Or. Admin. Code § 436-035-0430 - Endocrine System
(1) The
assessment of permanent impairment from disorders of the hypothalamic-pituitary
axis requires evaluation of (1) primary abnormalities related to growth
hormone, prolactin, or ADH; (2) secondary abnormalities in other endocrine
glands, such as thyroid, adrenal, and gonads, and; (3) structural and
functional disorders of the central nervous system caused by anatomic
abnormalities of the pituitary. Each disorder must be evaluated separately,
using the standards for rating the nervous system, visual system, and mental
and behavioral disorders, and the impairments combined. Impairment of the
hypothalamic-pituitary axis is determined under the following classes:
(a) Class 1: 5% when controlled effectively
with continuous treatment.
(b)
Class 2: 18% when inadequately controlled by treatment.
(c) Class 3: 38% when there are severe
symptoms and signs despite treatment.
(2) Impairment of thyroid function results in
either hyperthyroidism or hypothyroidism. Hyperthyroidism is not considered to
be a cause of permanent impairment, because the hypermetabolic state in
practically all patients can be corrected permanently by treatment. After
remission of hyperthyroidism, there may be permanent impairment of the visual
or cardiovascular systems, which should be evaluated using the appropriate
standards for those systems.
Hypothyroidism in most instances can be satisfactorily controlled by the administration of thyroid medication. Occasionally, because of associated disease in other organ systems, full hormone replacement may not be possible. Impairment of thyroid function is determined under the following classes:
(a) Class 1: 5% when (a)
continuous thyroid therapy is required for correction of the thyroid
insufficiency or for maintenance of normal thyroid anatomy; AND (b) the
replacement therapy appears adequate based on objective physical or laboratory
evidence.
(b) Class 2: 18% 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.
(3) Parathyroid: Impairment of parathyroid
function results in either hyperparathyroidism or hypoparathyroidism.
(a) In most cases of hyperparathyroidism,
surgical treatment results in correction of the primary abnormality, although
secondary symptoms and signs may persist, such as renal calculi or renal
failure, which should be evaluated under the appropriate standards. If surgery
fails, or cannot be done, the patient may require long-term therapy, in which
case the permanent impairment may be classified under the following:
(A) Class 1: 5% when symptoms and signs are
controlled with medical therapy.
(B) Class 2: 18% when there is persistent
mild hypercalcemia, with mild nausea and polyuria.
(C) Class 3: 78% when there is severe
hypercalcemia, with nausea and lethargy.
(b) Hypoparathyroidism is a chronic condition
of variable severity that requires long-term medical therapy in most cases. The
severity determines the degree of permanent impairment under the following:
(A) Class 1: 3% when symptoms and signs
controlled with medical therapy.
(B) Class 2: 15% when intermittent
hypercalcemia or hypocalcemia, and more frequent symptoms in spite of careful
medical attention.
(4) Adrenal cortex: Impairment of the adrenal
cortex results in either hypoadrenalism or hyperadrenocorticism.
(a) Hypoadrenalism is a lifelong condition
that requires long-term replacement therapy with glucocorticoids or
mineralocorticoids for proven hormonal deficiencies. Impairments are rated as
follows:
(A) Class 1: 5% when symptoms and
signs are controlled with medical therapy.
(B) Class 2: 33% when symptoms and signs are
controlled inadequately, usually during the course of acute
illnesses.
(C) Class 3: 78% when
severe symptoms of adrenal crisis during major illness, usually due to severe
glucocortocoid deficiency or sodium depletion.
(b) Hyperadrenocorticism due to the chronic
side effects of nonphysiologic doses of glucocorticoids (iatrogenic Cushing's
syndrome) is related to dosage and duration of treatment and includes
osteoporosis, hypertension, diabetes mellitus and the effects involving
catabolism that result in protein myopathy, striae, and easy bruising.
Permanent impairment ranges from 5% to 78%, depending on the severity and
chronicity of the disease process for which the steroids are given. On the
other hand, with diseases of the pituitary-adrenal axis, impairment may be
classified based on severity:
(A) Class 1: 5%
when minimal, as with hyperadrenocorticism that is surgically correctable by
removal of a pituitary or adrenal adenoma.
(B) Class 2: 33% when moderate, as with
bilateral hyperplasia that is treated with medical therapy or
adrenalectomy.
(C) Class 3: 78%
when severe, as with aggressively metastasizing adrenal carcinoma.
(5) Adrenal medulla:
Impairment of the adrenal medulla results from pheochromocytoma and is
classified as follows:
(a) Class 1: 5% when
the duration of hypertension has not led to cardiovascular disease and a benign
tumor can be removed surgically.
(b) Class 2: 33% when there is inoperable
malignant pheochromocytomas, if signs and symptoms of catecholoamine excess can
be controlled with blocking agents.
(c) Class 3: 78% when there is wide
metastatic malignant pheochromocytomas, in which symptoms of catecholamine
excess cannot be controlled.
(6) Pancreas: Impairment of the pancreas
results in either diabetes mellitus or in hypoglycemia.
(a) Diabetes mellitus is rated under the
following classes:
(A) Class 1: 3% when
non-insulin dependent (Type II) diabetes mellitus can be controlled by diet;
there may or may not be evidence of diabetic microangiopathy, as indicated by
the presence of retinopathy or albuminuria greater than 30 mg/100 ml.
(B) Class 2: 8% when non-insulin dependent
(Type II) diabetes mellitus; and 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.
(C) Class 3: 18% when
insulin dependent (Type I) diabetes mellitus is present with or without
evidence of microangiopathy.
(D)
Class 4: 33% when insulin dependent (Type I) diabetes mellitus, and
hyperglycemic or hypoglycemic episodes occur frequently in spite of
conscientious efforts of both the patient and the attending
physician.
(b)
Hypoglycemia is rated under the following classes:
(A) Class 1: 0% when surgical removal of an
islet-cell adenoma results in complete remission of the symptoms and signs of
hypoglycemia, and there are no post-operative sequelae.
(B) Class 2: 28% when signs and symptoms of
hypoglycemia are present, with controlled diet and medications and with effects
on the performance of activities of daily living.
(7) Gonadal hormones: A patient
with anatomic loss or alteration of the gonads that results in a loss or
alteration in the ability to produce and regulate the gonadal hormones receives
a value of 3% impairment for unilateral loss or alteration and 5% for bilateral
loss or alteration. Loss of the cervix/uterus or penile sexual function is
valued under OAR 436-035-0420.
Notes
Classes referenced are available from the agency.
Stat. Auth.: ORS 656.726
Stats. Implemented: ORS 656.005, 656.214, 656.268 & 656.726
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