A-3.001, r. 2 - Scale of Bodily Injuries Regulation

Full text
chapter A-3.001, r. 2
Scale of Bodily Injuries Regulation
INDUSTRIAL ACCIDENTS AND OCCUPATIONAL DISEASES — BODILY INJURIES
Act respecting industrial accidents and occupational diseases
(chapter A-3.001, s. 454, par. 3)
A-3.001
September 1 2012
1. Under section 84 of the Act respecting industrial accidents and occupational diseases (chapter A-3.001), the percentage of permanent physical or mental impairment is equal to the sum of the percentages calculated according to the scale of bodily injuries in Schedule 1 for anatomicophysiological deficits, disfigurement and the suffering or loss of enjoyment of life resulting from the deficit or disfigurement.
O.C. 1291-87, s. 1.
2. Assessment of the percentage of permanent physical or mental impairment shall be made as soon as the sequelae of the employment injury are medically determined.
O.C. 1291-87, s. 2.
3. Where the sum of the percentages of anatomicophysiological deficits fixed for the sequelae of the employment injury resulting from an event is greater than zero, a percentage for suffering and loss of enjoyment of life shall be fixed according to the table of suffering and loss of enjoyment of life in proportion to than sum.
When the sum of the percentages of disfigurement fixed for the sequelae of an employment injury resulting from an event is greater than zero, a percentage for suffering and loss of enjoyment of life shall be fixed according to the table of suffering and loss of enjoyment of life in proportion to that sum.
O.C. 1291-87, s. 3.
4. Where a worker suffers from one or more permanent physical or mental impairments as a result of the same employment accident or occupational disease, the percentage of physical or mental impairment shall be calculated by adding the percentages prescribed for each impairment.
Where the total of the percentages exceeds 100%, the health professional making the assessment shall indicate such total for the purposes of calculating the amount prescribed by section 87 of the Act.
O.C. 1291-87, s. 4.
5. Where a prior injury has occurred, the sequelae of the previous injury shall be evaluated according to the scale, but solely for purposes of calculating bodily injuries resulting from the injury evaluated.
The percentages resulting from the sequelae of the previous injury shall be deducted from the total of the percentages of bodily injury.
O.C. 1291-87, s. 5.
6. Where an injury results in sequelae to more than one system or organ of the human body, each sequela shall be evaluated in accordance with the chapter of the scale covering that system or organ.
Where the health professional who makes the evaluation observes that the injury has resulted in sequelae to a system or organ other than the one he is evaluating, he shall so state in his report and shall inform the worker.
O.C. 1291-87, s. 6.
7. Where a worker suffers, as a result of an industrial accident or an occupational disease, bilateral injury resulting from anatomicophysiological deficits in symmetrical organs or from an anatomicophysiological deficit in an organ that is symmetrical to the one already impaired, the scale shall award an additional percentage, corresponding to the sum of the percentages of anatomicophysiological deficits fixed for the less severely impaired organ.
This principle does not apply to the percentages prescribed for disfigurement or suffering and loss of enjoyment of life.
Where a prior injury has occurred, the sequelae of the previous injury shall be evaluated according to the scale, but solely for purposes of calculating bilateral injuries.
O.C. 1291-87, s. 7.
8. Special rules for evaluation are provided for each system of the human body at the beginning of each chapter in Schedule 1, taking into account the differing natures of the organs impaired and of the anatomical or functional nature of the deficits.
The rules also prescribe procedures for calculating bilateral injuries for each system.
O.C. 1291-87, s. 8.
9. (Omitted).
O.C. 1291-87, s. 9.
EXPLANATORY NOTES
(ss. 1 and 8)
(1) The percentages for anatomicophysiological deficits (APD) appear under the heading APD.
Where the indication “APD” appears under the heading APD, it indicates a reference to a table, a diagram or another chapter from which the percentages of APD can be determined.
(2) The percentages for suffering and loss of enjoyment of life (SLEL) appear in Chapter XIX under the heading SLEL.
For sexual dysfunction resulting from permanent sequelae to the external or internal genital organs, the percentages for suffering and loss of enjoyment of life (SLEL) appear under the heading SLEL in Chapter VIII on the female genital system and Chapter IX on the male genital system.
(3) The percentages for disfigurement (D) appear under the heading D in Chapter XVIII on disfigurement.
(4) The percentages of bodily injury are calculated to 2 decimal places.
SCHEDULE 1
CHAPTER I
MUSCULOSKELETAL SYSTEM EXCLUDING MAXILLARY-FACIAL SYSTEM
RULES APPLYING TO THIS CHAPTER
(1) Examination of a joint is done by comparing it to the joint of the opposed member where that member is healthy. Otherwise, reference is made to standard data.
(2) Where the ankylosis of a joint falls between 2 measures indicated in the scale, reference is made to the next higher measure of anatomicophysiological deficit (APD).
(3) (The maximum percentage awarded for a joint may not exceed the maximum prescribed for complete ankylosis of the joint (arthrodesis in functioning position).
(4) Bilaterality
Where a worker suffers anatomicophysiological deficits in symmetrical organs as a result of an employment injury, the total percentage awarded to him for such deficits shall be determined by adding the percentages of the anatomicophysiological deficits calculated for each of the organs and by adding a second time the percentage determined for the less severely impaired organ.
Bilaterality in limbs is determined by reference to the corresponding part, for example, right arm with left arm and right leg with left leg. The arm includes the scapula and the clavicle. The leg includes the hip and the hemipelvis. A sequela to the left hand with a sequela to the right scapula requires the application of bilaterality.
Similarly, the thoracic cage is divided into right and left parts from the median line of the cage.
(5) Where following arthodesis of a joint, unusual sequelae persist (effusion, chronic infection, pseudarthrosis), an additional percentage of anatomicophysiological deficit of the order of 10%, 15% or 25% of the percentage prescribed for arthrodesis of the joint in functioning position may be awarded depending on the extent of the sequelae.
The health professional who makes the evaluation shall indicate in his report the sequelae justifying the awarding of an additional percentage and their extent.
A) UPPER LIMBS AND SCAPULOTHORACIC GIRDLE
APD
%

(a) AMPUTATIONS

(i) Interscapulothoracic disarticulation 80

(ii) Disarticulation at the shoulder 75

(iii) Amputation above the deltoid insertion 70

(iv) Amputation below the deltoid insertion up to the
distal third of the humerus 65

(v) Amputation at the distal third of the humerus,
disarticulation at the elbow or above the bicipital
tuberosity of the radius 63

(vi) Amputation at the proximal third of the forearm below
the bicipital tuberosity of the radius 60

(vii) Amputation at the middle third or the distal third
of the forearm 57

(viii) Disarticulation at the wrist 55

(ix) Amputation of the hand (metacarpals, thumb and fingers)

Refer to diagrams 1, 2, 3, 4 and 5 of amputations of the hand. APD

(b) FRACTURE, DISLOCATION, SPRAIN

(1) Clavicle, scapula

(i) Consolidated fracture

· without functional sequelae, with or without
radiological changes 0

· with functional sequelae

Refer to Table 2 of ankyloses of the shoulder or of the
other joints impaired. APD

(ii) Sprain, partial acromioclavicular or sternoclavicular dislocation

· without functional sequelae 0

· with functional sequelae 1

(iii) Acromioclavicular or sternoclavicular dislocation

· persistent 2

· requiring resection 3

Also refer to Table 2 of ankyloses of the shoulder or
of the other joints impaired. APD

(iv) Pseudarthrosis of the clavicle proved by radiology 3

Also refer to Table 2 of ankyloses of the shoulder. APD

(2) Humerus

(i) Head and proximal matephysis

Consolidated fracture

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 2 of ankyloses of the shoulder or of the
other joints impaired. APD

(ii) Diaphysis and distal third

Consolidated fracture

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 2 of ankyloses of the shoulder or of
the other joints impaired. APD

· with axial angulation, whether single or multiple

· from 10° to 20° without limitation of rotation 2

· from 10° to 20° with limitation of rotation 3

· more than 20° without limitation of rotation 3

· more than 20° with limitation of rotation 5

· without angulation, but with limitation of rotation 1

· with shortening of the bony structure:

· of 2 cm 1

· of more than 2 to 4 cm 2

· of more than 4 cm 4

(3) Shoulder

(i) Dislocation

· without functional sequelae 0

· with functional sequelae

Refer to Table 2 of ankyloses of the shoulder or of
the other joints impaired. APD

· with continuing instability 3

· recurring, requiring surgical correction

Refer to Table 2 of ankyloses of the shoulder, without
exceeding the percentage prescribed for complete
ankylosis of the joint in functioning position. APD

(ii) Replacement of the head of the humerus by a cephalic
or total prosthesis

· without functional sequelae, including shortening 5

· with functional sequelae, including shortening 5

Also refer to Table 2 of ankyloses of the shoulder or
of the other joints impaired. APD

(iii) Rupture or degeneration of the rotator caul with
functional sequelae

Refer to Table 2 of ankyloses of the shoulder,
without exceeding the percentage prescribed for
complete ankylosis of the joint in functioning
position, and to the evaluation of impairment
of soft tissues. APD

(4) Biceps

(i) Musculotendinous rupture

· not operated on 2

· operated on 2

Also Refer to Table 2 of ankyloses of the shoulder or
of the other joints impaired, and to the evaluation of
impairment of soft tissues. APD

(ii) Dislocation of the long part of the biceps with
functional sequelae

Refer to Table 2 of ankyloses of the shoulder without
exceeding the percentage prescribed for complete ankylosis
of the joint in functioning position, and to the evaluation
of impairment of soft tissues. APD

(5) Elbow

(i) Fracture or dislocation of the radial head without resection

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 3 of ankyloses of the elbow. APD

(ii) Fracture or dislocation of the radial head with
resection without replacement by prosthesis

· without functional sequelae 2

· with functional sequelae 2

Also refer to Table 3 of ankyloses of the elbow or
of the other joints impaired. APD

(iii) Fracture or dislocation of the radial head with
resection and with replacement by prosthesis

· without functional sequelae 3

· with functional sequelae 3

Also refer to Table 3 of ankyloses of the elbow or
of the other joints impaired. APD

(iv) Articular or para-articular fracture
(e.g.: coronoid, olecranon, epicondyle, epitrochlea)

· without functional sequelae, with or
without radiological change 0

· with functional sequelae

Refer to Table 3 of ankyloses of the elbow. APD

(v) Dislocation of the elbow

· without functional sequelae 0

· with functional sequelae

Refer to Table 3 of ankyloses of the elbow. APD

(vi) Partial or total prosthesis of the elbow including
excision or replacement of the radial head, and
including shortening

· without functional sequelae 5

· with functional sequelae 5

Also refer to Table 3 of ankyloses of the elbow. APD

(vii) Permanent impairment of the soft tissues in
the area of the elbow

Refer to the evaluation of impairment of soft tissues. APD

(viii) Epicondylitis or epitrochleitis surgically treated

· without functional sequelae 0

· with functional sequelae

Refer to Table 3 of ankyloses of the elbow. APD

(6) Forearm and wrist

(i) Fracture of ulna or radius

· without functional sequelae, with or without
radiological change 0

· with axial angulation of more that 10°

Refer to Table 4 of ankyloses of the wrist or
of the other joints impaired. APD

(ii) Resection of distal extremity of the ulna

· without functional sequelae 2

· with functional sequelae 2

Also refer to Table 4 of ankyloses of the
wrist or of the other joints impaired. APD

(iii) Colles’ fracture, Smith’s fracture or other wrist fractures

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 4 of ankyloses of the wrist or
of the other joints impaired. APD

(iv) Dislocation of the wrist

· without functional sequelae 0

· with functional sequelae

Refer to Table 4 of ankyloses of the wrist or
of the other joints impaired. APD

(v) Fracture, dislocation, fracture-dislocation of
the scaphoid bone or the lunate bone

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 4 of ankyloses of the wrist or
of the other joints impaired. APD

(vi) Pseudarthrosis, avascular necrosis of
the scaphoid or of the lunate

· without functional sequelae 1

· with functional sequelae

Refer to Table 4 of ankyloses of
the wrist or of the other joints impaired. APD

(vii) Prosthesis of the scaphoid or of the lunate

· without functional sequelae 2

· with functional sequelae 2

Also refer to Table 4 of ankyloses of the wrist or
of the other joints impaired. APD

(viii) Fracture of other wrist bones

· without functional sequelae, with or
without radiological change 0

· with functional sequelae

Refer to Table 4 ankyloses of the wrist or
of the other joints impaired. APD

(ix) Carpal tunnel with or without decompression

· without functional sequelae or
electromyographic change 0

· without functional sequelae, but with
electromyographic change 1

· with functional sequelae

Refer to Chapter IV on the peripheral nervous
system for sensory or motor loss in the hand. APD

(7) The hand
Rules for evaluation of the hand:
(1) For purposes of this Division, the hand is deemed to consist of the thumb and 4 fingers.
(2) Hand deficits are evaluated per phalanx and per metacarpal.
(3) The rules for evaluation of partial or total amputation of the hand are set forth in (a) and (b) below.
The percentages of anatomicophysiological deficiencies (APD) are set forth in diagrams 1 to 5.
(4) The percentages prescribed for amputation of the hand by disarticulation at the wrist, ankyloses of the thumb and fingers and instability of the thumb are set forth in (c), (d) and (e) below under the heading HAND.
(5) For amputation of one or more fingers or the equivalent, where a finger is amputated by an employment injury, and another finger of the same hand had previously been amputated, the percentage for anatomicophysiological deficit (APD) for the finger amputated by the employment injury shall be fixed in accordance with the diagram corresponding to the total number of fingers amputated on that hand.
(a) Partial amputations
Partial amputation of one or more phalanges or metacarpals of the thumb or the fingers.
For each phalanx or metacarpal amputated 50% or less, the percentage of anatomicophysiological deficit (APD) shall be fixed at 50% of the percentage prescribed for a complete amputation of those phalanges or metacarpals.
For each phalanx or metacarpal amputated more than 50%, the percentage of anatomicophysiological deficit (APD) shall be fixed at 100% of the percentage prescribed for a complete amputation of those phalanges or metacarpals.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
(b) Total amputations
THUMB
(i) Total amputation of one or both phalanges of the thumb WITHOUT amputation of one or more fingers
For each phalanx amputated, the percentage of APD is set forth in diagram 1 of amputations of the thumb and metacarpals.
Also add the percentage prescribed for the disfigurement (D) from amputation. Refer to Chapter XVIII.
(ii) Total amputation of one or both phalanges of the thumb WITH amputation of one or more fingers
For each phalanx of the thumb amputated, the percentage of APD is set forth in diagram 1 of amputations of the hand.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
FINGERS
(i) Total amputation of one or more phalanges of ONE finger of one hand
For each phalanx amputated, the percentage of APD is set forth in diagram 2 of amputations of a finger.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
(ii) Total amputation of one or more phalanges of TWO fingers of one hand
For each phalanx amputated, the percentage of APD is set forth in diagram 3 of amputations of 2 fingers.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
(iii) Total amputation of one or more phalanges of THREE fingers of one hand
For each phalanx amputated, the percentage of APD is set forth in diagram 4 of amputations of 3 fingers.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
(iv) Total amputation of one or more phalanges of FOUR fingers of one hand
For each phalanx amputated, the percentage of APD is set forth in diagram 5 of amputations of 4 fingers.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
METACARPALS (thumb or fingers)
Total or partial amputation of one or more metacarpals of the hand
For each metacarpal amputated, the percentage of APD is set forth in diagram 1 of amputations of the thumb and metacarpals.
Also add the percentage prescribed for the D from amputation. Refer to Chapter XVIII.
.
HAND APD
%

(c) Amputation of the hand by disarticulation at the wrist 55

(d) Ankyloses

THUMB

(i) Complete, in functioning position

· of the interphalangeal 5

· of the metacarpophalangeal 2.5

· of both thumb joints 7.5

· of the trapezometacarpal 1.5

Add a percentage for any D.
Refer to Chapter XVIII.

(ii) Incomplete, in functioning position

For the distal phalanx with anankylosed joint, for each
ankylosed joint, the percentage of APD is fixed at 50%
of the percentage prescribed for a complete ankylosis
of that phalanx in functioning position.

Add a percentage for any D.
Refer to Chapter XVIII.

(iii) Complete or incomplete, in faulty position

For each distal phalanx with ankylosed joint, where the
non-functional ankylosis is harmful to the point of
warranting amputation, the percentage of APD is set
forth in diagram 1 of amputations of the thumb.

Add a percentage for any D.
Refer to Chapter XVIII. FINGERS

(i) Complete, in functioning position

For the distal phalanx with anankylosed joint, for each
ankylosed joint of one or more fingers, the percentage of
APD is fixed at 50% of the percentage prescribed in
diagram 2 of amputations of a finger.

Add a percentage for any D.
Refer to Chapter XVIII.

(ii) Incomplete, in functioning position

For the distal phalanx with an ankylosed joint, for each ankylosed
joint of one or more fingers, the percentage of
APD is fixed at 50% of the percentage prescribed for a
complete ankylosis of that phalanx in functioning position.

Add a percentage for any D.
Refer to Chapter XVIII.

(iii) Complete or incomplete, in faulty position

For each of the distal phalanges with an ankylosed
joint on one or more fingers, where a non-functional
ankylosis is harmful to the point of warranting one
or more amputations, the percentage of APD is set
forth in diagram 2, 3, 4 or 5 of amputations of the hand.

Add a percentage for any D.
Refer to Chapter XVIII.

(e) Instability of the thumb

With or without impairment of the other fingers

· interphalangeal 5

· metacarpophalangeal 2.5

· interphalangeal and metacarpophalangeal 7.5





c) IMPAIRMENT OF SOFT TISSUES (upper limb) APD
%

Permanent impairment of soft tissues (musculoskeletal)
where the sequelae are not already prescribed in the scale

· without financial sequelae or radiological change 0

· without functional sequelae, but with radiological change 1

· with functional sequelae 2

Also refer to the table of ankyloses of the joints
impaired and Table 5 of atrophies of the upper limb. APD

(B) PELVIS APD
%

(a) FRACTURE

(i) Consolidated without displacement

· without functional sequelae, with or without
radiological change 0

(ii) Consolidated with displacement

· without functional sequelae

· unilateral ischiopubic or ileopubic ramus 1

· iliac bone 1

· innominate bone 1

· intra-articular fracture of the pubic symphysis without diastasis 2.5

· sacrum 1

· coccyx 1

in the absence of consolidation, add the following
additional percentage 1

· with functional sequelae

· unilateral ishiopubic or ileopubic ramus 1.5

· iliac bone 2.5

· pubic symphysis

· with displacement of less than 2 cm 3.5

· with displacement of 2 cm and more 5.5

· sacrum with sacro-iliac impairment 3.5

· innominate bone 4

Where appropiate, add the percentages prescribed for
osseous dystocia in women before menopause. Refer to
Chapter VIII on the female genital system. APD

· simple or compound acetabulum fracture with
displacement, with or without central or posterior
dislocation of the hip 4

Also refer to Table 6 of ankyloses of the hip or
of the other joints impaired. APD

· coccyx

excision of the coccyx 1

(b) PARTIAL SACRO-ILIAC DISLOCATION

· residual 3

· residual requiring arthrodesis 5

(c) SPRAINS OF SACRO-ILIAC OR OF THE PUBIC SYMPHYSIS

Including traumatic sequelae to soft tissues
(e.g., myositis, fibrositis)

· without functional sequelae 0

· with functional sequelae, but without radiological change 1.5

· with functional sequelae and radiological changes 2

(C) LOWER LIMBS APD
%

(a) AMPUTATIONS

hemipelvectomy 70

disarticulation of the hip 60

thigh at middle third 50

disarticulation of the knee, transcondylar amputation,
or amputation below the knee, not permitting the wearing
of a prosthesis with patellar support 45

below the knee permitting the wearing of a prosthesis
with patellar support 35

Syme’s amputation 25

mediotarsal (amputation at Chopart’s joint) 25

tarsometatarsal amputation (Lisfranc) 15

transmetatarsal amputation 14

amputation of all 5 toes 8

amputation of great toe 4

amputation of a phalanx of the great toe 2

total or partial amputation of the 2nd, 3rd, 4th
and 5th toes, per toe 1

(b) FRACTURES, DISLOCATIONS, SPRAINS

(1) Hip

(i) Dislocation

· without functional sequelae 0

· with functional sequelae

Refer to Table 6 of ankyloses of the hip. APD

(ii) Replacement of the head of the femur by cephalic
prosthesis including shortening

· without functional sequelae 10

· with functional sequelae 10

Also refer to Table 6 of ankyloses of the hip. APD

(iii) Replacement of the hip by total prosthesis
including shortening

· without functional sequelae 15

· with functional sequelae 15

Also refer to Table 6 of ankyloses of the hip. APD

(iv) Resection of the hip (head and neck of the femur)
without replacement prosthesis 40

Also refer to Table 6 of ankyloses of the hip
and Table 7 of shortening and permanent muscular
atrophy of the lower limbs. APD

(2) Femur

(i) Metaphysis

Refer to Table 6 of ankyloses of the hip or of the
other joints impaired and Table 7 for shortening and
permanent muscular atrophy of the lower limbs. APD

(ii) Diaphysis

consolidated fracture with or without surgical reduction

· without functional sequelae, with or without
radiological change 0

· with axial angulation, whether single or multiple

· from 10° to 20° 4

· more than 20° 8

· with defect of internal rotation

· from 10° to 20° 5

· more than 20° 9

· with defect of external rotation

· from 10° to 20° 4

· more than 20° 7

(3) Knee

Examination is carried out with the knee in complete or maximum
extension.

(i) Fracture

of one or more tibial plateaux

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee or of the
other joints impaired and Table 9 of instabilities
of the knee. APD

of one or more condyles of the femur

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee or of the
other joints impaired and Table 9 of instabilities
of the knee. APD

osteochondral fracture of tibial plateaux

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee or of the
other joints impaired and Table 9 of instabilities
of the knee. APD

of tibial spines

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee or of the
other joints impaired and Table 9 of instabilities
of the knee. APD

of the anterior tibial tuberosity

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee or of the
other joints impaired and Table 9 of instabilities
of the knee. APD

(ii) Dislocation

· of the knee without functional sequelae 0

· of the knee with functional sequelae

Refer to Table 8 of ankyloses of the knee and
Table 9 of instabilities of the knee. APD

(iii) Total prosthesis of the knee including
osteo-articular shortening required for
fitting prosthesis

· without functional sequelae 15

· with functional sequelae 15

Also refer to Table 8 of ankyloses of the
knee and Table 9 of instabilities of the knee. APD

(iv) Partial prosthesis is the knee including
osteo-articular shortening required for
fitting prosthesis

· without functional sequelae 4

· with functional sequelae 4

Also refer to Table 8 of ankyloses of the
knee and Table 9 of instabilities of the knee. APD

(v) Arthrodesis of the knee following excision of
an intra-articular prosthesis

The evaluation is made by awarding the percentage
prescribed for arthrodesis of the knee (table 8)
and shortening (table 7). APD

(vi) Meniscectomy

· without functional sequelae

· internal 1

· external 1

· internal and external 2

· with functional sequelae

· internal 1

· external 1

· internal and external 2

Also refer to Table 8 of ankyloses of the knee
and Table 9 of instabilities of the knee. APD

(vii) Consolidated fracture of the rotula

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 8 of ankyloses of the knee,
without exceeding the percentage prescrided
for an arthrodesis of the knee in functioning position APD

(viii) Complete dislocation of the rotula

· without functional sequelae 0

· with objectified residual instability 2

· with functional sequelae requiring wearing
of an orthesis or corrective surgery 4

Also refer to Table 8 of ankyloses of the knee. APD

(ix) Rotulian or femoropatellar syndrome 2

(x) Patellectomy

· total

with or without replacement by prosthesis
including atrophy of the quadriceps and loss
of muscular strength

· without functional sequelae 5

· with functional sequelae 5

Also refer to Table 8 of ankyloses of the knee
and Table 9 of instabilities of the knee, without
exceeding the percentage prescribed for an
arthrodesis of the knee in functioning position. APD

· partial

· without functional sequelae 1

· with functional sequelae 1

Also refer to Table 8 of ankyloses of the knee
and Table 9 of instabilities of the knee, without
exceeding the percentage prescribed for an
arthrodesis of the knee in functioning position. APD

(4) Leg

Consolidated fracture of one or more leg bones with
or without surgical reduction

· without functional sequelae, with or without radiological change 0

· with axial angulation of the tibia (single or multiple)

· from 10° to 15° 5

· more than 15° 8

· with defect of internal rotation

· from 10° to 20° 4

· more than 20° 8

· with defect of external rotation

· from 10° to 20° 2

· more than 20° 5

(5) Ankle and foot

(i) Simple sprain, compartmented or avulsive
fracture, single, double or triple malleolar
fracture with or without surgical reduction, consolidated

· without functional sequelae, with or without
radiological change 0

· with functional sequelae, including diastasis 2

Also refer to Table 10 of ankyloses of the ankle
and foot, without exceeding the percentage prescribed à
for a tibiotarsal arthrodesis in functioning position. APD

(ii) Total prosthesis of the ankle, including
osteo-articular shortening required for fitting
the prosthesis, without functional sequelae 5

(iii) Total prosthesis of the ankle, including
osteo-articular shortening required for fitting
the prosthesis, with functional sequelae 5

Also refer to Table 10 of ankyloses of the ankle
and the foot, without exceeding the percentage
prescribed for a panarthrodesis APD

(iv) Arthrodesis of the ankle following excision
of an intra-articular prosthesis

Refer to Table 10 of ankyloses of the ankle and foot. ADD

(v) Chronic radiologically proved instability of the ankle 2

5.1 Talus

Avulsive, compartmented fracture of the
corpus or of the collum, consolidated

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 10 of ankyloses of the ankle and
foot, without exceeding the percentage prescribed
for a tibiotarsal arthrodesis or a subastragal and
mediotarsal arthodesis in functioning position. APD

5.2 Calcaneum

Consolidated intra or extra-articular fracture

· without functional sequelae, with or without radiological change 0

· making the wearing of a shoe difficult 1.5

· with functional sequelae (articular incongruity)

Refer to Table 10 af ankyloses of the ankle
and foot, without exceeding the percentage
prescribed for a tibiotarsal arthrodesis in
functioning position. APD

5.3 Other bones (scaphoid, cuboid, cuneate)

Consolidated fracture of such bones

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 10 af ankyloses of the ankle
and the foot, without exceeding the percentage
prescribed for an arthrodesis of the ankle and
the foot in functioning position. APD

5.4 Metatarsals

(i) Isolated fracture of one or more matatarsals, consolidated

· without functional sequelae, with or without
radiological change 0

· without functional sequelae causing difficulty
in walking; per metatarsal 1.5

(ii) Resection of heads of 1st and 5th metatarsals 10

(iii) Resection of head of 1st metatarsal 6

(iv) Resertion of head of 5th metatarsal 4

(v) Resection of heads of 2nd, 3rd and 4th
metatarsals; per head 1

(vi) Resection of exostosis 1

(c) IMPAIRMENT OF SOFT TISSUES (lower limb)

Permanent impairment of soft tissues
(musculoskeletal) where the sequelae
are not provided for in the scale

· without functional sequelae,
or radiological change 0

· with functional sequelae, but with radiological change 1

· with functional sequelae 2

Also refer to the table of ankyloses of
the joints impaired and Table 7 of trophy
of the lower limbs. APD

(D) SPINE APD
%
(a) CERVICAL COLUMN

(1) Sprain

· without objectified functional sequelae 0

· with objectified functional sequelae with
or without radiological change 2

(2) Fracture

(i) Consolidated compartmented fracture

· without functional sequelae, with or
without radiological change 0

· with functional sequelae

Refer to Table 11 of permanent ankyloses of
the cervical column. APD

(ii) Consolidated fracture by crushing of a
vertebral body

· less than 25% of the vertebral body 2

·25% or more of the vertebral body 4

(iii) Consolidated fracture of a vertebral body
with radiologically proved instability, but
without neurological sequelae and not
stabilized by grafting after one year 6

(iv) Fracture(s) of one or more vertebral bodies
stabilized by grafting or implant; per area grafted 3

Also refer to Table 11 of ankyloses of the cervical column. APD

(v) Consolidated fracture(s) of one or more vertebral
bodies with functional sequelae, without neurological
sequelae

Refer to Table 11 of ankyloses of the cervical column. APD

(vi) Consolidated fracture(s) of one or more vertebral
bodies with neurological sequelae

Evaluate by adding the percentages prescribed
for the fractures, the ankyloses and the neurological sequelae APD

(vii) Dislocation and fracture-dislocation

Evaluate by adding the percentages prescribed
for the ankyloses and the neurological sequelae. APD

(viii) Consolidated isolated fracture of one or more
elements (pedicle, transverse or spinous process, lamina)

· without financial sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 11 of ankyloses of the cervical column. APD

(ix) Excision of one or more posterior elements (pedicle,
transverse or spinous process, lamina)

· without functional sequelae 0

· with functional sequelae 1

Also refer to Table 11 of ankyloses of the cervical column. APD

(x) Pseudarthrosis of the atlas without instability 5

(xi) Pseudarthrosis of the atlas with instability 10

(xii) Bone graft of the occiput at C2 or C3 20

(xiii) Consolidated fracture of the odontoid

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 11 of ankyloses of the cervical column. APD

(xiv) Radiologically proved pseudarthrosis of the odontoid

· without instability 5

· with instability 10

(3) Other cervical pathologies

(i) Hernia of intervertebral disk not operated on,
proved clinically and by specific tests

Also add the percentage prescribed for ankyloses
and neurological sequelae.

Refer to Table 11 of ankyloses of the cervical
column and to chap. IV. APD

(ii) Objectified instability without any fracture 3

(iii) Anterior or posterior cervical discoidectomy
with or without graft

· without objectified functional sequelae; per area 3

· with functional sequelae; per area 3

Also add the percentage prescribed for
the ankyloses (table 11) and the neurological
sequelae, chap. IV. APD

(iv) Chemonucleolysis; per area 2

(v) Surgical cervical discoidectomy after
chemonucleolysis; per area 2

Also refer to Table 11 of ankyloses of
the cervical column. APD

(vi) Partial exploratory or decompressive unilateral
or bilateral laminectomy without discoidectomy;
per lamina 1

Also refer to Table 11 of ankyloses of the cervical column. APD

(vii) Total exploratory or decompressive laminectomy
(posterior arch: lamina and spinous process);
per posterior arch 3

Also refer to Table 11 of ankyloses of the cervical column. APD

(viii) Cervical graft by posterior passage; per area grafted 3

Also refer to Table 11 of ankyloses of the cervical column. APD

Add any percentage prescribed for neurological
sequelae, chap. IV. APD

(b) DORSOLUMBAR COLUMN

(1) Sprain

(including traumatic injuries to soft tissues and
the facet syndrome)

· without objectified functional sequelae 0

· with objectified functional sequelae, with or
without radiological change 2

(2) Fracture

(i) Consolidated compartmented fracture

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 12 of ankyloses of the dorsolumbar column. APD

(ii) Consolidate fracture by crushing of a vertebral
body without functional sequelae or instability

· less than 25% of the vertebral body 2

· 25% or more of the vertebral body 4

(iii) Consolidated fracture(s) of one or more vertebral bodies

· with radiologically proved instability, but
without neurological sequelae and not stabilized by
grafting after one year 6

· with functional sequelae, but without neurological sequelae

Refer to Table 12 of ankyloses of the dorsolumbar column. APD

· with neurological sequelae

Evaluate by adding the percentage prescribed for the
fracture(s), ankyloses (table 12) and neurological
sequelae, chap. IV. APD

(iv) Fracture(s) of one or more vertebral bodies stabilized
by grafting or implant; per area grafted 3

Also refer to Table 12 of ankyloses of the dorsolumbar column. APD

(v) Dislocation(s), fractures-disolocation(s)

Evaluate by adding the percentages prescribed
for the ankyloses, the instability and the
neurological sequelae, chap. IV. APD

(vi) Consolidated isolated fracture of one or more
posterior elements (pedicle, transverse or
spinous process, lamina)

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

Refer to Table 12 of ankyloses of the dorsolumbar column. APD

(vii) Excision of one or more posterior elements
(pedicle, transverse or spinous process, lamina)

· without functional sequelae 0

· with functional sequelae 1

Also refer to Table 12 of ankyloses of the dorsolumbar column. APD

(3) Other dorsal, lumbar or sacral pathologies

(i) Hernia of intervertebral disk not operated on,
proved clinically and by specific tests 2

Also add the percentages prescribed
for ankyloses and neurological sequelae. Refer to
Table 12 of ankyloses of the dorsolumbar
column and to chap. IV. APD

(ii) Dorsal, lumbar or lumbosacral discoidectomy

· without objectified functional sequelae; per area 3

· with functional sequelae; per area 3

Also add the percentages prescribed for
ankyloses and neurological sequelae. Refer to
Table 12 of ankyloses of the dorsolumbar
column and to chap. IV. APD

(iii) Chemonucleolysis; per area 2

(iv) Dorsal, lumbar or lumbosacral surgical discoidectomy
after chemonucleolysis; per area 2

Also refer to Table 12 of ankyloses of the dorsolumbar column. APD

(v) Partial exploratory or decompressive laminectomy
without discoidectomy; per lamina 1

(vi) Total exploratory or decompressive laminectomy
(posterior arch; lamina and spinous process);
per posterior arch 3

Also refer to Table 12 of ankyloses of
the dorsolumbar column. APD

(vii) Dorsal, lumbar or lumbosacral graft for other
pathologies; per area grafted 3

Also refer to Table 12 of ankyloses of
the dorsolumbar column. APD

(viii) Objectified instability without any fracture 3

(ix) Pachymeningitis or perineural fibrosis objectified
by specific tests 2

(E) THORACIC CAGE

APD
%
(a) FRACTURES OF THE STERNUM

(i) CONSOLIDATED FRACTURE

· without functional sequelae, with
or without radiological change 0

· with functional sequelae 2

· with sternoclavicular dislocation

· without functional sequelae 1

· with functional sequelae 1.5

Also refer to the table of ankyloses of the
joint(s) impaired. APD

(ii) Pseudarthrosis of the sternum 2

( iii) Xiphoid process (resection) 1

(iv) Costosternal syndrome 2

(b) RIB FRACTURES

Percentages are the same for one or more fractured ribs

(i) Consolidated or unconsolidated fracture(s)

· without functional sequelae, with or
without radiological change 0

· with minor functional sequelae (intercostal
neuralgia, chondrosternal or costovertebral
repercussions) 1.5

· with major sequelae having repercussions on
cardiorespiratory functions

Refer to the system(s) involved. APD

(c) THORACOCENTESIS 0

(d) THORACIC DRAINAGE 0

(e) THORACOTOMY 5

TABLE 2

PERMANENT ANKYLOSES OF THE SHOULDER
APD
%
(A) COMPLETE IN FUNCTIONING POSITION

· without movement of scapula 35

· with movement of scapula 25

(B) INCOMPLETE

(a) Adduction

(normal from 0° to 180° including scapula movements)


Lost Retained

0° 180° (normal) 0

20° 160° 1

40° 140° 2

60° 120° 3

80° 100° 4

100° 80° 5

120° 60° 6

140° 40° 7

160° 20° 9

180° 0° 10

(b) Front elevation

(normal from 0° to 180°)


Lost Retained

0° 180° (normal) 0

20° 160° 1

40° 140° 1.5

60° 120° 2

80° 100° 2.5

100° 80° 3

120° 60° 3.5

140° 40° 4

160° 20° 5

180° 0° 6

(c) External rotation

External rotation movements are measured with the patient
lying down or standing, and the shoulder in abduction at
90° (normal from 0° to 90°).


Lost Retained

0° 90° (normal) 0

20° 70° 1

40° 50° 2

60° 30° 3

90° 0° 4

(d) Internal rotation

Internal rotation movements are measured with the patient
lying down or standing, and the shoulder in abduction at
90° (normal from 0° to 40°).


Lost Retained

0° 40° (normal) 0

10° 30° 1

20° 20° 2

40° 0° 3

(e) External rotation where abduction at 90° is impossible

Movements are measured with the arm alongside the body
and the elbow bent at 90° (normal from 0° to 45°).


Lost Retained

0° 45° (normal) 0

5° 40° 1

15° 30° 2

30° 15° 3

45° 0° 4

(f) Internal rotation where abduction at 90° is impossible

Movements are measured with the arm alongside the body,
and the elbow bent at 90° (normal from 0° to 40°).


Lost Retained

0° 40° (normal) 0

10° 30° 1

20° 20° 2

40° 0° 3

(g) Extension

Retropulsion (normal from 0° to 40°)

complete absence 1

(h) Abduction

(normal from 0° to 20°)

loss of 10° or more 1

TABLE 3

PERMANENT ANKYLOSES OF THE ELBOW

Where the complete ankylosis of the elbow is not in the
functioning position, that is, 100°, refer to the
evaluation in: (E) Complete ankylosis with pronation and
supination retained; (F) Complete ankylosis of the elbow
in functioning position (100°) with loss of pronation;
and (G) Complete ankylosis of the elbow in functioning
position (100°) with loss of supination; the highest APD
of the 3 evaluation is used.

APD
%

(A) FLEXION

Flexion is measured from 0° or from the limit of
extension to 150° or to the limit of flexion:

Flextion to

0° 23

10° 22

20° 20

30° 19

40° 17

50° 16

60° 14

70° 13

80° 11

90° 10

100° 8

110° 6

120° 5

130° 3

140° 2

150° (normal) 0

(B) EXTENSION

Extension is measured from 150° or from the limit of
flexion to 0° or to the limit of extension:

Extension to

0° (normal) 0

10° 1

20° 2

30° 4

40° 5

50° 6

60° 7

70° 8

80° 10

90° 11

100° 12

110° 13

120° 14

130° 16

140° 17

150° 18

(C) ISOLATED PRONATION (normal from 0° to 80°)


Lost Retained

80° 0° 8

70° 10° 7

60° 20° 6

50° 30° 5

40° 40° 4

30° 50° 3

20° 60° 2

10° 70° 1

0° 80° (normal) 0

(D) ISOLATED SUPINATION (normal from 0° to 80°)


Lost Retained

80° 0° 8

70° 10° 7

60° 20° 6

50° 30° 5

40° 40° 4

30° 50° 3

20° 60° 2

10° 70° 1

0° 80° (normal) 0

(E) COMPLETE ANKYLOSIS WITH PRONATION AND SUPINATION RETAINED


Lost

0° (neutral position) 39

10° 38

20° 37

30° 36

40° 35

50° 34

60° 33

70° 32

80° 31

90° 31

100° (functioning position) 30

110° 35

120° 41

130° 46

140° 52

150° (maximum flexion) 57

(F) COMPLETE ANKYLOSIS OF THE ELBOW IN FUNCTIONING POSITION (100°)
WITH LOSS OF PRONATION

The APD includes complete ankylosis of the elbow and
loss of pronation.


Lost

0° (neutral position) 39

10° 41

20° 44

30° 46

40° 48

50° 50

60° 53

70° 55

80° (absence of pronation) 57

(G) COMPLETE ANKYLOSIS OF THE ELBOW IN FUNCTIONING POSITION (100°)
WITH LOSS OF SUPINATION

The APD includes complete ankylosis of the elbow and loss
of supination.


Lost

0° (neutral position) 39

10° 41

20° 44

30° 46

40° 48

50° 50

60° 53

70° 55

80° (absence of supination) 57

TABLE 4

PERMANENT ANKYLOSES OF THE WRIST

APD
%

(A) COMPLETE

Complete ankylosis in functioning position from 0° to 20°
of dorsiflexion, in neutral position of radial or cubital inclination 8

Complete ankylosis in faulty position, more than 10° of
cubital or radial deviation or more than 30° of
dorsiflexion or palmar flexion 12

(B) INCOMPLETE

Examination is carried out with the elbow in complete extension.

· Dorsiflexion or extension (normal from 0° to 60°)

up to 60° (normal) 0

up to 40° 1

up to 20° 2

nil 3

· palmar flexion (normal from 0° to 70°)

up to 70° (normal) 0

up to 60° 1

up to 40° 2

up to 20° 3

· cubital inclination

(normal from 0° to 30°)

completely nil 1

· radial inclination

(normal from 0° to 20°)

completely nil 1

TABLE 5

PERMANENT MUSCULAR ATROPHY OF UPPER LIMBS

APD
%

Permanent muscular atrophy, 3 cm or more, measured at
mid-arm, including any resulting muscular weakness 3.5

Permanent muscular atrophy, 2 cm or more, measured at
the upper third of the forearm, including any resulting
muscular weakness 2.5

TABLE 6

PERMANENT ANKYLOSES OF THE HIP

APD
%

(A) COMPLETE

· Complete ankylosis of the hip in straight position
at 0° and up to 20° of flexion, adduction and external
rotation 30

· Complete ankylosis of the hip in faulty position, more
than 20° of abduction or external rotation, or more than
10° of adduction or internal rotation, or more than 20°
of flexion 35


(B) INCOMPLETE

· flexion (normal 0° to 120°)

up to 120° (normal) 0

up to 110° 1

up to 100° 2

up to 90° 3

up to 70° 4

up to 50° 6

up to 30° 8

up to 20° 10

up to 0° 12

Extension of the hip is measured in the ventral position

· extension (normal 0° to 30°)

up to 30° (normal) 0

up to 15° 1

0° 2

· internal rotation (normal 0° to 40°)

up to 40° (normal) 0

up to 30° 1

up to 10° 2

0° 3

· external rotation (normal 0° to 50°)

up to 50° (normal) 0

up to 30° 2

up to 15° 3

0° 5

· abduction (normal 0° to 40°)

up to 40° (normal) 0

up to 20° 3

0° 6

· abduction (normal 0° to 20°)

up to 20° (normal) 0

up to 10° 1

0° 2

TABLE 7
SHORTENING AND PERMANENT MUSCULAR ATROPHY OF A LOWER LIMB

APD
%

(A) SHORTENING

Shortening of the bone structure of
a lower limb

1.5 cm or less (normal variation) 0

more than 1.5 cm and less than 2.5 2

2.5 cm and less than 3.5 3

3.5 cm and less than 4.5 4

4.5 cm and less than 5.5 6

5.5 cm and less than 6.5 8

6.5 cm and less than 7.5 10

7.5 cm or more 15

(B) ATROPHY

Permanent muscular atrophy of 3 cm or more, measured
15 cm above the upper pole of the patella, including any
muscular weakness resulting therefrom 3

Permanent muscular atrophy of 2 cm or more, measured
15 cm below the lower pole of the patella, including any
muscular weakness resulting therefrom 2

TABLE 8

PERMANENT ANKYLOSES OF THE KNEE

APD
%

(A) COMPLETE

Complete ankylosis of the knee in slight flexion of 10°
with or without patellectomy, without varus or valgus,
including actual shortening of 3 cm or less and
permanent and secondary muscular atrophy of the thigh 20

Complete ankylosis of the knee in correct position, but
with shortening of more than 3 cm, add to the preceding:

· more than 3 cm and less than 4.5 2

· 4.5 cm and less than 5.5 cm 4

· 5.5 cm and less than 6.5 cm 6

For complete ankylosis with concomitant deformities of
more than 10°, an additional APD of 2% is awarded for
each of the following deformities, with a maximum of 6%.

· recurvatum 2

· varus 2

· valgus 2

· rotation 2

(B) INCOMPLETE

· Flexion

Refer to the maximum flexion up to 130°.

up to 130° (normal) 0

up to 120° 1

up to 110° 2

up to 90° 4

up to 75° 5

up to 60° 6

up to 45° 8

up to 30° 10

up to 15° 15

0° 20

· Extension

Refer to the maximum extension up to 0°.

0° (normal) 0

up to 5° 1

up to 10° 4

up to 20° 7

up to 25° 8

up to 35° 10

up to 50° 30

more than 50° 45

For incomplete ankylosis with concomitant deformities of
more than 10°, an additional APD of 2% is awarded for
each of the following deformities, with a maximum of 6%.

· recurvatum 2

· varus 2

· valgus 2

· rotation 2

TABLE 9

INSTABILITIES OF THE KNEE

APD
%

· Slight laxity without functional sequelae 1

· Slight symptomatic ligamentary laxity 2

· Symptomatic ligamentary instability not requiring the
wearing of an orthesis 5

· Simple or complex instability requiring the wearing of
an orthesis for certain work or recreation activities 10

· Simple or complex instability requiring the wearing of
a functional orthesis for all activities 15

· Ligamentary instability accompanied by functional
sequelae

The percentage prescribed for each of the sequelae is
added, but their sum must not exceed the percentage
prescribed for arthrodesis of the knee in functioning
position. APD

TABLE 10

PERMANENT ANKYLOSES OF ANKLE AND FOOT

APD
%

(A) COMPLETE

tibiotarsal

· in neutral position or plantar flexion up to 10°
without inversion or eversion 12

· dorsiflexion at 10° 15

· dorsiflexion at 20° 25

· plantar flexion at 20° 14

· plantar flexion at 30° 18

· plantar flexion at 40° 20

· subastragal only, in correct position 5

· subastragal and mediotarsal (triple arthrodesis) 8

· tibiotarsal and subastragal 17

· tibiotarsal, subastragal and .
mediotarsal (panarthrodesis) 20

· tarsometatarsal 4

· metatarsophalangeal of great toe in functioning position 2

· interphalangeal of great toe 1

· interphalangeal of other toes
(resection or arthroplasty); per toe 0.5

The following percentages are added for any single or
multiple deformity of more than 5° (varus, valgus or
other) for one or more joints having incurred
arthrodesis (total) 3

(B) INCOMPLETE

· Tibiotarsal

The complete arc of movement is 60° as follows:

· 20° of dorsiflexion
· 40° of plantar flexion

loss of 60° 12

loss of 40° 7

loss of 30° 5

loss of 20° 3

loss of 10° 2

loss of less than 10° 1

normal 0

· subastragal

· loss of less than 50% of movements 2

· loss of 50% or more of movements 3

· mediotarsal · loss of less than 50% of movements 1

· loss of 50% or more of movements 2

TABLE 11

PERMANENT ANKYLOSES OF CERVICAL COLUMN

APD
%

(A) COMPLETE PERMANENT ANKYLOSIS 20

(B) INCOMPLETE ANKYLOSIS

· Anterior flexion(normal 0° to 40°)

· loss of less than 25% 1

· loss of 25% to less than 50% 1.5

· loss of 50% or more 3

· Extension (normal 0° to 30°)

· loss of less than 25% 1

· loss of 25% to less than 50% 1.5

· loss of 50% or more 3

· Lateral flexion (normal 0° to 40°)

· right

· loss of less than 25% 1

· loss of 25% to less than 50% 1.5

· loss of 50% or more 2

· left

· loss of less than 25% 1

· loss of 25% to less than 50% 1.5

· loss of 50% or more 2

· rotation (normal 0° to 60°)

· right

· loss of less than 25% 1

· loss of 25% to less than 50% 3

· loss of 50% or more 5

· left

· loss of less than 25% 1

· loss of 25% to less than 50% 3

· loss of 50% or more 5

TABLE 12

PERMANENT ANKYLOSES OF THE DORSOLUMBAR COLUMN à

APD
%

(A) COMPLETE PERMANENT ANKYLOSIS 30

(B) INCOMPLETE ANKYLOSIS

· Anterior flexion (normal 0° to 90°)

Lost Retained

90° 0° 9

60° 30° 7

40° 50° 5

20° 70° 3

0° 90° (normal) 0

· Extension (normal 0° to 30°)

Lost Retained

30° 0° 3

20° 10° 2

10° 20° 1

0° 30° (normal) 0

· Right lateral flexion (normal 0° to 30°)

Lost Retained

30° 0° 4

20° 10° 2

10° 20° 1

0° 30° (normal) 0

· Left lateral flexion (normal 0° to 30°)

Lost Retained

30° 0° 4

20° 10° 2

10° 20° 1

0° 30° (normal) 0

· Right rotation (normal 0° to 30°)

Lost Retained

30° 0° 5

20° 10° 3

10° 20° 1

0° 30° (normal) 0

· Left rotation (normal 0° to 30°)

Lost Retained

30° 0° 5

20° 10° 3

10° 20° 1

0° 30° (normal) 0

EXAMPLES APPLYING TO CHAPTER I

These examples illustrate the application of the principles laid down in the Act and in the Scale

___________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
___________________________________________________________________________________________________

(1) Amputation of both legs at mid-thigh

· Lower right leg 50 12
· Lower left leg 50 12
· Bilaterality 50 0
_____ _____ _____ _____
150 + 75 + 24 + 6 = 255

The total of the percentages fixed
is 255%.

The principle of bilaterality applies
solely to the APD (cf. special rules at
the beginning of Chapter I).

Note: Even where the percentage exceeds
100%, the health professional who made the
evaluation shall indicate the total of the
percentages he has fixed for purposes of
calculating the sum prescribed by section
87 of the Act (ch. Scale of Bodily Injuries
Regulation).

___________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
___________________________________________________________________________________________________

(2) Amputation of 3 phalanges of the
right index finger and the left ring finger

· Right index finger 5 1.5
· Left ring finger 3 1.5
· Bilaterality 3 0
_____ _____ _____ _____
11 + 2.2 + 3 + 0.3 = 16.5%

The total of the percentages fixed
is 16.5%.

The principle of bilaterality applies
solely to the APD (cf. special rules at the
beginning of Chapter I).

___________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
___________________________________________________________________________________________________

(3) Arthrodesis of the left wrist in
functioning position and internal
meniscectomy of the right knee

· Arthrodesis of the left wrist in
functioning position with flat 4 cm scar 8 0
· Internal meniscectomy of the right knee
without functional sequelae, with faulty 1.8 cm2 scar 1 1.8
· Bilaterality 0 0

_____ _____ _____ _____
9 + 1.35 + 1.8 + 0.1 = 12.25%

The total of the percentages fixed is
12.25%.

The principle of bilaterality does not
apply, since the sequelae affect an upper
limb and a lower limb (cf. special rules at
the beginning of Chapter I).
___________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
___________________________________________________________________________________________________

(4) Scars on right arm and restricted
extension of the left elbow with
slight deformation

· 1 cm2 faulty scar on right arm 0 0.5
· Restriction of extension of left elbow
up to 40°, with slight change in the shape
and summetry and flat 6 cm scar 5 0
· Bilaterality 0 0

_____ _____ _____ _____
5 + 0.75 + 0.5 + 0.01 = 6.26%

The total of the percentages fixed
is 6.26%.

The principle of bilaterality does not
apply, since the anatomicophysiological
sequelae (APD) affect only one limb
(cf. special rules at the beginning
of Chapter I).

__________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
__________________________________________________________________________________________________

(5) Amputation of 2 phalanges of the
right middle finger and one and a half
phalanges (more than 50% of the phalanx)
of the right ring finger

· Right middle finger 4.8 1
· Right ring finger 3.6 1
· Bilaterality 0 0

_____ _____ _____ _____
8.4 + 1.2 + 2 + 0.2 = 11.8%

The total of the percentages fixed
is 11.8%.

The principle of bilaterality does not
apply because the sequelae affect 2 fingers
on the same hand (cf. special rules at the
beginning of Chapter I).

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(6) Amputation of the 3 phalanges of the
left little finger at the time of a
previous non-work accident, with amputation
of the distal phalanx of the right middle
finger following a work accident

· Right middle finger 1.6 0.5
· Left ring finger (2)
· Bilaterality 1.6 0

_____ _____ _____ _____
3.2 + 0.3 + 0.5 + 0.01 = 4.01%

The total of the percentages fixed
is 4.01%.

Since the left little finger was amputated
at the time of a previous non-work accident,
the percentage of APD awarded for that
finger (2%) may not be added to the
percentage of APD fixed for the right
middle finger; the fixing of a percentage
of APD for the left little finger is used
solely to calculate bilaterality
(cf. special rules at the beginning
of Chapter I).

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(7) Complete ankylosis in functioning
position of the distal interphalangeal
joint of the index finger, without
scarring or deformation 1 0.1 0 0

The total of the percentages fixed
is 1.1%.

(8) Complete ankylosis in functioning
position of the proximal interphalangeal
joint of the index finger, without
scarring or deformation 1 0.1 0 0

The total of the percentages fixed
is 1.1%.

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(9) Complete ankylosis in functioning
position of the 2 interphalangeal joints of
the index finger, without scarring or
deformation 2 0.2 0 0

The total of the percentages fixed
is 2.2%.

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(10) Complete ankylosis in functioning
position of the 3 joints of the index
finger, without scamng or deformation 2.5 0.2 0 0

The total of the percentages fixed
is 2.7%.

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(11) Complete ankylosis in functioning
position of the distal interphalangeal
joint of the right middle finger and the
right little finger, without scarring or
deformation
· distal interphalangeal joint of middle
finger 0.8 0 0
· distal interphalangeal joint of little
finger 0.4 0 0

_____ _____ _____ _____
1.2 + 0.1 + 0 + 0 = 1.3%

The total of the percentages is fixed
at 1.3%

_________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_________________________________________________________________________________________________

(12) Complete ankylosis in functioning
position of the proximal interphalangeal
joint of the right middle finger and the
right little finger, without scarring or
deformation
· proximal interphalangeal joint of the
middle finger 0.8 0 0
· proximal interphalangeal joint of the
little finger 0.4 0 0

_____ _____ _____ _____
1.2 + 0.1 + 0 + 0 = 1.3%

The total of the percentages fixed
is 1.3%

________________________________________________________________________________________________

APD SLEL D SLEL
% % % %
________________________________________________________________________________________________

(13) Complete ankylosis in functioning
position of the 2 interphalangeal joints
of the left middle finger and the left
little finger, without scarring or
deformation
· proximal and distal interphalangeal
joints of middle finger 1.6 0 0
· proximal and distal interphalangeal
joints of little finger 0.8 0 0
_____ _____ _____ _____
2.4 + 0.2 + 0 + 0 = 2.6%

The total of the percentages fixed
is 2.6%.

_______________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_______________________________________________________________________________________________

(14) Complete ankylosis in functioning
position of the 3 joints of the middle
finger and the little finger
· metacarpophalangeal, proximal and distal
interphalangeal joints of middle finger 2 0 0
· metacarpophalangeal, proximal and distal
interphalangeal joints of little finger 1 0 0

_____ _____ _____ _____
3 + 0.3 + 0 + 0 = 3.3%

The total of the percentages fixed
is 3.3%.

_______________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_______________________________________________________________________________________________

(15) Complete ankylosis in functioning
position of the distal interphalangeal
joint of the ring finger, with faulty
0.8 cm2 scar 0.6 + 0.01 + 0.8 + 0.01 = 1.42%

The total of the percentages fixed
is 1.42%.
_______________________________________________________________________________________________

APD SLEL D SLEL
% % % %
_______________________________________________________________________________________________

(16) Incomplete ankylosis of the proximal
interphalangeal joints of the middle
finger and of the left little finger, with
slight deformation and faulty 0.6 cm2 scar
on the little finger
· middle finger 0.4 0
· little finger 0.2 0.6
_____ _____ _____ _____
0.6 + 0.01 + 0.6 + 0.01 = 1.22%

The total of the percentages fixed is
1.22%.

CHAPTER II

MAXILLOFACIAL SYSTEM

RULE APPLYING TO THIS CHAPTER

(1) Bilaterality

In this Chapter, the percentages resulting from
calculation of bilaterality, as a consequence of
permanent impairment of symmetrical organs, have already
been integrated. They are indicated under each sequela.
Where there is no such indication, the principle of
bilaterality does not enter into the calculation.

(2) Where the ankylosis of a joint falls between 2
measures indicated in the scale, reference is made to
the next higher measure of analomicophysiological deficit
(APD).

APD
%

(A) UPPER MAXILLARY

(a) PALATE AND DENTAL ARCH

(i) Loss of substance

· hard palate and total dental arch 20

· total hard palate 10

· dental arch

· allowing a simple prosthesis to be worn 3

· allowing a complex prosthesis to be worn 5

· soft palate

· without functional sequelae 1

· with objectified major rhinolalia (scopia) 10

· with slight permanent rhinolalia 3

· with tubal dysfunction 3

Add any percentages prescribed in Table 14
for dental alterations and losses. APD

(ii) Pseudarthrosis 4

Refer to Table 13 for any ankyloses of the
temporomandibular joints, without exceeding
the percentages prescribed for a complete
ankylosis of those joints. APD

(iii) Faulty consolidation

· with severe malocclusion and unilateral or
bilateral temporomandibular dysfunction 5

Refer to Table 13 for any ankyloses of the
temporomandibular joints, and Table 14 for
dental alteration and loses. APD

· with slight permanent unilateral or bilateral
malocclusion 2

Add any percentages prescribed in Table 14 for
dental alterations and losses. APD

· with obstruction of the rhinopharynx and
tubal dysfunction 3

(iv) Adequate consolidation, but with periodontal
problems 5

(b) NOSE

(1) External nose (except skin and teguments) 2

(i) Loss of substance

· nasofrontal and ascending process

· without functional sequelae 0.5

· with functional sequelae 5

· triangular and alar cartilage

· without functional sequelae 0.5

· with functional sequelae 5

(ii) Faulty consolidation

· without functional sequelae 0.5

· with functional sequelae 0.5

Also add the percentages prescribed for
sequelae in the internal nose. APD

(2) Internal nose

(i) Airways problems

· unilateral 1

· bilateral 3

(ii) Trophic problems

· local (crusts, dryness) 1

· remote (pharynx) 1

(iii) Perforation of the nasal septum 1

(3) Sinus: ethmoid, frontal, maxillary and sphenoidal

(i) Sequelae of sinusectomy

· frontal, radical

· unilateral 1

· bilateral 3

· maxillary

· unilateral 1

· bilateral 3

· ethmoid

· unilateral 2

· bilateral 6

· sphenoidal

· unilateral 2

· bilateral 6

(B) LOWER MAXILLARY

(a) COLLUM OF CONDYLE

(i) Consolidated fracture

· without functional sequelae, with
or without radiological change 0

(ii) Loss of substance resulting in unilateral or
bilateral temporomandibular dysfunction 3

Also refer to Table 13 of ankyloses of the
temporomandibular joints, without exceeding
the percentages prescribed for complete
ankylosis of those joints. APD

(iii) Pseudarthrosis

· without objectified functional sequelae 1

· with functional sequelae 3

Add any percentages prescribed in Table 14 for
dental alterations and losses. APD

(iv) Faulty consolidation with impairment in the
temporomandibular joints

Refer to Table 13 of temporomandibular
ankyloses, without exceeding the percentage
prescribed for complete ankylosis of those
joints. APD

(b) ASCENDING RAMUS

(i) Consolidated fracture

· without functional sequelae, with or without
radiological change 0

(ii) Loss of substance without solution of
continuity of mandibular arch 2

(iii) Loss of substance with pseudarthrosis 5

(iv) Faulty consolidation

· with slight malocclusion without
temporomandibular dysfunction 3

· with severe malocclusion and
temporomandibular dysfunction 5

Refer to Table 13 for any ankyloses of the
temporomandibular joints, without exceeding the
percentage prescribed for complete ankylosis
of those joints. APD

(c) HORIZONTAL RAMUS AND SYMPHYSIS

(i) Consolidated fracture

· without functional sequelae, with or without
radiological change 0

(ii) Partial loss of substance of dental arch
allowing a prosthesis to be worn 3

Refer to Table 13 for any ankyloses of the
temporomandibular joints, without exceeding the
percentage prescribed for complete ankylosis of
those joints and Table 14 for any dental
alterations and losses. APD

(iii) Loss of substance with severe pseudarthrosis 10

Refer to Table 13 for any ankyloses of the
temporomandibular joints, without exceeding the
percentage prescribed for complete ankylosis of
those joints. APD

Add any percentages prescribed in Table 14 of
dental alterations and losses. APD

(iv) Faulty consolidation

with slight malocclusion without
temporomandibular dysfunction 2

with severe malocclusion and
temporomandibular dys function 10

Also refer to Table 13 of ankyloses of the
temporomandibular joints, without exceeding the
percentage prescribed for complete ankylosis
of those joints. APD

(C) ZYGOMA AND MALAR BONE

Fracture

· without functional sequelae, with or without
radiological change 0

· with functional sequelae to outer canthus 3

· with impairment of orbital walls 3

Also refer to Chapter V on the visual system
for diplopia, enophthalmos and exophthalmos. APD

· with mechanical block, (limitation of half
of the lower maxillary) 3

Also refer to Table 13 of ankyloses of the
temporomandibular joints, without exceeding the
percentage prescribed for complete ankylosis
of those joints. APD

(D) ORBIT: FRAMEWORK, WALL, CONTENT

Fracture

· without functional sequelae, with or without
radiological change 0

· with functional sequelae

· with displacement of canthus

· inner 3

· outer 3

· with impairment of orbital walls

Refer to Chapter V on the visual system for
diplopia, enophthalmos and exophthalmos. APD

(E) SALIVARY GLANDS

Loss of salivary tissue without functional
sequelae 0.5

Loss of salivary tissue with hyposalivation 3

(F) TONGUE

Loss of substance

in front of lingual «V»

· lateral edge and tip 1

· lateral edges 3

· mid part 1

· base of the tongue 1

Refer to Chapter XII on the digestive system
for any problems caused by dysphagia. APD

(G) TEETH - ALTERATION AND DENTAL LOSS

Refer to Table 14 of dental alterations
and losses. APD

(H) CRANIAL NERVES

(a) TRIGEMINAL NERVE (V)

(1) Total and complete loss by impairment between the
nuclei and Gasser’s ganglions

· unilateral loss 20

· bilateral loss 60

Sensory loss only

· unilateral 15

· bilateral 45

Motor loss only

· unilateral 5

· bilateral 15

(2) Partial loss: ophthalmic ramus

lacrymal, frontal (supra-orbital)
and nasal nerves

· total and complete impairment

· unilateral 3

· bilateral 9

· partial impairment

· unilateral 2

· bilateral 6

(3) Partial loss: superior maxillary ramus suborbital,
sphenopalatine, posterior palatine, anterior palatine
nerves

· total and complete impairment

· unilateral 6

· bilateral 18

· partial impairment

· unilateral 3

· bilateral 9

(4) Partial loss: inferior maxillary ramus inferior
dental, mental, lingual, auriculotemporal nerves

· total and complete impairment

· unilateral 6

· bilateral 18

· partial impairment

· unilateral 3

· bilateral 9

(b) FACIAL NERVE (VII)

Peripheral loss

· all rami

· complete and unilateral 20

· complete and bilateral 60

· incomplete and unilateral 10

· incomplete and bilateral 30

· selective impairment

· upper ramus (orbicular nerve of lids, frontal)

· complete and unilateral 7

· complete and bilateral 21

· incomplete and unilateral 4

· incomplete and bilateral 12

· middle ramus

· complete and unilateral 6

· complete and bilateral 18

· incomplete and unilateral 3

· incomplete and bilateral 9

· cervicomandibular ramus

· complete and unilateral 7

· complete and bilateral 21

· incomplete and unilateral 3

· incomplete and bilateral 9

(c) OLFACTORY NERVE (I)

hyposmia, parosmia, dysosmia 1

objectified anosmia 5

(d) GLOSSOPHARYNGEAL NERVE (IX) AND VARIOUS (X)

· dysphagia

Refer to Chapter XII on the digestive system. APD

· dysphonia

Refer to Chapter XI on the larynx. APD

(e) HYPOGLOSSAL (XII)

· unilateral paralysis 2

· bilateral paralysis 6

· dysphagia

Refer to Chapter XII on the digestive system. APD

· dysarthria

· minor 5

· major 15

TABLEAU 13

PERMANENT ANKYLOSES OF THE TEMPOROMANDIBULAR JOINTS

APD
%

(A) COMPLETE ANKYLOSIS

Complete ankylosis may result from an intra or
extra-articular lesion.

This deficit refers to the overall function of
the 2 temporomandibular joints considered as a
whole. 30

(B) INCOMPLETE ANKYLOSIS

· Rotation (opening): distance measured
between the free edge of the upper and
lower incisors

Movement lost Movement retained
(in mm) (in mm)

40 0 10

30 10 7

20 20 5

10 30 3

0 40 (normal) 0

· Lateral movement

· loss of 50% or more 10

· loss of less than 50% 5

· no loss 0

· Propulsion (protrusion)

· loss of 50% or more 10

· loss of less than 50% 5

· no loss 0

TABLE 14

DENTAL ALTERATIONS AND LOSSES

The percentages for dental alterations and losses are
cumulative. The percentage fixed is reduced by two-thirds
where the worker is fitted with a fixed prosthesis.
The percentage fixed is reduced by one-third where the
worker is fitted with a removable prosthesis.

APD
%

UPPER OR LOWER MAXILLARY

central incisors, teeth no. 11 , 21, 31, 41; per tooth 1

lateral incisors, teeth no. 12, 22, 32, 42; per tooth 0.75

canines, teeth no. 13, 23, 33, 43; per tooth 1.5

first premolars, teeth no. 14, 24, 34, 44; per tooth 1

second premolars, teeth no. 15, 25, 35, 45; per tooth 1

first molars, teeth no. 16, 26, 36, 46; per tooth 1.25

second molars, teeth no. 17, 27, 37, 47; per tooth 1


CHAPTER III

CENTRAL NERVOUS SYSTEM

RULE APPLYING TO THIS CHAPTER

In this Chapter, the percentages resulting from the
calculation of bilaterality, as a consequence of permanent
impairment of symmetrical organs, have already
been integrated.

(A) BRAIN

(Deficits in cerebral functions)

(a) ORGANIC CEREBRAL SYNDROME:
COGNITIVE AND EMOTIVE

Deficits resulting from a cerebral impairment may be
manifested by problems of orientation, comprehension,
memory (immediate and past), judgment, self-criticism,
inability to make decisions, moods (euphoria and
depression), by spasmodic laughing or crying, inability
to bear frustration, behaviour problems and other
difficulties.

APD
%

Class 1

Integrated cerebral functions are impaired, but the
worker is capable of carrying on most ordinary activities. 15

Class 2

The extent of the deficit is such that the worker
requires some supervision or directions from other people
for carrying on many ordinary activities. 45

Class 3

The extent of the deficit is such that the worker
requires constant supervision and confinement at home or
in an institution. 80

Class 4

The extent of the deficit is such that the worker cannot
take care of himself. 100

(b) COMMUNICATION PROBLEMS

The principal communication problems result from cerebral
impairment affecting the central mechanism for language
comprehension, information storage and language
production in all its forms (aphasia, agraphia,
acalculia, alexia, dysphasia).

Class 1

Language problems interfering slightly with ordinary
activities. 15

Class 2

The worker understands speech but cannot produce it
adequately for ordinary activities. 40

Class 3

The worker does not understand speech and his speech is
unintelligible or inappropriate. 70

Class 4

The worker understands nothing and cannot express himself
in words. 100

(c) EPILEPSY

Evaluation is made according to the frequency and nature
of the seizures and the response to treatment.

Class 1

Seizures interfere slightly with ordinary activities. 15

Class 2

Seizures interfere moderately with ordinary activities. 30

Class 3

Seizures are frequent and serious to the point where the
worker requires constant supervision, either at home or
in an institution. 80

Class 4

Seizures render the worker totally incapable of carrying
on any ordinary activities. 100

(B) CRANIAL NERVES

(a) OLFACTORY NERVE (I)

Refer to Chapter II on the maxillofacial system. APD

(b) OPTIC NERVE (II)

Refer to Chapter V on the visual system. APD

(c) OCULOMOTOR NERVE OR COMMON OCULAR MOTOR NERVE (III)

PATHETIC OR TROCHLEAR NERVE (IV)

EXTERNAL OCULAR MOTOR NERVE (VI)

Refer to Chapter V on the visual system. APD

(d) TRIGEMINAL NERVE (V)

Refer to Chapter II on the maxillofacial system and
Chapter V on the visual system. APD

(e) FACIAL NERVE (VII)

Refer to Chapter II on the maxillofacial system. APD

(f) AUDITORY NERVE OR VESTIBULOCOCHLEAR NERVE (VII)

Refer to Chapter VI on hearing. APD

(g) GLOSSOPHARYNGEAL NERVE (IX)

Refer to Chapter II on the maxillofacial system. APD

(h) PNEUMOGASTRIC OR VAGUS NERVE (X)

Refer to Chapter II on the maxillofacial system. APD

(i) SPINAL NERVE (XI)

Complete paralysis of sternocleidomastoid

· unilateral 3

· bilateral 9

Complete paralysis of trapezius

· unilateral 5

· bilateral 15

(j) HYPOGLOSSAL NERVE (XII)

Refer to Chapter II on the maxillofacial system. APD

(C) CEREBROSPINAL IMPAIRMENT

(a) STANDING UPRIGHT AND WALKING

This classification applies solely to sequelae of a
cerebrospinal impairment.

Class 1

Can stand up and walk, but with certain difficulties up
and down staircases, on inclines, on uneven ground and
over long distances. 5

Class 2

Can stand up and walk, but not up and down staircases, on
inclines, on uneven ground or for long distances without
mechanical or other assistance. 20

Class 3

Can stand up and remain upright, but can take only a few
steps and requires assistance. 50

Class 4

Cannot stand upright without mechanical or other
assistance. 70

(b) USE OF THE UPPER LIMBS

This classification applies solely to sequelae of a
cerebrospinal impairment.

Class 1

Can use the impaired limb to grasp and hold for personal
needs without difficulty, but awkwardly.

· unilateral impairment 10

· bilateral impairment 25

Class 2

Can use the impaired limb to grasp and hold for personal
needs without difficulty, but manipulates objects with
difficulty.

· unilateral impairment 20

· bilateral impairment 40

Class 3

Can use the impaired limb, but with difficulty, even for
personal needs.

· unilateral impairment 40

· bilateral impairment 80

Class 4

Cannot use the impaired limb, even for personal needs.

· unilateral impairment 60

· bilateral impairment 100

(c) VESICAL FUNCTIONS

Refer to Chapter VII on the urinary system. APD

(d) ANORECTAL FUNCTIONS

Refer to Chapter XII on the digestive system. APD

(e) SEXUAL FUNCTIONS

Refer to Chapter VIII on the female genital system or
Chapter IX on the male genital system. APD

(D) CRANIOCEREBRAL TRAUMA

(a) CONCUSSION

A transitional alteration of the state of vigilance as a
side effect of cranial trauma, with or without loss of
consciousness, but quantifiable, and without permanent
deficit.

· Minor

amnesia or loss of consciousness of 60 minutes or less 1

· Moderate

amnesia or loss of consciousness of more than 60 minutes
but less than 24 hours 2

· Severe

amnesia or loss of consciousness for 24 hours and more 5

Where a cerebral concussion is followed by sequelae, the
highest percentage of APD for cerebral concussion or
functional sequelae is used.

(b) CONTUSION OR CEREBRAL LACERATION VISIBLE OR SHOWN
BY SPECIFIC TESTS

(including signs of concussion)

· Minor

without functional sequelae

· Major

with functional sequelae 10

Where there are functional sequelae, refer to the
appropriate chapters and add the percentages prescribed
for such sequelae. APD

(c) SKULL FRACTURE

Simple (flat) 1

Complex

· comminuted or open or of the base 2

· depressed (more than the thickness of the bone),
whether requiring elevation by trepanation or not 3

· depressed (more than the thickness of the bone)
requiring elevation by craniectomy or craniotomy with or
without plastic surgery on the bone or on the dura mater
or cranioplasty 7

Also add the percentage prescribed for concussion,
contusion, laceration or any other neurological sequelae. APD

(d) INTRACRANIAL HAEMATOMA OR HYGROMA

· Extracerebral (epidural or subdural) requiring
evacuation by craniectomy or trepanation(s) 3

· Extracerebral (epidural or subdural) requiring
evacuation by craniotomy 7

· Intracerebral haematoma (evacuated or unevacuated) 7

Also add the percentage prescribed for concussion,
contusion, laceration or any other neurological sequelae. APD

(e) SPINAL FLUID FISTULA

Evacuated by craniotomy or through the
otorhinolaryngologic passages 7

Not evacuated (with and without treatment) 10

(f) CAROTIDOCAVERNOUS FISTULA

Treated successfully

· without occlusion of the inner carotid

without functional sequelae 5

· without occlusion of the inner carotid

without functional sequelae 10

Treated unsuccessfully or not treated l5

Also add the percentage prescribed for neurological
sequelae. APD

(g) TRAUMA OF INNER CAROTID

Stenosis of 50% or less 5

Stenosis of more than 50% and less than 80% 10

Occlusion or stenosis of 80% or more 15

Also add the percentage prescribed for neurological
sequelae. APD

(h) POST-TRAUMATIC MENINGITIS OR ABSCESS

Without functional sequelae 5

Add the percentage prescribed for any trepanation
(or craniectomy) or for craniotomy. APD

(i) HYDROCEPHALUS WITH SHUNTING SPINAL FLUID

Also add the percentages prescribed for functional
sequelae. APD

CHAPTER IV

PERIPHERAL NERVOUS SYSTEM

RULES APPLYING TO THIS CHAPTER

(1) The classes of impairment are prescribed for motor
impairment or sensory impairment in Table 15.

Each class sets forth a criterion and a percentage of
loss of function corresponding to that criterion.

(2) The percentage of anatomicophysiological deficit
(APD) resulting from a nerve impairment is that prescribed
in Table 16.

Where there is a hyphen (-), no percentage of APD
may be awarded.

(3) The percentage is fixed according to whether it
applies to motor or sensory impairment and depending on
the class of impairment.

(4) The evaluation is made by multiplying the percentage
for the class (loss of function) fixed in accordance with
the criteria prescribed by Table 15 of the classes of
motor or sensory impairment by the maximum percentage of
APD prescribed for the structure injured.

Table 16 prescribes the maximum percentage of APD
to be awarded for an impaired structure, both for motor
impairment and for seniory impairment.

The table also prescribes calculations in terms of the
maximum percentage for an impaired structure and classes
of motor or sensory impairment.

(5) The percentage prescribed for an APD resulting
from motor impairment is added to that resulting from
sensory impairment.

(7) Bilaterality

Where a worker suffers from anatomicophysiological
deficits in symmetric organs as a result of an employment
injury, the total percentage awarded to him for such
deficits is determined by adding the percentages of the
anatomicophysiological deficits calculated for each
organ and by adding a second time the percentage
determined for the least severely impaired organ.

TABLE 15

CLASSE OF MOTOR AND SENSORY IMPAIRMENT

Loss of function
%

(A) MOTOR IMPAIRMENT

Class I no loss of motor function 0

Class II objective weakness against strong resistance 25

Class III objective weakness against slight resistance 50

Class IV objective weakness against gravity 75

Class V no motor strength 100

(B) SENSORY IMPAIRMENT

For compensation to be paid for sensory deficits, they
must have the objective characteristics usually
recognized on a scientific basis. The evaluation shall
take into account the dermatomes, the type of sensitivity
impaired and the plausibility of the clinical signs.

Class I no sensory impairment 0

Class II hypoaesthesia including dysaesthesia and pain 25

Class III anaesthesia (including pain) 100

TABLE 16

PERIPHERAL NERVOUS SYSTEM
_________________________________________________________________________________________________
_________________________________________________________________________________________________

INJURED STRUCTURE APD MOTOR SENSORY
(classes) (classes)

____________________________ ________________
Maximum
sensory I II III IV V I II III
and motor 0% 25% 50% 75% 100% 0% 25% 100%
_________________________________________________________________________________________________

NERVE ROOT

C-5 20% 0 4 8 12 16 0 1 4

C-6 24% 0 4.5 9 13.5 18 0 1.5 6

C-7 24% 0 5 10 15 20 0 1 4

C-8 28% 0 6 12 18 24 0 1 4

L-1 16% 0 3 6 9 12 0 1 4

L-2 16% 0 3 6 9 12 0 1 4

L-3 16% 0 3 6 9 12 0 1 4

L-4 16% 0 3 6 9 12 0 1 4

L-5 24% 0 5 10 15 20 0 1 4

S-1 16% 0 3 6 9 12 0 1 4

BRACHIAL PLEXUS

Total brachial
plexus 70% 0 12.5 25 37.5 50 0 5 20

Upper trunk C-5
C-6 Erb-Duchesne
syndrome 50% 0 10 20 30 40 0 2.5 10

Middle trunk C-7 28% 0 6 12 18 24 0 1 4

Lower trunk C-8
L-1 Klumpke-

Dejerine syndrome 50% 0 10 20 30 40 0 2.5 10

HEAD AND NECK

Greater occipital 1% - - - - - 0 0.25 1

Lesser occipital 1% - - - - - 0 0.25 1

Auricular ramus
C-2 C-3 2% - - - - - 0 0.50 2

UPPER LIMBS

Anterior thoracic
nerver 4% 0 1 2 3 4 - - -

Circumflex
(axillary) 24% 0 5 10 15 20 0 1 4

Dorsal scapular 4% 0 1 2 3 4 - - -

Long thoracic
(serratus anterior
nerve) 10% 0 2.5 5 7.5 10 - - -

Media1 brachial
cutaneous interna1
accessory 4% - - - - - 0 1 4

Median (above
middle forearm) 50% 0 7.5 15 22.5 30 0 5 20

Median (below the
junction of the
middle and distal
thirds of the
forearm) 40% 0 5 10 15 20 0 5 20

Musculocutaneous 24% 0 4 8 12 20 0 1 4

Radial (triceps
lost) 40% 0 9 18 27 36 0 1 4

Radial (triceps
spared) 28% 0 6 12 18 24 0 1 4

Subscapular nerve
(subscapularis) 4% 0 1 2 3 4 - - -

Suprascapular
nerve
(suprascapularis) 12% 0 2.5 5 7.5 10 0 0.5 2

Thoracodorsal
nerve
(thoracodorsalis) 8% 0 2 4 6 8 - - -

UPPER LIMBS

Ulnar (above the
middle and distal
thirds) (ulnaris) 28% 0 6 12 18 24 0 1 4

Ulnar (below the
junction of the
middle and distal
thirds) (ulnaris) 24% 0 5 10 15 20 0 1 4

INGUINAL REGION

Greater
abdominogenital
(iliohypogastricus) 4% - - - - - 0 1 4

Lesser
abdominogenital
(ilioinguinalis) 4% - - - - - 0 1 4

LOWER LIMBS

Femoral (cnemial) 20% - 4 8 12 16 0 1 4

Genitocnemial
(genitofemoralis) 4% - - - - - 0 1 4

Inferior gluteal 8% - 2 4 6 8 - - -

Lateral cutaneous
nerve of thigh 4% - - - - - 0 1 4

Obturator nerve 12% 0 2 4 6 8 0 1 4

Posterior
cutaneous nerve
of thigh 4% - - - - - 0 1 4

Superior gluteal 12% 0 3 6 9 12 - - -

Large sciatic,
above rami to
ischiotibial
muscles 60% 0 10 20 30 40 0 5 20

External popliteal
sciatic
(common peroneal) 20% 0 4 8 12 16 0 1 4

Deep peroneal
above mid-leg (peroneus
profundus) 12% 0 3 6 9 12 - - -

LOWER LIMBS

Deep peroneal
below mid-leg
(peroneus
profundus) 4% 0 1 2 3 4 - - -

Superficial
peroneal (peroneus
superficialis) 10% 0 1.5 3 4.5 6 0 1 4

Internal popliteal
nerve above knee 24% 0 4 8 12 16 0 2 8

Posterior tibial
in the annular
soleus region 16% 0 2 4 6 8 0 2 8

Posterior tibial
at mid-calf 12% 0 2 4 6 8 0 1 4

Medial plantar
(medial plantaris) 6% 0 1 2 3 4 0 0.5 2

Lateral plantar
(lateral
(plantaris) 6% 0 1 2 3 4 0 0.5 2

External
sapheneous
(cutaneous sural) 2% - - - - - 0 0.5 2

____________________________________________________________________________________

CHAPTER V

VISUAL SYSTEM

RULES APPLYING TO THIS CHAPTER

(1) The percentages resulting from impairment of the
ocular functions are added to the percentages resulting
from the accessory functions.

Bilaterality

The percentages resulting from calculation of
bilaterality have already been integrated into the
formulas for calculating the APD.

(2) Accessory functions (adnexa)

Bilaterality

Where a worker suffers from anatomicophysiological
deficits following an employment injury and resulting
from symmetrical impairment of accessory functions of
the visual system, the total percentage fixed for such
deficits is calculated by totalling the percentages of
APD fixed for each impairment and by adding a second
time the percentage fixed for the least severely impaired
function.

(3) No award is made for disfigurement (D) for the
loss of visual function. For the D related to the eye,
other than loss of visual function, refer to Chapter
XVIII on disfigurement.

APD
%

(A) THE VISUAL SYSTEM

(1) The visual system consists of the eyes and the
optic pathways from the ocular globe to the occipital
cortex.

It also includes the adnexa, which are essential for
the functioning of the system, consisting of the lacrymal
glands, the lacrymal passages and the eyelids.

(2) Any impairment of the following cranial nerves
can cause permanent damage to the visual system:

· Optical nerve (II)

· Common ocular motor nerve (III)

· Pathetic nerve (IV)

· Trigeminal nerve (V) (cf. Chapter II on the
maxillofacial system)

· External ocular motor nerve (VI)

· Facial nerve (VII) (cf. Chapter II on the
maxillofacial system)

· Auditory nerve, vestibular ramus (VIII)

(3) The evaluation of vision deals with the following
3 functions:

· Central visual acuity at a distance and close-up,
corrected

· Central and peripheral visual field

· Ocular motility without diplopia

(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.

Evaluation of these 3 functions is necessary and
essential to determine visual deficit. Although they are
not al1 equally important, vision is imperfect without
the coordinated function of all 3.

Percentages of deficit are awarded for other ocular
functions and for other ocular problems that affect one
or more of the coordinated functions in accordance with
the scale prescribed for those functions.

Other ocular functions or problems that do not affect
the coordinated functions of the eye are evaluated under
the headings of Accessory functions and Other deficits
of ocular functions, at the end of this chapter.

(2) MAXIMUM PERCENTAGES OF DEFICIT

Loss of vision in one eye 25

Loss of vision in both eyes 100

(3) 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 18 and 19.

(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 diagram 6.

The minimum normal extent of the visual field from
the point of fixation is indicated in diagram 6.

The percentage of retained visual field in one eye is
obtained by adding the number of degrees of the eight
principal meridians shown in diagram 6 for the 3/330
isopter, which normally is 500 degrees, and dividing by
five. Conversely, the percentage of deficit of visual
field is obtained by adding the degrees lost, as measured
according to the norms in diagram 6, 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 two adjacent meridians. The
deficit of visual field can be calculated for other defects
in the same way.

Table 20 shows percentages of deficit of visual field,
calculated on the basis of degrees lost, expressed in
increments of 5 degrees. The following illustration
provides an example of the calculation of deficit of
visual field.

EXAMPLE

Calculation of deficit of visual field

Deficit Degrees retained Normal
________________________________________________________________________________________

Temporally 55 85
Down temporally 55 85
Down 35 65
Down nasally 20 50
Nasally 30 60
Up nasally 25 55
UP 25 45
Up temporally 15 55
_____ _____
TOTAL 260 500

(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 extent of the diplopia
when the worker 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 subject 1 m distant 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 worker looks in
various directions as given in diagram 7.

(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
acuity field motility efficiency
retained retained retained of eye
_____________________________________________________________________________________________
Right
eye _____ X _____ X _____ X _____

Left
eye _____ X _____ X _____ X _____

(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 APD for the entire visual system.

% of efficiency
% of efficiency % of efficiency of binocular
of better eye of other eye vision
____________________________________________________________________________________________
( X 3) + =
_________________________________________ _________
4

% of efficiency % of APD of the
of binocular entire visual
vision system
___________________________________________________________________________________________
100 - _________ = _________

Add the percentage of APD prescribed for any problems
of colour vision and adaptation to darkness and
any objectified neurosensory problems.








TABLE 18

RATING OF CENTRAL VISUAL ACUITY

(A) DISTANCE

SNELLEN SNELLEN % of deficit
of central
English metric 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

% of deficit
of central
Snellen Jaeger Point 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 8 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 19

DEFICIT OF CENTRAL VISION * (Snellen’s scale)

close-up vision

14* 14 14 14 14 14 14 14 14 14 14
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
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 APD prescribed for pseudoaphakia.

TABLE 20

DEVIDIT 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
100 400 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 fields is impaired, the percentage of APD is that of the
concomitant loss of visual acuity. If the visual acuity is normal, the percentage
of APD is calculated on the basis of the degrees lost.

(B) ACCESSORY FUNCTIONS (ADNEXA)
APD
%

(1) Lacrymal system

section of lacrymal canal with continuous watering

slight 1
moderate 2
significant 3

secretion problems caused by impairment of the
sympathetic cervical nerve 1

For secretion problems caused by impairment of the
trigeminal nerve (V) or the facial nerve (VII), refer
to Chapter II on the maxillofacial system. APD

(2) Eyelid protective system

damage to eyelid by faulty scar (trichiasis,
entropion, ectropion, symblepharon) 3

Add any percentage for impairment of the visual function.

ptosis of the eyelid caused by impairment of the
sympathetic cervical nerve 1

For blepharospasm, blinking and palpebral occlusion,
refer to Chapter II on the maxillofacial system. APD

Add any percentage for impairment of the visual function. APD

(3) Eyebrows
loss of function 1

(4) Eyelashes
loss of function 1

(C) OTHER DEFICITS OF OCULAR FUNCTIONS

The percentage fixed for such deficits is added to the
percentage fixed for impairment of the visual function. APD

Paralysis of accommodation or loss of close-up vision 3

Cataract or aphakia 12

Pseudaphakia 6

Exophthalmia

Refer to procedure for evaluation of vision. APD

Enophthalmia

Refer to procedure for evaluation of vision. APD

Iridoplegia or fixed mydriasis based on photophobia,
disturbance of close-up vision, dizziness 3

Myosis caused by impairment of the sympathetic cervical
nerve 1

Also add the percentage for impairment of the visual
function. APD

Hemianopsia

Refer to procedure for evaluation of vision. APD

· Periocular sensitivity

Refer to Chapter II on the maxillofacial system. APD

Objectified problems of colour vision 0.5

Objectified problems in adapting to darkness 0.5

Objectified neurosensory problems 0.5

EXAMPLE OF EVALUATION OF VISION

Percentage of visual efficiency as a whole

Left eye:

(a) Visual acuity

· Close-up vision, 14/28

· Distance vision, 20/80

· According to Table 19, the deficit of central
vision is 25%;

retained acuity is therefore 75% or 0.75.

(b) Visual field

· Loss of 100°

· According to Table 20, the deficit of visual
field is 20%;

retained visual field is therefore 80% or 0.80.

(c) Ocular motility

· Deficit of 30%;

retained ocular motility is therefore 70% or 0.70.

PERCENTAGE OF EFFICIENCY OF LEFT EYE

0.75 x 0.80 x 0.70 = 0.42 or 42%

Right eye

(a) Visual acuity

· Close-up vision, 14/22

· Distance vision, 20/50

· According to Table 19, the deficit of central
vision is 15%;

retained acuity is therefore 85% or 0.85.

(b) Visual field

· Loss of 150°

· According to Table 20, the deficit of visual field is
30%;

retained visual field is therefore 70% or 0.70.

(c) Ocular motility

· Deficit of 20%;

retained ocular motility is therefore 80% or 0.80.

PERCENTAGE OF EFFICIENCY OF RIGHT EYE

0.85 x 0.70 x 0.80 = 0.476 or 47.6%

EFFICIENCY OF ENTIRE VISUAL SYSTEM

(3 x 47.6) + 42 = 46.2% efficiency of binocular vision
________________
4

100% - 46.2% = 53.8% of APD

The percentage of APD is 53.8%.

The percentage for the resulting SLEL is 21.6%.

The total of the percentage fixed is 75.4%.

No percentage is fixed for D (cf. special rules at the
beginning of this Chapter).

CHAPTER VI
HEARING
(INCLUDING OUTER, MIDDLE AND INNER EAR)

RULES APPLYING TO THIS CHAPTER

1. The frequencies used in determining the average of
the thresholds are 500, 1000, 2000 and 4000 hertz (Hz).

2. For the purposes of calculating the APD of the
auditory function, where the hearing threshold at a given
frequency is higher than 100 decibels (dB), it is deemed
to be 100 dB.

3. The minimum compensation threshold is 30 dB and the
maximum compensation threshold is 70 dB.

4. No adjustment for presbyacusis shall be made in
evaluating hearing.

5. For complete hearing loss, the percentage of APD is
54%.

6. No award is made for disfigurement (D) resulting
from auditory functional sequelae.

7. Bilaterality

Anatomical sequelae

Where a worker suffers anatomicophysiological deficits
resulting from anatomical sequelae to the ears and caused
by an employment injury, the total percentage fixed for
such deficits is calculated by totalling the percentages of
APD fixed for each impairment and adding a second time
the percentage fixed for the least severe impairment.

Functional sequelae

The percentages resulting from the calculation of
bilaterality following permanent impairment due to
functional sequelae have already been integrated into
the figures.

(A) ANATOMICAL SEQUELAE
APD
%
(i) Pinna (per ear)

· Amputation of one-third 2

· Amputation of two-thirds 4

· Complete amputation 6

(ii) External auditory ductule

· Scar without functional sequelea 1

· Cicatricial stenosis impeding normal cleaning
of the external auditory ductule 2

· Complete, uncorrected stenosis 4

Add any percentage prescribed for functional
sequelae.

(iii) Tympanum

· Serious scarring 2

· Significant sequelae (perforation or other),
uncorrected 4

Add any percentage prescribed for functional
sequelae.

(B) FUNCTIONAL SEQUELAE

(a) PROCEDURE FOR EVALUATING HEARING DEFICIT

(1) Step I

For each ear, the average of the thresholds recorded
at frequencies of 500, 1000, 2000 and 4000 Hz is
calculated and rounded off in accordance with Table 22.

Average
rounded off
Thresholds in dB at frequencies Average with table 22

500 1000 2000 4000 HZ

Right _____ + ______ + ______ + _______ = _______ - 4 = _______ _____________
ear

Left _____ + ______ + ______ + _______ = _______ - 4 = _______ _____________
ear

TABLE 22
___________________________________________________________________________________________
Average of the Average of the
thresholds at thresholds at
frequencies of Average frequencies Average
500, 1000, 2000, rounded of 500, 1000, rounded
and 4000 Hz off 2000 and 4000 Hz off
___________________________________________________________________________________________
30 30 50 50
31.25 30 51.25 50
32.5 35 52.5 55
33.75 35 53.75 55
35 35 55 55
36.25 35 56.25 55
37.5 40 57.5 60
38.75 40 58.75 60
40 40 60 60
41.25 40 61.25 60
42.5 45 62.5 65
43.75 45 63.75 65
45 45 65 65
46.25 45 66.25 65
47.5 50 67.5 70
48.75 50 68.75 70
70 or more 70

(2) Step II

The percentage of anatomicophysiological deficit (APD)
is calculated based on Table 23.

Average rounded
according to APD
Table 22 %
More ______ ______
severely carried over
impaired ear to Table 23

Less ______ ______
severely carried over
impaired ear to Table 23

TABLE 23

PERCENTAGE OF ANATOMICOPHYSIOLOGICAL DEFICITS (APD)

Less severely More severely
impaired ear impaired ear
Average threshold APD APD
in dB % %

30 2.5 0.5
35 5 1
40 7.5 1.5
45 12.5 2.5
50 22.5 4.5
55 32.5 6.5
60 40 8
65 42.5 8.5
70 and more 45 9

APD
%

(b) ADDITIONAL PERCENTAGES OF APD FOR TRAUMATIC LOSS
OF HEARING (sudden)

(i) Average threshold rounded off, 30 to
45 dB

unilateral 0.2

bilateral 0.6

(ii) Average threshold rounded off, 50
70 dB

unilateral 0.3

bilateral 0.9

(iii) Threshold higher than 70 dB

A valid response is obtained to sound stimulation
and communication is possible, especially with an
auditory prosthesis.

The following percentage is added to the
percentage fixed in accordance with the evaluation
procedure for the deficit of auditory function:

unilateral 2
bilateral 6

A valid response cannot be obtained and
communication is impossible, even after auditory
amplification.

The following percentage is added to the
percentage fixed in accordance with the evaluation
procedure for the deficit of auditory function:

unilateral 10

bilateral 30

EXAMPLES OF EVALUATION OF DEFICIT OF AUDITORY FUNCTION

EXAMPLE A: work-related loss of hearing (progressive)

Step I

500 1000 2000 4000 Hz Average

O.D. 20 + 25 + 35 + 75 = 155 / 4 = 38.75 dB
O.G 20 + 25 + 35 + 70 = 150 / 4 = 37.5 dB

Refer to Table 22.

Average Average rounded off

R.E. 38.75 40 dB
L.E. 37.5 40 dB

Step II

Refer to Table 23.
APD
%

R.E. (more severely impaired): 40 dB 1.5%
L.E. (less severely impaired): 40 dB 7.5%

APD 9.0% + SLEL 1.35% = 10.35%

EXAMPLE B: work-related loss of hearing (progressive)

Step I

500 1000 2000 4000 Hz Average

R.E. 20 + 20 + 30 + 40 = 110 / 4 = 27.5 dB
L.E. 20 + 25 + 30 + 50 = 125 / 4 = 31.25 dB

Refer to Table 22.

Average Average rounded off

R.E. 27.5 <30 dB
L.E. 31.25 30 dB

Step II

Refer to Table 23.

APD
%

R.E. (less severely impaired): <30 dB 0% (cf. special rule No. 3)
L.E. (more severely impaired): 30 dB 0.5%

APD 0.5% + SLEL 0.01% = 0.51%

EXAMPLE C: work-related loss of hearing (progressive) with right ear deaf
since childhood

Step I

500 1000 2000 4000 Hz Average

R.E. 80 + 100 + 100 + 100 = 380 / 4 = 95 dB
L.E. 20 + 30 + 40 + 55 = 145 / 4 = 36.25 dB

Refer to Table 22.

Average Average rounded off

R.E. 95 >70 dB
L.E. 36.25 35 dB

Step II

Refer to Table 23.

APD
%

R.E. (more severely impaired): >70 dB 0%
L.E. (less severely impaired): 35 dB 5%

APD 5% + SLEL 0.75% = 5.75%

EXAMPLE D: traumatic loss of hearing (sudden) in left ear

Step I

500 1000 2000 4000 Hz Average

R.E. 0 + 5 + 10 + 20 = 35 / 4 = 8.75 dB
L.E. 50 + 70 + 75 + 80 = 275 / 4 = 68.75 dB

Refer to Table 22.

Average Average rounded off

R.E. 8.75 <30 dB
L.E. 68.75 75 dB

Step II

Refer to Table 23.

APD
%

R.E. (less severely impaired): <30 dB 0% (cf. special rule No. 3)
L.E. (more severely impaired): 70 dB 9%
traumatic loss of hearing 0.3%
APD 9.3% + SLEL 1.35% = 10.65%

(C) VERTIGO

TOTAL LOSS OF VESTIBULAR FUNCTION

The loss may be considered as a labyrinthectomy

unilateral 5

bilateral 15

Add a percentage of anatomicophysiological deficit
appropriate to the degree of functional deficit.

Class 1

Signs of peripheral or central vertigo present; can
carry out everyday activities without assistance 2

Class 2

Signs of peripheral or central vertigo present; can
carry out everyday activities without assistance, except
certain activities that might endanger the safety of the
person or of others, such as driving a motor vehicle or
riding a bicycle 15

Class 3

Signs of peripheral or central vertigo present; cannot
carry out everyday activities without assistance, except
simple activities such as personal needs, domestic tasks
or walking 30

Class 4

Signs of peripheral or central vertigo present; cannot
carry out normal everyday activities without assistance,
except for personal needs 50

Class 5

Signs of peripheral or central vertigo present; cannot
carry out everyday activities without assistance, except
personal needs, and is confined to the home or an
institution owing to the problem of vertigo 60

CHAPTER VII
URINARY SYSTEM

RULE APPLYING TO THIS CHAPTER

In this Chapter, the percentages resulting from the
calculation of bilaterality following permanent impairment
to symmetrical organs have already been integrated into
the figures. They are indicated under each sequela.

Where there is no such indication, the principle of
bilaterality does not apply.

APD
%

(A) KIDNEY

(a) ANATOMICAL SEQUELAE

(i) Total unilateral nephrectomy 10

(ii) Total bilateral nephrectomy 30

(iii) Partial unilateral nephrectomy 5

(iv) Partial bilateral nephrectomy 15

(v) Calicine cicatricial lesions 1

(vi) Objectified perirenal sclerosis 1

(vii) Lombotomy 3

Also add the percentages prescribed below for
functional sequelae. APD

(b) FUNCTIONAL SEQUELAE

Impairment of renal functions according to clinical
signs and modifications of functional tests.

Evaluation is made by calculating the percentage of
APD and the percentage of SLEL resulting therefrom for
the clinical signs and for the modifications of
functional tests. The higher percentage of the 2 is
used (not both).

Clinical signs

(i) Absence of clinical signs 0

(ii) Intermittent symptoms and signs not requiring
supervision or continuing treatment 5

(iii) Signs requiring frequent treatment and
continuous medical supervision 15

(iv) Signs controlled incompletely by medical or
surgical treatment 30

(v) Signs not controlled by medical or surgical
treatment 60

Functional tests

(i) Normal tests 0

(ii) Persistent minor modifications of tests,
whether or not associated with a loss of renal
function of 25% or less 5

(iii) Persistent modifications of tests associated
with a loss of 50% or less, but more than 25%
of renal function 15

(iv) Modifications of tests associated with a loss
of 75% or less, but more than 50% of renal
function 30

(v) Modifications of tests associated with a loss
of more than 75% of renal function 60

(B) UPPER EXCRETORY SYSTEM (CALIX, RENAL PELVIS, URETER)

The following deficits, both anatomical and functional,
are added to any deficits already awarded for the
kidney.

ANATOMICAL SEQUELAE

(i) No deficiency 0

(ii) Ureteric, calicine or pyelic ectasia 5

(iii) High, cutaneous or intestinal urinary shunt,
whether intubated or not, with or without
cystectomy 40

Also add the percentages prescribed for
functional sequelae of kidneys. APD

(C) BLADDER

(a) ANATOMICAL SEQUELAE

The following anatomical deficits, both anatomical
and functional, are added to any deficits already awarded
for the upper excretory system and for the kidney.

(i) Rupture of bladder not requiring surgical
repair and without objectified anatomical deficit 0

(ii) Rupture of bladder requiring surgical repair 3

(iii) Partial cystectomy 5

(iv) Cystectomy (enterocystoplasty) 10

(v) Total cystectomy 30

(vi) Low, cutaneous or intestinal urinary shunt,
whether intubated or not, including permanently
installed urethral catheter, with or without
cystectomy 40

Also add the percentages prescribed below for
functional sequelae. APD

(b) FUNCTIONAL SEQUELAE

(i) Without functional sequelae 0

(ii) Clinical signs or sequelae requiring occasional
treatment 5

(iii) Clinical signs or sequelae requiring continuing
medical supervision and medication
(examples: recurring cystitis, incontinence
through precipitant urination controlled by
medication) . 15

(iv) Clinical signs or sequelae incompletely
controlled notwithstanding standing medical and
surgical treatment (examples: retention or
partial, intermittent incontinence) 30

(v) Clinical signs or sequelae not controlled
notwithstanding medical and surgical treatment
(examples: total incontinence or complete
urinary retention) 60

(D) URETHRA

The following deficits, both anatomical and the
functional, are added to any deficits already awarded for
the bladder, the upper excretory system and the kidney.

ANATOMICAL AND FUNCTIONAL SEQUELAE

(i) None 0

(ii) Constriction requiring occasional dilation
every 3 or 4 months 5

(iii) Constriction requiring dilation every 3 or 4 weeks 10

(iv) Fistulae 15

(v) Diverticula 5

CHAPTER VIII
FEMALE GENITAL SYSTEM

RULE APPLYING TO THIS CHAPTER

In this Chapter, the percentages resulting from
calculation of bilaterality following permanent impairment
to symmetrical organs have already been integrated into
the figures. They are indicated under each sequela.

Where there is no such indication, the principle of
bilaterality does not apply.

(A) INTERNAL GENITAL ORGANS

(i) Ovaries

· Loss of an ovary 7

· Anatomical or functional loss of both ovaries,
including replacement therapy 21

Also add one of the following percentages, depending on age:

· 50 years old or younger 7

· 51 years old or older 2

Add a percentage of SLEL for any problems in the sexual function.

(ii) Loss of uterus 10

Also add a percentage of SLEL depending on age, up to age 50. 0

Add a percentage of SLEL for any problems of the sexual function.

(B) EXTERNAL GENITAL ORGANS

Class 1

No deficit 0

Class 2

Sexual relations possible, but with slight difficulty
(delivery by birth canal possible) 5

Class 3

Sexual relations possible, but difficult (delivery by
birth canal restricted) 15

Class 4

Sexual relations impossible (delivery by birth canal
impossible) and symptoms not controlled by medical or
surgical treatment 20

Add a percentage of SLEL for any problems of the sexual function.

(C) DYSTOCIA DUE TO BONE STRUCTURE

These percentages are awarded only where there is a
pregnancy requiring a caesarian section. The percentages
include those prescribed for caesarian section. 5

(D) CAESARIAN SECTION

Add these percentages to the percentage prescribed for
laparotomy; cf. Chapter XII on the digestive system. 2

(E) PROBLEMS OF THE SEXUAL FUNCTION

These percentages are awarded only where there are
problems of the sexual function resulting from permanent
sequelae to the external or internal genital organs, as
prescribed in this chapter.

SLEL
%

(i) Minor deficit

Lack of interest sufficient to cause a reduction in the
frequency of sexual activities, but without alteration
in the level of satisfaction 5

(ii) Moderate deficit

Lack of interest sufficient to cause a considerable
reduction in the frequency, or sometimes to impede the
completion of the regular sexual cycle 10

(iii) Major deficit

Repeated sexual failure leading to avoidance of
sexual activity 15

(iv) Absence of sexual function

No sexual activity possible 30

CHAPTER IX
MALE GENITAL SYSTEM

RULE APPLYING TO THIS CHAPTER

In this Chapter, the percentages resulting from
calculation of bilaterality following permanent impairment
to symmetrical organs have already been integrated into
the figures. They are indicated under each sequela.

Where there is no such indication, the principle of
bilaterality does not apply.

(A) PENIS

APD
%

Class 1 0

No deficiency

Class 2

Sexual relations possible but with slight objectified
and documented difficulty 5

Class 3

Sexual relations possible, but with objectified and
documented difficulty 15

Class 4

Sexual relations impossible for objectified anatomical or
physiological cause
(example: amputation of penis) 20

Add a percentage of SLEL for any problems of the
sexual function.

(B) SCROTUM

Class 1

No sequelae 0

Class 2

Minor sequelae, symptoms and signs of scrotal loss or
impairment 5

Class 3

Major sequelae, symptoms and signs of scrotal loss or
impairment requiring testicular reimplantation 15

Add a percentage of SLEL for any problems of the sexual
function.

(C) SCROTAL CONTENTS

Class 1

No sequelae 0

Class 2

Clinical signs or sequelae of any of the elements of the
cord with alteration not requiring continuing treatment
and without anomalies of the seminal or hormonal
function (examples: chronic epididymitis, loss of a
testicle) 7

Class 3

Clinical signs or sequelae of any of the elements of the
cord with anatomical alteration requiring frequent or
continuous treatment and with objectified seminal or
hormonal anomalies 15

Class 4

Complete bilateral anatomical or functional loss of
elements contained in the scrotum 21

Also add one of the following percentages, depending
on age:

· 50 years old or younger 7

· 51 years old or older 2

Add a percentage of SLEL for any problems of the
sexual function.

(D) PROSTATE AND SEMINAL VESICLES

Class 1 0

No deficit

Class 2

Intermittent and objectified signs of impairment

· of the prostate 5

· of a seminal vesicle 4

Class 3

Frequent, severe and objectified signs requiring
continuous treatment

· of the prostate 10

· of the seminal vesicles 12

Add a percentage of SLEL for any problems of the
sexual function.

(E) PROBLEMS OF THE SEXUAL FUNCTION

These percentages are awarded only where there are
problems of the sexual function resulting from permanent
sequelae to the external or internal genital organs, as
prescribed in this chapter.

SLEL
%

(i) Minor deficit

Lack of interest sufficient to cause a reduction in
the frequency of sexual activities, but without
alteration in the level of satisfaction 5

(ii) Moderate deficit

Lack of interest sufficient to cause a considerable
reduction in the frequency, or sometimes to impede the
completion of the regular sexual cycle 10

(iii) Major deficit

Repeated sexual failure leading to avoidance of
sexual activity 15

(iv) Absence of sexual function

No sexual activity possible 30

CHAPTER X
ENDOCRINE SYSTEM

RULES APPLYING TO THIS CHAPTER

(1) In this Chapter, the percentages resulting from
the caluclation of bilaterality following permanent
impairment to symmetrical organs have already been
integrated into the figures. They are indicated under
each sequela.

Where there is no such indication, the principle of
bilaterality does not apply.

(2) Evaluation is made 12 months after the event.

(A) FUNCTIONAL IMPAIRMENT OF THE HYPOTHALAMUS AND
HYPOPHYSIS LEADING TO HYPOPITUITARISM
APD
%

Total 60

Partial

Refer to the appropriate hormone deficit . APD

Diabetes insipidus

· total 30

· partial 20

Deficit in growth hormone

· 0 to 12 years old 55

· 13 to 16 years old 30

· 17 to 22 years old 20

(B) IMPAIRMENT OF THE THYROID GLAND

(a) ANATOMICAL SEQUELAE

Partial or total thyroidectomy 3

(b) FUNCTIONAL SEQUELAE

Primary, secondary or tertiary hypothyroidism where
hormone replacement is needed 15

In the case of cardiac complications, refer to
Chapter XIII on the cardiovascular system. APD

(C) IMPAIRMENT OF THE PARATHYROIDS

(a) ANATOMICAL SEQUELAE

Partial or total parathyroidectomy 3

(b) FUNCTIONAL SEQUELAE

Hypoparathyroidism 25

(D) FUNCTIONAL IMPAIRMENT OF THE PANCREAS

(pancreatoprivic diabetes)

Controlled by diet 10

Controlled by diet and oral medication 20

Controlled by diet and insulin 50

Also add the following percentages according to age

· 0 to 30 years old 30

· 31 to 40 years old 20

· 41 to 50 years old 15

· 51 to 60 years old 10

· over 60 years old 5

(E) IMPAIRMENT OF THE ADRENAL GLANDS

(a) ANATOMICAL SEQUELAE

Adrenalectomy

· unilateral 8

· bilateral, including replacement therapy 24

(b) FUNCTIONAL SEQUELAE

Hypo-adrenalism, requiring replacement therapy 20

(F) INJURY TO THE GONADS

(ovaris and testicles)

Refer to Chapter VIII on the female genital system
and Chapter IX on the male genital system.

CHAPTER XI
LARYNX AND TRACHEA

RULE APPLYING TO THIS CHAPTER

The principle of bilaterality does not apply to this Chapter.

(A) LARYNGECTOMY

Partial 3

Also add the percentage prescribed for dysphonia. APD

Total 5

Also add the percentage prescribed for permanent
tracheostomy. APD

(B) TRAUMATIC TRACHEAL INJURY

Without functional sequelae 0

With persistent stenosis, without any change in the
respiratory function 3

Add the percentage prescribed for any change in the
respiratory function resulting from the stenosis. Refer
to Chapter XVI on the respiratory system. APD

With stenosis requiring a permanent tracheostomy,
including alteration in phonation 30

(C) DYSPHONIA

(alteration of phonation without permanent tracheostomy)

The evaluation is based on the following 3 functions:

· audibility

· intelligibility

· functional efficiency

Class 1

only one function is impaired 3

Class 2

2 functions are impaired 6

Class 3

all 3 functions are impaired 15

CHAPTER XII
DIGESTIVE SYSTEM AND SPLEEN

RULES APPLYING TO THIS CHAPTER

(1) In this Chapter, the percentages resulting from
the calculation of bilaterality following permanent
impairment to symmetrical organs have already been
integrated into the figures. They are indicated under
each sequela.

Where there is no such indication, the principle of
bilaterality does not apply.

(2) Although the spleen is not part of the digestive
system, it is included in this Chapter because of its
location within the abdomen.

Laparotomy 3

Laparocentesis 0

Abdominal drainage 0

Thoracolaparotomy 7

(A) OESOPHAGUS AND DIAPHRAGM

Evaluation is made in terms of digestive problems
and their functional consequences. Digestive problems
may involve the sequelae such as gastro-oesophageal
reflux, problems in deglutition with or without
oesophageal stenosis and their consequences on the
patient’s general condition.

(a) ANATOMICAL SEQUELAE

(1) Repair of an oesophageal lesion or trauma

· without objectified functional sequelae 3

· with objectified functional sequelae 5

Also add the percentage prescribed below for functional
sequelae.

(b) FUNCTIONAL SEQUELAE

Class 1

Presence of sequelae controlled by diet or medical
treatment, such as medication or dilation of the
oesophagus, without significant weight loss (loss of
weight less than 10% in relation to actual weight at the
time of the event) 10

Class 2

Presence of sequelae partially controlled by medical
treatment, or associated with a loss of weight of 10% to
20% in comparison with actual weight at the time of the
event 25

Class 3

Presence of sequelae not controlled by medical treatment,
such as gavage or gastrostomy or hyperalimentation, or
associated with a loss of weight of more than 20% in
comparison with the actual weight at the time of the
event 60

(B) STOMACH AND DUODENUM

Evaluation is made in terms of digestive problems,
problems in absorption and their consequences on the
patient’s general condition and his state of
nutrition.

(a) ANATOMICAL SEQUELAE

Vagotomy and pyloroplasty or correction of trauma
(perforation) without resection 5

Vagotomy with antrectomy 10

Subtotal gastrectomy (more than 50%) 20

Total gastrectomy 40

Also add any percentage prescribed for the functional
sequelae below.

(b) FUNCTIONAL SEQUELAE

Class 1

Without objectified functional sequelae, not requiring
continuous medical treatment 0

Class 2

Presence of sequelae requiring continuous medical
treatment, but without impairment of general condition
and without significant loss of weight (loss of weight
of less than 10% in comparison with actual weight at the
time of the event) 5

Class 3

Presence of sequelae partially controlled by continuous
medical or by surgery, associated with some restriction
of activities or a loss of weight of 10% to 20% in
comparison with actual weight at the time of the event 10

Class 4

Presence of sequelae not controlled by continuous medical
treatment or by surgery, associated with a significant
restriction of activities or a loss of weight of more
than 20% in comparison with actual weight at the time of
the event 25

(C) SMALL INTESTINE

Evaluation is made in terms of digestive problems,
problems in absorption and their consequences on the
patient’s general condition and his state of nutrition.

(a) ANATOMICAL SEQUELAE

Class 1

Repair of a lesion or a trauma without
resection and no objectified sequelae 3

Class 2

Resection of 50% and less 7

Class 3

Resection of more than 50% 30

Add any percentages prescribed for the functional
sequelae below.

(b) FUNCTIONAL SEQUELAE

Class 1

Presence of sequelae controlled by continuous medical
treatment but without impairment of the general condition 5

Class 2

Presence of sequelae partially controlled by continuous
medical treatment, associated with some restriction of
activities, or a loss of weight of 10% to 20% in comparison
with actual weight at the time of the event 15

Class 3

Presence of sequelae not controlled by continuous medical
treatment, associated with a significant restriction of
activities, or a loss of weight of more than 20% in
comparison with actual weight at the time of the
event 50

(D) COLON

Evaluation is made in terms of digestive problems and
their consequences on the patient’s general condition
and his state of nutrition.

(a) ANATOMICAL SEQUELAE

Class 1

Repair of a lesion or trauma of the colon without
resection 3

Class 2

Repair of a lesion or trauma of the colon with partial
resection 7

Class 3

Repair of a lesion or trauma of the colon with resection
of the left colon or the right colon 15

Class 4

Pancolic resection with permanent ileostomy or colostomy 40

Add any percentage prescribed for the functional
sequelae below.

(b) FUNCTIONAL SEQUELAE

Class 1

Without objectified functional sequelae, and not
requiring continuous medical treatment 0

Class 2

Presence of sequelae requiring controlled medical
treatment, but without impairment of the general
condition, restriction of activities or significant
loss of weight (loss of weight of less than 10% in
comparison with actual weight at the time of the event) 5

Class 3

Presence of sequelae not controlled by continuous medical
treatment, associated with some restriction of
activities, or a loss of weight of 10% to 20% in
comparison with actual weight at the time of the event 10

Class 4

Presence of sequelae not controlled by continuous
medical treatment, associated with a significant
restriction of activities, or a loss of weight of more
than 20% in comparison with actual weight at the time of
the event 25

(E) ANUS AND RECTUM

(anorectal function)

Class 1

Repair of a lesion without functional sequelae 1

Class 2

Repair of a lesion followed by sequelae controlled by
medical treatment 5

Class 3

Repair of a lesion followed by sequelae requiring
continuous medical supervision 10

Class 4

Repair of a lesion followed by sequelae incompletely
controlled by medical treatment or surgery 20

Class 5

Repair of a lesion followed by sequelae not controlled
by medical treatment or surgery 40

(F) LIVER

(a) REPAIR OF A TRAUMA TO OR LACERATION OF THE LIVER

Without resection 3

With resection 5

(b) PARENCHYMATOUS HEPATIC DISEASE

(1) Acute hepatic disease without sequelae 0

(2) Acute hepatic disease with sequelae

· non-specific hepatitis or persistent chronic hepatitis
histologically confirmed, or

biological evidence of chronic hepatic disease without
clinical signs of decompensation of the hepatic function
(jaundice, ascites, hepatic encephalopathy or digestive
haemorrhage by portal hypertension) 10

· chronic active hepatitis or cirrhosis
histologically confirmed without clinical signs of
decompensation of the hepatic function 30

· biological or histological evidence of chronic hepatic
disease with clinical signs of decompensation of the
hepatic function 80

(G) HEPATIC DUCTS AND GALLBLADDER

Class 1

Repair of trauma or laceration without objectified
sequelae 3

Class 2

Repair of trauma or laceration, with functional
symptomatic sequelae, without evidence of biological or
anatomical anomalies 5

Class 3

Repair of trauma or laceration without functional or
biological sequelae, but with anatomical sequelae
(including cholecystectomy or biliodigestive anastomosis) 7

Class 4

Repair of trauma or laceration with biological or
anatomical sequelae (excluding cholecystectomy or
biliodigestive anastomosis)

(i) without evidence of chronic evolutive
hepatobiliary disease 25

(ii) with evidence of evolutive hepatobiliary disease
(episodes of cholangitis or progressive obstruction
of hepatic ducts) or with signs of decompensation
of the hepatic function 60

(H) PANCREAS

Evaluation is made in terms of digestive problems
and problems in absorption and their consequences
on the patient’s general condition and his state of
nutrition. For glycoregulation, refer to Chapter X
on the endocrine system.

Acute pancreatitis or pancreatic trauma, without
resection, without objectified sequelae 3

Pancreatic trauma having required resection
or having evolved towards chronic pancreatitis

· without exocrine pancreatic insufficiency 10

· with exocrine pancreatic insufficiency

(i) controlled by diet, medical treatment or
surgery, without significant weight loss (loss
of weight of less than 10% in comparison with
actual weight at the time of the event) 15

(ii) partially controlled by diet, medical treatment or
surgery, or loss of weight of 10% to 20% in
comparison with actual weight at the time of
the event 25

(iii) not controlled by diet, medical treatment or
surgery, or patient frequently symptomatic
with restriction of his activities, or with
loss of weight of more than 20% in comparison
with actual weight at the time of the event 50

(I) HERNIA

(a) OPERATED ON

(1) Inguinal (direct, indirect) or femoral

unilateral 1

bilateral 3

(2) Epigastic or umbilical 1

(3) Incisional 2

(4) Recurring inguinal

unilateral 1

bilateral 3

(b) NOT OPERATED ON

(1) Inguinal (direct, indirect), femoral

not voluminous, reducible

unilateral 2

bilateral 6

moderately voluminous difficult to reduce

unilateral 5

bilateral 15

voluminous, irreducible

unilateral 7

bilateral 21

(2) Indicisional

not voluminous, reducible 2

moderately voluminous,
difficult to reduce 5
voluminous, irreducible 7

(J) SPLEEN

Ablation of the spleen may disturb the haematopoietic
system and may cause an immunological deficit.

Splenectomy

· 0 to 6 years 8

· 7 to 15 years 5

· over 15 years 3

Also add the percentage prescribed for laparotomy.

CHAPTER XIII
CARDIOVASCULAR SYSTEM

RULES APPLYING TO THIS CHAPTER

Bilaterality

(1) In this Chapter, with the exception of Raynaud’s
phenomenon and sequelae of a vascular lesion in the
upper and lower limbs and sequelae of venous and
lymphatic lesions, the percentages resulting from the
calculation of bilaterality following permanent impairment
of symmetrical organs have already been integrated
into the figures. They are indicated under each
sequela. Where there is no such indication, the principle
of bilaterality does not apply.

(2) Raynaud’s phenomenon and sequelae of a vascular
lesion in the upper and lower limbs and sequelae
of venus and lymphatic lesions

Where a worker suffers anatomicophysiological deficits
(APD) in symmetrical organs as a result of an
employment injury owing to Raynaud’s phenomenon or
sequelae of a vascular lesion in the upper and lower
limbs or sequelae of venous and lymphatic lesions, the
total percentage awarded to him for such deficits is
determined by adding the percentages of APD calculated
for each organ and by adding a second time the
percentage determined for the least severely impaired
organ.

(A) CARDIAC LESIONS

The evaluation of cardiac sequelae must take place
after consolidation of the lesion:

(i) not less than 6 months after medical treatment;

(ii) not less than one year after surgical treatment.
Frequent discrepancy between objective signs and subjective
symptoms must be noted.

Frequent discrepancy between objective signs and
subjective symptoms must be noted.

For instance, a worker with coronary disease may
have a normal physical examination with normal
electrocardiogram at rest.

Under exercise evaluation, the electrocardiogram
may remain normal in spite of significant angina symptoms.

The presence of certain symptoms suggestive of heart
disease does not necessarily imply the presence of an
organic or functional impairment (cf. Table 24 of
residual functional capacity following cardiovascular
lesion).

(B) PERICARDITIS

APD
%

Refer to Table 24 of residual functional capacity
following cardiac lesion APD

(C) THORACIC ARTERIAL LESIONS

The evaluation takes place after consolidation of the
lesion, i.e., from 6 to 12 months after the event.

(a) REPLACEMENT OF ASCENDING THORACIC AORTA BY
PROSTHESIS

Without functional sequelae 8

With functional sequelae 8

Also refer to Table 24 of residual functional capacity
following cardiac lesion APD

(b) REPLACEMENT OF DESCENDING THORACIC AORTA BY
PROSTHESIS

Without functional sequelae 5

With functional sequelae 5

Also refer to Table 24 of residual functional capacity following cardiac lesion APD

(D) PERIPHERAL ARTERIAL LESIONS

(Subclavian artery, upper limbs, lower limbs)

Abdominal aorta surgery
(endartenectomy or grafts)

· without functional sequelae 5

· with functional sequelae 5

Also refer to Table 25 of residual functional capacity
following vascular lesion in lower limbs APD

Peripheral artery surgery (endarteriectomy, grafts or
arteriography)

· without functional sequelae 3

· with functional sequelae 3

Also refer to Table 25 of residual functional capacity
following vascular lesion in lower limbs, or Table 26
of residual functional capacity following vascular
lesion in upper limbs APD

Sympathectomy

· unilateral 3

· bilateral 9

Transluminal angioplasty 3

One or more carotid lesions may leave sequelae in the brain.

Refer to Chapter III on the central nervous system. APD

(E) VENOUS AND LYMPHATIC LESIONS

Superficial venous insufficiency or recurring
superficial thrombophlebitis 2

Postphlebitic venous insufficiency or lymphatic
insufficiency

· class 1

few or no sequelae 3

· class 2

minor postphlebitic syndrome, well controlled by
standard medical treatment 5

· class 3

moderate prostphlebitic syndrome, not completely
controlled by standard medical treatment 10

· class 4

market postphlebitic syndrome, not controlled by standard
medical treatment and with trophic problems without
ulceration 15

· class 5

marked postphlebitic syndrome, not controlled by standard
medical treatment and with trophic problems and recurring
ulceration 25

(F) RAYNAUD’S PHENOMENON AND THE VIBRATORY SYNDROME

Refer to Table 27 of the classification of Raynaud’s
phenomenon and the vibratory syndrome.

TABLE 24

RESIDUAL FUNCTIONAL CAPACITY FOLLOWING CARDIOVASCULAR LESION

The measurement of residual functional capacity is
based on the following classification, according to the
results of the maximum exercise tolerance test.

The unit of measurement is the mets. One mets is equal
to the consumption of 3.5 ml of oxygen at rest per
kilogram of weight per minute.

Class 1 (over 7 mets)

· without symptoms (angina or shortness of breath),
either spontaneous or induced (maximum exercise
tolerance test) 10

· with symptoms (angina or shortness of breath), either
spontaneous or induced (maximum exercise tolerance test) 20

Class 2 (5, 6, 7 mets)

No symptoms (angina or shortness of breath), for
following everyday physical activities (walking,
climbing stairs, carrying packages) 30

Class 3 (4 mets)

Slight limitation for everyday activities (angina or
shortness of breath occurs when walking fast, or on
rough ground, or on level ground after a meal, or under
cold or windy weather conditions, or under emotional
stress, or in the morning after waking up; angina occurs
when climbing one flight of stairs at a fast pace or more
than one flight of stairs at a normal pace) 40

Class 4 (2, 3 mets)

Moderate limitation for everyday physical activities
(angina or shortness of breath occurs when climbing one
flight of stairs a normal pace or walking one or 2 city
blocks on level ground) 60

Class 5 (1, 2 mets)

Marked limitation for light physical activities (angina
or shortness of breath occurs after walking a few steps
or performing the motions required for persona1 hygiene;
angina may occur at rest or during sleep) 80

TABLE 25

RESIDUAL FUNCTIONAL CAPACITY FOLLOWING VASCULAR LESION
IN LOWER LIMBS

Class 1

Vascular lesions without functional sequelae 0

Class 2

Intermittent claudication, slightly inhibiting, occurring
on walking 300 to 500 metres at an average pace; per limb 15

Class 3

Inhibiting claudication occurring on walking 120 to 150
metres at an average pace; per limb 30

Class 4

Incapacitating claudication occurring on walking 75 metres
at an average pace; per limb 40

Class 5

Severe arterial insufficiency with pain at rest and
trophic problems, ulceration; per limb 50

TABLE 26

REESIDUAL FUNCTIONAL CAPACITY FOLLOWING VASCULAR LESION
IN UPPER LIMBS, EXCLUDING RAYNAUD’S PHENOMENON AND THE
VIBRATORY SYNDROME
APD
%

Class 1

Vascular lesion without functional sequelae 0

Class 2

Intermittent pain, slightly inhibiting, occurring after
major exertion; per limb 15

Class 3

Inhibiting pain occurring after ordinary exertion;
per limb 30

Class 4

Considerable pain occurring after light exertion;
per limb 40

Class 5

Pain at rest with trophic problems, ulcerations; per limb 50

TABLE 27

CLASSIFICATION OF RAYNAUD’S PHENOMENON AND THE VIBRATORY
SYNDROME

For assignment to a class, not all the parameters
comprised within the class need be present, except for
vascular tests, where one of the 2 must be positive.

Where class 5 conditions are encountered, an
evaluation must be made of the musculoskeletal
system, and the higher of the 2 percentages of APD
shall be awarded.

Where there are other sequelae belonging to the
vibratory syndrome, refer to the appropriate chapters.




CHAPTER XIV
SKIN AND SENSITIZATION

RULES APPLYING TO THIS CHAPTER

(A) DERMATOSES INCLUDING CUTANEOUS SENSITIZATION

(1) Dermatological medical evaluation involves the
skin and its appendages.

Functional limitations to the movement of underlying
joints that are incidental to cutaneous impairment are
included in the percentage of anatomicophysiological
deficit (APD) where such limitations represent 50% or
less of normal articular function.

In cases where the limitation is greater than 50% of
total normal articular function, an additional medical
evaluation of musculoskeletal function shall be made,
and the percentage of APD calculated as a result of the
2 evaluations shall be the higher of the 2.

(2) The medical evaluation shall be made when the
dermatosis is in a period of chronic clinical stability
with no recent, significant change in the medication
being taken.

(3) The fixing of a percentage of APD for cutaneous
sequelae shall be in accordance with the following
principles:

The first medical evaluation for the purpose of
calculating the percentage of APD shall be made within
the first 6 months during which the dermatosis is
observed. Following this evaluation, 50% of the percentage
calculated shall be awarded.

The second medical evaluation, for the purpose of
readjusting the initial percentage, shall be made 2 years
after the first evaluation. Following this reevaluation,
100% of the percentages fixed, minus the amount
already awarded after the first evaluation, shall be
awarded.

If, following the second evaluation, the final
percentage is less than that awarded at the time of the
first evaluation, the initial percentage shall be
maintained.

(4) The total of the percentages fixed for a bodily
segment may not be higher than the maximum percentage
for such segment.

(5) In the case of CONTACT DERMATITIS THROUGH
SENSITIZATION, a basic percentage of APD shall be awarded
for sensitization as soon as a diagnosis of contact
dermatitis through sensitization is confirmed by a medical
evaluation. This percentage is as follows:
APD
%

Sensitization 2

The percentages calculated later are added to this
percentage.

Bilaterality

Where a worker suffers from anatomicophysiological
deficits of the skin as a result of an employment injury
and resulting in impairment of symmetrical organs, the
total percentage awarded to him for such deficits is
determined by adding the percentages of APD for each
organ and by adding a second time the percentage
determined for the less severely impaired organ.

For the limbs, bilaterality is calculated from limb to
limb, i.e., the upper right limb with the upper left limb
and the lower right limb with the lower left limb.

For instance, a sequela to the left hand with a
sequela to the right shoulder requires application of the
principle of bilaterality.

Similarly, the trunk, the neck and the head are
divided into 2 symmetrical parts, right and left,
starting from the median line.

(B) SENSITIZATION OTHER THAN CUTANEOUS AND PULMONARY

(1) Although not belonging to this Chapter, certain
phenomena of sensitization are included for the sake of
convenience.

(2) In cases of sensitization demonstrated by an
IMMUNOLOGICAL RESPONSE OTHER THAN CUTANEOUS OR PULMONARY,
a basic percentage of APD is awarded as soon as a
diagnosis of the state of sensitization of the worker is
confirmed by a medical evaluation.

The percentage is as follows:

Sensitization 3

The percentages calculated later are added
to this percentage.

(3) To evaluate the other permanent sequelae resulting
from sensitization, refer to the chapter covering the
system or organ impaired.

(4) Bilaterality

The principle of bilaterality applies as prescribed in
the chapter used to evaluate the sequelae.

(C) PULMONARY SENSITIZATION

Refer to Chapter XVII on bronchial asthma.

PROCEDURE FOR EVALUATION OF DEFICIT

STEP I

DETERMINATION OF ELEMENTS USED TO FIX THE PERCENTAGE OF APD.

Step I consists in determining the following 3 elements:

· COEFFICIENT OF ANATOMICOPHYSIOLOGICAL IMPAIRMENT

· ANATOMICAL AREA

· MAXIMUM PERCENTAGE OF APD PRESCRIBED FOR THE
SEGMENT IMPAIRED

(a) COEFFICIENT OF ANATOMICOPHYSIOLOGICAL IMPAIRMENT

The coefficient of anatomicophysiological impairment
includes the following 3 elements:

· LOSS OF CUTANEOUS FLEXIBILITY, including functional
limitation

· THICKENING (lichenization, keratinization)

· DEHYDRATION (dryness, fissures)

Each of these 3 elements is graded according to the
following scale of 0 to 1 for each side of the body
(half of the body).

SCALE OF EVALUATION FOR EACH ELEMENT

0 .1 2. .3 .4 .5 .6 .7 .8 .9 1
NORMAL MODERATE SEVERE

The coefficient of anatomicophysiological impairment
is determined by taking the average of the 3 elements
as follows:

Coefficient of
anatomico-
Loss of physiological
flexibility Thickening Dehydration impairment
____________________________________________________________________________________
Right
Side
_____ + _____ + _____ + _____ / 3 = _____

Left
Side
_____ + _____ + _____ + _____ / 3 = _____

(b) ANATOMICAL AREA

The extent of the cutaneous area impaired is first
located within a segment, represented in
,
and evaluated in accordance with the scale below.

SCALE OF EVALUATION OF ANATOMICAL AREA
0 .1 ,2 .3 .4 .5 .6 .7 .8 .9 1
NORMAL 50% OF TOTAL 100% OF TOTAL
AREA IMPAIRED AREA IMPAIRED
DIAGRAM 9

BODY SEGMENTS AND MAXIMUM PERCENTAGES OF ANATOMICOPHYSIOLOGICAL DEFICIT (APD) FOR EACH SEGMENT
The percentages of APD listed in this diagram
represent the maximum impairment for each of
the body segments.

Maximum Coefficient of
APD Anatomical physiological
% area impairment
____________________________________________________________________________________
Metacarpal area 5 x 1 x 1 = 5%

Thumb 3 x 1 x 1 = 3%

Four fingers (4 x 3) x 1 x 1 = 12%

______
TOTAL = 20%

(C) MAXIMUM PERCENTAGE OF APD PRESCRIBED FOR THE
SEGMENT IMPAIRED

The maximum percentage for an impaired segment
is fixed in diagram 9.

STEP II

FIXING OF APD

Using the elements fixed in Step I, the percentage
of APD is calculated as follows:

Maximum
Coefficient percentage
physiological Anatomical of APD
impairment area for a segment APD %
_________________________________________________________________________________________

Right
side
_____ x _____ x _____ = _____

Left
side
_____ x _____ x _____ = _____

ILLUSTRATION OF CALCULATION OF BODILY DAMAGE FOR DERMATOSIS

In this case, dermatosis affects both hands partially.

In the right hand, there is partial impairment of the
metacarpal area, the thumb, the index finger, the
middle finger, the ring finger and the little finger.

In the left hand, there is partial impairment of the
metacarpal area, the index finger and the middle finger.

Step I

DETERMINATION OF THE MAXIMUM PERCENTAGE OF APD, OF THE
ANATOMICAL AREA IMPAIRED AND OF THE COEFFICIENT OF
ANATOMICOPHYSIOLOGICAL IMPAIRMENT

Maximum percentage of APD

For each segment impaired, the maximum percentage
has been fixed based on diagram 9.

The percentages are entered in column (a) of the
results (1).

Percentage of anatomical area impaired

For each segment impaired, the percentage of the value
representing the anatomical area impaired has been
determined based on the scale of evaluation of anatomical
area impaired.

These values are entered in column (b) of the
results (1).

Coefficient of anatomicophysiological impairment

For each segment impaired, the loss of flexibility,
thickening and dehydration have been evaluated based
on the scale for evaluation of anatomicophysiological
impairment.

The coefficient of anatomicophysiological damage is
calculated by adding these 3 parameters.

The coefficient is calculated for each segment impaired
and the figures entered in column (c) are the results
of that calculation, cf. results (1).

Step II

FIXING OF THE APD AND APPLICATION OF THE PRINCIPLE OF
BILATERALITY

Fixing of the percentage of APD

The percentage of APD is fixed by multiplying the
maximum percentage of APD (a) by the value representing
the anatomical area (b) by the coefficient of
anatomicophysiological damage (c).

The calculation has been made for each segment
impaired, cf. results (2).

RESULTS (1)

CALCULATION OF THE COEFFICIENT OF ANATOMICOPHYSIOLOGICAL DAMAGE

(a) (b) (c)
Average Coefficient
anato- Loss of of anatomico-
Body APD mical flex- Thicken- Dehy- physiological
segments Max. area bility ing dration impairment
%
_________________________________________________________________________________________

RIGHT

metacarpal
area 5 0.3 0.3 + 0.2 + 0.2 = 0.7 / 3 = 0.23
thumb 3 0.2 0.3 + 0.3 + 0.2 = 0.8 / 3 = 0.27
index
finger 3 0.4 0.4 + 0.4 + 0.3 = 1.1 / 3 = 0.37
middle
finger 3 0.3 0.3 + 0.2 + 0.3 = 0.8 / 3 = 0.27
ring
finger 3 0.3 0.2 + 0.2 + 0.3 = 0.7 / 3 = 0.23
little
finger 3 0.2 0.2 + 0.2 + 0.3 = 0.7 / 3 = 0.23

LEFT

metacarpal
area 5 0.1 0.2 + 0.2 + 0.2 = 0.6 / 3 = 0.2
index
finger 3 0.2 0.1 + 0.1 + 0.2 = 0.4 / 3 = 0.13
middle
finger 3 0.1 0.1 + 0.1 + 0.1 = 0.3 / 3 = 0.1

RESULTS (2)

CALCULATION OF BODILY DAMAGE

RIGHT LEFT
(a) (b) (c) (a) (b) (c)
Body
segment
________________________________________________________________________________________

metacarpal area 5 x 0.3 x 0.23 = 0.35 5 x 0.1 x 0.2 = 0.1
thumb 3 x 0.2 x 0.27 = 0.16
index finger 3 x 0.4 x 0.37 = 0.44 3 x 0.2 x 0.13 = 0.08
middle finger 3 x 0.3 x 0.27 = 0.24 3 x 0.1 x 0.1 = 0.03
ring finger 3 x 0.3 x 0.23 = 0.21
little finger 3 x 0.2 x 0.23 = 0.14
______ ______

TOTAL = 1.54 TOTAL = 0.21

Total % of APD: 1.54 + 0.21 = 1.75
% for bilaterality: 0.21
% for SLEL: 0.1
% for D: 0

TOTAL: 1.75 + 0.21 + 0.1 = 2.06 %

The percentage of bodily damage is 2.06 %

CHAPTER XV
PSYCHIC SYSTEM

RULES APPLYING TO THIS CHAPTER

1. The principle of bilaterality does not apply in this
Chapter.

2. No compensation for disfigurement (D) is awarded
for permanent sequelae of the psychic system.

The psychic functions (mental, psycho-affective,
adaptive, behavioural) of some workers may be permanently
affected.

(A) GENERAL MECHANISMS CAUSING DEFICITS

APD
%

Such deficits are sometimes the direct consequence
of an anatomicophysiological lesion of the central
nervous system; in such an instance they are evaluated
from a psychiatric or neurological point of view, with,
in some cases, a psychological evaluation which goes
beyond the neurological deficit. In other cases, the
deficit reflects a permanent psycho-affective
dysfunction expressing chronic psychological
maladjustment to a trauma that affected another part of
the bodily integrity in a temporary or permanent
manner. Deficits of this nature sometimes result from
the interaction of both source mechanisms.

(B) GENERAL CRITERIA FOR EVALUATION

The deficient is evaluated by a clinical psychiatric
examination supplemented, where necessary, by
psychological tests. Adequate knowledge of the
previous personality, the antecedents and the habitual
style of adaptation of the worker is necessary for
clinical evaluation. The premorbid level of personal
adaptation of the worker must be taken into account in
order to determine the degree of functional alteration
caused by a permanent psychic impairment resulting from
an employment injury.

A detailed objective mental examination is
indispensable; the symptoms must form a plausible,
complete and coherent syndrome. A deficit in the
psychic functions must be shown by changes in
ordinary activities and in interpersonal relations and
must be accompanied in certain cases by
physiopathological signs. The presence of symptoms
over a sufficiently long time is necessary, and as a
general rule, normal therapeutic methods must have
been applied persistently, but unsuccessfully. An
abnormal mental condition is usually studied by means
of supplementary objective information or
documentation obtained from the patient’s milieu and
from attending personnel; a purely subjective and
unverifiable syndrome rarely indicates an
anatomicophysiological deficit of much significance.

The clinical evaluation may sometimes be
supplemented by a social or psychometric evaluation.
Unfavourable social circumstances may affect
rehabilitation and the overall prognosis of a
beneficiary, but they do not in themselves constitute a
deficit in psychic functions. The evaluation must take
the patient’s motivation into account. A deficit for
which such a psychiatric evaluation is made,
supplemented by psychological tests where necessary,
is by its very nature different from loss of enjoyment
of life or loss of a mutilated organ.

(C) CATEGORIES AND GROUPS OF DEFICITS

Permanent deficits of the psychic functions of an
accident victim may result from:

· cerebral syndromes,

· psychoses,

· neuroses,

· personality problems.

The history of psychiatric or psychopathological
sequelae with the specific content of the mental
examination and the supplementary examinations
usually make it possible to arrive at a single
nosological category. Psychotic or neurotic signs or
signs of personality deterioration may occur
concomitantly with organic cerebral syndromes and
thus may be included in the clinical table and in the
evaluation of such syndromes.

Symptomatic intensity is accompanied by repercussions
that go beyond the experience of the worker and change
the ordinary activities of daily life or personal or
social achievement, requiring continuous supervision or
therapy, special assistance or a special environment.
Sometimes it may even be necessary to submit the patient
to total supervision in order to meet his essential needs.

Depending upon the objective effects of the syndrome
evaluated and applying in each case general criteria for
evaluation, a diagnosis must be made of the degree of
intensity of the deficit affecting the whole person by
referring to 4 degrees of seriousness.

· GROUP 1

minor deficit

· GROUP 2

moderate deficit

· GROUP 3

serious deficit

· GROUP 4

very serious deficit

Precise quantification within a group may be difficult,
whence the necessity of comparing the symptoms with those
of similar cases whose history is known to the evaluator.
There may have to be a waiting period before a final
evaluation of the deficit can be made.

It may happen that the clinical psychiatric evaluation
supplemented by a psychological evaluation, where
necessary, does not uncover any additional deficit and
is useful only in evaluating the motivation of a patient
affected by a deficit in another bodily system, or that
the possibilities of more complete rehabilitation of a
patient warrant closer study before setting the rate for
such a deficit.

In such a case. it is preferable to wait 2 years before
evaluation of the psychiatric deficit.

(a) CHRONIC CEREBRAL SYNDROMES

For evaluation of these syndromes, refer to Chapter
III on the central nervous system. APD

(b) PSYCHOSES

Psychosis means a profound mental disturbance likely
to cause a deficit, the extent of which depends upon its
nature, its intensity, the patient’s antecedents, its
duration, its repercussions and the response to
therapeutic measures. It is often preferable to wait 2
years before definitive evaluation of such deficit.

The clinical table may then stabilize and leave
permanent signs: sometimes, the basic deficit may be
only a more or less serious potential for future
recurrences.

The syndrome is essentially characterized by
emotional disturbances, problems of perception, of
thought (process, form, content), of behaviour and
anomalies in emotional control. It is usually
accompanied by a lack of self-criticism, and often
includes abnormal behaviour perceptible to his
associates.

Group 1 (minor)

A deficit in this category is shown by minor and discrete
anomalies in perception, thought, emotional control or
behaviour, but there is little repercussion on the
functioning of the patient compared to his adaptation
before the accident. Patients effectively controlled by
constant psychotropic medication enabling them to
avoid further hospitalization fall into this group. 5

Group 2 (moderate)

The psychotic syndrome is evident upon the mental
examination, is easily observed by the patient’s
associates, and has repercussions in the form of
difficult social functioning, strange behaviour, and a
more or less marked reduction in social and personal
achievement. The behavioural problems are fairly reduced,
enabling the patient to be tolerated in his milieu. 15

Group 3 (serious)

The patient’s cooperation is variable and inconstant,
the risk of occasional hospitalization is probable and
the syndrome is not effectively controlled by medication.
The patient may require occasional supervision and
direction in his ordinary activities. 45

Group 4 (very serious)

The psychotic syndrome is of such intensity that the
patient shows disturbances in perception and in thought,
and a lack of emotional control leading to behaviour that
is intolerable for his associates or dangerous to himself.
The patient requires at least partial supervision at all
times and direction in his ordinary activities. In the
most serious cases, he may require a protected
environment or constant care in an institution,
with repeated hospitalization. 100

(c) NEUROSES

Since individuals react differently to difficulties in
their lives, some workers are likely to develop a
neurotic adaptation to trauma and its sequelae.
Neuroses have no demonstrable organic basis. The
patient remains lucid and able to distinguish between
external reality and his subjective experience. The
personality is not disorganized, but behaviour may be
disturbed within limits that are generally socially
acceptable. The syndrome consists of excessive
anxiety, phobias, hysterical, obsessional, compulsive
and depressive symptoms, sometimes with a
psychosomatic component.

Group 1 (minor)

The neurotic syndrome is mainly subjective, but plausible,
complete, coherent and accompanied by minor changes which
do not make the patient incapable of adaptive behaviour.
There is no reduction in ordinary activities or
alteration in social or persona1 achievement. 5

Group 2 (moderate)

The symptomatic intensity of the neurosis, although
ordinarily variable, obliges the patient to have constant
recourse to therapeutic measures, and forces a change in
his ordinary activities leading to a more or less marked
reduction in his social and personal achievement. The
syndrome may be accompanied by functional
psychophysiological disorders requiring symptomatic
treatment and occasionally interrupting regular activities. 15

Group 3 (serious)

The neurotic syndrome is invasive and leads to noticeable
deterioration in social and personal achievement. It is
accompanied by serious and constant changes in interpersonal
relations: isolation or need to be encouraged and
comforted. Ordinary activities are disrupted, and the
patient needs supervision or assistance from his
associates. The psychosomatic component may include
pathological tissular lesions that are more
or less reversible. 45

Group 4 (very serious)

The neurotic state is accompanied by a state of regression,
deterioration and significant dependence. The patient
requires occasional supervision and direction in his
ordinary life. 100

(d) PERSONALITY DISORDERS

These are essentially character disorders
accompanying a lack of emotional maturity expressed
in difficulty in interpersonal relations, lack of
control over inhibitions, reduced tolerance of
frustration, exaggerated egocentrism, inconsistency
in achievement, and more or less serious social
maladjustment.

If changes in personality are due to an organic
cerebral syndrome, they must be evaluated according
to the scale for such syndrome

Refer to Chapter III on the central nervous system. APD

Group 1 (minor)

Disorders result in slight difficulty in adapting to the
constraints of ordinary life. 5

Group 2 (moderate)

The level of character adaptation existing before the
event is exacerbated in a constant manner and leads to 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. There is a kind of inability to adapt
to the difficulties of ordinary life. 15

Group 3 (serious)

The maladjustment syndrome is such that the individual
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 have resulted in legal
supervision in various forms. Only rarely is an isolated
psychiatric deficit awarded for personality disorders.
Such objective behavioural deterioration must be
investigated to determine whether it belongs to another
type of deficit. 45

Group 4 (very serious)

There is total loss of independence and social
maladjustment requiring permanent control. 100

CHAPTER XVI
RESPIRATORY SYSTEM EXCLUDING BRONCHIAL ASTHMA

RULES APPLYING TO THIS CHAPTER

(1) Bilaterality

In this Chapter, the principle of bilaterality applies to
anatomiçal sequelae, but not to other sequelae.

(2) The evaluation must take into account the anatomical
sequelae, the functional sequelae, and any factors of
severity for both irreversible and regressive pulmonary
lesions. A distinction must also be made between
work-related and any non-work-related factors.

(3) Special provisions for evaluation of occupational
pulmonary disease are prescribed in sections 226 to 233
of the Act.

(4) A percentage of APD is awarded as soon as a
diagnosis of irreversible occupational pulmonary disease
is confirmed by the special committee. The percentage is
as follows:

Irreversible occupational pulmonary disease 5

The percentages calculated later are added to this
percentage.

ANATOMICAL SEQUELAE

Simple lobectomy 3

Bilobectomy 6

Pneumonectomy 20

Also add the percentage of APD prescribed for thoracotomy,
cf. Chapter 1 on the musculoskeletal system, and the
percentages prescribed for functional sequelae. APD

FUNCTIONAL SEQUELAE

The evaluation of functional deficit makes it
possible to classify the sequelae on a scale containing
5 classes. That scale appears in Table 32 of evaluation
of the pulmonary function.

Assignment to classes must not be made solely in
terms of the values entered in each class, but also
in terms of an equivalent actual functional loss.

Assignment to a class does not require the presence
of all the parameters in a class.

Add the percentages prescribed for any additional
severity factor(s).

ADDITIONAL SEVERITY FACTORS

The additional severity factors shall be calculated
in terms of a given class, fixed in accordance with
Table 32 of evaluation of the pulmonary function.

Extent of symptoms, clinical signs and medication
requirements

discrete anomalies 5
significant anomalies 10

Severity of radiographic anomalies

discrete anomalies 5
significant anomalies 10

Inability to sustain effort

discrete anomalies 5
significant anomalies 10

Changes recorded on certain other tests of
respiratory function

discrete anomalies 5
significant anomalies 10

TABLE 32
EVALUATION OF THE PULMONARY FUNCTION
____________________________________________________________________________________
MSEV or
MSEV
VC VC CDDC
TEST*(1) TEST*(2) TEST*(3) APD
CLASSES % % % %
____________________________________________________________________________________
1 80 to 120 over 85 80 to 120 0

2 over 75 75 to 85 over 70 20

3 60 to 75 55 to 70 60 to 70 40

4 50 to 60 under 55 50 to 60 60

5 under 50 under 55 under 50 100

Values obtained through the maximum VP2 measurement
(maximum consumption of oxygen under effort) are used in
the evaluation of functional limitations.

(1) VC vital capacity

(2) MSEV maximum/second expiratory volume

(3) CDDC carbon dioxide diffusion capacity

* Actual value already known, or, if lacking, the
percentage of value predicted.

CHAPTER XVII
BRONCHIAL ASTHMA

RULES APPLYING TO THIS CHAPTER

(1) Bilaterality

The principle of bilaterality does not apply to this
Chapter.

(2) A percentage of APD is awarded for sensitization,
as soon as a diagnosis of bronchial asthma is confirmed by
the special committee. The percentage is as follow:

Sensitization 3

The percentages calculated later are added to this
percentage.

(3) Special provisions for evaluation of occupational
pulmonary disease as prescribed in sections 226 to 233
of the Act.

(4) The evaluation must distinguish between
work-related and non-work-related factors.

(A) CRITERIA FOR EVALUATING DEFICIT

The medical evaluation is carried out when the
disease is in a period of clinical stability without
recent significant change in current medication.

It is based on an estimate of the actual need for
medication, on evaluation of the degree of bronchial
obstruction revealed during tests of respiratory function
and on the degree of non-allergenic bronchial
hyperreactivity as indicated by the histamine or
methacholine provocation test.

The evaluation makes it possible to classify the
sequelae on a scale containing 6 classes. The classes
and the percentages of APD are set forth in Table 33 of
the evaluation of the pulmonary function - work-related
asthma, according to the results of the functional tests
and certain criteria peculiar to this type of evaluation.

Add a percentage for any additional severity factors
based on the significance of dyspnea and of respiratory
symptoms and signs showing a non-allergenic bronchial
hyperreactivity.

ADDITIONAL SEVERITY FACTORS

Non-allergenic bronchial hyperreactivity

On considerable physical effort, or in cold 2

On walking in good weather, or when the worker is exposed
to irritants, such as smoke or strong odours 4

On normal household activities 6

Continuously, including at night 10

TABLE 33
EVALUATION OF PULMONARY FUNCTION - WORK-RELATED ASTHMA
________________________________________________________________________________________
Degree of Degree of Requirement in medication
bronchial bronchial (beclomethasone or APD
Class obstruction* reactivity** related drugs, steroids) %
________________________________________________________________________________________
l 0 0 None 0

2 0 1 None 5

0 1 Bronchodilators (BD) as required

(pres.)*** 8

0 1 BD on a regular basis (reg.)**** 10

0 2 None 10

0 2 BD pres. or reg. 13

0 3 BD pres. or reg. 15

3 1 1 BD pres. or reg. 18

1 2 BD pres. or reg. 20

1 3 BD pres. or reg. 25

4 2 1-2 BD pres. or reg. 28

2 3 BD pres. or reg. 33

5 3 1-2 BD pres. or reg. 50

3 3 BD pres. or reg. 60

6 4 1-2-3 BD pres. or reg. with oral steroids
with or without inhaled steroids 100
Add, where necessary,
· for inhaled steroids 3
· for oral steroids, with or without
inhaled steroids 10

DEGREE OF BRONCHIAL OBSTRUCTION* DEGREE OF BRONCHIAL REACTIVITY**
0 MEVS* and/or MEVS*/VC > 85% (%pred) 0 CP 20 > 16 mg/ml
1 MEVS and/or MEVS/VC = 71%-85% (%pred) 1 CP 20 = 2-16 mg/ml
2 MEVS and/or MEVS/VC = 56%-70% (%pred) 2 CP 20 = 0.25-2 mg/ml
3 MEVS and/or MEVS/VC = 40%-55% (%pred) 3 CP 20 < 0.25 mg/ml
4 MEVS and/or MEVS/VC < (%pred)

TABLE 33 (explanations)

*MEVS, MEVS/VC (percentage expressed in relation to values
predicted). More precise tests of respiratory function
could be used, such as pulmonary volume, carbon dioxide
diffusion, gas exchanges at rest and under effort, the
flow-volume loop and a study of the resistance of the airways.

**According to the results of the histamine or
methacholine tests. The test is carried out using the
standardized method of Cockcroft and Coll. (Clinical
Allergy 1977; 7: pp. 235-243).

***Bronchodilators (BD) include adrenergic Beta-2
derivatives, theophyllines and iprotropium bromide.

****On a regular basis (reg.) means daily.

CHAPTER XVIII
DISFIGUREMENT (D)

RULES APPLYING TO THIS CHAPTER

(1) The principle of bilaterality does not apply to
this Chapter.

(2) Any adhesion or sensitivity in a scar are part of
the anatomicophysiological deficit, without being part
of disfigurement.

(3) Surgical scars must be evaluated on the same basis
as other scars.

(4) A deformity in a joint is limited to the maximum
percentage of D prescribed for the segment of the limb
below the deformity.

(5) The evaluation of disfigurement is based on the
ideas of deformity or disfiguration, changing the form,
symmetry, physiognomy or general appearance.

The evaluation of disfigurement is also based on
cicatricial impairment of the skin, considering the
texture, colouring and configuration of the area impaired.

A scar or a deformity must first be evaluated based on
its impact on symmetry, physiognomy and general
attractiveness, rather than simply its size or appearance.

(6) The rules of evaluation to be followed for the use
of Tables 34 and 35 appear at the beginning of each table.

(7) For compensation to be paid, a scar or deformation
must be evident when not covered.

(8) The percentages of D are fixed depending upon the
state of the impairment if it is permanent at the time
of the evaluation or depending upon expected improvement
considering the medical or surgical possibilities.

(9) The percentages of D for cutaneous telangiectasia
are listed under the title: Cutaneous telangiectasia.

(10) The percentage of D for enucleation of the eye is
listed under the title: Eye.

(11) The percentages related to the D of partial or
total amputation of an upper limb or a lower limb are
listed under the title: Disfigurement from partial or
total amputation of limbs.

(12) The minimum time preceding the evaluation of a
scar resulting from an employment injury is 6 months.

(13) The area in square centimetres of a scar is
obtained by multiplying the average width by the average
length. The total percentage of D for a scar is fixed by
multiplying the area in square centimetres by the
appropriate percentage of D.

DEFINITIONS

Cicatricial impairment (scarring) means any qualitative
or quantitative change in the skin; the idea includes flat
and, faulty scars.

Flat scar (not conspicuous)

Almost linear scar, at the same level as the adjoining
tissue and almost the same colour, causing no contraction
or distorsion of neighbouring structures.

Faulty scar

A scar that may be misaligned, irregular, depressed,
deeply adhering, pigmented, scaly or retractile.

It is keloidal where there is an abnormal fibrous proliferation
located in the dermis, characterized by elevation,
invasion of surrounding healthy tissue, continuing but
intermittent growth, an absence of significant regression
and strong tendency to recur.

It is hypertrophic where there is an abnormal fibrous
proliferation located in the dermis, characterized by a
limited elevation of damaged tissue, stabilizing and
regressing in time, with a possibility of recurrence.

TABLE 34
DISFIGUREMENT OF THE FACE

Rules for evaluation

For purposes of evaluation of disfigurement (D) of the
face, reference is made to each of the following anatomical
elements:

the forehead

the orbits, (each orbit constitutes an element)

the lids (each lid constitutes an element)

the eyes, visible part of the ocular globes (each eye
constitutes an element)

the cheeks (each cheek constitutes an element)

the nose (including the nostrils and the base)

the lips (each lip constitutes an element)

the ears (each ear constitutes an element)

the chin

The extent of D affecting the face must first be
assessed overall in terms of the physiognomy, in order
to determine the class of impairment.

For classes 1 to 4 within the class of impairment of
the physiognomy determined, the percentage of D is fixed
in relation to the changes in the form and symmetry of
the scarring, without exceeding the maximum percentage
of D prescribed for that class.

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
determined.

For classes and 6, the changes in the form and
symmetry and the scarring are considered as a whole. If
a worker has an impairment under any heading, the
percentage of D awarded is the maximum percentage
prescribed for the class.
_____________________________________________________________________________________
Impairment Max.
physiognomy Changes in form Scarring D
(classes) and symmetry %
_____________________________________________________________________________________

Class 1

None None evident None evident 0

Class 2

Very slight Very slight Flat: the D 3
is 1%/cm2

Class 3

Slight Obvious

Affecting one anatomical element
(for example: deformity of the nose):
the D is 3%

Affecting 2 anatomical elements Flat: the D is 1%
(for example: nose and upper lip or
nose and one cheek):
the D is 4% Faulty:
the D is 2%/cm2
Affecting more than 2 anatomical
elements:
the D is 7% 7

Class 4

Moderate Obvious and holds one’s attention

Affecting one anatomical element:
the D is 16%
Flat:
Affecting 2 anatomical elements: the D is 1 %
the D is 18%
Faulty:
Affecting more than 2 anatomical the D is 3%/cm2
elements:
the D is 20% 20
Class 5

Severe Affecting several elements 30

Class 6

Disfiguration Affecting all the elements 50

TABLE 35
DISFIGUREMENT OF OTHER PARTS OF THE BODY

RULES FOR EVALUATION

For parts of the body other than the face, the
disfigurement (D) is calculated by using the criteria
mentioned under the heading Changes in form and symmetry
or under the heading Scarring.

Where there is impairment only under the heading
Changes in form and symmetry, the degree of impairment
is calculated and the percentage of D prescribed for that
part of the body is awarded.

Where there is impairment only under the heading
Scarring, the degree of impairment is calculated, the
surface area of the scar is measured and the percentage
prescribed per cm2 is awarded, without exceeding the
maximum percentage of D prescribed for that part of the
body.

Where there are both changes in the form and symmetry
and scarring, the higher percentage obtained under
either heading is awarded as the percentage of D related to
those sequelae, without exceeding the maximum percentage
prescribed for that part of the body.

____________________________________________________________________
Changes in form and
symmetry D
degree of impairment % Scarring
___________________________________________________________________________________________

Scalp and skull

Not obvious or slight 0 Not evident or flat:
the D is 0%

Moderate 4
Faulty:
Severe 8 the D is 0.5%/cm2

The maximum percentage of D is 8%.

Neck

Delimited at the back by the base of the occiput and
the first ribs, and at the front by the chin line and
the angle of the sternum including the sternoclavicular
joints.

Not obvious or slight 0 Not obvious or flat:
the D is 0%

Moderate 10
Faulty:
Severe 15 the D is 1%/cm2

The maximum percentage of D is 15%.

Arm, shoulder and elbow

Not obvious or slight 0 Not obvious or flat:
the D is 0%

Moderate 2
Faulty:
Severe 4 the D is 0.5%/cm2

The maximum percentage of D for both
arms including both shoulders and both elbows is 8%.

Forearm and wrist

Not obvious or slight 0 Not obvious or flat:
the D is 0%

Moderate 2
Faulty:
Severe 5 the D is 1%/cm2

The maxim percentage of D for both forearms including
both wrists is 10%.

Hands

Not obvious or slight 0 Not obvious or flat:
the D is 0%
Moderate 4
Faulty:
Severe 8 the D is 1%/cm2

The maximum percentage of D for both hands is 16%.

Trunk

Not obvious or slight 0 Not obvious or flat:
the D is 0%
Moderate 3
Faulty:
Severe 6 the D is 0.5%/cm2

The maximum percentage of D for the trunk (front and
rear) is 12%.

Lower limbs

Not obvious 0 Not obvious or flat:
the D is 0%
Moderate 5
Faulty:
Severe 10 the D is 1%/cm2

The maximum percentage of D for both lower limbs is 20%.

CUTANEOUS TELANGIECTASIA

Class 1

Slight impairment of the trunk 0.5

Class 2

Moderate impairment of the trunk 1

Class 3

Impairment of the trunk and limbs 2

Class 4

Impairment of the trunk, limbs and face 3

EYE

Enucleation with or without replacement
by prosthesis 5

(Where necessary, refer to the Table of
Disfigurement of the Face.)

DISFIGUREMENT FROM PARTIAL OR TOTAL AMPUTATION OF LIMBS

UPPER LIMBS

Fingers; per phalanx up to a
maximum of 5% 0.5

Thumb; per phalanx 1

Metacarpals; per metacarpal up to a
maximum of 2% 0.2

Radiocarpal and transcarpal 10

Forearm 12

Elbow 15

Arm 17

Disarticulation of the shoulder 20

Interscapulothoracic disarticulation 30

LOWER LIMBS

Toes, except great toe; per phalanx,
up to a maximum of 1% 0.2

Great toe; per phalanx 0.5

Metatarsal; per metatarsal, up to a
maximum of 1% 0.2

Transmetatarsal 3

Tarsometatarsal (Lisfranc’s) 5

Midtarsal (Chopart’s) 5

Ankle (Syme’s) 6

Leg 8

Knee 10

Thigh 12

Disarticulation of the hip 15

Hemipelvectomy 20

CHAPTER XIX
PERCENTAGES FOR SUFFERING AND LOSS OF ENJOYMENT OF LIFE
RESULTING FROM ANATOMICOPHYSIOLOGICAL DEFICIT OR
DISFIGUREMENT

TABLE OF SLEL

Sum of percentages SLEL
of APD or of D %
____________________________________________________________________________________

0.01 to 0.99 0.01
1 to 1.99 0.1
2 to 2.99 0.2
3 to 3.99 0.3
4 to 4.99 0.4
5 to 5.99 0.75
6 to 6.99 0.9
7 to 7.99 1.05
8 to 8.99 1.2
9 to 9.99 1.35
10 1.5
10.01 to 11 2.2
11.01 to 12 2.4
12.01 to 13 2.6
13.01 to 14 2.8
14.01 to 15 3
15.01 to 16 3.2
16.01 to 17 3.4
17.01 to 18 3.6
18.01 to 19 3.8
19.01 to 20 4.
20.01 to 21 5.25
21.01 to 22 5.50
22.01 to 23 5.75
23.01 to 24 6
24 01 to 25 6.25
25.01 to 26 6.50
26.01 to 27 6.75
27.01 to 28 7
28.01 to 29 7.25
29.01 to 30 7.5
30.01 to 31 9.3
31.01 to 32 9.6
32.01 to 33 9.9
33.01 to 34 10.2
34.01 to 35 10.5
35.01 to 36 10.8
36.01 to 37 11.1
37.01 to 38 11.4
38.01 to 39 11.7
39.01 to 40 12
40.01 to 41 14.35
41.01 to 42 14.7
42.01 to 43 15.05
43.01 to 44 15.4
44.01 to 45 15.75
45.01 to 46 16.1
46.01 to 47 16.45
47.01 to 48 16.8
48.01 to 49 17.15
49.01 to 50 17.5
50.01 to 51 20.4
51.01 to 52 20.8
52.01 to 53 21.2
53.01 to 54 21.6
54.01 to 55 22
55.01 to 56 22.4
56.01 to 57 22.8
57.01 to 58 23.2
58.01 to 59 23.6
59.01 to 60 24
60.01 to 61 27.45
61.01 to 62 27.9
62.01 to 63 28.35
63.01 to 64 28.8
64.01 to 65 29.25
65.01 to 66 29.7
66.01 to 67 30.15
67.01 to 68 30.6
68.01 to 69 31.05
69.01 to 70 31.5
70.01 or more 50% of the percentage
of APD or of D
O.C. 1291-87, Sch. 1; Erratum, 1998 G.O. 2, 2065.
REFERENCES
O.C. 1291-87, 1987 G.O. 2, 3270 and 1998 G.O. 2, 2065