INTRODUCTION
Abnormal findings in other body systems may be associated with hypersecretion or hyposecretion of hormones, and some of these findings may persist indefinitely, even after therapy of the underlying hormonal dysfunction. Such impairment should be evaluated in accordance with criteria in the appropriate sections, and when appropriate, impairment ratings of other body systems should be combined with impairment ratings based on this section, using the Combined Values Chart to determine impairment of the whole person.
Neoplasms of the endocrine glands may produce nonhormonal permanent impairments manifested by pain or by effects involving other body systems. Such impairments should be evaluated with criteria set forth in the sections concerning the respective body systems. It is recognized that, in addition to those discussed in this section, other abnormalities may occur that involve the endocrine system. If such abnormalities produce permanent impairment, the physician should attempt to assign a value based on the degree of the impairment and one that is consistent with established values.
The focus of this section is the evaluation of physical impairment that may result from endocrine dysfunction. Since many of the endocrine abnormalities produce cosmetic and/or psychological abnormalities, the evaluator may wish to consider the criteria for impairment from mental and behavioral disorders. Similarly, many of the abnormalities require chronic replacement medications, perhaps for the lifetime of the individual. At the discretion of the evaluating physician, an added impairment of 0% to 5% may be allotted for this aspect of an endocrine disorder.
HYPOTHALAMIC PITUITARY AXIS
Class 1—Impairment of the Whole Person, 1 - 10%
A patient with hypothalamic-pituitary disease belongs in Class 1 when the disease can be controlled effectively with continuous treatment.
Class 2—Impairment of the Whole Person, 11—24%
A patient with hypothalamic-pituitary disease belongs in Class 2 when the symptoms and signs are inadequately controlled by treatment.
Class 3—Impairment of the Whole Person, 25—50%
A patient with hypothalamic-pituitary disease belongs in Class 3 when severe symptoms and signs persist despite treatment.
When appropriate, other impairments, i.e., neurologic or visual impairments, may be combined with the above impairments.
THYROID STRUCTURE OR FUNCTION
Class 1—Impairment of the Whole Person, 1—10%
A patient belongs in Class 1 when (a) continuous thyroid therapy is required for correction of the thyroid insufficiency or for maintenance of normal thyroid anatomy; and (b) there is no objective physical or laboratory evidence of inadequate replacement therapy.
Class 2—Impairment of the Whole Person, 11—20%
A patient belongs in Class 2 when (a) symptoms and signs of thyroid disease are present or there is anatomic loss or alteration; and (b) continuous thyroid hormone replacement therapy is required for correction of the confirmed thyroid insufficiency; but (c) the presence of a disease process in another body system or systems permits only partial replacement of the thyroid hormone.
May combine with other disorders where appropriate, i.e., cardiovascular disease.
PARATHYROID STRUCTURE OR FUNCTION
Severity of Hyperparathyroidism ... % Impairment of the Whole Person
Hypoparathyroidism is a chronic condition of variable severity that requires long term medical therapy in most cases. The degree of severity determines the degree of permanent impairment according to the following:
Severity of Hypoparathyroidism ... % Impairment of the Whole Person
When other disorders exist, i.e., renal calculi, renal failure, these disorders may be combined with the above impairments.
STRUCTURAL OR FUNCTIONAL DISORDERS OF THE ADRENAL CORTEX
Impairment of the whole person may result from hypersecretion or hyposecretion of the cortical hormones. Such an abnormality may be associated with dysfunction of another endocrine gland, for instance, the pituitary. If this occurs, impairment from the adrenal abnormality is evaluated together with the other dysfunction using the Combined Values Chart.
Severity of Hypoadrenalism ... % Impairment of the Whole Person
Severity of Hyperadrenocorticism ... % Impairment of the Whole Person
STRUCTURAL OR FUNCTIONAL DISORDERS OF THE ADRENAL MEDULLA
Pheochromocytoma—Permanent impairment from the pheochromocytoma may be classified using the following table.
Severity of Pheochromocytoma ... % Impairment of the Whole Person
STRUCTURAL OR FUNCTIONAL DISORDERS OF THE ENDOCRINE PANCREAS (ISLETS OF LANGERHANS)
Diabetes Mellitus — Criteria for evaluating permanent impairment related to diabetes mellitus are as follows.
Class 1 — Impairment of the Whole Person, 1—5%
A person with diabetes mellitus belongs in Class 1 if he or she has noninsulin dependent (Type II) diabetes mellitus that can be controlled by diet; the person may or may not have evidence of diabetic microangiopathy, as indicated by the presence of retinopathy and/or albuminuria greater than 30 mg/100 ml.
Class 2 — Impairment of the Whole Person, 6—14%
A patient belongs in this classification when there is diagnosis of noninsulin dependent (Type II) diabetes mellitus; and when satisfactory control of the plasma glucose requires both a restricted diet and hypoglycemic medication, either an oral agent or insulin. Evidence of microangiopathy, as indicated by retinopathy or by albuminuria of greater than 30 mg/100 ml, may or may not be present.
Class 3 — Impairment of the Whole Person, 15—24%
A patient belongs in this class when insulin dependent (Type I ) diabetes mellitus is present with or without evidence of microangiopathy.
Class 4 — Impairment of the Whole Person, 25—40%
A patient belongs in Class 4 when the patient has the diagnosis of insulin dependent (Type I) diabetes mellitus and when hyperglycemic and/or hypoglycemic episodes occur frequently in spite of conscientious efforts of both the patient and his or her physician.
HYPOGLYCEMIA
Class 1 — Impairment of the Whole Person, 0%
A patient has Class 1 impairment when surgical removal of an islet-cell adenoma results in complete remission of the symptoms and signs of hypoglycemia, and there are no postoperative sequelae.
Class 2 — Impairment of the Whole Person, 1—50%
A patient with symptoms and signs of hypoglycemia has Class 2 impairment of the whole person ranging from 1% to 50%, depending on the degree of control obtained with diet and medications and on how the condition affects activities of daily living.
GONADS
A patient with anatomic loss or alteration of the gonads that results in an absence or abnormally high level of gonadal hormones would have 0% to 5% impairment of the whole person. Impairment due to inability to reproduce and other impairments associated with gonadal dysfunction should be evaluated in accordance with the criteria set forth in the genitourinary section.
MAMMARY GLANDS
The mammary glands make, store, and deliver milk. Absence of the mammary glands does not cause impairment of the whole person in males, but in females it will prevent nursing. Absence of mammary gland function in females due to an endocrine disorder can be rated 0—20% of the whole person. Cosmetic deformities should be rated under the section covering skin. In some endocrine disorders there may be galactorrhea in the female and gynecomastia in the male. Gynecomastia in the male may be accompanied by galactorrhea.
A female patient in the childbearing age with absence of the breasts, a patient with galactorrhea sufficient to require the use of absorbent pads, and a male patient with painful gynecomastia that interferes in the performance of daily activities would each have 0% to 5% impairment of the whole person.
METABOLIC BONE DISEASE
Metabolic bone disease such as osteoporosis, vitamin D-resistant osteomalacia, and Paget’s disease, may require continuous therapy. These conditions; unless accompanied by pain, skeletal deformity, or peripheral nerve involvement, should be rated at 0% impairment of the whole person. When continuous hormones and mineral therapy give complete relief of symptoms, impairment of the whole person may be considered to be 3%. When continuous therapy is required to relieve pain, and the activities of daily living are restricted because of pain, the rating should be 5% to 15% impairment of the whole person. Any associated loss of motion should be evaluated in accordance with the criteria set forth in the section on the extremities and spine, and the section on the nervous system.