Resolution SBS 4768-2017: Amending Chapter III Rheumatology of the Manual for Evaluation and Qualification of Degree of Invalidity and Issuing Other Provisions

Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239 Lima, December 13, 2017

S.B.S. Resolution
No. 4768-2017

The Superintendent of Banks, Insurance, and Private Pension Fund Administrators

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Unified Text of Ordinance (TUO) of the Law of the Private System for the Administration of Pension Funds was approved;

That, by Supreme Decree No. 004-98-EF, the Regulation of the aforementioned Unified Text of Ordinance was approved;

That, additionally, in accordance with the Third Final and Transitory Provision of the Regulation of the Law, the Superintendence is empowered to issue the complementary operational norms necessary for the proper functioning of the Private System for the Administration of Pension Funds;

That, by Supreme Decree No. 061-2007-EF, Article 129 of the cited Regulation of the Law was modified, referring to the Technical Medical Commission (CTM), which establishes that this body is responsible for reviewing the technical norms for the evaluation and qualification of the degree of invalidity, reaching the Superintendence with the proposals corresponding to the modification of the respective Manuals for Evaluation and Qualification of the Degree of Invalidity to which the Medical Committee of the AFP (COMAFP) and the Medical Committee of the Superintendence (COMEC) must adhere, as well as to the other functions assigned to it by the Superintendence;

That, the evaluation and qualification of invalidity are carried out by the COMAFP or COMEC, based on uniform criteria and methods established by the CTM for the assignment of impairment derived from physical or mental impediments, contained in the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its amendments;

That, the Superintendence, through Office No. 34862-2017-SBS, requested the CTM to review a proposal for the modification of the Rheumatology Chapter, specifically regarding the osteoarthritis module, in order to improve the criteria and establish procedures that represent a higher degree of objectivity for the evaluation of impairment and qualification of invalidity, incorporating advances in medical science in this matter;

That, in this regard, the CTM, as part of the tasks entrusted by the Superintendence, has carried out the technical review of the proposal for modification subject of this resolution, submitting an improved proposal for the corresponding regulatory modification supported by Report No. 006-2017-CTM;

Having the approval of the Adjunct Superintendencies of Private Pension Fund Administrators, and of Legal Advice; and,

In exercise of the powers conferred by numeral 9 of Article 349 of the General Law of the Financial System and the System of Insurance and Organization of the Superintendence of Banks and Securities, Law No. 26702 and its amendments, subsection d) of Article 57 of the Unified Text of Ordinance of the Law of the Private System for the Administration of Pension Funds, approved by Supreme Decree No. 054-97-EF and on the basis of the exceptional conditions set forth in numeral 3.2 of Article 14 of Supreme Decree No. 001-2009-JUS and its amendments;

RESOLVES:

Article First.- Incorporate numeral 3.12 in Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its amendments, as follows:

3.12 EVALUATION OF IMPAIRMENT DUE TO OSTEOARTHRITIS IN WEIGHT-BEARING JOINTS:
HIPS, KNEES, AND ANKLES

1. • PERSONAL ASPECTS (max impairment 10%)

Aspects to value (Prognostic factors) | Scales | Percentage | Mark what corresponds --- | --- | --- | --- Age | | | Less than or equal to 30 years | 0% | Greater than 30 and less than 50 years | 1% | Greater than or equal to 50 years | 2% | Education Level | | | Elementary studies | 2% | Secondary studies | 1% | Higher studies | 0% | Economic Situation | | | Poor | 2% | Medium | 1% | Good | 0% | Support from environment (family or other) | | | No support | 2% | Partial support | 1% | Complete/good support | 0% | Labor Situation: | | | Unemployment, or if working: subsidy time 1 in the last year | | | Unemployed | 1% | No subsidy | 0% | Less than 3 months | 0.5% | Greater than or equal to 3 and less than or equal to 5 months | 1% | Greater than 5 months | 2% |

Global percentage of impairment attributable to personal aspects =

1 Subsidy: Must be understood as temporary incapacity established by EsSalud.

Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239

2. • CLINICAL-THERAPEUTIC ASPECTS (max impairment 74%)

PAIN - WOMAC QUESTIONNAIRE - see Annex A (max 18%)

Score < 5 | Mild Pain | 4%
Score ≥ 5 ≤ 10 | Moderate Pain | 8%
Score > 10 ≤ 15 | Severe Pain | 13%
Score > 15 ≤ 20 | Very Severe Pain | 18%
Score = | Assigned Percentage = |

STIFFNESS - WOMAC QUESTIONNAIRE - see Annex B (max 18%)

Score < 2 | Mild Stiffness | 4%
Score ≥ 2 ≤ 4 | Moderate Stiffness | 8%
Score > 4 ≤ 6 | Severe Stiffness | 13%
Score > 6 ≤ 8 | Very Severe Stiffness | 18%
Score = | Assigned Percentage = |

FUNCTIONAL CAPACITY - WOMAC QUESTIONNAIRE - see Annex C (max 18%)

Score < 17 | Little Limitation | 4%
Score ≥ 17 ≤ 34 | Moderate Limitation | 8%
Score > 34 ≤ 51 | Severe Limitation | 13%
Score > 51 ≤ 68 | Very Severe Limitation | 18% Score = | Percentage of impairment = |

RADIOLOGICAL ASSESSMENT OF OSTEOARTHRITIS - KELLGREN AND LAWRENCE CLASSIFICATION - See Annex (max 6%)

Grade 0 | Score 0 | 0%
Grade 1 | Score 1 | 1.5%
Grade 2 | Score 2 | 3%
Grade 3 | Score 3 | 4.5%
Grade 4 | Score 4 | 6%
Score = | Percentage of impairment = |

THERAPEUTIC ASPECTS (max 5%)

Assessment of response to administered treatment (max 3%) Good: suppression of pain and improvement of functionality | Mild | 1% Regular: partial relief of pain and partial improvement of functionality | Moderate | 2% Poor: no improvement in pain or functionality | Severe | 3%

Assessment of adverse effects of treatments (max 2%) Gastrointestinal and intestinal effects | Mild ≤ 1 adverse effect | 0.5% Systemic effects: hepatic, renal, neurological, etc. | Moderate = 2 or 3 effects | 1% Other: HTA, etc. | Severe > 3 effects | 2%

Treatment response score =
Adverse effects score =
Global Score =
Percentage of impairment =

In case of not undergoing treatment, the assessment will not be applied until treatment is initiated and has been carried out for at least 3 months.

ASSOCIATED COMORBIDITIES (max 9%)

Obesity | Yes | No
Osteoporosis | Yes | No
Others: fractures, connective tissue diseases | Yes | No

Mild ≤ 1 of the associated pathologies | 3%
Moderate = 2 or 3 of the associated pathologies | 6% Severe > 3 associated pathologies | 9%

Percentage of impairment =
Global percentage of impairment in clinical-therapeutic aspects =

Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239

3.- LABOR ASPECTS (max impairment 5%)

Score | Percentage | Incapacity
0 - 54 | 1% | Mild
55 - 108 | 3% | Moderate
109 - 156 | 5% | Severe

Final Score = | Percentage of impairment = | Grade =

CHECK LIST - LABOR SITUATION

Tasks	Score (between 0 - 6)
	Not applicable	1/3 shift	2/3 shift	Full shift
Manual handling of loads (MMC)	MMC ≤ 5 kg	0	1	2
MMC > 5 and ≤ 10 kg	0	2	3	4
---	---	---	---	---
MMC > 10 and ≤ 25 kg	0	3	4	5
MMC > 25 kg	0	4	5	6
Repetitive movements (MR)	Shoulder elevation > 90º	0	2	4
Flex-ext or pron-sup. of wrist	0	2	4	6
---	---	---	---	---
Flex-ext. Trunk	0	2	4	6
Prolonged postures	Prolonged ambulation	0	2	4
Continuous sitting	0	2	4	6
---	---	---	---	---
Continuous standing	0	2	4	6
Work organization	Continuous work without alternation of tasks in your job	0	2	4
Performs repetitive/monotonous tasks	0	2	4	6
---	---	---	---	---
Fixed postures without alternation of positions in your job	0	2	4	6
Cannot take breaks to rest during work	0	2	4	6
Is able to finish the tasks assigned to you in your job	0	2	4	6
Has shift/night work (evaluate monthly shift)	0	2	4	6
Labor conditions	Workload is inadequate (excessive, irregular, not adapted to your capacities…)	0	2	4
Environmental conditions of your work (temperature, humidity…) worsen your clinical condition	0	2	4	6
---	---	---	---	---
Does not have support elements in your tasks (devices, instruments, machines…)	0	2	4	6
Performs work at height (>3 m)	0	2	4	6
Performs work in confined spaces (tunnel, drain, pit…)	0	2	4	6
Performs electrical work under tension	0	2	4	6
Has to drive in your job	0	2	4	6
Operates risky machines or tools	0	2	4	6
Handles dangerous chemical substances	0	2	4	6
Is exposed to biological contaminants	0	2	4	6
Performs tasks requiring high attention/concentration	0	2	4	6

(Total maximum score = 156)

Score in the case evaluated:

4.- SOCIAL ASPECTS-QUALITY OF LIFE-HAQ (max impairment 10%)

HAQ Score | Degree of limitation | Assigned Percentage 0 – 0.625 | No limitation/incapacity | 0%
0.75 – 1.25 | Mild limitation/incapacity | 4%
1.375 – 1.875 | Moderate limitation/incapacity | 6%

2 | Severe limitation/incapacity | 10%

Score obtained = | Assigned Percentage =

Impact on activities of daily life (max 10%)
HAQ DISABILITY QUESTIONNAIRE*

Areas | Score (0-3) | Corrector Coefficient* | Final Score 3 --- | --- | --- | ---

1. Dressing and grooming | | |
2. Getting up | | |
3. Eating | | |
4. Walking | | |
5. Hygiene | | |
6. Reach | | |
7. Grip | | |
8. Others | | |
   Correcting Questions 2 | | |
   Need for third-person help | Need for utensil help | |

*See Annex

2 If the score is 2 or 3 there is no corrector coefficient. If it is 0 or 1 and the correcting questions modify it, it is added. 3 The average of the 8 values of each of the areas is calculated. If any area has not been answered, the sum of the answered ones will be divided by the number of areas that have been answered.

Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239

Article Second.- The evaluation and qualification of invalidity that is not due to osteoarthritis of the hips, knees, and ankles, must be carried out based on the general provisions contained in the Manual for Evaluation and Qualification of Invalidity (MECGI).

Article Third.- Repeal any provision that contradicts the provisions contained in Article First of this resolution.

Article Fourth.- Approve Annex No. 1, which forms part of the provisions approved by Article First, and which is published on the institutional Portal (www.sbs.gob.pe), in accordance with what is established in Supreme Decree No. 001-2009-JUS.

FINAL COMPLEMENTARY PROVISION

Sole.- This resolution enters into force as of December 18, 2017.

Register, communicate, and publish,

SOCORRO HEYSEN ZEGARRA
Superintendent of Banks, Insurance, and Private Pension Fund Administrators