Permanent impairment of the skin is any anatomic or functional abnormality or loss, including burns (thermal or electrical), scarring, and acquired immunologic capacity to react to antigens that persists after medical treatment and rehabilitation, and after a length of time sufficient to permit regeneration and other physiologic adjustments. The degree of permanent impairment of the skin may not be static. Therefore, findings should be subject to review and the patient’s impairment should be reevaluated at appropriate intervals. In the evaluation of a permanent impairment resulting from a skin disorder, the actual functional loss is the prime consideration, although the extent of cosmetic or cutaneous involvement may also be important.
Impairments of other body systems, such as behavioral problems and restriction of motion or ankylosis of joints, and respiratory, cardiovascular, endocrine, and gastrointestinal disorders, may be associated with a skin impairment.
When there is permanent impairment in more than one body system, the degree of impairment for each system should be evaluated separately and combined using the Combined Values Chart, to determine the impairment of the whole person. Manifestations of skin disorders may be influenced by physical and/or chemical agents that a patient may encounter. While the avoidance of these irritant agents, possibly through a change in occupation, might alleviate the manifestations of the skin disorder, the presence of a skin disorder should be recognized and evaluated in accordance with the following criteria.
Impairment Classification for Skin Disease
Class 1—Impairment of the Whole Person, 1—9%
A patient belongs in Class 1 when signs or symptoms of skin disorder are present;
and
With treatment, there is no limitation, or minimal limitation, in the performance of the activities of daily living, although exposure to certain physical or chemical agents might increase limitation temporarily.
Class 2—Impairment of the Whole Person, 10—25%
A patient belongs in Class 2 when signs and symptoms of skin disorder are present;
and
Intermittent treatment is required;
and
There is limitation in the performance of some of the activities of daily living.
Class 3—Impairment of the Whole Person, 26—55%
A patient belongs in Class 3 when signs and symptoms of skin disorder are present;
and
Continuous treatment is required;
and
There is limitation in the performance of many activities of daily living.
Class 4—Impairment of the Whole Person, 56—80%
A patient belongs in Class 4 when signs and symptoms of skin disorder are present;
and
Continuous treatment is required, which may include periodic confinement at home or other domicile;
and
There is limitation in the performance of many of the activities of daily living.
Class 5—Impairment of the Whole Person, 81—95%
A patient belongs in Class 5 when signs and symptoms of skin disorder are present;
and
Continuous treatment is required, which necessitates confinement at home or other domicile;
and
There is severe limitation in the performance of activities of daily living.
Signs or symptoms of skin disorders classified in Classes 1 and 2 may be intermittent and may not be present at the time of examination.
NOTE: For specific examples of patients within each class, refer to the AMA “Guides to the Evaluation of Permanent Impairment” (current edition), chapter on Skin Disease. Disfigurement and behavioral changes that may be present should be evaluated in accordance with the section on Mental and Behavioral Disorders.