AMA Criteria for Lower Extremity Impairment in Peripheral Vascular Disease

 

NOTE: The impairments for each class below refer to lower extremity impairment, rather than whole person impairment (see formula at end of section).

 

NOTE: Assigning whole person impairment when one or both extremities are involved needs to be clarified. While the findings used to classify the patient can involve findings in both extremities, according to the AMA Guides it appears as if impairment for each lower extremity is graded separately.

 

Class 1 (0-9% impairment of lower extremity)

• The patient experiences neither intermittent claudication nor pain at rest.

OR

• The patient experiences only transient edema.

AND

• On physical examination, not more than the following findings are present

• loss of pulses

• minimal loss of subcutaneous tissue

• calcification of arteries as detected on radiographic examination

• asymptomatic dilation of arteries or of veins, not requiring surgery and not resulting in curtailment of activities

 

Class 2 (10-39% impairment of lower extremity)

• The patient experiences intermittent claudication on walking at least 100 yards at an average pace. (with severe usage)

OR

• There is persistent edema of a moderate degree, incompletely controlled by elastic supports.

OR

• There is evidence of vascular damage (healed, painless stump of an amputated digit showing evidence of persistent vascular disease or a healed ulcer)

 

Class 3 (40-69% impairment of lower extremity)

• The patient experiences intermittent claudication on walking as few as 25 yards and no more than 100 yards at average pace.

OR

• There is marked edema that is only partially controlled by elastic supports.

OR

• There is evidence of vascular damage (healed amputation of 2 or more digits of one extremity, with evidence of persisting vascular disease or superficial ulceration)

 

Class 4 (70-89% impairment of lower extremity)

• The patient experiences intermittent claudication on walking less than 25 yards.

OR

• The patient experiences intermittent pain at rest.

OR

• The patient has marked edema that cannot be controlled by elastic supports.

OR

• There is evidence of vascular damage such as:

• amputation at or above an ankle of one extremity

• amputation of 2 or more digits of 2 extremities with persistent vascular disease, or

• persistent widespread or deep ulceration involving one extremity

 

Class 5 (90-100% impairment of lower extremity)

• The patient experiences severe and constant pain at rest.

OR

• There is evidence of vascular damage:

• amputation at or above the ankles of both extremities, or

• amputation of all digits of 2 or more extremities, with evidence of persistent, widespread or deep ulceration involving 2 or more extremities.

 

whole person impairment =

= 0.4 * (impairment of the lower extremity)