Resolution SBS No. 2321-2017: Incorporates Section 3.9 into Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI)

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239 Lima, June 7, 2017

Resolution S.B.S.
No. 2321-2017

The Superintendent of Banks, Insurance and Private Pension Fund Administrators

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Single Text of the Law on the Private System of Administration of Pension Funds was approved;

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

That, additionally, in accordance with the Third Final and Transitional 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 of 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 it is responsible for the review of 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 Letter No. 10543-2017-SBS, requested the CTM to review a proposal for the modification of the Rheumatology Chapter, specifically regarding the rheumatoid arthritis 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 the matter;

That, in this regard, the CTM, as part of the tasks entrusted by the Superintendence, has carried out the technical review of the proposed modification presented, validating the corresponding normative modification proposal;

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239 Having obtained 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 Insurance System and Organic Law of the Superintendence of Banking and Insurance, Law No. 26702 and its amendments, subsection d) of Article 57 of the Single Text of the Law on the Private System of Administration of Pension Funds, approved by Supreme Decree No. 054-97-EF and based on 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 3.9 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:

3.9 EVALUATION OF IMPAIRMENT DUE TO RHEUMATOID ARTHRITIS

A. PERSONAL ASPECTS

PERSONAL ASPECTS (max impairment 10%)

Factors to be valued (Prognostic factors) | Scales | Percentage of Invalidity | Mark what corresponds --- | --- | --- | --- Age | | | Less than or equal to 30 years | 0% | Greater than or equal to 31 and less than 50 years | 1% | Greater than or equal to 50 years | 2% | Education Level | | | Primary/elementary studies | 2% | Secondary studies | 1% | Higher studies | 0% | Economic Situation | | | Poor | 2% | Medium | 1% | Good | 0% | Support from the environment (family or other type) | | | No support | 2% | Partial support | 1% | Complete/good support | 0% | Labor Situation: Unemployment, or if working: time off work in the last year 1 | | | Unemployed | 1% | No time off | 0% | Less than 3 months | 0.5% | Greater than or equal to 3 and less than or equal to 5 months | 1% | Greater than or equal to 6 months | 2% |

Global percentage of impairment in personal aspects =

1 Work leave: Temporary incapacity subject to EsSalud subsidies must be understood as such.

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

B. CLINICAL-THERAPEUTIC ASPECTS

B.1 CLINICAL-THERAPEUTIC ASPECTS (max impairment 74%)

PAIN INTENSITY

Scales	Percentage
Minimal	1%
Mild	2%
Moderate	3%
Marked	5%

Percentage of impairment due to pain intensity in the case valued:

PAIN FREQUENCY

Scales	Percentage
Intermittent	1%
Sporadic	2%
Frequent	3%
Constant	5%

Percentage of impairment due to pain frequency in the case valued:

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B.2 MOBILITY LIMITATION

Only the affected joint or area will be valued.

B.2.1 CERVICAL

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0 – 10% | 11 – 40% | 41 – 70% | 71- 100%
Flexion | 65º | 0 Points | 1 point | 2 points | 3 points Extension | 65º | 0 Points | 1 point | 2 points | 3 points Lateralization | 45º | 0 Points | 1 point | 2 points | 3 points Rotation | 75º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 12 points)

Percentage of impairment due to the cervical spine:
(max 2% disability)

0-2 points: 0% | 3-5 points: 1% | 6-8 points: 1.5% | 9-12 points: 2%

B.2.2 LUMBAR

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0 – 10% | 11 – 40% | 41 – 70% | 71- 100%
Flexion | 60º | 0 Points | 1 point | 2 points | 3 points Extension | 35°- 40º | 0 Points | 1 point | 2 points | 3 points Lateralization | 30º (for each side) | 0 Points | 1 point | 2 points | 3 points Rotation | 20º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 12 points)

Percentage of impairment due to the lumbar spine:
(max 2% disability)

0-2 points: 0% | 3-5 points: 1% | 6-8 points: 1.5% | 9-12 points: 2%

B.2.3 SHOULDER

Movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Flexion | 180º | 0 Points | 4 points | 8 points | 12 points Extension | 60º | 0 Points | 1 point | 2 points | 3 points Abduction | 180º | 0 Points | 2 points | 4 points | 6 points Adduction | 45º | 0 Points | 1 point | 2 points | 3 points Internal Rotation | 80º | 0 Points | 1 point | 2 points | 3 points External Rotation | 90º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 30 points)

Percentage of impairment caused by shoulder:
(max 1.5% each shoulder)

0-7 points: 0% | 8-14 points: 0.5% | 15-22 points: 1% | 23-30 points: 1.5%

Value each shoulder separately. If both are affected, sum the percentages of disability.

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

B.2.4 ELBOW

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Flexion | 135° - 150º | 0 Points | 1.5 point | 3 points | 4.5 points Extension | 0 - 5º | 0 Points | 1.5 point | 3 points | 4.5 points Pronation | 90º | 0 Points | 1 point | 2 points | 3 points Supination | 90º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 15 points)

Percentage of impairment caused by elbow: (max 1.5% each elbow)

0-3 points: 0% | 4-7 points: 0.5% | 8-11 points: 1% | 12-15 points: 1.5%

Value each elbow separately. If both are affected, sum the percentages of disability.

B.2.5 WRIST

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Dorsal Flexion | 70º | 0 Points | 2 point | 4.5 points | 7 points Palmar Flexion | 75º | 0 Points | 2 point | 4.5 points | 7 points Ulnar Inclination | 35º | 0 Points | 1 point | 2 points | 3 points Radial Inclination | 20º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 20 points)

Percentage of impairment caused by wrist: (max 1.5% each wrist)

0-5 points: 0% | 6-10 points: 0.50% | 11-15 points: 1% | 16-20 points: 1.5%

Value each wrist separately. If both are affected, sum the percentages of disability.

B.2.6 HAND

Value each hand separately. If both are affected, sum the percentages of disability at the end.

Movement | FINGERS 2nd to 3rd | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
IFD Flexion | 90º | 0 Points | 2 points | 3.5 points | 6.5 points IFP Flexion | 70º | 0 Points | 3 points | 6.5 points | 10.5 points MCF Flexion | 90º | 0 Points | 4 points | 8 points | 13 points

Total score =
(from 0 to 30 points)

Percentage of impairment caused by finger: (max 0.75% each finger)

0-10 points: 0.25% | 11-20 points: 0.50% | 21-30 points: 0.75%

Movement | FINGERS 4th to 5th | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
IFD Flexion | 90º | 0 Points | 2 points | 3.5 points | 6.5 points IFP Flexion | 70º | 0 Points | 3 points | 6.5 points | 10.5 points MCF Flexion | 90º | 0 Points | 4 points | 8 points | 13 points

Total score =
(from 0 to 30 points)

Percentage of impairment caused by finger: (max 0.35% each finger)

0-10 points: 0.1% | 11-20 points: 0.2% | 21-30 points: 0.35%

Movement	THUMB	Impairment
0-10%	11-40%	41-70%
IF Flexion	80 º	0 Points

Total score = (from 0 to 30 points)

Percentage of impairment caused by thumb:
(max 1.4% each thumb)

0-10 points: 0.4 % | 11-20 points: 0.9 % | 21 to 30 points: 1.4 %

Total percentage of impairment caused by the hand (max 2.5% each hand)

Total percentage of impairment caused by both hands:
(max 5%)

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

B.2.7 HIP

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Flexion | 0 º - 20º | 0 Points | 1 point | 2 points | 3 points Extension | 45 º - 50º | 0 Points | 1 point | 2 points | 3 points Abduction | 40 º - 45º | 0 Points | 1 point | 2 points | 3 points Adduction | 45º | 0 Points | 1 point | 2 points | 3 points Internal Rotation | 40º - 45º | 0 Points | 1 point | 2 points | 3 points External Rotation | 0 º - 20º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 18 points)

Percentage of impairment caused by hip: (max 0.5 % each hip)

0-4 points: 0% | 5-8 points: 0.15% | 9-13 points: 0.25% | 14-18 points: 0.5%

Value each hip separately. If both are affected, sum the percentages of disability.

B.2.8 KNEE

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Flexion | 0º | 0 Points | 1 point | 2 points | 3 points Extension | 130º - 140º | 0 Points | 1 point | 2 points | 3 points

Total score =
(from 0 to 6 points)

Percentage of impairment caused by knee:
(max 0.75% each knee)

0 points: 0% | 1-2 points: 0.25% | 3-4 points: 0.5 % | 5-6 points: 0.75 %

Value each knee separately. If both are affected, sum the percentages of disability.

B.2.9 ANKLE/FOOT

Type of movement | Degrees of normal mobility | Impairment --- | --- | ---
| 0-10% | 11-40% | 41-70% | 71-100%
Plantar Flexion | 45º | 0 Points | 1 point | 2 points | 3 points Dorsiflexion | 20º | 0 Points | 1 point | 2 points | 3 points Eversion | 25º | 0 Points | 1 point | 2 points | 3 points Inversion | 35º | 0 Points | 1 point | 2 points | 3 points

Total score = (from 0 to 12 points)

Percentage of impairment caused by ankle/foot (max 1% each ankle)

0-2 points: 0% | 3-5 points: 0.25% | 6-8 points: 0.5% | 9-12 points: 1%

Value each ankle/foot separately. If both are affected, sum the percentages of disability.

SUM OF IMPAIRMENT PERCENTAGES (maximum 24%) = (cervical + lumbar + shoulders + elbows + wrists + hands + hips + knees + ankles/feet)

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B.2.10 DISEASE ACTIVITY - DAS 28

Score	Range	Percentage
< 3.2	Low activity	6 %
≥ 3.2 < 5.1	Moderate activity	13 %
≥ 5.1	High activity	20 %

Score = Assigned Percentage =
*Activity Range = from 0 to 9.4.
Low activity < 3.2; Moderate activity ≥ 3.2 to < 5.1; High activity ≥ 5.

B.2.11 MUSCLE BALANCE-STRENGTH

Daniels Scale	Score	Percentage
Absence of contraction	0	5%
Contraction is seen or palpated, but there is no movement	1	4% Movement occurs in the absence of gravity

Percentage of impairment in the case valued:

B.2.12 THERAPEUTIC ASPECTS

Assessment of response to administered treatment (max 4%)

Variable	Score	Percentage
Good: pain suppression and improvement in functionality	Mild	1% Regular: partial pain relief and partial improvement in functionality

Assessment of adverse effects of treatments (max 2%)

Gastric Effects | Mild ≤ 1 adverse effect | 0.5% Immunosuppressive Effects | Moderate = 2 or 3 effects | 1% Others: HTA, increased transaminases……etc. | Severe > 3 effects | 2%

Treatment response score = Adverse effects score = Global Score = Percentage of impairment caused by therapeutic aspects =

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

B.2.13 ASSOCIATED COMORBIDITIES

Diseases | Comorbidities | Score | Percentage --- | --- | --- | --- Ophthalmological | Yes No | | Renal | Yes No | Mild = 1 of the associated pathologies | 3% Pulmonary | Yes No | | Dermatological | Yes No | Moderate = 2 or 3 of the associated pathologies | 6% Cardiological | Yes No | | Neurological | Yes No | | Hematological | Yes No | Severe > 3 associated pathologies | 9% Vasculitis | Yes No | | Systemic: fatigue, weakness, infections, amyloidosis, etc. | Yes No | |

Score of the case valued = Percentage of impairment in the case valued:

Global percentage of impairment caused by clinical-therapeutic aspects =

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C. LABOR ASPECTS

C.2 CHECK LIST-LABOR SITUATION

Tasks	Score (between 0 - 6)
Not applicable	1/3 shift
Manual handling of loads MMC ≤ 5 kg	0

C.1 LABOR ASPECTS (max 5%)

Score	Percentage	Disability Degree
0 - 54	1%	Mild
55 - 108	3%	Moderate
109 - 162	5%	Severe

Final score = Percentage of impairment = Degree =

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

Labor conditions
Your work's environmental conditions (temperature, humidity…) worsen your clinical condition | 0 | 2 | 4 | 6 You do 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 work | 0 | 2 | 4 | 6 Handles risky machines or tools | 0 | 2 | 4 | 6 Handles hazardous 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 = 6 x 27 = 162)

Score in the case valued:

D. SOCIAL ASPECTS-QUALITY OF LIFE

D.1 SOCIAL ASPECTS-QUALITY OF LIFE-HAQ (max 10%)

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

2 | Severe limitation/disability | 10%

Score obtained = Percentage of impairment in the case valued =

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

D.2 Impact on activities of daily life (max 10%) – HAQ DISABILITY QUESTIONNAIRE*

Areas | Score (0-3) | Corrective Coefficient* | Final Score 2 --- | --- | --- | ---

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

*See Annex No.1"

Article Second.- Repeal any provision that contradicts the provisions contained in the first article of this resolution.

Article Third.- Annex No.1 and Annex No.2 which form part of the provisions approved by Article First, are published on the Institutional Portal (www.sbs.gob.pe), in accordance with what is established in Supreme Decree No. 001-2009-JUS.

Article Fourth.- This resolution enters into force on June 19, 2017.

Register, communicate and publish

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

2 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. 3 If the score is 2 or 3 there is no corrective coefficient. If it is 0 or 1 and the correcting questions modify it, it is added.