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This page is designed to provide you with easy access to the AMA Guides to the Evaluation of Permanent Impairment 6th Edition, 2021 tables. Jump to Chapter:

Chapter 1: Conceptual Foundations and Philosophy

Chapter 2: Practical Application of the Guides

Chapter 3: Pain-Related Impairment

Chapter 4: The Cardiovascular System

Chapter 5: The Pulmonary System

Chapter 6: The Digestive System

Chapter 7: The Urinary and Reproductive Systems

Chapter 8: The Skin

Chapter 9: The The Hematopoietic System

Chapter 10: The Endocrine System

Chapter 11: Ear, Nose, Throat, and Related System

Chapter 12: The Visual System

Chapter 13: The Central and Peripheral Nervous System

Chapter 14: Mental and Behavioral Disorders

Chapter 15: The Upper Extremities

Chapter 16: The Lower Extremities

Chapter 17: The Spine and Pelvis

Appendix

Chapter 1: Conceptual Foundations and Philosophy
Tables
Table 1-1: Self-Care
Table 1-2: Hierarchy of Study Types
Table 1-3: ICF Codes and Functional Levels
Table 1-4: Sample Impairment Function Classification
Table 1-5: Generic Template for Impairment Classification Grids
Table 1-6: General Principles for Calculating Impairment

Chapter 2: Practical Application of the Guides
Tables
Table 2-1: Fundamental Principles of the Guides

Chapter 3: Pain-Related Impairment
Tables
Table 3-1: Pain-Related Impairment and Whole Person Impairment Based on Pain Disability Questionnaire

Chapter 4: The Cardiovascular System
Tables
Table 4-1: NYHA Functional Classification of Cardiac Disease
Table 4-2: Relationship of METs and Functional Class According to 5 Treadmill Protocols
Table 4-3: Energy Expenditure in METs During Bicycle Ergometry
Table 4-4: Methodology for Determining the Grade in an Impairment Class
Table 4-5: Criteria for Rating Permanent Impairment due to Valvular Heart Disease
Table 4-6: Criteria for Rating Impairment due to Coronary Artery Disease
Table 4-7: Criteria for Rating Impairment due to Cardiomyopathies
Table 4-8: Criteria for Rating Impairment due to Pericardial Heart Disease
Table 4-9: Criteria for Rating Impairment due to Dysrhythmias
Table 4-10: Classification of Blood Pressure for Adults
Table 4-11: Criteria for Rating impairment due to Hypertensive Cardiovascular Disease
Table 4-12: Criteria for Rating Impairment due to Peripheral Vascular Disease – Lower Extremity
Table 4-13: Criteria for Rating Impairment due to Peripheral Vascular Disease – Upper Extremity
Table 4-14: Criteria for Rating Impairment due to Diseases of the Pulmonary Artery
Table 4-15: Cardiac Impairment Evaluation Summary

Chapter 5: The Pulmonary System
Tables
Table 5-1: Impairment Classification of Dyspnea (Adapted)
Table 5-2: Impairment Classification for Prolonged Physical Work Intensity by Oxygen Consumption
Table 5-3: Methodology for Determining the Grade in an Impairment Class
Table 5-4: Criteria for Rating Permanent Impairment due to Pulmonary Dysfunction
Table 5-5: Criteria for Rating Permanent Impairment due to Asthma
Table 5-6: Scale for Judging Capabilities of Subjects With Cancer
Table 5-7: Pulmonary Impairment Evaluation Study

Chapter 6: The Digestive System
Tables
Table 6-1: Desirable Weights for Men by Height and Body Build
Table 6-2: Desirable Weights for Women by Height and Body Build
Table 6-3; Methodology for Determining the Grade in an Impairment Class
Table 6-4: Criteria for Rating Permanent Impairment due to Upper Digestive Tract (Esophagus, Stomach and Duodenum, Small Intestine, and Pancreas) Disease
Table 6-5: Criteria for Rating Permanent due to Colonic and Rectal Disorders
Table 6-6: Criteria for Rating Impairment due to Anal Disease
Table 6-7: Impairments from Surgically Created Stomas
Table 6-8: Criteria for Rating Permanent Impairment due to Liver Disease
Table 6-9: Criteria for Rating Impairment due to Biliary Tract Disease
Table 6-10: Criteria for Rating due to Herniation Functional History Adjustment – Lower Extremities
Table 6-11: Digestive System Impairment Evaluation Summary

Chapter 7: The Urinary and Reproductive Systems
Tables
Table 7-1: Methodology for Determining the Grade in an Impairment Class
Table 7-2: Criteria for Rating Permanent Impairment due to Upper Urinary Tract Disease
Table 7-3: Criteria for Rating Permanent Impairment due to Urinary Diversion Disorders
Table 7-4: Criteria for Rating Permanent Impairment due to Bladder Disease
Table 7-5: Criteria for Rating Permanent Impairment due to Urethral Disease
Table 7-6: Criteria for Rating Permanent Impairment due to Penile Disease
Table 7-7: Criteria for Rating Permanent Impairment due to Scrotal Disease
Table 7-8: Criteria for Rating Impairment due to Testicular, Epididymal, and Spermatic Cord Disease
Table 7-9: Criteria for Rating Impairment due to Prostate Disease
Table 7-10: Criteria for Rating Permanent Impairment due to Vulval and Vaginal Disease
Table 7-11: Criteria for Rating Permanent Impairment due to Cervical and Uterine Disease
Table 7-12: Criteria for Rating Permanent Impairment due to Fallopian Tube and Ovarian Disease
Table 7-13: Urinary and Reproductive Systems Impairment Evaluation Summary

Chapter 8: The Skin
Tables
Table 8-1: Structure, Functions, and Disorders of the Skin
Table 8-2: Criteria for Rating Permanent Impairment due to Skin Disorders
Table 8-3: Skin Impairment Evaluation Summary

Chapter 9: The Hematopoietic System
Tables
Table 9-1: Karnofsky Performance Status Scale Definitions Rating (%) Criteria
Table 9-2: Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PSS)
Table 9-3: Burden of Treatment Compliance
Table 9-4: Methodology for Determining the Grade in an Impairment Class
Table 9-5: Criteria for Rating Permanent Impairment due to Anemia
Table 9-6: Criteria for Rating Permanent Impairment due to Neutropenia
Table 9-7: Criteria for Rating Permanent Impairment due to the Leukemias Leukemias
Table 9-8: Criteria for Rating Permanent Impairment due to HIV Disease
Table 9-9: Criteria for Rating Impairment due to Platelet Disorders
Table 9-10: Criteria for Rating Impairment due to the Hemophilias
Table 9-11: Criteria for Rating Impairment due to Other Bleeding Disorders
Table 9-12: Criteria for Rating Impairment due to Thrombotic Disorders
Table 9-13: Criteria for Rating Impairment due to Lymphoma and Metastatic Disease
Table 9-14: Hematologic Impairment Evaluation Summary

Chapter 10: The Endocrine System
Tables
Table 10-1: Methodology for Determining the Grade in an Impairment Class
Table 10-2a: Enteral, Intranasal, and Topical Medications
Table 10-2b: Parenteral Medications
Table 10-3: Points Assigned for Dietary Modification
Table 10-4: Procedure-Based Points
Table 10-5: Criteria for Rating Impairment due to Disorders of the Hypothalamic-Pituitary Axis
Table 10-6: Criteria for Rating Impairment due to Thyroid Abnormalities
Table 10-7: Criteria for Rating Impairment due to Disorders of the Parathyroids
Table 10-8: Criteria for Rating Impairment due to Disorders of the Adrenal Cortex
Table 10-9: Criteria for Rating Impairment due to Disorders of the Adrenal Medulla
Table 10-10: Criteria for Rating Impairment due to Diabetes Mellitus
Table 10-11: Criteria for Rating Impairment due to Hypoglycemia
Table 10-12: Criteria for Rating Impairment due to Gonadal Disorders
Table 10-13: Criteria for Rating Impairment due to Mammary Disorders
Table 10-14: Criteria for Rating Impairment due to Metabolic Bone Disease
Table 10-15: Endocrine System Impairment Evaluation Summary

Chapter 11: Ear, Nose, Throat, and Related Structures
Tables
Table 11-1: Monaural Hearing Loss and Impairment
Table 11-2: Computation of Binaural Hearing Impairment
Table 11-3: Relationship of Binaural Hearing Impairment to Impairment of the Whole Person
Table 11-4: Criteria for Rating Impairments due to Vestibular Disorders
Table 11-5: Criteria for Rating Impairment due to Facial Disorders and/or Disfigurement
Table 11-6: Criteria for Rating Impairment due to Air Passage Deficits
Table 11-7: Impairments of Mastication and Deglutition: Relationship of Dietary Restrictions to Permanent Impairment
Table 11-8: Criteria for Rating Voice and Speech Impairment

Chapter 12: The Visual System
Tables
Table 12-1: Calculation Steps for the Visual System
Table 12-2: Impairment of Visual Acuity
Table 12-3: Calculation of the Acuity-Related Impairment Rating
Table 12-4: Classification of Impairment of Visual Acuity
Table 12-5: Impairment of Visual Field
Table 12-6: Conversion of Field Radius to Field Score
Table 12-7: Calculation of the Visual Field–Related Impairment Rating
Table 12-8: Classification of Impairment of Visual Field
Table 12-9: Correction for Central Scotomata
Table 12-10: Classification of Impairment of the Visual System and of the Whole Person
Table 12-11: Determination of Reading Acuity and Impairment Rating, Using Letter Size and Viewing Distance

Chapter 13: The Central and Peripheral Nervous System
Tables
Table 13-1: Summary of Chapters Used to Rate Various Neurologic Disorders
Table 13-2: Activities of Daily Living
Table 13-3: Neurologic Impairments That Are Combined With the Most Severe Cerebral Impairment
Table 13-4: Criteria for Rating Impairment of Consciousness and Awareness
Table 13-5: Criteria for Rating Impairment due to Episodic Loss of Consciousness or Awareness
Table 13-6: Criteria for Rating Impairment due to Sleep and Arousal Disorders
Table 13-7: Mental Status Exam for the Neurologically Impaired Patients
Table 13-9: Criteria for Rating Impairment due to Aphasia or Dysphasia
Table 13-10: Global Assessment of Functioning (GAF) Impairment Score
Table 13-11: Criteria for Rating Impairments of the Upper Extremities due to CNS Dysfunction
Table 13-12: Criteria for Rating Impairments due to Station and Gait Disorders
Table 13-13: Criteria for Rating the Neurogenic Bowel
Table 13-14: Criteria for Rating the Neurogenic Bladder
Table 13-15: Criteria for Rating Neurogenic Sexual Dysfunction
Table 13-16: Criteria for Rating Neurogenic Respiratory Dysfunction
Table 13-17: Dysesthetic Pain Secondary to Peripheral Neuropathy or Spinal Cord Injury
Table 13-18: Grading System for Rating Impairment due to Migraine Headache
Table 13-19: Criteria for Rating Trigeminal or Glossopharyngeal Neuralgia
Table 13-20: Criteria for Rating Miscellaneous Peripheral Nerves

Chapter 14: Mental and Behavioral Disorders
Tables
Table 14-1: Mental Status Examination
Table 14-2: Selected Psychological Assessment Tools in Adults
Table 14-3: Suggestions for the Mental and Behavioral Disorders Independent Medical Examination
Table 14-4: Functional Impairment Scales for Patients With Mental and Behavioral Disorders (M&BDs)
Table 14-5: Factors That May Affect Motivation
Table 14-6: Characteristics Suggestive of the Need to Evaluate for Malingering
Table 14-7: Brief Psychiatric Rating Scale Form
Table 14-8: Impairment Score of Brief Psychiatric Rating Scale
Table 14-9: Self-Care, Personal Hygiene, and Activities of Daily Living
Table 14-10: Role Functioning, Social and Recreational Activities
Table 14-11: Travel
Table 14-12: Interpersonal Relationships
Table 14-13: Concentration, Persistence, and Pace
Table 14-14: Resilience and Employability
Table 14-15: Impairment Score of Psychiatric Impairment Rating Scale

Chapter 15: The Upper Extremities
Tables
Table 15-1: Definition of Impairment Classes
Table 15-2: Digit Regional Grid: Digit Impairments
Table 15-3: Wrist Regional Grid: Upper Extremity Impairments
Table 15-4: Elbow Regional Grid: Upper Extremity Impairments
Table 15-5: Shoulder Regional Grid: Upper Extremity Impairments
Table 15-6: Adjustment Grid: Summary
Table 15-7: Functional History Adjustment: Upper Extremities
Table 15-8: Physical Examination Adjustment: Upper Extremities
Table 15-9: Clinical Studies Adjustment: Upper Extremities
Table 15-10: Methodology for Determining the Grade in an Impairment Class
Table 15-11: Impairment Values Calculated From Upper Extremity Impairment
Table 15-12: Impairment Values Calculated From Digit Impairment
Table 15-13: Monofilament Test Criteria
Table 15-14: Sensory and Motor Severity
Table 15-15: Sensory Quality Impairment Classification
Table 15-16: Digit Impairment for Transverse and Longitudinal Sensory Losses in Thumb and Little Finger Based on Percent of Digital Length Involved
Table 15-17: Digit Impairment for Transverse and Longitudinal Sensory Losses in Index, Middle, and Ring Fingers Based on Percent of Digital Length Involved
Table 15-18: Impairment for Sensory Only Peripheral Nerve Injury
Table 15-19: Origins and Functions of Peripheral Nerves of Upper Extremity Emanating From Brachial Plexus
Table 15-20: Brachial Plexus Impairment: Upper Extremity Impairments
Table 15-21: Peripheral Nerve Impairment: Upper Extremity Impairments
Table 15-22: Activities of Daily Living (ADLs)
Table 15-23: Entrapment/Compression Neuropathy Impairment
Table 15-24: Diagnostic Criteria for Complex Regional Pain Syndrome
Table 15-25: Objective Diagnostic Criteria Points for Complex Regional Pain Syndrome
Table 15-26: Complex Regional Pain Syndrome (Type I): Upper Extremity Impairments
Table 15-27: Level of Amputation
Table 15-28: Impairment for Upper Limb Amputation at Various Levels
Table 15-29: Amputation Impairment
Table 15-30: Thumb Range of Motion
Table 15-31: Finger Range of Motion
Table 15-32: Wrist Range of Motion
Table 15-33: Elbow/Forearm Range of Motion
Table 15-34: Shoulder Range of Motion
Table 15-35: Range of Motion Grade Modifiers
Table 15-36: Functional History Grade Adjustment: Range of Motion
Table 15-37: Activities of Daily Living Questionnaire
Table 15-38: ADLs Questionnaire Evaluation
Table 15-39: Comparison Between QuickDASH and ADL Questionnaires
Table 15-40: Self-Report Functional Assessment Measures

Chapter 16: The Lower Extremities
Tables
Table 16-1: Definition of Impairment Classes
Table 16-2: Foot and Ankle Regional Grid – Lower Extremity Impairments
Table 16-3: Knee Regional Grid – Lower Extremity Impairments
Table 16-4: Hip Regional Grid – Lower Extremity Impairments
Table 16-5: Adjustment Grid: Summary
Table 16-6: Functional History Adjustment – Lower Extremities
Table 16-7: Physical Examination Adjustment – Lower Extremities
Table 16-8: Clinical Studies Adjustment – Lower Extremities
Table 16-9: Methodology for Determining the Grade in an Impairment Class
Table 16-10: Impairment Values Calculated From Lower Extremity Impairment
Table 16-11: Sensory and Motor Severity
Table 16-12: Peripheral Nerve Impairment – Lower Extremity Impairments
Table 16-13: Diagnostic Criteria for Complex Regional Pain Syndrome
Table 16-14: Objective Diagnostic Criteria Points for Complex Regional Pain Syndrome
Table 16-15: Complex Regional Pain Syndrome (Type I) – Lower Extremity Impairments
Table 16-16: Amputation Impairment
Table 16-17: Functional History Net Modifier
Table 16-18: Lesser Toe Impairments
Table 16-19: Greater Toe Impairments
Table 16-20: Hindfoot Motion Impairments
Table 16-21: Ankle or Hindfoot Deformity Impairments
Table 16-22: Ankle Motion Impairments
Table 16-23: Knee Motion Impairments
Table 16-24: Hip Motion Impairments – Lower Extremity Impairment
Table 16-25: Range of Motion ICF Classification

Chapter 17: The Spine and Pelvis
Tables
Table 17-1: Definition of Impairment Classes and Impairment Ranges
Table 17-2: Cervical Spine Regional Grid: Spine Impairments
Table 17-3: Thoracic Spine Regional Grid: Spine Impairments
Table 17-4: Lumbar Spine Regional Grid: Spine Impairments
Table 17-5: Adjustment Grid: Summary
Table 17-6: Functional History Adjustment: Spine
Table 17-7: Physical Examination Adjustment: Spine
Table 17-8: Common Radicular Syndromes
Table 17-9: Clinical Studies Adjustment: Spine
Table 17-10: Methodology for Determining the Grade in an Impairment Class
Table 17-11: Diagnosis-Based Impairment Grid: Pelvis
Table 17-12: Functional History Adjustment: Pelvis
Table 17-13: Physical Examination Adjustment: Pelvis
Table 17-14: Clinical Studies Adjustment: Pelvis
Table 17-A: PDQ Scoring

Appendix

Combined Values Table
Burden of Treatment Compliance
B-1: Burden of Treatment Compliance
B-2a: Oral, Intranasal, Ocular, Skin
B-2b: Inhaled, Rectal
B-2c: Points for Subcutaneous, IM, Intradermal, IV, and Intracavitary Medication
B-3: Points Assigned For Dietary Modification
B-4: Points Assigned for Procedures

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