Impairment Ratings in Virginia Workers’ Comp: What a Rating Is Worth

Nothing in this article should be taken as legal advice. Every case is different.

There is no reliable average impairment rating for a knee replacement, an ankle fracture, a rotator cuff repair, or back surgery in Virginia. A rating is a doctor’s percentage of permanent loss of use of an arm, leg, hand, foot, or other body part listed in Virginia law, and each percent is worth a set number of weeks of pay. A 10% rating to the leg, for example, pays 17.5 weeks at your weekly compensation rate. What your rating will be depends on your injury, how it healed, which body part it is rated to, and which doctor the Commission believes.

What Is an Impairment Rating in Virginia Workers’ Comp?

An impairment rating is a percentage that measures how much permanent use you have lost in a body part listed on Virginia’s schedule. Virginia calls the benefit permanent partial disability, or PPD. The schedule gives each body part a number of weeks, and you are paid a share of those weeks equal to your rating (Va. Code § 65.2-503). The rating has to be a number. The Court of Appeals has said a numerical rating is required so the benefit can be paid in proportion to the loss (Loudoun County v. Richardson, Va. Ct. App. 2019).

PPD pays for the lost use of the body part, not for lost wages. Wage loss is paid under a different part of the law (Va. Code § 65.2-500 and § 65.2-502), and the rating is based on loss of use of the body part (§ 65.2-503(D)). So a rating can be owed even if you went back to work.

How Many Weeks Does Virginia Pay for Each Body Part?

Virginia’s schedule sets the number of weeks for the total loss, or total loss of use, of each body part (Va. Code § 65.2-503(B)). A partial loss of use is paid in proportion (§ 65.2-503(D)).

The back, neck, shoulder, hip, and knee are not on that list. That doesn’t mean injuries to them can’t be rated. It means the rating has to be stated as a loss of use of a body part that is on the list, such as the arm or the leg. More on that below.

How Much Is a 10% Impairment Rating Worth in Virginia?

Multiply your rating by the weeks for that body part, then multiply by your weekly compensation rate. Your compensation rate is generally two-thirds of your average weekly wage over the 52 weeks before the accident, up to a weekly maximum. For injuries on or after July 1, 2026, the maximum is $1,507.01 a week (Commission rate chart; formula in Va. Code § 65.2-500). Rating checks are subject to the same maximum and minimum (§ 65.2-503(E)).

Example only. Say your compensation rate is $800 a week. These numbers are for illustration and are not a prediction for any case:

The same percentage is worth very different amounts depending on the body part. A 10% rating to the leg pays 40% more than a 10% rating to the foot. That is why the question of which body part the rating is assigned to is often fought as hard as the number itself.

When Do You Get an Impairment Rating?

A doctor rates permanent loss of use only after you reach maximum medical improvement (MMI). The Supreme Court of Virginia has said that for a PPD award, it must appear both that the loss is permanent and that the injury has reached maximum medical improvement (County of Spotsylvania v. Hart, 218 Va. 565 (1977), quoted in Loudoun County v. Richardson). MMI means no reasonable expectation of further functional improvement from treatment, even if you still hurt (Gunst Corp. v. Childress, 29 Va. App. 701 (1999), same opinion). Here’s more on what maximum medical improvement means in Virginia.

Usually your treating doctor gives the rating. Many treating doctors don’t do it on their own. Someone has to ask, and the request has to be specific: a percentage, the body part it applies to, and a statement that you are at MMI.

When Is the Rating Paid?

Rating checks are paid after your checks for temporary total disability end (Va. Code § 65.2-503(E)(1)). They can’t run at the same time as full wage checks. They can be paid at the same time as partial wage checks for light duty at lower pay, but each combined week counts as two weeks against the 500-week limit (§ 65.2-503(E)(2)).

The law says compensation for a permanent loss “shall be awarded” (§ 65.2-503(A)). That doesn’t mean the insurance company will agree to your rating without a fight.

Which Edition of the AMA Guides Does Virginia Use?

Many doctors rate using the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and different doctors use different editions. In one case, the worker’s doctor used the Fifth Edition and the insurance company’s reviewer suggested the Sixth (Blakey). The Commission has said it is not bound by the AMA Guides, and in an unpublished opinion the Court of Appeals agreed that neither a doctor nor the Commission is limited to specific guides or tables when deciding a rating (same opinion). The Commission’s stated policy lets it consider the nature of the disability, the effect of pain on use, and other relevant facts in deciding the loss of use (Rivera v. Ford Motor Co., VWC File No. 216-39-16 (2006), quoted in Blakey).

Expect the method to be attacked anyway. In Blakey, the Commission discounted a 72% arm rating because the doctor added extra percentage for pain, weakness, and loss of function on top of a base rating, and it awarded 43% instead. In an unpublished 2-1 decision, the Court of Appeals reversed, holding that the Commission was wrong to discount the rating for those reasons, and sent the case back. It took an appeal to get there. How a doctor reaches a number, and how well the doctor explains it, is often where a rating is won or lost.

What If the Insurance Company’s Doctor Gives a Lower Rating?

The Commission decides the rating based on all the evidence, and it gives great weight to the treating doctor’s opinion, but it doesn’t have to accept it. The Court of Appeals has said the Commission “gives great weight to the treating physician’s opinion” when it decides PPD (United Airlines, Inc. v. Sabol, 47 Va. App. 495 (2006), quoted in Loudoun County v. Richardson, Va. Ct. App. 2019). It has also said that opinion is “not conclusive, especially when the opinion is not accompanied by any reasoning or explanation” (Thompson v. Brenco, Inc., 38 Va. App. 617 (2002), quoted in Blakey, unpublished).

In practice, a rating fight usually looks like this:

1. Your treating doctor gives a rating at MMI.
2. The insurance company sends you to its own doctor for an independent medical exam, or has a doctor review the records. That doctor gives a lower number, or rates a smaller body part, such as the foot instead of the leg.
3. The Commission compares them: who examined you, who treated you over time, what each doctor measured, and whether each explained how the number was reached.

In Blakey, the Court of Appeals threw out a rating from a doctor who never examined the worker, never reviewed the medical records, and didn’t give an actual rating at all. Here’s what happens after a workers’ comp IME in Virginia.

What Changes an Impairment Rating?

Since there is no average, it helps to know what actually moves the number:

• What the doctor measures. Lost motion, weakness, instability, nerve damage, and a limp can each count. A finding that isn’t in the records won’t be in the rating.
• Which body part the rating is assigned to. Leg or foot, arm or hand. The weeks differ a lot.
• The method. Different editions of the AMA Guides, or different chapters within one, can produce different numbers for the same injury.
• Pain, to the extent it limits use. Pain alone isn’t paid, but pain that limits how the arm or leg works can be considered (Blakey).
• Timing. A rating given before MMI isn’t enough for an award.
• Joint replacement. If a joint replacement improves how your leg works, Virginia measures the loss of use as it was before the replacement, not after (Loudoun County v. Richardson, Va. Ct. App. 2019, aff’d, Supreme Court of Virginia, 2020). In that case, the Commission accepted a 74% rating to the leg from before a hip replacement instead of an 11% rating from after it.
• Which doctor the Commission believes, when there is more than one rating.

Ratings by Body Part

Knee

A knee injury is rated as loss of use of the leg, at 175 weeks, or 1.75 weeks of pay for each 1% (§ 65.2-503). The knee itself isn’t on the schedule. The rating has to be to the leg, not just the knee. If a knee replacement improves how your leg works, the loss of use is measured as it was before the replacement, not after (Richardson). There is no average rating for a total knee replacement. See our guide to knee injury compensation in Virginia.

Ankle and Foot

An ankle injury is usually rated to the leg (175 weeks), and sometimes to the foot (125 weeks), depending on the injury and the medical evidence. A 20% rating is 35 weeks of pay as a leg rating but 25 weeks as a foot rating. Common reasons for an ankle rating include lost motion, instability, a fusion, and arthritis after a fracture. See our guides to ankle injuries at work and Achilles tendon ruptures.

Shoulder and Arm

A shoulder injury is rated as loss of use of the arm, at 200 weeks, or 2 weeks of pay for each 1%. The shoulder isn’t on the schedule, so a rotator cuff tear, a labral tear, or a shoulder replacement is paid through the arm. In one unpublished case, the Court of Appeals upheld a 34% arm rating for a shoulder injury because the doctor tied the lost shoulder motion and strength to the use of the arm (Northern Virginia Training Center v. Adomako, Va. Ct. App. 2014, unpublished). The doctor has to connect the shoulder findings to how the arm works. The courts’ reasoning in Richardson covers prosthetic devices generally, so a shoulder replacement that improves how the arm works is likely measured as it was before the replacement, though that case involved a hip. See common causes of shoulder injuries at work.

Hip

A hip injury is paid through a rating to the leg. The Court of Appeals upheld a leg rating for a hip injury because the injury showed up as a loss of use of the leg (Richardson). The doctor’s rating has to be to the leg, not just the hip. That case is also the source of the rule that a hip replacement is measured as it was before the replacement. See what to do if you hurt your hip at work.

Back and Neck

The back and neck are not on Virginia’s schedule, so a spine injury pays PPD only through a rated loss of use of a body part that is on the schedule, usually an arm or a leg. The Court of Appeals has allowed PPD for a back injury that showed up as a loss of use of the leg, reading the law to cover any work injury “which manifests itself in a scheduled member” (Washington Metro. Area Transit Auth. v. Rogers, 17 Va. App. 657 (1994), quoted in Richardson). So a herniated disc that causes numbness, weakness, or nerve damage in a leg can lead to a leg rating. A rating “to the whole person” or “to the spine” isn’t enough by itself. Back surgery doesn’t come with an average rating. See herniated disc injuries at work.

Hand

A hand injury may be rated to the hand (150 weeks) or to the arm (200 weeks), depending on the medical evidence of which body part has lost use. Thumbs and fingers have their own weeks on the schedule. Losing more than one phalanx (bone segment) of a finger or thumb counts as losing the whole finger or thumb, and pay for more than one finger can’t exceed pay for the hand (§ 65.2-503(B)).

What If You Lose the Use of Two Body Parts?

Losing both hands, both arms, both feet, both legs, both eyes, or any two of them is treated as permanent total disability (Va. Code § 65.2-503(C)). The loss can come from the same accident or from a compensable consequence of the original injury, such as a second injury caused by the first. Permanent loss of use counts the same as loss of the body part (§ 65.2-503(D)). Total paralysis and a brain injury severe enough to make you permanently unemployable also qualify. Benefits are paid at your compensation rate for the rest of your life, without a limit on the total amount (Va. Code § 65.2-500). These cases are rare and hard-fought.

How Long Do You Have to Claim a Rating?

A claim for a rating, or a higher rating, generally must be filed within 36 months from the last day for which compensation was paid under an award (Va. Code § 65.2-708(A)). If no compensation was ever paid, the Commission can award a rating within 36 months from the date of the accident (§ 65.2-708(B)). A rating can change, for example after a later surgery, so these deadlines matter even after a first rating is paid.

None of that helps if the original claim was never filed. The claim must generally be filed with the Virginia Workers’ Compensation Commission within two years of the accident, although exceptions apply (Va. Code § 65.2-601). File it even if the insurance company accepts your injury and starts paying.

Impairment Rating Questions

What is the average impairment rating for a total knee replacement?

There isn’t one in Virginia. The rating is to the leg, and if the replacement improves how the leg works, the loss of use is measured as it was before the replacement, not after (Richardson). Each 1% of the leg pays 1.75 weeks of compensation.

What is the average impairment rating for back surgery?

There isn’t one. The back isn’t on Virginia’s schedule. A back injury pays a rating only if it causes a permanent loss of use of a body part on the schedule, usually an arm or a leg, and the rating is to that body part.

Can I get a rating if I went back to my old job?

Yes, it’s possible. PPD pays for lost use of the body part, not lost wages. You still need to be at MMI and have a percentage rating to a body part on the schedule.

Talk to Pathfinder Injury Law About Your Rating

Pathfinder Injury Law handles only Virginia workers’ compensation claims. Call 804-505-0633 or use our online contact form.