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DISORDERS OF THE FACE
In evaluating permanent impairment from a disorder of the face, functional capacity as well as structural integrity are considered. Impairment in this section is limited to abnormality in structural integrity only. (For loss of function, refer to sections regarding specific anatomical areas). Loss of structural integrity can result from cutaneous disfigurement, such as that due to abnormal pigmentation or scars, or from loss of supporting structures, such as soft tissue, bone, or cartilage of the facial skeleton.
Class 1 Impairment of the Whole Person, 1—5% A patient belongs in Class 1 when the facial abnormality is limited to a disorder of the cutaneous structures, such as visible scars and abnormal pigmentation.
Class 2 impairment of the Whole Person, 6—10% A patient belongs in Class 2 when there is loss of supporting structures of part of the face,with or without cutaneous disorder. Depressed cheek, nasal, or frontal bones constitutea Class 2 impairment.
Class 3 Impairment of the Whole Person, 11—15% A patient belongs in Class 3 when there is absence of a normal anatomical area of the face.Loss of an eye (see Section 10) or loss of part of the nose with the resulting cosmeticdeformity constitute a Class 3 impairment.
Class 4 impairment of the Whole Person, 16—35% A patient belongs in Class 4 when facial disfigurement is so severe that it precludes social acceptance. Massive distortion of normal facial anatomy constitutes a Class 4 impairment.
RESPIRATION
Air passage defects may result in permanent impairment. The following provides a rating classification system for air passage defects (excluding larynx air ways and lung parenchyma). Permanent impairment from obstructive sleep apnea should be evaluated using the neurologic section.
Classes of Air Passage Defects
Class 1 Impairment of the Whole Person, 0—10% A recognized air passage defect exists.Dyspnea does not occur at rest.Dyspnea is not produced by walking or climbing stairs freely, performance of other usual activities of daily living, stress, prolonged exertion, hurrying, hill climbing, or recreation* requiring intensive effort or similar activity.Examination reveals one or more of the following: partial obstruction of oropharynx, laryngopharynx, larynx, upper trachea (to 4th ring), lower trachea, bronchi, or complete obstruction of the nose (bilateral), or nasopharynx. *prophylactic restriction of activity such as strenuous competitive sports does not exclude patient from Class 1.
NOTE: Patients with successful permanent tracheostomy or stoma should be rated at 25% impairment of the whole person.
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