436-035-0110 Other Upper Extremity Findings (1) Loss of palmar sensation in the hand, finger(s), or thumb is rated based on the location and quality of the loss, and is measured by the two-point discrimination method. (a) Sensation is determined by using any instrumentation that allows for measuring the distance between two pin pricks applied at the same time (two-point) and using the following procedure: (A) With the worker’s eyes closed, the examiner touches the tip of the instrument to the digit in the longitudinal axis on the radial or ulnar side. (B) The worker indicates whether one or two points are felt. (C) A varied series of one or two points are applied. (D) Testing is started distally and proceeds proximally to determine the longitudinal level of involvement. (E) The ends of the testing device are set first at 15 mm apart and the distance is progressively decreased as accurate responses are obtained. (F) The minimum distance at which the individual can accurately discriminate between one and two point tests in two out of three applications is recorded for each area. (b) If enough sensitivity remains to distinguish two pin pricks applied at the same time (two point), the following apply: [Rating not included. See ED. NOTE.] (c) In determining sensation findings for a digit that has been resected or amputated, the value is established by comparing the remaining overall length of the digit to the table in subsection (1)(d) of this rule and rating the length equivalency. For example: Amputation of 1/2 the middle phalanx of the index finger with total sensory loss extending from the level of amputation to the metacarpophalangeal joint, results in a value for 1/2 the digit or 33%. (d) Loss of sensation in the finger(s) or thumb is rated as follows: [Rating not included. See ED. NOTE.] (e) If the level of the loss is less than 1/2 the distal phalanx or falls between the levels in subsection (d) of this section, rate at the next highest (or more proximal) level. (f) In determining sensation impairment in a digit in which the sensation loss does not extend to the distal end of the digit, the value is established by determining the value for loss from the distal end of the digit to the proximal location of the loss, and subtracting the value for loss from the distal end of the digit to the distal location of the loss. Example: Grade 2 sensation in the index finger between the PIP joint and the MP joint: Loss from distal end of the finger to the MP joint (proximal location of loss) — 25% Minus loss from distal end of the finger to the PIP joint (distal location of loss) — 20% Equals loss between MP and PIP — 5% (g) Sensation loss on the palmar side of the hand is rated as follows: [Rating not included. See ED. NOTE.] (h) Loss of sensation or hypersensitivity on the dorsal side of the hand, fingers or thumb is not considered a loss of function, so no value is allowed. (i) Sensory loss or hypersensitivity in the forearm or arm is not considered a loss of function, therefore no value is allowed. (j) When there are multiple losses of palmar sensation in a single body part (e.g., hand, finger(s), or thumb), the impairment values are first combined for an overall loss of sensation value for the individual digit or hand. This value is then combined with other impairment values for that digit or hand prior to conversion. (k) Hypersensitivity is valued using the above loss of sensation tables. Mild hypersensitivity is valued at the equivalent impairment level as less than normal sensation, moderate hypersensitivity the equivalent of protective sensation loss, and severe hypersensitivity the equivalent of a total loss of sensation. (l) When there is a loss of use or function due to hypersensitivity and decreased two-point discrimination (i.e., sensation loss), both conditions are rated. (2) When surgery or an injury results in arm length discrepancies involving the injured arm, the following values are given on the affected arm for the length discrepancy: [Rating not included. See ED. NOTE.] (3) Joint instability in the finger(s), thumb, hand, or wrist is rated based on the body part affected: [Rating not included. See ED. NOTE.] (4) Lateral deviation or malalignment of the upper extremity is valued as follows: (a) Increased lateral deviation at the elbow is determined as follows: [Rating not included. See ED. NOTE.] (b) Fracture resulting in angulation or malalignment, other than at the elbow, is determined as follows: [Rating not included. See ED. NOTE.] (c) Rotational, lateral, dorsal, or palmar deformity of the thumb receives a value of 10% of the thumb for each type of deformity. (d) Rotational, lateral, dorsal, or palmar deformity of a finger receives a value of 10% for the finger for each type of deformity. (5) Surgery on the upper extremity is valued as follows: [Rating not included. See ED. NOTE.] (6) Dermatological conditions, including burns, which are limited to the arm, forearm, hand, fingers, or thumb are rated based on the body part affected. The percentages indicated in the classes below are applied to the affected body part(s), e.g., a Class 1 dermatological condition of the thumb is 3% of the thumb, or a Class 1 dermatological condition of the hand is 3% of the hand, or a Class 1 dermatological condition of the arm is 3% of the arm. Contact dermatitis of an upper extremity is rated in this section unless it is an allergic systemic reaction, which is also rated under OAR 436-035-0450. Contact dermatitis for a body part other than the upper or lower extremities is rated under OAR 436-035-0440. Impairments may or may not show signs or symptoms of skin disorder upon examination but are rated under the following classes: (a) Class 1: 3% for the affected body part if treatment results in no more than minimal limitation in the performance of activities of daily living (ADL), although exposure to physical or chemical agents may temporarily increase limitations. (b) Class 2: 15% for the affected body part if intermittent treatments and prescribed examinations are required, and the worker has some limitations in the performance of ADL. (c) Class 3: 38% for the affected body part if regularly prescribed examinations and continuous treatments are required, and the worker has many limitations in the performance of ADL. (d) Class 4: 68% for the affected body part if continuous prescribed treatments are required. The treatment may include periodically having the worker stay home or admitting the worker to a care facility, and the worker has many limitations in the performance of ADL. (e) Class 5: 90% for the affected body part if continuous prescribed treatment is required. The treatment necessitates having the worker stay home or being permanently admitted to a care facility, and the worker has severe limitations in the performance of ADL. (7) Vascular dysfunction of the upper extremity is valued based on the affected body part, using the following classification table: (a) Class 1: 3% for the affected body part if the worker experiences only transient edema; and on physical examination, the findings are limited to the following: loss of pulses, minimal loss of subcutaneous tissue of fingertips, calcification of arteries as detected by radiographic examination, asymptomatic dilation of arteries or veins (not requiring surgery and not resulting in curtailment of activity); or cold intolerance (e.g., Raynaud’s phenomenon) which results in a loss of use or function that occurs with exposure to temperatures below freezing (0° centigrade). (b) Class 2: 15% for the affected body part if the worker experiences intermittent pain with repetitive exertional activity; or there is persistent moderate edema incompletely controlled by elastic supports; or there are signs of vascular damage such as a healed stump of an amputated digit, with evidence of persistent vascular disease, or a healed ulcer; or cold intolerance (e.g., Raynaud’s phenomenon) which results in a loss of use or function that occurs on exposure to temperatures below 4° centigrade. (c) Class 3: 35% for the affected body part if the worker experiences intermittent pain with moderate upper extremity usage; or there is marked edema incompletely controlled by elastic supports; or there are signs of vascular damage such as a healed amputation of two or more digits, with evidence of persistent vascular disease, or superficial ulceration; or cold intolerance (e.g., Raynaud’s phenomenon) which results in a loss of use or function that occurs on exposure to temperatures below 10° centigrade. (d) Class 4: 63% for the affected body part if the worker experiences intermittent pain upon mild upper extremity usage; or there is marked edema that cannot be controlled by elastic supports; or there are signs of vascular damage such as an amputation at or above the wrist, with evidence of persistent vascular disease, or persistent widespread or deep ulceration involving one extremity; or cold intolerance (e.g., Raynaud’s phenomenon) which results in a loss of use or function that occurs on exposure to temperatures below 15° centigrade. (e) Class 5: 88% for the affected body part if the worker experiences constant and severe pain at rest; or there are signs of vascular damage involving more than one extremity such as amputation at or above the wrist, or amputation of all digits involving more than one extremity with evidence of persistent vascular disease, or persistent widespread deep ulceration involving more than one extremity; or cold intolerance such as Raynaud’s phenomenon which results in a loss of use or function that occurs on exposure to temperatures below 20° centigrade. (f) If partial amputation of the affected body part occurs as a result of vascular disease, the impairment values are rated separately. (8) Neurological dysfunction resulting in cold intolerance in the upper extremity is valued under the affected body part using the same classifications for cold intolerance due to vascular dysfunction in section (7) of this rule. (9) Injuries to unilateral spinal nerve roots or brachial plexus with resultant loss of strength in the arm, forearm or hand are rated based on the specific nerve root which supplies (innervates) the weakened muscle(s), as described in the following table and modified under OAR 436-035-0011(7): (a) Spinal nerve root arm impairment; [Rating not included. See ED. NOTE.] (b) For loss of strength in bilateral extremities, each extremity is rated separately. (10) When a spinal nerve root or brachial plexus are not injured, valid loss of strength in the arm, forearm or hand is valued as if the peripheral nerve supplying (innervating) the muscle(s) demonstrating the decreased strength was impaired, as described in the following table and as modified under OAR 436-035-0011(7). [Rating not included. See ED. NOTE.] Example 1: A worker suffers a rupture of the biceps tendon. Upon recovery, the attending physician reports 4/5 strength of the biceps. The biceps is innervated by the musculocutaneous nerve which has a 25% impairment value. 4/5 strength, under OAR 436-035-0011(7), is 20%. Final impairment is determined by multiplying 25% by 20% for a final value of 5% impairment of the arm. Example 2: A worker suffers a laceration of the median nerve below the mid-forearm. Upon recovery, the attending physician reports 3/5 strength in the forearm. The median nerve below the mid-forearm has a 44% impairment value. 3/5 strength, under OAR 436-035-0011(7), is 50%. Final impairment is determined by multiplying 44% by 50% for a final value of 22% impairment of the forearm. (a) Loss of strength due to an injury in a single finger or thumb receives a value of zero, unless the strength loss is due to a compensable condition that is proximal to the digit. (b) Decreased strength due to an amputation receives no rating for weakness in addition to that given for the amputation. (c) Decreased strength due to a loss in range of motion receives no rating for weakness in addition to that given for the loss of range of motion. (d) When loss of strength is present in the shoulder, refer to OAR 436-035-0330 for determination of the impairment. (11) For motor loss in any part of an arm that is due to brain or spinal cord damage, impairment is valued as follows: (a) Class 1: 14% when the involved extremity can be used for self care, grasping, and holding but has difficulty with digital dexterity. (b) Class 2: 34% when the involved extremity can be used for self care, grasping and holding objects with difficulty, but has no digital dexterity. (c) Class 3: 55% when the involved extremity can be used but has difficulty with self care activities. (d) Class 4: 100% when the involved extremity cannot be used for self care. (e) When a value is granted under this section, additional impairment values are not allowed for strength loss, chronic condition, or reduced range of motion in the same extremity because they are included in the impairment values shown in this section. (f) For bilateral extremity loss, each extremity is rated separately. [ED. NOTE: Ratings and Values referenced are available from the agency.] [Publications: Publications referenced are available from the agency.] [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 2-2010, f. 5-5-10, cert. ef. 6-1-10 WCD 10-2007, f. 11-1-07, cert. ef. 1-1-08 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2003, f. 1-15-03, cert. ef. 2-1-03 WCD 6-1998, f. 5-13-98, cert. ef. 7-1-98 WCD 1-1997, f. 1-9-97, cert. ef. 2-15-97 WCD 3-1996, f. 1-29-96, cert. ef. 2-17-96 WCD 6-1992, f. 2-14-92, cert. ef. 3-13-92 WCD 2-1991, f. 3-26-91, cert. ef. 4-1-91 WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89, Renumbered from 436-030-0220 WCD 5-1988, f. 9-2-88, cert. ef. 8-19-88 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88 WCD 5-1981, f. 12-30-81, ef. 1-1-82, Renumbered from 436-065-0530 WCD 4-1980, f. 3-20-80, ef. 4-1-80