Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › IMPAIRMENT RATING › Section 296-20-220 - Special rules for evaluation of permanent bodily impairment

Current through Register Vol. 24-14, July 15, 2024
(1) Evaluations of
				permanent bodily impairment using categories require uniformity in procedure
				and terminology. The following rules have been enacted to produce this
				uniformity and shall apply to all evaluations of permanent impairment of an
				unspecified nature.
(a) Gradations of
				relative severity shall be expressed by the words "minimal," "mild," "moderate"
				and "marked" in an ascending scale. "Minimal" shall describe deviations from
				normal responses which are not medically significant. "Mild," "moderate" and
				"marked" shall describe ranges of medically significant deviations from normal
				responses. "Mild" shall describe the least severe third. "Moderate" shall
				describe the middle third. "Marked" shall describe the most severe
				third.
(b) "Permanent" describes
				those conditions which are fixed, lasting and stable, and from which within the
				limits of medical probability, further recovery is not expected.
(c) "Impairment" means a loss of physical or
				mental function.
(d) "Total bodily
				impairment," as used in these rules, is the loss of physical or mental function
				which is essentially complete short of death.
(e) The examiner shall not assign a
				percentage figure for permanent bodily impairment described in the categories
				established herein.
(f) The method
				of evaluating impairment levels is by selection of the appropriate level of
				impairment. These descriptive levels are called "categories." Assessments of
				the level of impairment are to be made by comparing the condition of the
				injured workman with the conditions described in the categories and selecting
				the most appropriate category.
These rules and categories for various bodily areas and
				  systems provide a comprehensive system for the measurement of disabling
				  conditions which are not already provided for in the list of specified
				  permanent partial disabilities in
				  RCW
				   51.32.080(1). Disabilities
				  resulting from loss of central visual acuity, loss of an eye by enucleation,
				  loss of hearing, amputation or loss of function of the extremities will
				  continue to be evaluated as elsewhere provided in
				  RCW
				   51.32.080.
The categories have been classified in percentages in
				  reasonable proportion to total bodily impairment for the purpose of determining
				  the proper award. Provision has been made for correctly weighing the overall
				  impairment due to particular injuries or occupational disease in cases in which
				  there are preexisting impairments.
(g) The categories of the various bodily
				areas and systems are listed in the order of increasing impairment except as
				otherwise specified. Where several categories are given for the evaluation of
				the extent of permanent bodily impairment, the impairments in the higher
				numbered categories, unless otherwise specified, include the impairments in the
				lesser numbered categories. No category for a condition due to an injury shall
				be selected unless that condition is permanent as defined by these rules.
The examiner shall select the one category which most
				  accurately indicates the overall degree of permanent impairment unless
				  otherwise instructed. Where there is language in more than one category which
				  may appear applicable, the category which most accurately reflects the overall
				  impairment shall be selected.
The categories include appropriate subjective complaints in
				  an ascending scale in keeping with the severity of objective findings, thus a
				  higher or lower category is not to be selected purely on the basis of unusually
				  great or minor complaints.
(h) When the examination discloses a
				preexisting permanent bodily impairment in the area of the injury, the examiner
				shall report the findings and any category of impairment appropriate to the
				worker's condition prior to the industrial injury in addition to the findings
				and the categories appropriate to the worker's condition after the
				injury.
(i) Objective physical or
				clinical findings are those findings on examination which are independent of
				voluntary action and can be seen, felt, or consistently measured by
				examiners.
(j) Subjective
				complaints or symptoms are those perceived only by the senses and feelings of
				the person being examined which cannot be independently proved or
				established.
(k) Muscle spasm as
				used in these rules is an involuntary contraction of a muscle or group of
				muscles of a more than momentary nature.
(l) An involuntary action is one performed
				independently of the will.
(m)
				These special rules for evaluation of permanent bodily impairment shall apply
				to all examinations for the evaluation of impairment, in accordance with
				RCW
				 51.32.080, for the body areas or systems
				covered by or enumerated in WAC
				296-20-230 through
				296-20-660.
(n) The rules for evaluation of each body
				area or system are an integral part of the categories for that body area or
				system.
(o) In cases of injury or
				occupational disease of bodily areas and/or systems which are not included in
				these categories or rules and which do not involve loss of hearing, loss of
				central visual acuity, loss of an eye by enucleation or loss of the extremities
				or use thereof, examiners shall determine the impairment of such bodily areas
				and/or systems in terms of percentage of total bodily impairment.
(p) The words used in the categories of
				impairments, in the rules for evaluation of specific impairments, the general
				rules, and the special rules shall be deemed, unless the context indicates the
				contrary, to have their general and accepted medical meanings.
(q) The rating of impairment due to total
				joint replacement shall be in accordance with the limitation of motion
				guidelines as set forth in the "Guides to the Evaluation of Permanent
				Impairment" of American Medical Association, with department of labor and
				industries acknowledgement of responsibility for failure of prostheses beyond
				the seven year limitation.