| (1)
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Permanent Impairment—This is a purely medical condition. Permanent
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impairment is any anatomic or functional abnormality or loss after maximal medical improvement has been achieved, which abnormality or loss the physician considers stable or nonprogressive at the time evaluation is made. It is always a basic consideration in the evaluation of permanent disability.
| (2)
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Permanent Disability—This is not a purely medical condition. A patient is
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“permanently disabled” or “under a permanent disability” when his/her actual or presumed ability to engage in gainful activity is reduced or absent because of “impairment” which, in turn, may or may not be combined with other factors. A permanent condition is found to exist if no fundamental or marked change can be expected in the future.
| (3)
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Evaluation (Rating) of Permanent Impairment—This is a function that
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physicians alone are competent to perform. Evaluation of permanent impairment defines the scope of medical responsibility and therefore represents the physician’s role in the evaluation of permanent disability. Evaluation of permanent impairment is an appraisal of the nature and extent of the patient’s illness or injury as it affects his personal efficiency in one or more of the activities of daily living. These activities are self-care, communication, normal living postures, ambulation, elevation, traveling and nonspecialized hand activities.
| (4)
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Evaluation (Rating) of Permanent Disability—In the last analysis, this is an
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administrative and not solely a medical responsibility and function. Evaluation of permanent disability is an appraisal of the patient’s present and future ability to engage in gainful activity as it is affected by such diverse factors as age, sex, education, economic and social environment, in addition to the definite medical factor-permanent impairment. The first group of factors has proved extremely difficult to measure. For this reason, permanent impairment is in fact the sole or real criterion of permanent disability far more often than is readily acknowledged. In actual practice, however, the final determination of permanent disability is an administrative decision as to the patient’s entitlement. Under no circumstances shall this guide be used to determine disability. This guide is intended to be used solely for the purpose of rating impairments. Competent evaluation of permanent impairment requires an adequate and complete medical examination, and the avoidance of subjective impressions and such factors, as age, sex, or employability.
| (5)
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Maximum Medical Improvement or Date of Maximum Medical Improvement—
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the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.
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