximum length of the surface observed from a front or side view:
(a) total length up to a quarter of the distance on the projection of the lateral thoracic wall: 1%
(b) total length exceeding a quarter of the distance on the projection of the lateral thoracic wall up to a half of this distance: 2%
(c) total length exceeding a half of the distance on the projection of the lateral thoracic wall: 3%
Assessment of deficit
The percentage obtained for the width is multiplied by the figure obtained for the extent, which determines the percentage of deficit assigned to the pleural thickening.
In the case of bilateral pleural thickening, the percentages are added for each side, to a total maximum allowed of 18%.
(B) FILLING OF A CAVITY
From the TT 1/1 image to the horizontal line touching the crest of the diaphram: 1 to 5%
Note: Total pleural impairment cannot exceed a maximum deficit of 20%.
TITLE VI
DIGESTIVE SYSTEM AND SPLEEN
(1) Oesophageal stenosis: 5 to 10%
(2) Alteration of tissue
(1) alteration of tissue following a first laparotomy: 2%
(2) alteration of tissue following a laparotomy other than the first:
(a) through a route previously used: 1%
(b) through a new route: 2%
(3) alteration of tissue following a first laparoscopy: 0.5%
(4) alteration of tissue following a laparoscopy other than the first:
(a) through a route previously used: 0.25%
(b) through a new route: 0.5%
(5) Alteration of tissue following abdominal drainage: 0.5%
(3) Stomach, duodenum, small intestine or colon:
— alteration of tissue, including any functional problems:
(a) with resection: 3 to 15%
(b) without resection: 2%
(4) Anus and rectum:
(1) Loss of anus and rectum, including the absence of control over anorectal functions and by-passes: 15%
(2) Anorectal function:
(a) absence of control: 12%
(b) reduction of control: 3 to 10%
(5) Liver:
(1) Complication of fistulae with impairment of the hepatic function, including lacerations: 10 to 15%
(2) Lacerations with or without important loss of tissue, including any functional problems: 2 to 10%
(6) Pancreas:
(1) alteration with digestive problems: 5 to 10%
(2) alteration without digestive problems: 3%
(7) Spleen:
(1) Loss of the spleen with disturbance of the hematopoietic system: 5%
(2) Loss of the spleen without disturbance of the hematopoietic system: 3%
(3) Laceration of the spleen with or without loss of tissue: 1%
(8) Abdominal wall, inguinal or femoral:
(1) Recurring hernia, whatever the number of recurrences: 2%
(2) Non-recurring hernia: 1%
TITLE VII
CARDIOVASCULAR SYSTEM
(1) Cardiac lesions: According to Table 11
(2) Thoracic arterial lesions:
(1) Surgically corrected alteration of the ascending thoracic aorta: 2 to 6%
(2) Surgically corrected alteration of the descending thoracic aorta: 2 to 4%
(3) Functional limitations: According to Table 11
(3) Peripheral arterial lesions:
(1) Surgically corrected alteration of the abdominal artery: 2 to 4%
(2) Surgically corrected alteration of a peripheral artery: 0.5 to 2%
(3) Functional alteration following a unilateral sympathectomy: 2%
(4) Alteration of a blood vessel corrected by transluminal angioplasty: 2%
(5) Functional limitations: According to Tables 12 and 13
(4) Venous and lymphatic lesions:
(1) Postphlebitic venous insufficiency or lymphatic insufficiency:
(a) very severe, not controlled by standard medical treatment, with trophic problems and recurring ulceration: 12%
(b) severe, not controlled by standard medical treatment, with trophic problems, but without recurring ulceration: 8%
(c) moderate, not completely controlled by standard medical treatment: 5%
(d) minor, well controlled by standard medical treatment: 3%
(2) Superficial venous insufficiency: 1%
TABLE 11
FUNCTIONAL LIMITATIONS FOLLOWING CARDIOVASCULAR LESION
Class 5 (under 2 mets):
— Severe limitation characterized by angina or shortness of breath for physical activities such asa walking a few steps or while performing movements needed for personal hygiene; angina or shortness of breath may occur at rest or during sleep: 80%
Class 4 (2, 3 mets):
— Moderate limitation characterized by angina or shortness of breath for physical activities such as climbing stairs at a normal pace or while walking on level ground over a distance of one or 2 city blocks: 40 to 50%
Class 3 (4 mets):
— Minor limitation characterized by angina or shortness of breath for physical activities such as walking at a brisk pace on rough ground or on level ground after a meal, in cold or windy weather, under emotional stress, in the morning after waking, when climbing one flight of stairs at a fast pace or more than one flight of stairs at a normal pace: 25 to 35%
Class 2 (5, 6, 7 mets):
— Cardiovascular lesion without angina nor shortness of breath when performing physical activities such as walking, climbing stairs or carrying packages: 10 to 20%
Class 1 (over 7 mets):
(a) cardiovascular lesion with angina or shortness of breath when undergoing a maximum stress test: 5 to 10%
(b) cardiovascular lesion without angina nor shortness of breath when undergoing a maximum stress test: 1 to 4%
TABLE 12
FUNCTIONAL LIMITATIONS FOLLOWING VASCULAR LESION IN A LOWER LIMB
(1) Severe arterial insufficiency, with trophic problems and ulcerations, with inability to walk: 45%
(2) Intermittent claudication, occurring when walking at an ordinary pace over a distance of less than 75 m: 30 to 35%
(3) Intermittent claudication, occurring when walking at an ordinary pace over a distance of 75 to 120 m: 20 to 25%
(4) Intermittent claudication, occurring when walking at an ordinary pace for a distance of over 120 m, but less than 30 m: 10 to 15%
(5) Slightly inhibiting intermittent claudication, occurring when walking at an ordinary pace over a distance of 300 to 500 m: 5%
TABLE 13
FUNCTIONAL LIMITATIONS FOLLOWING VASCULAR LESION IN AN UPPER LIMB
(1) Severe arterial insufficiency, with trophic problems and ulcerations, inhibiting exertion or causing ischemic pain at rest: 45%
(2) Arterial insufficiency causing significant intermittent ischemic pain that occurs under light exertion: 25 to 35%
(3) Arterial insufficiency causing intermittent ischemic pain that occurs under moderate exertion: 10 to 20%
(4) Arterial insufficiency causing intermittent ischemic pain that occurs under heavy exertion: 5%
TITLE VIII
ENDOCRINE SYSTEM
DIVISION I
HYPOTHALAMUS, HYPOTHYSIS, THYROID GLAND AND THE PARATHYROIDS
(1) Total hypopituitarism, excluding diabetes insipidus: 60%
(2) Partial hypopituitarism, excluding diabetes insipidus: 10 to 45%
(3) Diabetes insipidus: 5 to 10%
(4) Impairment of the parathyroids:
(1) Not controlled by replacement therapy: 10 to 15%
(2) Controlled by replacement therapy: 5 to 8%
(5) Alteration or loss of the thyroid gland requiring hormone therapy: 5 to 10%
(6) Alteration of the thyroid gland not requiring hormone therapy: 2%
DIVISION II
PANCREAS
(7) Diabetes:
(1) Requiring insulin therapy: 15 to 25%
(2) Controlled by diet and oral medication: 6 to 10%
(3) Controlled by diet: 5%
DIVISION III
ADRENAL GLANDS
(8) Loss of 2 adrenal glands with hormone therapy: 20%
(9) Loss of one adrenal gland: 5%
TITLE IX
PSYCHIC SYSTEM
DIVISION I
ORGANIC BRAIN SYNDROMES
(1) Alteration of the higher cognitive or affective functions which impair the performance of activities of daily living or require continuous supervision for performing such activities or confinement, including any side effects of medication: 100%
(2) Alteration of the higher cognitive or affective functions which significantly impair the performance of activities of daily living and require near-continuous supervision for performing such activities, including any side effects of medications: 50 to 80%
(3) Alteration of the higher cognitive or affective functions which moderately impair the performance of activities of daily living and require occasional supervision for performing such activities, including any side effects of medication: 20 to 45%
(4) Alteration of the higher cognitive or affective functions which slightly impair the performance of activities of daily living, including any side effects of medication: 7 to 15%
(5) Alteration of the higher cognitive or affective functions which very slightly impair the performance of activities of daily living, including any side effects of medication: 1 to 5%
DIVISION II
PSYCHOSES
(6) Psychotic syndrome such that it requires a protected environment of continuous institutional care with recurrent hospitalizations, including any side effects of medication: 100%
(7) Psychotic syndrome of such intensity that the victim shows disturbances in perception and in thought and a lack of emotional control leading to behaviour that is intolerable for his associates or dangerous for himself, requiring near-continuous supervision in his daily life, including any side effects of medication: 50 to 80%
(8) Psychotic syndrome, not effectively controlled by medication, evident upon mental examination, easily observed by the victim’s associates and having repercussions in the form of difficult social functioning, strange behaviour, a more or less marked reduction in social and personal achievement, with fairly reduced behavioural problems, enabling the victim to be tolerated in his milieu but requiring occasional supervision in his daily life owing to his variable and inconsistent cooperation, including any side effects of medication: 20 to 45%
(9) Minor and discrete anomalies in perception, thought, emotional control or behaviour, having little effect on the functioning of the victim, with or without constant psychotropic medication, including any side effects of medication: 1 to 15%
DIVISION III
CHRONIC NEUROSES
(10) The neurotic syndrome is invasive and leads to complete deterioration of social and personal achievement. It is accompanied by serious and constant changes in interpersonal relations, disrupting ordinary activities and requiring continuous supervision or confinement, including any side effects of medication: 100%
(11) The symptomatic intensity of the neurotic syndrome, although ordinarily variable, requires the victim to have constant recourse to therapeutic measures and to change his ordinary activities leading to a marked reduction in his social and personal achievement, such a syndrome being accompanied by functional psychophysiological disorders requiring symptomatic treatment and causing a constant interruption of regular activities, including any side effects of medication: 50 to 80%
(12) The symptomatic intensity of the neurotic syndrome, although ordinarily variable, requires to victim to have occasional recourse to therapeutic measures and to change his ordinary activities leading to a moderate reduction in his social and personal achievement, including any side effects of medication: 20 to 45%
(13) Complete and coherent neurotic syndrome accompanied by minor changes which do not make the victim incapable of adaptive behaviour, without a significant reduction of daily activities nor an alteration of social or personal achievement, including any side effects of medication: 1 to 15%
DIVISION IV
PERSONALITY DISORDERS
(14) Complete loss of independence and social maladjustment requiring continuous supervision or confinement, including any side effects of medication: 100%
(15) The maladjustment syndrome is such that the victim has lost the greater part of his self-control, is incapable of correcting himself by experience and causes repeated and serious harm to his associates and himself. The lack of social control may lead to legal supervision in various forms, including any side effects of medication: 50 to 80%
(16) The level of character adaptation existing before the event is exacerbated in a constant manner and leads to moderate personality disorders that are seen by a more pronounced deficiency in social judgment, deterioration in interpersonal relations, increased inconsistency in achievement, erratic behaviour and inability to avoid coming into conflict with society or harming oneself, including any side effects of medication: 20 to 45%
(17) The level of character adaptation existing before the event is exacerbated and leads to minor personality disorders that are seen by a certain deficiency in social judgment and adaptation to the constraints of daily living, including any side effects of medication: 1 to 15%
TITLE X
COCHLEOVESTIBULAR APPARATUS
DIVISON I
HEARING
(1) Complete and sudden bilateral deafness: 50%
(2) Complete and sudden unilateral deafness: 5%
(3) Reduction of hearing: according to Table 14
DIVISION II
VESTIBULAR FUNCTION
(4) Loss of both labyrinths: 15%
(5) Loss of one labyrinth: 5%
(6) Impairment of the vestibular function:
(1) Peripheral or central vertigo requiring continuous supervision for the performance of ordinary daily activities other than personal hygiene and requiring confinement of the victim at home or in an institution: 50 to 60%
(2) Peripheral or central vertigo requiring continuous supervision for the performance of ordinary daily activities other than personal hygiene: 35 to 45%
(3) Peripheral or central vertigo requiring continuous supervision for the performance of ordinary daily activities other than simple activities such as personal hygiene, household chores or walking: 20 to 30%
(4) Peripheral or central vertigo not affecting the capacity to perform ordinary daily activities except for certain activities which may endanger the victim’s or other people’s safety such as driving an automobile or riding a bicycle; 5 to 15%
(5) Peripheral or central vertigo not affecting the capacity to perform ordinary daily activities: 2%
TABLE 14
LOSS OF HEARING
_________________________________________________________________________________
| | | |
| Reduction of | Most | Less severely |
| hearing in decibels* | impaired ears | impaired ear |
|__________________________|__________________________|___________________________|
| | | |
| DB | % | % |
|__________________________|__________________________|___________________________|
| | | |
| 25 ISO | 0.5 | 2.5 |
|__________________________|__________________________|___________________________|
| | | |
| Over 25 | 1.0 | 5.0 |
| to 30 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 30 | 1.5 | 7.5 |
| to 35 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 35 | 2.0 | 10.0 |
| to 40 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 40 | 2.5 | 12.5 |
| to 45 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 45 | 3.0 | 15.0 |
| to 50 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 50 | 3.5 | 17.5 |
| to 55 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 55 | 4.0 | 20.0 |
| to 60 ISO | | |
|__________________________|__________________________|___________________________|
| | | |
| Over 60 ISO | 5.0 | 25.0 |
|__________________________|__________________________|___________________________|
* According to the average obtained by a valid audiogram on frequencies of 500, 1000 and 2000 cycles.
PART II
DISFIGUREMENT
DIVISION I
DEFINITIONS
(1) Cicatricial impairment (scarring) means any qualitative or quantitative change in the skin; the idea includes flat and faulty scars.
(2) A flat scar is a scar that is almost linear, at the same level as the adjoining tissue and almost the same colour, causing no contraction or distortion of neighbouring structures.
(3) A faulty scar is a scar that is misaligned, irregular, depressed, deeply adhering, pigmented, scaly, retractile, keloidal or hypertrophic.
DIVISION II
DISFIGUREMENT OF THE FACE
(4) For purposes of assessing disfigurement of the face, reference is made to each of the following anatomical elements:
(1) the forehead;
(2) the orbits;
(3) the eyelids;
(4) the visible part of the ocular globes;
(5) the cheeks;
(6) the nose;
(7) the lips;
(8) the ears;
(9) the chin.
(5) The extent of disfigurement affecting the face must first be assessed overall in terms of the physiognomy, in order to determine the class of impairment.
(6) For classes 1 to 4, within the class of impairment of the physiognomy determined, the percentage of disfigurement is fixed in relation to the changes in the form and symmetry of the scarring, without exceeding the maximum percentage of disfigurement prescribed for that class, according to Table 15.
Where there are both scarring and changes in the form and symmetry, the percentages of the 2 are totalled up to the maximum percentage prescribed for the class.
(7) For classes 5 and 6, the changes in the form and symmetry and the scarring are considered as a whole and the percentage awarded is the maximum prescribed for the class, according to Table 16.
DIVISION III
DISFIGUREMENT OF OTHER PARTS OF THE BODY
(8) Where there is impairment only by changes in form and symmetry, the degree of impairment is calculated and the percentage of disfigurement prescribed for that part of the body is awarded, according to Table 17.
(9) Where there is impairment only by scarring, the surface area of the scar is measured and the percentage prescribed per cm2 is awarded, without exceeding the maximum percentage prescribed for that part of the body, according to Table 17.
(10) Where there are both changes in the form and symmetry and scarring, the higher percentage obtained under either heading is awarded, without exceeding the maximum percentage prescribed for that part of the body, according to Table 17.
DIVISION IV
DISFIGUREMENT FROM PARTIAL OR TOTAL AMPUTATION
(11) The percentage awarded for a disfigurement due to amputation takes into account the scars inherent in amputation.
(12) Eye:
Enucleation with or without replacement by prosthesis, including impairment inherent in the physiognomy: 5%
(13) Upper limb:
(1) Interscapulothoracic disarticulation: 12%
(2) Disarticulation of a shoulder: 11%
(3) Amputation of an arm: 10%
(4) Amputation of an elbow: 9%
(5) Amputation of a forearm: 8%
(6) Amputation of a radiocarpal and transcarpal: 8%
(7) Amputation of a thumb:
— per phalanx: 1.5%
(8) Amputation of a finger other than the thumb:
— per phalanx, up to a maximum of 6%: 0.5%
(9) Amputation of a metacarpal:
— per metacarpal, up to a maximum of 2%: 0.4%
(14) Lower limb:
(1) Hemipelvectomy: 12%
(2) Disarticulation of the hip: 10%
(3) Amputation of a thigh: 8%
(4) Amputation of a knee: 7%
(5) Amputation of a leg: 6%
(6) Ankle amputation (Symes): 5%
(7) Midtarsal amputation (Chopart): 4%
(8) Tarsometatarsal amputation (Lisfranc): 3%
(9) Transmetatarsal amputation: 2%
(10) Amputation of a great toe:
— per phalanx: 0.4%
(11) Amputation of a metatarsal:
— per metatarsal, up to a maximum of 1%: 0.25%
(12) Amputation of a toe other than the big toe:
— per phalanx: 0.1%
TABLE 15
EVALUATION OF PHYSIOGNOMY IMPAIRMENTS


Evaluation of physioghomy impairments


Class of
physiognomy Changes in the form Cicatricial Max.
impairments and symmetry impairment Disfig.



Class 1
No impairment No conspicuous change No conspicuous -
impairment


Class 2
Very minor Very minor change Conspicuous impairment 3%
impairment affecting 1 1%/cm2
anatomical element: 1%


Class 3
Minor Conspicuous change: Conspicuous impairment 7%
impairment a) affection 1 anatomical a) flat scar: 1%/cm2
element: 3% b) faulty scar: 2%/cm2
b) affecting 2 anatomical
elements: 4%
c) affecting more than 2
anatomical elements: 7%


Class 4
Moderate Conspicuous change that Conspicuous impairment 15%
impairment holds one’s attention

a) affection 1 anatomical a) flat scar: 1%/cm2
element: 10% b) faulty scar: 3%/cm2
b) affection 2 anatomical
element: 12%
c) affecting more than 2
anatomical elements: 15%

TABLE 16
EVALUATION OF PHYSIOGNOMY IMPAIRMENTS
Classes of Changes in the form and symmetry and cicatricial Disfig.
physiognomy impairment
impairments



Class 5
Severe impairment Changes and impairment affecting several elements 20%


Class 6
Disfiguration Change and impairment affecting all elements 30%

TABLE 17
EVALUATION OF IMPAIRMENTS TO OTHER PARTS OF THE BODY


Evaluation of impairments to other parts of the body


Cicatricial impairment

Change of form and damage to full thickness damage to partial
Parts of symmetry of the skin (dermis and thickness of the skin
the body (epidermis) (epidermis)*



Scalp and Minor or moderate Conspicuous impairment: Conspicuous impairment:
skull change: 0.5%/cm2 0.05%/cm2
1 to 3%
Severe change: 5%

The maximum percentage of impairment for the skull and scalp together is 5%


Neck Minor or moderate Conspicuous impairment: Conspicuous impairment:
change: 1%/cm2 0.1%/cm2
1 to 5%
Severe change: 8%

The maximum percentage of impairment for the neck is 8%


Shoulders, Minor or moderate Conspicuous impairment: Conspicuous impairment:
arms and change: 0.5%/cm2 0.05%/cm2
elbows 0.05 to 2%
Severe change: 4%

The maximum percentage of impairment for the shoulder, arms and elbow
together is 4% on the right side and 4% on the left side



Forearms Minor or moderate Conspicuous impairment: Conspicuous impairment:
and change: 1%/cm2 0.1%/cm2
wrists 0.5 to 2%
Severe change: 5%

The maximum percentage of impairment for the forearm and wrist together
is 5% on the right side and 5% on the left side



Hand Minor or moderate Conspicuous impairment: Conspicuous impairment:
change: 1%/cm2 0.1%/cm2
1 to 3%
Severe change: 6%

The maximum percentage of impairment for a hand is
6% on the right side and 6% on the left side.



Trunk Minor or moderate Conspicuous impairment: Conspicuous impairment:
change: 0.5%/cm2 0.05%/cm2
1 to 3%
Severe change: 6%

The maximum percentage of impairment for the trunk is 6% in front
and 6% in the rear



Lower Minor or moderate Conspicuous impairment: Conspicuous impairment:
limbs change: 1%/cm2 0.1%/cm2
1 to 4%
Severe change: 8%

The maximum percentage of impairment for the lower limb is 8% on
the right side and 8% on the left side


* Example: surface that is hypo- or hyperpigmented.
O.C. 1921-89, Sch. I; O.C. 766-96, ss. 4 and 5.
SCHEDULE II
(s. 5)
CALCULATION OF SUCCESSIVE REMAINDERS
Table for combining 2 or more permanent impairments in order to obtain the adjusted value in conformity with the successive remainders principle:
(1) Ordinate A% combined with abscissa B% adjusted value.
(2) Decimals have been rounded to the next highest unit.
(3) Where several impairments are to be combined, the same procedure is utilized by taking the adjusted value as ordinate and combining, in the same manner, as abscissa, the percentage of the third impairment or others where applicable.
O.C. 1921-89, Sch. II.
REFERENCES
O.C. 1921-89, 1989 G.O. 2, 4610
O.C. 766-96, 1996 G.O. 2, 2884