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6.6 - 6.9 Respiration (AMA5 Section 11.4a, pp 259-61)

6.6 In regard to sleep apnoea (third paragraph of AMA5 Section 11.4a, p 259), a sleep study and an examination by an ear, nose and throat specialist is mandatory before assessment by an approved assessor.

6.7 The assessment of sleep apnoea is addressed in AMA5 Section 5.6 (p 105) and assessors should refer to this chapter, as well as paragraphs 8.8 - 8.10 in Chapter 8 of the Guidelines.

6.8 AMA5 Table 11-6, ‘Criteria for rating impairment due to air passage defects’ (p 260), should be replaced with Table 6.2, below, when assessing permanent impairment due to air passage defects.

Table 6.2: Criteria for rating permanent impairment due to air passage defects

Percentage impairment of the whole person
Class 1a
0-5%

There are symptoms of significant difficulty in breathing through the nose. Examination reveals significant partial obstruction of the right and/ or left nasal cavity or nasopharynx or significant septal perforation.

Class 1
0-10%

Dyspnea does not occur at rest

and

dyspnea is not produced by walking freely on a level surface, climbing stairs freely or performance of other usual activities of daily living

and

dyspnea is not produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities requiring intensive effort*

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, bronchi or complete (bilateral) obstruction of the nose or nasopharynx.

Class 2
11-29%

Dyspnea does not occur at rest

and

dyspnea is not produced by walking freely on a level surface, climbing one flight of stairs or performance of other usual activities of daily living

but

dyspnea is produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities (except sedentary forms)

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, bronchi or complete (bilateral) obstruction of the nose or nasopharynx.

Class 3
11-29%

Dyspnea does not occur at rest

and

dyspnea is produced by walking freely more than one or two level blocks, climbing one flight of stairs, even with periods of rest, or performance of other usual activities of daily living

and

dyspnea is produced by stress, prolonged exertion, hurrying, hill climbing, or recreational or similar activities

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea or bronchi.

Class 4
50-89%

Dyspnea occurs at rest, although individual is not necessarily bedridden

and

dyspnea is aggravated by the performance of any of the usual activities of daily living (beyond personal cleansing, dressing or grooming)

and

examination reveals partial obstruction of the oropharynx, laryngopharyx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea, and/or bronchi.

Class 5
90%+

Severe dyspnea occurs at rest and spontaneous respiration is inadequate

and

respiratory ventilation is required

and

examination reveals partial obstruction of the oropharynx, laryngopharynx, larynx, upper trachea (to the fourth cartilaginous ring), lower trachea or bronchi.

* Prophylactic restriction of activity, such as strenuous competitive sport, does not exclude subject from class 1.

Note: Individuals with successful permanent tracheostomy or stoma should be rated at 25% WPI. AMA5 example 11-16 (p 261), ‘Partial obstruction of the larynx affecting only one vocal cord’, is better linked to voice (AMA5 Section 11.4e).

6.9 When using AMA5 Table 11-7 ‘Relationship of dietary restrictions to permanent impairment’ (p 262), the first WPI category is to be 0–19%, not 5–19%.