359/2009 Sb.



The DECREE



of 9 June. October 2009,



laying down the percentage rates of decline of incapacitation and

reports on disability and modifies the assessment work

the ability for the purposes of the disability



(Decree on the assessment of disability)



The Ministry of labour and Social Affairs provides under section 108, paragraph. 1 (a).

(b)) of the Act No 155/1995 Coll., on pension insurance, as amended by Act No.

306/2008 Coll. and under section 127, paragraph. 2 Act No. 582/1991 Coll., on the

the Organization and implementation of social security, as amended by Act No.

479/2008 Coll.:



§ 1



The percentage rate of decline in employment skills



(1) Percentage rate decrease working capacity according to the types of health

disability are listed in the annex to this Decree.



(2) if the disability that is the cause of the long-term

adverse health condition, is not listed in the annex, shall be determined

the percentage rate of decline in the capacity to work under such a health

disability referred to in the annex, which is the functional impact of the most

comparable.



The assessment of the decline in work skills



§ 2



(1) for the determination of the percentage decline in the rate of work is necessary to

determine the disability that cause long-term adverse

State of health of the insured person, and their influence on the decline of the working

the ability of the policyholder.



(2) the disability for which occurs continuously to the deterioration and

improving the State of health shall be the percentage drop rate

work skills to match the average range of functional

disability and the corresponding decline in the capacity to work.



(3) if the cause of the adverse long-term health insurance policy holders

multiple disability, the individual values of the percentage rates of decline

work set for the individual with a disability

not cumulative; in this case, specifies that disability is

crucial cause of long-term adverse health status, and

the percentage rate of decline in the capacity to work shall be determined in accordance with this

disability in the light of the seriousness of the impact the other

disability on the decline in the insured person's working capacity. For

crucial cause of long-term adverse health status

considers such a disability, which has the most significant impact on

the decline in the insured person's working capacity.



§ 3



(1) in the event that the cause of long-term adverse health

the insured person is more health and disability as a result of the action of these

disability is the decline in the insured person's working capacity is greater,

than the upper limit of the rate of decrease in the working capabilities of the intended

According to the decisive causes of long-term adverse health

This upper limit can be increased by up to 10 percentage points.



(2) in the event that the long-term negative health status of the insured person has

such an impact on his ability to use the formal education, experience, and

knowledge, the ability to resume a previous employment or

on the ability of retraining, the decline in the insured person's working ability is

greater than the upper limit of the rate of decline in the capacity to work for

the causes, or the decisive causes of long-term adverse

the health status of this upper limit can be increased by up to 10 percentage

points.



(3) the increase in the upper limit of the rate of decline in the capacity to work according to the

paragraphs 1 and 2 shall not in the aggregate exceed 10 percentage points.



§ 4



(1) in the event that the insured's State of health does not have an adverse

the influence of, or has only marginal influence on the ability of the policyholder

benefit from formal education, experience and knowledge and on the ability to

to continue the previous gainful activity and as a result, the decline in

the insured person's working capacity less than the lower bounds of the extent

decline in the capacity to work for the causes, or the decisive cause of

long term adverse health condition, this lower limit

reduced by up to 10 percentage points.



(2) in the event that the long-term negative health status of the insured person is

stabilized or beneficiary is adapted to their disability and

as a result, the decline in the insured person's working capacity less than

corresponds to the lower border of the extent of the downturn to work for causes,

where appropriate, the decisive causes of long-term adverse health

the State can be reduced to the lower border of about 10 percentage points.



(3) reduce the lower limit of the rate of decline in the capacity to work according to the

paragraphs 1 and 2 shall not in the aggregate exceed 10 percentage points.



§ 5



The method of assessment and the use of preserved working ability for disability

the first and second degree



In the case of a decrease in the capacity to work a minimum of 35% and most of the 69%

to determine whether the beneficiary is able to



and exercise after the birth of invalidity) of first or second degree

gainful activity just



1. with a significantly smaller demands on physical, sensory or mental

capabilities,



2. with a significantly smaller demands on the qualifications,



3. in a substantially smaller range and intensity; a substantially smaller claims,

the extent or the intensity of the downturn in the event of incapacitation

at least 35%, and most of the 49% considered the reduction of at least one-third, and in the

If the decline in working capacity by at least 50% and most of the 69%

reduce by at least half,



(b)) re-qualification on another kind of activity, if it is not able to

take advantage of formal education, experience, and knowledge of, or continue

previous employment.



§ 6



Extraordinary conditions



Quite extraordinary conditions, under which the beneficiary is incapable of earning

activities in the case of decrease in the capacity to work at least 70%

means a profound modification of working conditions, the acquisition and use of

special equipment of the workplace, special modifications to existing machines,

instruments, the use of special tools or daily

aid or assistance in the workplace in the form of předčitatelských services

interpretation services or employment assistance.



section 7 of the



Reports on disability



The opinion of invalidity has



and the designation of the authority of the social security), which assess the health

the status and working ability of the policyholder, the name, or names, surname

and the title of the competent doctor and his signature and the stamp of the authority,



(b) the name, if applicable), name and surname of the insured person, the social security number

the insured person, or if it is not allocated, the date of birth of the insured person,

the address of the place of residence of the insured person, or, in the case of foreigners,

the address of the place of stay on the territory of the Czech Republic and does not have it, the address of the

resident abroad,



(c) the purpose of the assessment and the date) health assessment and working

the ability of the policyholder,



(d) the enumeration of the relevant supporting documents) about the health of insured persons, of which

social security institution based health assessment and

the working ability of the policyholder,



e) facts, to which the social security authority came when

assessment of the health status and work ability of the policyholder,



(f)) the result of the health assessment and the extent of the decline in work

the capabilities of the determination of the



1. whether it is a long-term negative health status,



2. the rate of decline in the capacity to work,



3. the degree of invalidity,



4. the date of disability, the date changes to the degree of disability or the date of demise

disability,



5. the ability to use the preserved work ability under section 5 for

insured persons whose working capacity decrease rate of not less than 35% and

most 69%,



6. If the beneficiary is in the case of a decrease in the capacity to work at least 70

% capable of gainful employment for the whole of the emergency conditions,



7. the period of validity of an opinion for the purpose of proving that a natural person who

recognised invalidity, is a person with a disability under the Act

on employment of ^ 1), if such person is not the beneficiary of invalidity

retired ^ 2)



(g)) justification the outcome of the assessment of the health status and the extent of the decline in

working abilities.



§ 8



Cancellation provisions



In the Decree No. 284/1995 Coll., implementing the law on pension

insurance, as amended by Decree No. 157/1997 Coll., Decree No. 302/1997 Coll.,

Decree No. 40/2000 Coll. and Decree No. 328/2007 Coll., section 5 to 8 and

Annex No. 2 to 4 shall be deleted.



§ 9



The effectiveness of the



This Decree shall take effect on 1 January 2005. January 1, 2010.



Minister:



JUDr. Šimerka in r.



Annex



THE PERCENTAGE RATE OF DECLINE IN EMPLOYMENT SKILLS



Chapter I-



INFECTION

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

the decisive outcome of the interaction between infectious agents, his

quantity, aggression, defenses of the organism and therapeutic

process. In doing so, it is necessary to take into account that some infectious

agents can perzistovat in the body under the control of the immune

system, or with possible reaktivacemi, residues may remain

After the acute disease, the transition can occur in chronic

stage, one species (type) of the micro-organism may affect different

institutions or systems. The rate of decline in the capacity to work with

provides a functional disability of the contested authority or

the system, according to the activities of the process and the impact on overall performance.
In assessing the extent of the downturn to work with infectious

disability should reference period applicable for the assessment of

take typically one year.

Itself having suffered loss or infection, no functional disorders

the nature of long-term adverse health, does not

the decline in work skills. Detection of nosičství, even if it is

the reason for the exclusion of certain work activities, does not

the decline in work skills.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Chronic viral hepatitis-B, C, D

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the functional capabilities

the capacity of the liver by biochemical and

histological activity (inflammatory and

fibrotické), metabolic disorders,

encephalopathy, mimojaterní manifestations and

the result of the treatment. In chronic viral

hepatitis B is evaluated serological card

HBsAg, HBeAg and their respective antibodies

quantitative evaluation of viremie and the response

on virus treatment, liver biopsy and

determination of gradingu and staging. In chronic

viral hepatitis (C) shall be evaluated serological

demonstration of anti-HCV, molecular genetic

card of HCV RNA, liver biopsy and

determination of gradingu and staging. For

determination of the rate of decline in employment skills

It is critical, the impact of disability

the liver and the mimojaterních expressions for the total

the performance and the ability to perform daily

activity.

Disability after hepatitis and, if working

disorders have long-term character

adverse health status,

be treated comparably.

---------------------------------------------------------------

1A minimum functional disability, 10-15

with a minimum of biochemical and histologickou

activity, the uncomplicated course or

stabilized conditions with low sérokonverzí

HBsAg, anti-HBs in States with low viral

bombs, in the phase of imunotolerantní,

with increased fatigability

---------------------------------------------------------------

1B light functional disability, 20-35

in the phase of imunoaktivní, with a slightly increased

biochemical and histologickou activity, with the

light, with a slight decrease of complications

overall performance under normal load

---------------------------------------------------------------

1 c moderate functional disability, 40-60

with enhanced biochemical and histologickou

activity, compensated cirrhosis, severe

mimojaterní speeches, where disorders are

the range of moderate disorders, with a medium

severe decrease in performance during normal

the load according to the extent of the disability

---------------------------------------------------------------

1 d hard working disability, 70-80

dekompenzovaná cirrhosis, severe mimojaterní

speeches, where disorders have a range of more than

half of the full scale of failure or

with the association with hepatocelulárním Carcinoma

or the final stages with the indications

to liver transplant

---------------------------------------------------------------

2 HIV infection/AIDS

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the ability of viral

charge and the number of CD4 + lymphocytes, the result

treatment, the presence of opportunistic infections,

the syndrome of decay, HIV encephalopathy,

Polyneuropathy, development of tumors and the impact

information on the overall

performance.

---------------------------------------------------------------

2A lightweight functional disability, 10-15

Stadium A1, A2, A3, asymptomatic

Stadium, persistent generalized

Lymphadenopathy

---------------------------------------------------------------

2B moderate functional disability, 25-40

stage B1, B2

---------------------------------------------------------------

2 c heavy functional disability, 50-60

Stadium B3, C1

---------------------------------------------------------------

2D functional disabilities particularly hard, 70-80

stage C2, C3, severe opportunistic infections,

decay syndrome, encephalopathy, development

tumors

---------------------------------------------------------------

3 Neuroinfekce

Encephalitida, herpetic

As chronic neuroinfekce may

manifest cytomegalovirová infection

Porcine enterovirus infection in persons

with agamaglobulinemií, measles, syphilis,

tuberculosis, brucellosis, kandidová and

aspergilová infection and more.

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the consequences

infection, and anatomical and functional,

in particular, disability of brain nerve paresis,

secondary epilepsy, disability of intellect,

cognitive impairment, behavioral disorders,

the consequences on kinematic mechanism of sensory

or other organs and the impact of the

the facts on overall performance and

ability to handle daily activities.

---------------------------------------------------------------

3A minimal functional disability, 10-15

increased unavitelnost

---------------------------------------------------------------

3B light functional disability, 20-35

light motor, sensory or

cognitive dysfunction

---------------------------------------------------------------

3 c moderate functional disability, 40-60

medium-heavy duty motor, sensory or

cognitive dysfunction, unstable

secondary epilepsy, according to extent and gravity

disability

---------------------------------------------------------------

3D hard functional disability, 70-80

heavy duty motor, sensory or

cognitive dysfunction

---------------------------------------------------------------

4 Lyme borreliosis

The medical aspect:

When determining the rate of decline in employment

the ability to assess the severity of the need

the affection of the nervous system, skin, joints and

the heart, the result of an immunological examination

ELISA and of immunoblot (W-B), whether it is a

the transition to a prolonged course of infection, whether and

How often to relapsům or whether they are

already changes permanent.

---------------------------------------------------------------

4A minimum functional disability, 10-15

increased unavitelnost, arthralgia

---------------------------------------------------------------

4B light functional disability, 20-35

acrodermatitis chronica skin form with

chronic atrophicans, moderately active

arthritis, a light decline in cardiac performance

under normal load

---------------------------------------------------------------

4 c moderate functional disability, 40-60

where the failure to have a range of moderate

disorders, mild cognitive decline

performance under normal load

---------------------------------------------------------------

4 d hard working disability, 70-80

chronic late stadium with chronic

encephalitis, subacute encephalopathy and

severe impairment of cognitive function, and

intellect, the joint form with heavy

disabilities of knee joints and

the mobility of the

---------------------------------------------------------------

5 Toxoplasmosis

The medical aspect:

When determining the rate of decline in employment

skills in clinical

evaluate what form of manifestation,

toxoplasmosis is acquired (at the

humans who are immunocompetent, obtained

toxoplasmosis in immune deficiency of the person,

eye form, congenital form or

toxoplasmosis in graviditě), to distinguish the

chronic latent infection from acute

infection and chronic active infection and

to assess the functional disabilities affected

authorities and its impact on the overall performance.

---------------------------------------------------------------

5A light functional disability, 10-20

some authorities isolated the disability

with the light function disorder

---------------------------------------------------------------

5B medium hard functional disability, 30-60

in particular, relates to the nod/scid

to different organs, with symptoms of encephalitis,

Pneumonitis, myocarditis,

chorioretinitidy

---------------------------------------------------------------

5 c heavy functional disability, 70-80

hard to reduce mental and physical

performance and vision

---------------------------------------------------------------

6 Roses (erysipelas)

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the consequences

an acute or recurrent

the infection if they are fixed or

the lasting nature of the local and the overall

status (an inflammatory activity) and the impact on

the overall performance.

If it is the result of suffering a streptococcal

infection of the Lymphoedema limb, health

disability and the labour intensity

capacity shall be determined according to a comparably

items 9, section B, chapter IX.

---------------------------------------------------------------

7 Extrapulmonary mykobakteriózy

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate what authority
or the system is affected by (the central nervous

system, bones, joints, spine, pleura,

the pericardium, liver, digestive tract, including the

urogenital tract, peritonitis) and what

the functional scope of the disability. While it is

need to take into account the length of therapy

extrapulmonální tuberculosis, its possible

the consequences, whether it is sensitive or

resistant form, whether it is a disability

patients who are immunocompromised persons.

---------------------------------------------------------------

7A Lymphadenopathy or skin Forms 10

---------------------------------------------------------------

7B light functional disability, 20-30

Genitourinary form,

straightforward progress of disability

gastroinstestinálního tract

Granulomatous hepatitis,

otitida,

infections of the eye (chorioidální tuberkulomy,

Uveitis, otitida) with regard to disability

Vizu

---------------------------------------------------------------

7 c medium-severe functional disability, 50

late nasedající on intestinal obstruction

Granulomatous inflammation of the bowel or peritonea

---------------------------------------------------------------

7 d hard functional disability, 70-80

acute Miliary Tuberculosis,

cryptic Miliary Tuberculosis,

the generalized form of late,

nonreactive tuberculosis with plenty of

micro-organisms and with little tissue responses

(septic or typhoidal form),

tuberculous meningitis

skeletal form. spondylodiscitidy

(Pott's disease),

Paraplegia, Pottovy

Pericarditis,

laryngeal tuberculosis during treatment,

Multiresistant forms or conditions on

long-term therapy (if it will take longer than

one year)

---------------------------------------------------------------

8 of infection cardiovascular

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the consequences

history of infections (endocarditis,

myocarditis, pericarditis,

mediastinitida) if they are fixed

or lasting nature, the impact on the function of the

the cardiovascular system, heart performance

and on the overall performance.

Disability and the rate of decline in the

capacity to work shall be

comparably, according to item 1 or 5,

section A, chapter IX.

---------------------------------------------------------------

9 Infectious motoric system

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the consequences

an infection if they are fixed

or lasting nature, the impact on the function of the

the locomotive and the support system and the overall

performance.

Disability and the rate of decline in the

working ability shall be equally

According to item 1 or 2, section A, chapter

XIII.

---------------------------------------------------------------

10 močopohlavního Tract Infection

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the long-term

or the permanent consequences of an infection,

recurrent or chronic infections,

in relation to the damage to the kidney function and

chronic renal insufficiency.

Disability and the rate of decline in the

capacity to work shall be

comparably by 2, 4, 6, section

And, chapter XIV.

---------------------------------------------------------------

11 other infections

Imported disease

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the consequences

an infection if they are fixed

or lasting nature, scope, and chargeable to the

disability affected organs and systems, and

the impact of the infringement on the total

performance.

Disability and the rate of decline in the

capacity to work shall be determined according to the

the prevailing type of disability

comparably with the relevant health

disabilities.

---------------------------------------------------------------



Chapter II-



ONCOLOGY

---------------------------------------------------------------

SECTION A-MALIGNANT NEOPLASMS

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work based on the

from a functional disability, which is involved in how cancer disease

so oncological therapy. It assesses the overall condition,

disability features organs or body systems, long-term or

permanent disability caused as a result of chemotherapy,

radiotherapy, hormonoterapie, biological treatment, disability after

allogeneic transplantation of hematopoietic cells, the extent of the conserved

functional abilities (functional staging, according to the World Health

organization-who), and the ability to perform daily activities. For

daily activities shall be considered as activity in accordance with the international

the classification of functional ability, disability, and health (according to the

The who). Impact on working ability to not only have a functional disability

as a result of malignant disease, but also side effects

oncological therapy. The most common long-term consequences

Cancer disability are chronic pain, psychological changes,

chronic fatigue, shortness of breath, námahová the musculoskeletal changes

disruption of the function of the legs, Lymphedema, cytopenie, disorders of immunity,

hemorrhagic manifestations, neuropathy, the range of operational performance, including

a serious aesthetic handicap, speaking disorders, adoption

food, digestion, urination, and defecation disorders total

mobility. When considering the decline in the capacity to work on

insured persons with localized tumors (stage I, II, III) views

as potentially curable and guest rates decline

the work capacity depends on the outcome of the treatment, the clinical

the image of the extent and gravity of functional disability. By diseminovaných

tumors (i.e., in stage IV), which can generally be considered

a particularly severe functional disability, disability may be

potentially reversible with vyléčitelných tumors.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Neoplasms

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the functional capabilities

capabilities in terms of kurability,

ongoing cancer treatment in relation to the

the defined period and the effects of the tumor

or therapy and focus on

reversible or treatment of a controlled

health problems.



1A minimum disability, 5-10

asymptomatic conditions, the minimum functional

disorders or

After treatment of the surface skin and

mucosal tumors (primary

lokoregionální treatment), in situ tumors or

tumors that do not require adjuvant

oncological treatment, States where there is no need to

Cancer stabilize or

less operating performance with minimal

operational impact

States without restrictions on the performance of daily activities

---------------------------------------------------------------

1B light disability, 15-25

States in complete remission, usually after 6

months after their active cancer

treatment, stabilized or

the smaller performances for reasons of malignant tumors in the,

resection or amputation from the outside directly

the invisible, the amputation of parts, where it is possible

prosthetic replacement (e.g.. mastectomy,

partial loss of limbs, amputační

parts of the bowel resection, hysterectomy,

enukleace bulbu of the eye when a good feature

one of the eye) or

States with functional disabilities

some organs or systems,

the performance of some of the daily activities with difficulty

or with the use of compensatory mechanisms and

resources

---------------------------------------------------------------

1 c moderate disability, 35-45

States in complete remission, usually after 6

months after their active cancer

treatment, stabilized, where disturbances have

full range of mid-scale fault

functional skills,

for example. Stoma, penektomie, colectomy or

enukleace bulbu the eye degraded vizu

SEER, eye or

the loss of a limb in the forearm or lower leg

or

partial or laryngektomie

stabilization after allogeneic transplant or

States during the administration of biological treatment,

adverse and long-term major functional

due to long-term disability

hormonoterapie or biological treatment,

the performance of some of the daily activities limited

---------------------------------------------------------------

1 d heavy disability, 50-65

States in complete remission, after their

Active cancer treatment, stabilized,

where the failure to have a range of more than half of the

scale full functional disorders

capabilities,

for example. total laryngektomie or

the harvesting performances in the area of head and neck

with the mutilujícími the consequences or

the loss of a limb in the thigh or arm

or

some types of diseminovaných tumours (i.e., in the

stage IV), reversible, cured, after

achieving stabilization of condition,

the performance of some of the daily activities significantly

limited
---------------------------------------------------------------

1E difficult disability, 70-80

malignant tumors of the localized (stage I, II,

III) during the treatment of oncological and usually

within 6 months after its completion, if it takes

complete remission, or

malignant tumors of the generalized (stadium

(IV)),

primarily disseminated tumors, usually by

one year after their cancer

treatment, if it takes a complete remission or

the States with the persistence or the progression of the tumor

or

States within 6 months after the end of radiotherapy

on kranium or

nephrostomy, a combination of a colostomy or

Ileostomy or urostomie or

complete loss of lower limb or top

limbs or completely short stump,

elephantiasis legs, mutilující growth

the tumor or

States during the transplant treatment

(stem cell transplants), and

as a rule, within 6 months after the end of

or

Chronic Graft versus host disease

(GvHD), manifesting as multiple organ

Autoimmune disabilities or

heavy cytopenie, heavy disorders of immunity

with the manifestations of the opportunistic infections or

septickými States, severe hemorrhagic manifestations

or

States with eating disorders,

urinary incontinence, severe mobility restrictions

(functionally comparable with heavy parézami

the limbs) or States where

a body or system,

the performance of most daily activities heavily restricted

---------------------------------------------------------------

SECTION B-BENIGN NEOPLASMS

---------------------------------------------------------------

General medical principles:

In cases where the result of the nezhoubného of the tumor is

decrease or loss of function of the authority or of the system, the rate of

decline in the capacity to work shall be determined according to a comparably

disability neonkologického nature, according

the scope and functions of the competent authority, or disability

system, any adverse accompanying manifestations,

limit the overall performance and the performance of daily activities.

---------------------------------------------------------------



Chapter III-



DISORDERS OF IMMUNITY, ANEMIA, COAGULATION DISORDERS, BLEEDING

---------------------------------------------------------------

SECTION A-IMMUNITY DISORDERS

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work based on the

from detailed laboratory immunological examination, clinical

organ complications, functional disability, organ or systems,

the total resistance-stamina and the impact of the identified

information on the overall performance and the ability to perform daily

activity. In the case of the hyperimunních-system status

connective tissue disease-is to determine the extent of the downturn

the working range and activity of decisive ability to process and

range of functional impairments of the individual organs and systems.

Asymptomatic derogations-laboratory defect itself

do not drop the working abilities.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Immunodeficiencies

---------------------------------------------------------------

1A light degree of immunity disorders, 15-25

deficits of antibody immunity with frequent

the occurrence of microbial infections

(sinusitis, pneumonia, adnexitidy, etc.),

deficits of antibody immunity

with lymfopenií, neutropenií and

recidivujícími febrile infekty

plísňovými, parazitárními, with a slight

by reducing the overall performance

---------------------------------------------------------------

1B immunity disorders moderate, 35-45

accompanied by deficits in cellular immunity

the occurrence of recurrent fungal,

parasitic or opportunistic infections

with a significant reduction in the total resistance and

by reducing overall performance during normal

load

---------------------------------------------------------------

1 c disorders of immunity difficult 50-60

deficits fagocytárního system

with the recidivujícími skin infections,

pyogenními abscesses, inflammation of the flegmonózními

and the septickými States, with heavy reduction

the overall performance

---------------------------------------------------------------

1 d immunity disorder very hard, 70-80

severe immunodeficiencies with extensive and

repeatedly or continuously active

infectious complications, complete with

the treatment, inability to any load

---------------------------------------------------------------

2 Hyperimunní States-disability

connective tissue

The medical aspect:

Functional disability and the degree of a decline in work

capacity shall be determined in accordance with section D,

Chapter XIII.

---------------------------------------------------------------

SECTION B-ANEMIA, COAGULATION DISORDERS, BLEEDING

---------------------------------------------------------------

General medical principles:

The rate of decline in the capacity to work for the diseases of the blood and

hematopoietic organs shall be determined according to the scale and gravity of disability,

the degree of anemia, coagulation disorders, cytopenie or

hepatosplenomegaly, disorders of immunity, adaptation to disability,

the overall performance and the ability to perform daily activities. If

is anemia, coagulation disorders, cytopenie or disorders of immunity

part of the symptomatology of another disability or is

in a causal relationship with another disability treatment

than referred to in chapter III, section A, the rate of decline in employment

capacity shall be determined in accordance with such a disability.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 loss of spleen

---------------------------------------------------------------

1A the loss of spleen with a light impaired immunity 10

---------------------------------------------------------------

1B loss of spleen, the more severe the disorder 20

immunity

---------------------------------------------------------------

2 Splenomegaly

The medical aspect:

The rate of decline in the capacity to work with

provides for a comparably by the health

disability, which is the cause of

splenomegaly.

---------------------------------------------------------------

3 Anemia

---------------------------------------------------------------

3A minimal functional disorders, 5-10

hemoglobin below 110 g/l, hypochromic

red cells, reduced the level of iron in serum,

the reduced concentration of the ferritinu, increased

unavitelnost under normal load

---------------------------------------------------------------

3B with medium-heavy speeches, 15-25

hemoglobin below 100 g/l, the reduction in the total

performance under normal load

---------------------------------------------------------------

3 c major speeches, 30-45

hemoglobin under 90 g/l, with a significant

by reducing overall performance during normal

load some of the daily activities

performed with difficulty

---------------------------------------------------------------

3D heavy disability, 50-70

major speeches, hemoglobin below

80 g/l, the other organ complications, repeated

the need for transfusions, immunosuppression, significant

the reduction of overall performance, the performance of the

some of the daily activities significantly limited

---------------------------------------------------------------

4 haemostasis and hemostasis

Congenital and acquired disorders of blood clotting

(hemophilia, von Willebrand disease,

hypofibrinogenemie, afibrinogenemie, other

deficits of individual coagulation factors,

trombocytopenická purpura, hemolytic-

uremic syndrome, idiopathic

trompocytopenická purpura, thrombophilic

States and other rare disorders).

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the ability to kind of

disability, the scope and frequency of

bleeding and thrombotic complications, kind of

treatment and its effect (immunosuppressive treatment,

substitution treatment), damage to the joints in the

repeated bleeding atakách and functional

the result of the carried out operational procedures.

---------------------------------------------------------------

4A the occasional attacks of bleeding or functionally easy 10-20

thrombotic complications with the need

intermittent treatment with light limitation

the overall performance, some daily activities

performed with difficulty

---------------------------------------------------------------

4B of major speeches, substitution therapy, 30-50

immunosuppression therapy, cytostatics or significant

reduce the overall performance of the possibly

mobility, some daily activities

limited

---------------------------------------------------------------

4 c heavy progressive or relapsing forms of 60-70

unresponsive to treatment, with severe restrictions

the overall efficiency and mobility, performance
daily activities significantly limited

---------------------------------------------------------------

5 Cytopenie, other diseases of the blood

---------------------------------------------------------------

5A light speeches, 10-20

light limit the overall performance, the performance of the

some of the daily activities with difficulty

---------------------------------------------------------------

5B severe functional disorders, 30-45

a significant reduction in overall performance when

the normal load, some daily activities

limited

---------------------------------------------------------------

5 c heavy disability, 50-70

with severe manifestations, other organ

complications, a substantial reduction in the total

performance, the performance of some of the daily activities

considerably limited

---------------------------------------------------------------



Chapter IV-



ENDOCRINE DISORDERS, NUTRITION, AND THE CONVERSION OF SUBSTANCES

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work when

endocrine disorders, disorders of nutrition and the conversion of substances are

critical functional consequences of these disorders, IE. the range and weight

the disability of the individual organs and systems, the impact on the total

the status, performance, and the ability to handle daily activities.

Deviations from the standards of asymptomatic laboratory values

shall decrease working capacity. When assessing the degree of

the decline in work in disorders of endocrine, nutritional and

the conversion of substances, the reference period applicable to the assessment of the degree of

the decline in the working abilities, should take usually one year.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 thyroid disorders

Hypothyroidism, hyperthyroidism, goitre, inflammation

the thyroid gland.

The medical aspect:

When determining the rate of decline in employment

the ability to assess the severity of the need

disorders of thyroid function, both in the

the meaning of the flip, so in the sense of

hypothyroidism, or other manifestations of disorder

the thyroid gland, such as mechanical syndrome

When an enlarged thyroid gland, endocrine

Orbitopathy or nerve paresis of returnable

If surgery occurred

their damage, and impact of the

the facts on overall performance.

The rate of decline in the capacity to work for

cretinism is assessed according to the downturn

mental functions according to item 8, chapter

In the.

---------------------------------------------------------------

1A minimum functional disability, 5

subclinical forms, regardless of the cause,

change function is recognized only

laboratory tests, increased risk

the transition to the clinically manifestní forms

---------------------------------------------------------------

1B light functional disability, 15

disorders of thyroid function, regardless of the

cause, sufficiently compensated when

established treatment

---------------------------------------------------------------

1 c moderate functional disability, 30-40

disability of the thyroid gland, regardless of the

the etiology, the long-

function disorder even when established

the treatment, a significant failure of the overall performance,

some of the daily activities carried out

with difficulty

---------------------------------------------------------------

1 d hard functional disability, 50-60

with complications of heart, eye,

mental health and the other, a serious restriction of

overall performance and some daily

activities

---------------------------------------------------------------

2 Diabetes mellitus

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the long-term

the image of the metabolic glucose control,

metabolic profile, compliance with režimových

measures, the presence of severe chronic

diabetic vascular and organ

complications and associated disability and

their impact on overall performance.

---------------------------------------------------------------

2A minimum functional disability, 10

good glucose control, without diabetic

complications

---------------------------------------------------------------

2B light functional disability, 15-25

satisfactory compensation or occasional

metabolic variations, or incipient

diabetic complications

---------------------------------------------------------------

2 c moderate functional disability, 30-45

with a few diabetickými complications

light to medium grade (vascular, ophthalmic,

Neurological), retained the ability to manage

the normal load, some daily activities

performed with difficulty, according to the scale

disability

---------------------------------------------------------------

2D hard functional disability, 50-60

recurring metabolic decompensation

(usually more than twice a year), progression

chronic complications of diabetes to the level

heavy disorders of vision, restricted by reducing

mobility, blood circulation, the decline in disabilities

overall performance during normal load,

some of the daily activities are limited

---------------------------------------------------------------

2E difficult functional disability, 70-80

severe long-term complications of diabetes

with disabilities (loss of several systems

eyesight, kidney failure need

chronic dialysis treatment, heavy

form of diabetic polyneuropathy with heavy

mobility disorders, diabetic syndrome

feet, gangrene), some of the daily activities

severely limited

---------------------------------------------------------------

3 Hypoparatyreóza

The medical aspect:

The rate of decline in the capacity to work with

determined by the nature, incidence and frequency of

seizures and the impact on overall performance.

---------------------------------------------------------------

3A light functional disability (fleeting 5

paresthesias, light organ spasm)

---------------------------------------------------------------

3B moderate functional disability (cramps, 15-20

heavier or more common organ spasm,

in particular, laryngospasm and bronchial

spasm), where I can't

correct the laboratory findings, or

in cases where it is hypoparatyreóza

part of the polyglandulárních of hormonal

deficits, reduced adaptability

in stress situations

---------------------------------------------------------------

4 Hyperparathyroidism

Primary, secondary hyperparathyroidism.

The medical aspect:

When determining the rate of decline in employment

the ability for primary hyperparathyroidism is

need to assess the extent of functional disorders,

the presence of a disability, in particular organ

kostně-renal syndrome and the effect of

the detected disorders on overall performance.

The rate of decline in the capacity to work in the case

organ complications-osteoporosis is

provides for a comparably by item 1,

section B, chapter XIII.

The rate of decline in the capacity to work with

in the case of secondary hyperparathyroidism

determined in accordance with the basic disability that

hyperparatyreózu (in particular makes the

renal insufficiency, malabsorpční

syndrome) in accordance with chapter XIV of comparably

or (XI).

---------------------------------------------------------------

4A asymptomatic form 5

---------------------------------------------------------------

5 adults (Hypopituitarismus insufficiency

the frontal lobe of the pituitary gland)

---------------------------------------------------------------

5A light functional disability, 10

light reduction adaptation capabilities on

the stress of the situation and the physical load

introduced substitution treatment

---------------------------------------------------------------

5B medium hard functional disability, 25-35

moderate reduction in adaptation

the stress of the situation and the physical

load introduced substitution treatment,

a significant reduction in overall performance when

the normal load, some daily activities

performed with difficulty

5 c heavy functional disability, 50-60

heavy reduction ability of adaptation to

the stress of the situation and the physical load

introduced substitution treatment, reduction

total performance in a light load,

some of the daily activities are limited

---------------------------------------------------------------

5 d especially severe disability, 70-80

the reduction in overall performance when the light

load, with severe functional

complications, severe visual disorders

nerves and other brain structures,

the oculomotor nerve disorders, disability

psyche, diencefalických structures

with other symptoms, such as. bulimia,

hypodipsií, adipsií

---------------------------------------------------------------

6 Pituitary nanismus

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and

borne by the disability in terms of

the overall performance and the ability to handle
the day's activities. The rate of decline in employment

capacity shall be determined comparably according

disorders of growth-by item 4, section B,

Chapter XIII.

---------------------------------------------------------------

Acromegaly and GIGANTISM 7

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the activity of the

disability and the presence of organ

complications (kardiopatie, myopathies,

arthritis, arterial hypertension,

secondary diabetes mellitus and others) and

the resulting functional disorders-

cardiac insufficiency, adynamie and impact

status on the overall performance.

---------------------------------------------------------------

7A light functional disability, 10-15

light organ complications with light

by reducing the overall performance

---------------------------------------------------------------

7B moderate functional disability, 30-50

moderate organ complications, considerable

the decline in performance during normal load,

According to the extent of the disability

---------------------------------------------------------------

7 c heavy functional disability, 60-80

serious complications (heart disability,

the skeleton, adynamie), a persistent activity

even with treatment, the reduction of the overall performance of the

When light load

---------------------------------------------------------------

8 Diabetes insipidus

---------------------------------------------------------------

8A light functional disability, 10-15

satisfactory compensation to substitution treatment

---------------------------------------------------------------

8B moderate functional disability, 30-40

Despite the lack of long term compensation

the established replacement therapy,

with complications such as. hypodipsií, adipsií,

with damage to the hypotalamických center,

recidivujícími water disruptions and

the mineral economy, according to the degree of

disorders

---------------------------------------------------------------

9 Hypotalamické syndromes with endocrine

a manifestation of the

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the ability to scope and type

disability to the hypothalamus (insufficiency

liberinů, glucocorticoids, sex

hormones, vasopressin, etc.) and with him

related disorders and present complications

both the endocrine and

neendokrinologické including hydrocephalus

(eating disorders, fluid disorder

Regulation of vegetative nervous system

failure of thermoregulation, sleep, memory,

concentration, personality changes, epilepsy and

For more) and impact of the infringement on

the overall performance.

---------------------------------------------------------------

9A light functional disability, 10-15

satisfactory compensation for the disorder, the reduction

adaptation capabilities on the burden

---------------------------------------------------------------

9B moderate functional disability, 30-40

the lack of compensation with ranging from how

complications are muscle weakness,

serious disorders and elektrolytového

water, hypoglykémiemi,

with the continuing adverse impact on

krvetvorný system or the central nervous

the system, a significant drop in performance when

the normal load, some daily activities

limited

---------------------------------------------------------------

9 c hard work disability, 60-70

developed complications with substantial reduction in

the overall performance, with serious

disorders of the mind and memory, adynamie,

significant weight loss in the long term

gastric and intestinal, 138.39 days;

the reduction in overall performance when the light

load some of the daily activities significantly

limited

---------------------------------------------------------------

10 Chronic insufficiency, adrenal cortex

---------------------------------------------------------------

10A light functional disability, 10-20

a satisfactory compensation in substitution

the treatment, premature unavitelnost,

Orthostatic disorders

---------------------------------------------------------------

10B moderate functional disability, 30-40

a substantial reduction in overall performance,

lack of response to the load even when

substitution treatment, some of the daily activities

performed with difficulty or slightly limited

---------------------------------------------------------------

10 c heavy functional disability, 60-70

adynamie, elektrolytového disorders and

water management, fault

their saccharide metabolism, weight loss, severe

gastric and intestinal disorders, substitution

little effective treatment, some of the daily activities

greatly reduced

---------------------------------------------------------------

11 an overactive adrenal cortex

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed

functional disorder-hypertension, heart

insufficiency, diabetes, osteoporosis,

muscle weakness. Iatrogenic Cushing's

for the purposes of determining the syndrome rates

the decline in work skills assessed

in the framework of the original disability.

The rate of decline in the capacity to work with

determined in accordance with the prevailing organ

complications of comparably by the competent

disability and the conditional

functional disorders.

---------------------------------------------------------------

12 an overactive adrenal Medulla

---------------------------------------------------------------

12A stabilisation of health, 10

the minimum residual symptoms

---------------------------------------------------------------

12B moderate disability, 25-35

functionally significant residual residual

symptoms

---------------------------------------------------------------

12 c heavy functional disability, 50-70

serious symptoms, persistent overproduction

Catecholamines, manifestations paroxysmal or

persistent hypertension, heart

rhythm, psychological changes, weight loss, cases,

When surgical treatment is not possible and

pharmacological treatment is not effective, the total

performance and daily activities significantly reduced,

According to the extent of the restrictions

---------------------------------------------------------------

13 nutrition Disorders, malnutrition and other disorders

metabolism

The medical aspect:

When determining the rate of decline in employment

the ability to assess the nutritional status is to be

and its impact on the overall performance.

The very disorder of the metabolism of certain substances,

that does not lead to a serious malfunction of the functionally

nutrition, do not fall in the working

abilities.

---------------------------------------------------------------

13A light functional disability, 10-15

increased unavitelnost, permanent light drop

the overall performance

---------------------------------------------------------------

13B moderate functional disability, 30-40

Permanent serious decline in weight and

proteinoenergetické nutrice, a substantial

the decline in the overall performance during normal

load despite treatment at specialized

the workplace, some daily activities

performed with difficulty or limited

---------------------------------------------------------------

13 hard work disability, 60-70

heavy grade proteinoenergetické

malnutrition, persistent heavy decline in total

performance despite treatment at specialized

the workplace, some of the daily activities of the heavily

limited

---------------------------------------------------------------

14 Obesity

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the ability of somatic and

Metabolic complications of obesity, in particular

the presence, extent and chargeable to the cardio-vascular

disability and cardiorespiratory performance,

metabolic impairments, gastrointestinal

disability, skin complications, articular

disability and mobility, any

depressive syndrome. To classification

Obesity uses the index of the body

weight (BMI). To the objectification of the functional

disability is needed obezitologické

examination.

---------------------------------------------------------------

14A obesity degree, a BMI of 30-34.9 10

---------------------------------------------------------------

14B obesity II. instance, a BMI of 35-39.9, 20-30

impervious treatment on the professional workplace,

with the decline in the overall performance of the

---------------------------------------------------------------

14 c obesity III. instance, a BMI of over 40, 40-60

impervious treatment of vocational work, with

the significant decline in cardiorespiratory

performance and reducing momentum, according to

the range of functional disability

---------------------------------------------------------------

14 d of obesity with a BMI of over 45, with manifestations of the heart of 70-80

insufficiency or severely limited

mobility

---------------------------------------------------------------

15 Phenylketonuria

The medical aspect:

The rate of decline in the capacity to work with

determined according to the gravity psychomotor

under item 8 of the retardation of comparably,

Chapter V.

Phenylketonuria in compliance with diet and

normal psychomotorickém development does not

the decline in work skills.

---------------------------------------------------------------
16 of purine and pyrimidine metabolism Disorders

The medical aspect:

The rate of decline in the capacity to work with

determined by the extent and gravity of disability

joints (especially in chronic tyfózní gout

with chronic synovitidou, destructive

artropatií, secondary osteoarthritis,

deformitami of the joints), or according to the

disability, kidney, manifestations of coronary artery

heart disease and the impact of functional disorders

on the overall performance by overriding

type of symptomatology in chapter XIII,

XIV or IX.

---------------------------------------------------------------

17 cystic fibrosis (mukoviscidóza)

with pulmonálními, pankreatickými and above

complications

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and

chargeable to the disability, pancreatic and lung function

the liver and the impact of failures on the

the overall performance.

---------------------------------------------------------------

17A light functional disability, 10-15

bronchitis, lung disorder

ventilation, pancreatic and liver

functions, nutritional status satisfactory

---------------------------------------------------------------

17B moderate functional disability, 30-45

peribronchiální infiltration, starting

bronchiectasis, incipient emphysema,

medium heavy ventilatory failure, alteration

Pancreatic and liver function, reduced

nutritional status, with the decline in the overall performance of the

under normal load, some day

activities performed with difficulty

---------------------------------------------------------------

17 c hard work disability, 60-70

severe bronchitis, bronchiectasis,

emphysema, a disorder of the ventilation of the heavy grades,

severe pancreatic and liver function disorder,

malabsorption, biliary cirrhosis, some

daily activities greatly reduced

---------------------------------------------------------------

17 d especially severe functional disability, 80

chronic respiratory failure

---------------------------------------------------------------

18 the tumors of the thyroid gland, pituitary gland, hypotalamo-

the area of the pituitary, adrenal

The medical aspect:

Disability and the rate of decline in the

capacity to work shall be determined according to the

Chapter II. Decisive for the determination of

rate of decline in the capacity to work in the States

stabilized functional manifestations and

the consequences after oncological treatment.

---------------------------------------------------------------



Chapter V-



MENTAL DISORDERS AND BEHAVIORAL DISORDERS

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work it is necessary to

to assess the level of psychological, mental, social, and

job functions and the ability to perform work activities

in such a way or in such limits, which are considered

in the socio-cultural environment. It is based on the

from the course and severity of the disability, the total

physical conditions, adaptation, personality

characteristics, level of intellect, social adaptability,

coping with the burden and impact on work ability and the ability to

to perform daily activities. To evaluate the impact of mental disorders and

behavioral disorders on work ability and the ability to perform

daily activity uses the survey methods and assessment

scales, which assesses the intensity of psychopathological symptoms,

the subjective condition and experiencing, psychosocial adaptation and

the ability of the way of life of an adequate social status.

Part of the assessment is generally psychological examination,

in particular, the findings of the impact of failures on the personality and performance.

Functionally, it is necessary to distinguish the scope of the disability. The minimum

disability means that you present a departure from standards in one or

several areas, or mild disability in certain

periods. In the light of disability is a distinct departure from the norm,

light disability takes most of the reference period, or on the

moderate disability in some shorter periods. Medium

severe disability is accompanied by a significant departure from the norm in

most of the activities, moderate disability lasts for most of the

the reference period or harder to handicap is recorded only

in certain limited periods. Severe disability is

a significant departure from the norm in all activities, the disability lasts

most of the reference period. A particularly severe disability means

such a departure from the norm, which is a very significant degree with the

the long-term duration.

In assessing the extent of the downturn to work for

mental disorders and behavioral disorders would the reference period, the applicable

for the assessment of the rate of decline in the capacity to work, should take

usually a year.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 organic or symptomatic mental disorder

Dementia, organic psychosyndromy,

post-traumatic and other changes.

The medical aspect:

When determining the rate of decline in employment

It is necessary to comprehensively assess the ability

disorders of cognitive functions, i.e.. disorders

intellect, memory and learning, thinking and

judgement, the ability to differentiate and

classify external stimuli, to plan and

organize, create an abstraction,

mood disorder and emotivity, personality and

the behavior of the. The assessment must take account of

the scope and structure of the organic

disability, disability, development speed

premorbidní personalities, including education,

ability of sociability and adaptability.

---------------------------------------------------------------

1A minimum disability, 5-10

departure from the standards in the performance of one or

several daily activities or roles, which

the socio-cultural environment

expected

---------------------------------------------------------------

1B light disability, 15-20

slight disability thinking, noticeable departure from the

standards, deteriorating social dysfunction

adaptability, the consequences are manifested after the

most of the reference period or medium

serious disability in several periods during the

of the year,

light moving away from the standards in the performance of some

daily activities and role

---------------------------------------------------------------

1 c moderate disability, 30-45

moderate disability thinking, distinct

departure from the standards in the performance of some

activities and roles

---------------------------------------------------------------

1 d heavy disability, 60

a significant departure from the standards in the performance of most of the

daily activities and role

---------------------------------------------------------------

1E difficult disability, 70-80

heavy disorder of thought, reserve compensation

brain mechanisms have been exhausted, a departure from the standards

in the performance of all the activities and roles

disintegration, the crisis level of disorder

---------------------------------------------------------------

2 mental disorders and disorders caused by

psychoactive substances

Disorder-induced effect of psychoactive

substances, alcohol, opioids, cannabinoids,

sedatives or hypnotics, cocaine, other

stimulants, hallucinogens, tobacco,

organic solvents or other

psychoactive substances.

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate not only the

disability, mental functions and intellect,

the disruption of social and job functions,

the level of psychosocial adaptation, but also

disability, the scope and degree of somatic

disruption of the overall efficiency and performance

daily activities.

If as a result of malicious use or after

treatment remains the only damage

the function of certain organs or systems, the degree of

decline in the capacity to work shall be

According to the organ or

the system of disability.

---------------------------------------------------------------

2A use the stabilization or harmful or 10

the maintenance phase of treatment, with

the consolidation of the social and labour

problems, the States without the functionally severe

damage to the function of organs and systems

---------------------------------------------------------------

2B States with severe impairment in thinking, behavior, 70-80

deteriorací cognitive abilities,

depression, anxiety or accompanied by

severe damage to the function of various organs and

systems or

the syndrome of dependence during the provision of the

institutional care in a hospital or specialized

treatment of the Institute for the purpose of healing

depending, if the treatment is to take

or takes longer than one year,

for example. psychotic disorder or psychotic

States, amnestický syndrome, residual status,

serious behavioral disorders, a combination of syndrome

According to another side

mental disorder (dual diagnosis)

delirium tremens, Korsakovova psychosis,

Wernickeho encephalopathy, heavy an alcoholic

dementia, severe alcohol Polyneuropathy,
severe uncompensated reduced or hospital

refractory epilepsy

---------------------------------------------------------------

2 c after the annual abstinence, accompanied by a heavy 50-70

deteriorací personality, personality change,

dementia, loss of responsibility,

social degradation or heavy

damage to the function of some organs and

systems, according to the extent of the disability, the total

performance and the ability to perform daily

activities

---------------------------------------------------------------

3 Schizophrenia, schizophrenic disorder and

disorder with delusions

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the presence of capacity

psychotic symptoms, duration and progress of the

attacks, peace, real estate inspections, the presence of

social and work dysfunction, scope and

the severity of the negative residual

symptomatiky, quality and length of remission. When

the assessment of the need to take account of the průběhovým

characteristics, to the total physical

the State, the adaptation, the premorbidní personality

the level of intellect, social adaptability,

zvládáni psychosocial burden and the impact of

the ability to perform daily activities.

---------------------------------------------------------------

3A minimal disability, 10

maintain the ability of social involvement

the corresponding social status

---------------------------------------------------------------

3B light disability, 15-20

a slightly reduced level of social functioning,

the only attacks with full remissions or unique

attacks, which is a long period between atakami

stabilization, with a light residual

symptomatikou, without any impact on performance

daily activities

---------------------------------------------------------------

3 c moderate disability, 30-45

significantly reduced the level of social functioning,

the only attacks or isolated attacks, after

where the residual persists

symptomatika, the performance of some of the daily

disturbance activities

---------------------------------------------------------------

3D heavy disability, 50-60

more frequent attacks, between atakami persists

serious residual symptomatika, performance

some of the daily activities significantly

disturbed by the

---------------------------------------------------------------

3E particularly severe disability, 70-80

frequent attacks with functionally severe residual

symptomatikou, persistent psychotic or

residual symptomatika of heavy grade,

serious disturbance to the performance of almost all the daily

activities

4 Affective disorders-mood disorders

Depression, mania, hypomanie, cyklotymie,

dystymie.

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the nature and

the severity of the stages (episodes), mood disorders,

their duration, frequency and intervals between

each of the phases, the presence or

the absence of physical and mental

the symptoms.

---------------------------------------------------------------

4A minimum disability, 5-10

the States with the requirements for full remission and

psychosocial adaptation, without distortion

social functioning

---------------------------------------------------------------

4B light disability, 15-20

depressive episodes, a slight phase shorter

duration, slightly reduced level hypomanie,

social functioning, some day

activities performed with difficulty

---------------------------------------------------------------

4 moderate disability, 30-45

depressive or manic episodes of medium

difficult, sufficiently long remissions, considerably

the reduced level of social functioning, performance

some of the daily activities of the limited

---------------------------------------------------------------

4 d heavy disability, 60

major depressive episode without psychotic heavy

the symptoms, chronic, the hospital resistant

depression or severe mania, fast

cycling, short remission, Ultrafast

changes, the recurrence of depressive episodes

with occasional hypomanickými or manickými

episodes, leading to the provision of the constitutional

care in a hospital or specialized treatment

the Constitution, the exercise of most daily activities

substantially limited

---------------------------------------------------------------

4E heavy disability, 70-80

major depressive episode of severe and chronic or

severe mania, often with psychotic

the symptoms, the need for repeated provision of

institutional care in a hospital or specialized

therapeutic Institute, serious disruption of performance

almost all daily activities

---------------------------------------------------------------

5 disorders of neurotic, stress-induced and

psychosomatic disorders

Anxiety and fobické disorders, generalized

anxiety disorder, social phobia,

specific phobia, mixed anxiety-

major depressive disorder, obsessive compulsive

disorder, responses to serious stress and disorder

adaptation, post-traumatic stress

disorder, dissociative disorder, disorder

somatoform, neurasthenia.

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the type, scope, and

borne by the psychological symptoms, duration of the disorder

as well as somatic symptoms that

However, they are not accompanied by organic correlate.

Psychological testing is used

to clarify the causes and motivation difficulties and

event. secondary gain.

---------------------------------------------------------------

5A minimum functional disability, 5-10

a neurotic activity, without disability

the basic mental functions and without fault

personality

---------------------------------------------------------------

5B light disability, 15-20

disruption of social contacts and links,

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

5 c moderate functional disability, 25-35

significantly reduced the level of social functioning,

the performance of some of the daily activities significantly

limited

---------------------------------------------------------------

5 d heavy disability, 70

obsessive compulsive disorder

with the failure of contact outside of the natural

social environment leading to the provision of

institutional care in a hospital or specialized

treatment of the Institute,

severe disruption of the social and labour

the features and performance of most daily activities

---------------------------------------------------------------

6 Behavioral Disorders linked

with physiological and somatic factors

Eating disorders, for example. mental

anorexia, bulimia nervosa.

The medical aspect:

When determining the rate of decline in employment

the ability to assess the scope and should be borne by the

mental and physical symptoms and their

impact on work and social functions.

---------------------------------------------------------------

the States with the decrease in BMI 6A under 17.5, with 70

kachektizací, somatic symptomatologií,

for example. oedema, leukopenia, metabolic

the breakdown, malfunction of the kidneys, the heart, the

osteoporosis, co-morbidity with other mental health

disorders with depressions, stocks with cognitive

dysfunction,

with the purgativním behaviour, with the absence of a preview,

disruption of the social relations and social

insulation

---------------------------------------------------------------

6B States in remission, the normalization of weight 5-10

where appropriate, the light, the absence of underweight

diagnostic criteria

---------------------------------------------------------------

7 personality disorders

The medical aspect:

When determining the rate of decline in employment

It is necessary to demonstrate the essential skills

work and social disruption

functioning because of personality disorders in the

more than two of the following areas-

cognition, emotivitě, afektivitě, control,

the control of impulses, in the manner of behavior,

coping with interpersonal situations and

in the area of relationships.

---------------------------------------------------------------

7A light disability, 5-10

States with impaired social adaptability,

increased konfliktností, dysharmonickými

attitudes and behaviour, with the disruption of relations and

social communication or

personality of the anomalous, accented

---------------------------------------------------------------

7B moderate disability, 30-45

States with substantial distortions of the work and

social functioning, serious

maladaptive behavior, repeated situational

decompensation

---------------------------------------------------------------

7 c heavy disability, 70

heavily affected by the performance of most of the daily

activities, functionally significant personality disorders

accompanied by other serious mental

disabilities, severe disruption to the adaptability of

or

When the psychopathological manifestations

other serious mental disorders

(simplex schizophrenia, schizotypní

failure) or

an unmanageable primitive instinctive behaviour

or

States during the provision of institutional care

in a hospital or specialized treatment Institute

for the purpose of healing disorders (e.g. dangerous
sexual deviance), if the treatment has

take or lasts longer than one year.

---------------------------------------------------------------

8 mental retardation

The medical aspect:

When determining the rate of decline in employment

It is necessary to comprehensively assess the ability

mental defect, level of cognitive

features, performance, storage capacity,

afektivity, the overall performance, the ability to

sociability and acquisition work

habits. At the same time it is necessary to take into account,

If the mental defect associated with another

mental or organic impairment,

personality disturbances, serious disorders

the behavior and adjustment or with physical or

sensory disabilities.

---------------------------------------------------------------

8A light dumbness (oligofrenie), light 10-20

mental subnorma, IQ 70-85

some of the daily activities carried out

with difficulty

---------------------------------------------------------------

8B mental disability light degree 30-45

(the imbecile), IQ 50-69

disturbance of adaptive behavior, greatly

the reduced level of social skills,

present preview, impaired or reduced

the control and detection capabilities, performance

some of the daily activities of the limited

---------------------------------------------------------------

8 c medium-heavy mental disability degree, 70-80

IQ 35-49

maintain the ability to simple physical

and social activities, the heavy reduction of up to

the disappearance of the control and detection

capabilities

---------------------------------------------------------------

8 d mental disability severe or grade 100

deep, 34 and a lower IQ

the inability of social contact

---------------------------------------------------------------

9 mental development Disorders

Speech and language disorders, mixed specific

developmental disorders, pervasive developmental

disorders.

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the mental and

mental ability, speech, communication,

motor skills, ability to establish and

maintain relationships, the level of social adaptation and

social skills.

---------------------------------------------------------------

9A light disability, 15-20

a slightly reduced level of social functioning,

some of the daily activities carried out

with difficulty or significant deviation from the standards in the

their performance

---------------------------------------------------------------

9B moderate disability, 35-60

a substantially reduced level of social

the operation, in accordance with the scale and gravity of disability

functionality, performance, most of the daily

disturbance activities

---------------------------------------------------------------

9 c heavy disability, 70-80

severe disruption of social skills,

intelligence, language skills,

verbal thinking, disintegration, serious

co-morbidity, including mental retardation,

behavioral disorders, the substantial reduction of the mobility

---------------------------------------------------------------

10 Disorders of behavior and emotions, tic disorders

The medical aspect:

When determining the rate of decline in employment

ability to evaluate mental and mental

abilities, behavior, emotions, cognitive

function, the ability to control and compliance

rules, communication and motor

skills, the ability to establish and maintain

relations, social adaptation and social

skills.

The rate of decline in the capacity to work shall be

According to the predominant type of symptomatology and

conditional by a decline in work skills

comparably with some health

disabilities referred to in chapter v.

---------------------------------------------------------------



Chapter VI-



THE AFFECTION OF THE NERVOUS SYSTEM

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in the capacity to work with

based on the detailed neurological disorders of each award,

functional systems and structures, scope and weight of motor,

sensory, cognitive disorders, disorders of expression, disorders

the senses, disorders of the nerves of the bladder and the rectum. When

the guest would be the reference period, the applicable rates for the assessment

the decline in the working abilities, should take usually one year.

The rate of decline in the capacity to work on diseases of the nervous system,

determined by the extent, degree, and location of the health

disabilities, the impact of the disability on the mental and physical performance,

the function of the movement and the carrier system and the ability to handle

the day's activities.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Vascular brain and spinal cord disability, children's

cerebral palsy

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and the chargeable

disorders of the motor, sensory, speech and

cognitive. Cognitive deficit is significantly

especially after repeated vascular

brain events.

---------------------------------------------------------------

1A minimum functional disability, 10

insignificant weakening functions with delicate loss

special skills, maintain the ability to

to carry out daily activities

---------------------------------------------------------------

1B light functional disability, 20-35

light motor, sensory, speech or

cognitive dysfunction, some daily activities

performed with difficulty or can be

exercise with the use of compensatory

mechanisms and resources

---------------------------------------------------------------

1 c moderate functional disability, 40-60

medium-heavy duty motor, sensory, speech

or cognitive dysfunction, some day

activities limited

---------------------------------------------------------------

1 d hard working disability, 70-80

heavy duty motor, sensory, speech and

cognitive dysfunction, most daily

activities limited

---------------------------------------------------------------

2 Alzheimer's disease

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the ability of disability

mental, physical and social

capabilities. In doing so, account should be taken

the outcome of the Mini-mental state examination

(MMSE).

---------------------------------------------------------------

2A minimum functional disability, 10

brain damage with minimum reduction

the intellectual and the overall performance of MMSE, 25-26

points, some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

2B light functional disability, 20-40

brain damage with a slight lowering of the mental and

the overall performance of MMSE, 18-24, some of the

daily activities are limited

---------------------------------------------------------------

2 c moderate functional disability, 50-60

brain damage is considerable mental

and overall performance, the development of behavior disorders,

MMSE 7-17 points, some daily activities

substantially limited

---------------------------------------------------------------

2D hard working disability, 70-80

brain damage especially hard, with a heavy

disruption of the integrity of brain function,

behaviorally psychiatric symptoms in

dementia (BPSD), MMSE less than 7 points,

most daily activities heavily restricted

---------------------------------------------------------------

3 the disability system, extrapyramidového

Parkinson's disease and other extrapyramidal

disorders

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the capabilities of accretion

driving complications (rigidity,

akinéza/hypokinéza and tremor, appearance

fluctuations, mimovolních movements, disability

speech), the presence of depression, cognitive

alteration of, response to treatment, and their impact on the

the overall performance and the ability to perform

the day's activities.

---------------------------------------------------------------

3A completely light form, 10

unilateral impairment, the minimum functional

disorder, full mobility, stadium and,

some of the daily activities carried out with difficulty

---------------------------------------------------------------

3B of the light form, 20-40

bilaterizace, but asymmetry,

anteroverze hull, present all the

the classic symptoms of the disorder, at the level of light

movement ideas, incipient failure

postural stability, stadium II, some

daily activities are limited

---------------------------------------------------------------

3 c medium-heavy form, 50-60

all the classic symptoms present in the level

moderate disorder, dysarthria,

mikrografie, depression, stadium III, some of the

daily activity substantially limited

---------------------------------------------------------------

3D heavy form, 70-80

a persistent tremor, heavy akinéza, rigidity,

cognitive function disorder, confusion
speech, stage IV or V, the daily activities of the heavily

limited

---------------------------------------------------------------

4 Epilepsy

The medical aspect:

When determining the rate of decline in employment

the ability to assess the severity of the need

Epilepsy (a type of epilepsy, severity

the bout, the frequency of seizures,

the countervailability of the treatment, including saturation

the result of the treatment with antiepileptic drugs and operating),

functional status in the period between seizures,

neuro-psychiatric state deficit and undesirable side

the effects of the treatment.

---------------------------------------------------------------

4A form compensated, 10-15

usually one year without seizures, treatment and

without treatment, without the neuropsychického of disability,

completely isolated bouts during the

the year, retained the ability to perform daily

activities

---------------------------------------------------------------

4B form partially compensated, 25-40

Typically, more than one month without seizures,

several seizures during the year, but not more than

12 seizures a year, the presence of light

organic brain disability different etiology,

without neurological deficit and no other

mental disorders, some daily activities

limited

---------------------------------------------------------------

4 c form of uncompensated reduced 50-60

seizures are more frequent than once a month,

usually more than 12 attacks a year,

serious neuro-psychiatric state deficit, the presence of

organic brain damage and organic

mental disorders of different etiologies, some

daily activity substantially limited

---------------------------------------------------------------

the 4 d form of uncompensated reduced heavy, 70-80

seizures completely refractory to treatment, heavy

neuro-psychiatric state deficit, the daily activities of the heavily

limited

---------------------------------------------------------------

5, narcolepsy, Hypersomnia, sleep apnea syndrome

Apnea

The medical aspect:

When determining the rate of decline in employment

skills need to be functional disability

objectify night polysomnography and

a subsequent test of multiple sleep latency

(MSLT).

---------------------------------------------------------------

5A light form, 10-20

light reduction in mental and physical

the performance, some of the daily activities

performed with difficulty

---------------------------------------------------------------

5B medium-heavy form, 30-45

some of the daily activities are limited

---------------------------------------------------------------

5 c heavy form, 60-70

hard to reduce mental and physical

the performance; a severe form of narcolepsy,

When she falls asleep if, despite the established

treatment of walking, eating, during an interview

etc., daily activities significantly limited

---------------------------------------------------------------

6 Demyelinating disability, multiple

sclerosis, Ms,

other degenerative disability, CNS

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the status of the capabilities of the functional

systems-pyramid, mozečkového,

senzitivního, optic, tribal, function

sfinkterů, the ability to walk, stand, the impact

information on the overall

performance. To assess the degree of

multiple sclerosis is used

Kurtzkeho EDSS scale. The finding of CT, MRI

without clinical and functional korelátu

disability does not have an impact on working ability.

---------------------------------------------------------------

6a minimum functional disability, 10

without the coarser disorders or small

neuroimaging findings, overall performance and

the mobility of the affected at least, slight weakness

or spasticita, light monoparéza, mild

trouble walking and reduce the reach of the walk,

extraocular disorders, some daily activities

performed with difficulty, EDSS 2-3

---------------------------------------------------------------

6B light functional disability, 25-35

the overall performance of the limited mobility

maintained, walk with a reduced range (approx.

500 m), expressed the basic symptoms or

the combination of more mild symptoms (e.g. light

paresis of the two extremities, light sfinkterové

difficulties, disorders of the eyeball), some day

activities performed with difficulty or

carried out with the use of compensatory

mechanisms and resources, EDSS 4

---------------------------------------------------------------

6 c moderate functional disability, 50

the decline in the overall performance during normal

load, moderate disorder of motor skills,

walk for a short distance (approx. 300 m),

significant sfinkterové disorders, according to the scale

clinical presentation and functional disability,

some of the daily activities are limited, EDSS 5-6

---------------------------------------------------------------

6 d hard working disability, 60

substantial reduction of the overall performance and

mobility (walk 100 m, functionally significant

spasticita on two limbs, ataxia,

affective or cognitive disorders), some

daily activity substantially limited

---------------------------------------------------------------

6E difficult functional disability, 70-80

the heavy drop in overall performance when the light

load, heavy disorders of the motor (on the level of

heavy palsy limbs), mobility very

difficult movements at very short distance

respectively. reliance on a wheelchair,

severe affective or cognitive disorder

daily activities heavily restricted, EDSS more than

7

---------------------------------------------------------------

7 Encephalitis

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the resulting

a disorder of the central nervous system function and

peripheral innervation with regard to

neurological or psychiatric and

the psychological impact of the disability on the award and

the overall performance and the ability to handle daily

activity.

---------------------------------------------------------------

7A the minimum functional disability, 10

without a decrease in overall performance during normal

load, without neurological deficit

---------------------------------------------------------------

7B light functional disability, 20-30

a light decline in overall performance, lightweight

residual neurological finding, some day

activities limited

---------------------------------------------------------------

7 c medium-severe functional disability, 40-60

medium heavy decline in overall performance,

functionally significant neurological and psychological

defect, some daily activities significantly

limited

---------------------------------------------------------------

7 d hard functional disability, 70-80

severe disability, motor skills, the psyche,

the intellect. and sensory functions, heavy

the decline in overall performance, daily activities

severely limited

---------------------------------------------------------------

8 Disability the spinal cord, spinal roots and knitting,

syndromes of paralysis

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the functional capacity of lunges

on the limbs and disorders of innervation of urinary

the bladder and the rectum, and their impact on the

the overall performance, mobility and the ability to

to perform daily activities. In doing so, it is necessary to

differentiate whether it is affected by the dominant

upper limb and whether it is a light,

moderate or severe parézu or plegii.

Chargeable and the type of fault, it is necessary to objectify

in particular, the muscle test, dynamometrickým

examination, findings, muscle tone and strength

and tests of functional disability of the hand. While it is

account should be taken of the fact that the functional

disability in Central spastic paresis is

less significant than for poor peripheral paresis.

---------------------------------------------------------------

8A monoplegie, 40-60

muscle strength 0-1, there is no sensory or

motor function

---------------------------------------------------------------

8B hemiplegia, 70-80

There is no sensory or motor function on the two

the limbs or

hemiparesis,

on two limbs preserved incomplete

sensory functions and possibly unhelpful

motor function or

triparéza heavy duty or heavy duty, paraparéza

daily activities heavily restricted

---------------------------------------------------------------

8 c paraplegia or 75-80

kvadruparéza heavy duty,

most daily activities heavily restricted

---------------------------------------------------------------

8 d kvadruplegie, 80-90

There is no sensory or motor function on the

any of the limbs

---------------------------------------------------------------

8e monoparéza light, 15

preserved incomplete sensory function and

useful motor function, muscle strength 4,

maintain the ability to carry out daily activities

---------------------------------------------------------------

8F monoparéza medium, 30-35

preserved incomplete sensory function and

unhelpful motor function, muscle strength 3,

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

8 g monoparéza, 50-60
preserved incomplete sensory function and

or unhelpful motor function,

muscular force 2 or

triparéza light,

daily activity substantially limited

---------------------------------------------------------------

8 h light hemiparesis, 20-30

less muscular strength and agility, changes

quality changes in reflexes, sensation, some

the daily activities carried out with difficulty or

paraparéza light,

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

8i hemiparesis medium or 50-70

paraparéza medium

severe restrictions of functions of two limbs with

by limiting the momentum and force, violation of grasping

the ability of the hand, a serious disorder and

walk, serious restrictions on the total performance,

some of the daily activities significantly limited

---------------------------------------------------------------

8j triparéza medium, 60-70

some of the daily activities significantly limited

---------------------------------------------------------------

8 k kvadruparéza light, 50

some of the daily activities significantly limited

---------------------------------------------------------------

8 l kvadruparéza medium, 60-70

some of the daily activities heavily restricted

9 Disability of peripheral nerves,

polyradikuloneuritidy, neuropathy

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the range of capabilities, borne by and

the localization of the disability and to take into account

the outcome of EMG examination and dominance

the limb. The rate of decline in employment skills

shall be adopted in accordance with the limitations of physical performance

the mobility of the limbs, the extent of the disability

motor and sensory functions in the upper

limb according to the ability of handling and

migrating objects and functionality

hand, in the case of lower limb by distortion

features standing and walking, the disability

mezižeberních the nerves under the impact of the

ventilation.

In the event that the disability leads to paréze or

plegii, the rate of decline in the capacity to work with

determined in accordance with item 8, chapter VI, under the

the range of functional disability.

---------------------------------------------------------------

9A light functional disability, 10

the restriction of load capacity of one limb, or

in part, some of the daily activities

performed with difficulty

---------------------------------------------------------------

9B moderate functional disability, 20-40

fatal disorder of motor function,

substantial restrictions on the mobility of one

limb or part thereof or light

impairment of functions of two limbs, some

daily activities are limited

---------------------------------------------------------------

9 c hard work disability, 60-70

heavy disorder of motor function of one

limb or

moderate disability, motor functions

the two limbs or

another heavy deficit neurological Associates

the limitations of momentum, muscle strength, physical

performance, or even brass features

some of the daily activities heavily restricted

---------------------------------------------------------------

10 Muscle impairment

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the degree of ability to muscle

weakness, disability function

the limbs, the overall performance and mobility,

the ability to walk and stand and disability

the respiratory muscles. It is based on the

the result of the EMG, examination of the vital capacity

the lungs, the assessment of muscle strength muscle

the test, or the result of spiroergometry.

---------------------------------------------------------------

10A light functional disability, 10-25

light malfunction and overall performance

under normal load, limiting the reach of the walk,

some of the daily activities carried out with difficulty

or limited

---------------------------------------------------------------

10B moderate functional disability, 35-50

a substantial reduction in overall performance when

the normal load, reduction in mobility, gait

for a shorter distance (typically 300-500

m), mild limitation of breathing functions under

the extent of disability, daily activities significantly

limited

---------------------------------------------------------------

10 c heavy functional disability, 60-70

heavy disorders of mobility, restrictions

brass features a range of restrictions,

some of the daily activities heavily restricted

---------------------------------------------------------------

10 d especially severe functional disability, 80

the minimum mobility up to immobilita, breathing

the inadequacy of

---------------------------------------------------------------

11 Migraine

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the frequency of the

the seizures, the duration of the bout, the intensity of the

the pain and the presence of accompanying phenomena

(vegetative disorders, eye symptoms, other

cerebral irritating speeches) and the impact of State

on the overall performance.

---------------------------------------------------------------

11A of form with a slight progress, 5

subjective difficulty without pronounced objective

clinical presentation, a bout of migraines

neinterferuje with work activities and

does not require incapacity, daily

no limits as to activity

---------------------------------------------------------------

11B form with medium-heavy, 10-20

severe headache with phenomena,

attack affects work, some

daily activity limited to seizure

---------------------------------------------------------------

11 c form with heavy progress, 25-35

prolonged bouts with strongly expressed

phenomena, the pauses between bouts of just

for several days, the status of migrenosus,

some of the daily activities are limited in a fit of

and between the seizures carried out with difficulty

---------------------------------------------------------------

12, particularly the trigeminal Neuralgia trigeminal

nerve

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the frequency of the

seizures and possible subsequent psychological

the changes, the result of the treatment, and the impact of the condition on the performance of the

daily activities.

---------------------------------------------------------------

12A light form, 5

rarely occurring pain or conditions

Hospital, without impact on compensated day

activities

---------------------------------------------------------------

12B medium-heavy form, 10-20

pain in the middle of the degree already induced by light

irritation, low frequency,

each month, some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

12 c heavy form, 25-40

frequent attacks of pain (every week), some

daily activities are limited

---------------------------------------------------------------

12d difficult form, 50-70

strong, persistent pain or pain attacks

more than once a week, the pain resistant to treatment,

personality changes, some daily activities

severely limited

---------------------------------------------------------------

13 Palsy of the facial nerve

The medical aspect:

The rate of decline in the capacity to work shall be

According to the scale and gravity of functional disability,

in particular, the eye complications, the disorder of income

eating disorders, articulation, taking into account

undesirable aesthetic consequences

---------------------------------------------------------------

13A light form, 10

the exclusion of the eye of vision

---------------------------------------------------------------

13B heavy form, 10-25

multiple complications, according to the scale and gravity

---------------------------------------------------------------

14 Neurotraumata

The medical aspect:

The rate of decline in the capacity to work shall be

According to the scale and gravity the symptomatology,

the corresponding localization of the lesion, the functional

disability, motor, sensory or

mental abilities, the weight of posttraumatic

epilepsy and the impact on the State's ability to

to perform the daily activities of comparably

with one of the disabilities listed

in chapter V or VI.

---------------------------------------------------------------

15 of tumors of the central nervous system

The medical aspect:

The rate of decline in the capacity to work shall be

referred to in chapter II.

After reaching stabilization after cancer

healing is possible functional disability and peace

decline in working capacity also provide for

comparably with some health

disabilities referred to in chapter VI.

---------------------------------------------------------------

Myasthenia gravis and 16 myasthenic syndromes

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the weakness and

únavnost skeletal muscles, the impact on the physical

the performance, mobility and the ability to perform

the day's activities. In doing so, it is necessary to take into account

the fact that all the symptoms are

měnlivé; You may experience to remisím

with the disappearance of symptoms. Therefore, the reference

period applicable to the assessment of the extent of the downturn

working abilities, should take as a rule

one year.

---------------------------------------------------------------
16A minimum functional disability, 5-10

intermittent problem, increased unavitelnost in and

After the load, retained the ability to perform

daily activities

---------------------------------------------------------------

16B light functional disability, 15-25

light symptoms after the implementation of clinical

the tests, much fatigue after a typical workload, some

the daily activities carried out with difficulty

---------------------------------------------------------------

16 c moderate functional disability, 30-40

symptoms after stress, intermittent diplopia and

Ptosis, weakness in the area of pletencového

muscle, stress, decrease overall Dyspnea

performance under normal load, some

daily activities are limited

---------------------------------------------------------------

16d heavy functional disability, 50-60

symptoms are present continuously or at frequent

atakách disease, significant physical limitations

performance in a light load, námahová

shortness of breath, the drop in overall performance when

a light load, some daily activities

substantially limited

---------------------------------------------------------------

16e difficult functional disability, 70-80

very heavy and long-lasting unavitelnost and

weakness, developed symptoms, especially

girdle muscles and respiratory disability,

resting dyspnea, severe physical limitations

the performance, some of the daily activities of the heavily

limited

---------------------------------------------------------------

17 Huntington's disease

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed

neuropsychiatrickou, the impact of 138.39 days;

motor and mental disorders to the total

the performance and the ability to perform daily

activity.

---------------------------------------------------------------

17A light functional disability, 10-25

light neuropsychiatric symptomatology,

some of the daily activities carried out with difficulty

---------------------------------------------------------------

17B moderate functional disability, 40-60

functionally significant disorder of executive functions,

major changes in personality and behavior,

dyskinéze, dysarthria, disorders of stability

with crashes, the overall performance and some daily

activities greatly reduced, according to the scale

clinical presentation and functional limitations

---------------------------------------------------------------

17 c hard work disability, 70-80

the failure of the memory and of the Executive

capabilities, difficult personality disorders and

behavior, severe motor disorders, daily

activities heavily restricted

---------------------------------------------------------------



Chapter VII-



THE AFFECTION OF THE EYE, ADNEXA, VISION

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

a critical evaluation of the quality of vision, according to the results of a series of

functional testing: Visual acuity in the distance and near,

field of vision, contrast sensitivity, adaptation to darkness,

barvocitu, eye motility. For the determination of the rate of decline in employment

ability is a crucial degree of deterioration of Visual functions and

its impact on the quality of vision, the ability to read, the ability to work

in the near, the orientation in space, adaptability to changing

with the light conditions. For the assessment of the degree of a decline in work

ability, the vision is always evaluated with optimal

correction.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 low vision of both eyes

The medical aspect:

When determining the rate of decline in employment

the ability is crucial disability vizu.

In doing so, account must be taken both to any

barvocitu failure or breakdown of the adaptation to

the darkness.

---------------------------------------------------------------

1A light low vision of both eyes 5-15

---------------------------------------------------------------

1B medium low vision of both eyes, 25-30

optimal visual acuity with correction

in the interval of 6/36 (0.16)-better than 6/60

(0.10)

---------------------------------------------------------------

1 c strong low vision of both eyes, 35-40

optimal visual acuity with correction

in the interval of 6/60 (0.10)-better than 3/60

(0.05)

---------------------------------------------------------------

1 d heavy duty low vision of both eyes, the 45-60

optimal visual acuity with correction

in the interval of 3/60 (0.05)-better than 1/60

(0.02)

---------------------------------------------------------------

1E heavy low vision of both eyes, 70-80

with severe disabilities of intellect or

hearing on the level of deafness

---------------------------------------------------------------

2 Blindness

---------------------------------------------------------------

2A practical blindness of both eyes, 70-80

optimal visual acuity with correction

in the interval 1/60 (0.02)-světlocit

with a projection or

the limitations of the Visual field to 5 degrees from the point of

the fixation, without the limitations of Visual acuity

---------------------------------------------------------------

2B complete blindness of both eyes, 80

loss of vision involving States from the total

loss of světlocitu after conservation

světlocitu with the wrong light projection

---------------------------------------------------------------

3 Disturbances of the Visual field

---------------------------------------------------------------

3A two-sided Visual field defects sector 5-10

and smaller

---------------------------------------------------------------

3B mutual absolute defects quarters 20-35

or half of the Visual field, according to the scale

---------------------------------------------------------------

3 c double sided concentric narrowing of vision 25-35

the field to 20 degrees from the point of fixation, without the

limitation of Visual acuity

---------------------------------------------------------------

3D double-sided concentric narrowing of vision 50-60

field in the range from 5 to 10 degrees from the point of

the fixation, without the limitations of Visual acuity,

with regard to the possible failure of the barvocitu

or failure of adaptation to darkness

---------------------------------------------------------------

3E double-sided central scotomas, 30-35

decreasing Visual acuity, especially to

close up with the impossibility of reading the text < Jaeger

No 5

---------------------------------------------------------------

3F diffuse the decrease in sensitivity in both the ocular 15-35

the fields on the decreasing Visual acuity

light to medium level slabozrakosti,

According to the degree of limitation of vision

---------------------------------------------------------------

concentric narrowing of the Visual field, 3 g, a single 25-35

eye Visual acuity of 6/10-6/6 (0.66-

1.0) to 45 degrees from the point of fixation

---------------------------------------------------------------

3 concentric narrowing of the Visual field, a single 55-60

eye Visual acuity of 6/10-6/6 (0.66-

1.0) to 20 degrees from the point of fixation

---------------------------------------------------------------

3i concentric narrowing of the Visual field, a single 70

eye Visual acuity of 6/10-6/6 (0.66-

1.0) to 5-10 degrees from the point of fixation

---------------------------------------------------------------

4 loss of the eye or the vizu eye

---------------------------------------------------------------

4A the loss of one eye or loss of vizu 20

one eye with normal vision

the features on the second eye

---------------------------------------------------------------

4B loss of one eye or loss of vizu 40-50

one eye is a more serious disorder

Visual functions on the second eye (vizus

equal to or worse than 6/60, 0.10) or

concentric narrowing of the Visual field to 45

degrees from the point of fixation or Visual acuity

with optimal correction reduced at least to

6/36 (0.16)

---------------------------------------------------------------

5 the oculomotor Palsy and muscle of the eyelids

---------------------------------------------------------------

5A upper eyelid paralysis, with full closure of the eye 10

stěrbiny, or Blepharospasm,

paraspazmus the facial nerve, lagophtalmos

---------------------------------------------------------------

5B polio eye muscles in one eye, if 10-15

the eye must be excluded from the vision

---------------------------------------------------------------

5 c permanent diplopia when looking directly down 20-25

---------------------------------------------------------------

5 d loss of binocular vision 10

---------------------------------------------------------------

6 Other disorders and disabilities of the eye, eyes

---------------------------------------------------------------

6a light stabilized forms without limits 5

the function of the eye/eyes

---------------------------------------------------------------

6B light, lingering forms of the injurious part 10-15

the function of the eye/eyes

---------------------------------------------------------------

6 c severe, protracted forms, healing and defiant, 15-20

permanently affecting the function of the eye

(unilateral)
---------------------------------------------------------------

6 d tough, protracted forms, healing and defiant, 35-50

permanently affecting the function of both eyes, according to the

the range limitations of Visual features

---------------------------------------------------------------

7 functional disorders after intraocular operations

The medical aspect:

Disability and the rate of decline in the

working ability shall be equally

According to the extent of the impairment of Visual features

comparably, the conditions set out in items

1-6, section A, Chapter VII.

---------------------------------------------------------------

8 eye Tumors

The medical aspect:

Disability and the rate of decline in the

capacity to work shall be determined according to the

Chapter II, or after the stabilisation of the condition

According to the extent of the impairment of Visual features

comparably, the conditions set out in items

1-6 of section A, Chapter VII.

---------------------------------------------------------------



Chapter VIII-



THE AFFECTION OF THE EAR, THE TIP OF THE MASTOID, HEARING

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

critical range limitations of sensory hearing function related

to the perception of the presence of the sounds, and lateralizace sounds,

determine the height, depth and quality of sounds, speech recognition and

the ability of speaking/speech. Demonstration of deafness or hearing disorders

must be based on medical history, otoskopické, audiological examination

examination of tone and Word audiometrií, tympanometrií, measurement

reflexes středoušních muscle evoked potentials of tribal

(BERA), examination of otoakaustických emissions, test understanding speech

with the hearing aid. The boundary between the nedoslýchavostí and deafness is that

hearing impaired, equipped with a hearing aid, in a quiet room, in

that level of noise does not exceed 50 dB, means without

lip-reading, voicing simple sentences of at least 90 per cent. For

determination of the rate of decline in the capacity to work are the most important

of hearing loss on speech frequencies 500 Hz, 1000 Hz, 2000 Hz

and 4000 Hz airspace management to better school. For the assessment of

rates of decline of working ability, hearing disorders,

always be evaluated with optimal correction hearing aid/implant.

---------------------------------------------------------------

SECTION A-DISABILITY EAR, MASTOID, HEARING

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 double-sided practical deafness 40

hearing loss in the tonal audiometry

in the range of 70-90 dB, residual hearing

the hearing loss of 85-90%,

the hearing impaired is able to perceive the sound

speech only with the hearing aid, but means

He at least (from 10-15%)

---------------------------------------------------------------

2 double-sided complete deafness 50-60

the inability to hear sounds and understand speech

even with the most powerful hearing aid

---------------------------------------------------------------

3 double-sided complete or practical deafness, 70-80

with severe disabilities of intellect or

sight on the level of the hard slabozrakosti both

the eyes

---------------------------------------------------------------

4 with communication disorders Deafness after

cochlear implantation or stem

neuroprotézy (tribal implant)

---------------------------------------------------------------

4A the ability to understand speech without lip-reading, 15

telephony, communication at the level of light

hearing loss

---------------------------------------------------------------

(4B) the ability to understand common without lip-reading, 20-35

phrases and a frequent phrase,

identify the General sounds, communication to the

the level of moderate to severe

hearing loss, according to a range of disorders

---------------------------------------------------------------

4 c differentiation of just the General sounds, the detection of 40-60

the sound, the minimal understanding of speech communication

on the practical level of deafness or

the inability to hear sounds and understand speech,

communication on the level of complete deafness, according to the

the range of disorders

---------------------------------------------------------------

5 double-sided severe conductive hearing loss

hearing loss in the range of 56-69 dB, loss of

hearing 65-84%

---------------------------------------------------------------

5A when you use a hearing aid with a good 25

communication capabilities

---------------------------------------------------------------

5B when using a hearing aid with limited 35

communications capabilities, without the lip reader

understanding common phrases and only

a frequent phrase, the ability to

identify the General sounds

---------------------------------------------------------------

6 double-sided moderate conductive hearing loss 20

hearing loss in the range of 41-55 dB, loss of

hearing 40-64%

---------------------------------------------------------------

7 double-sided light conductive hearing loss 10

hearing loss in the range of 20-40 dB loss

hearing 10-39%

---------------------------------------------------------------

8 Objektivizovatelné disorders of balance

(disorders of the vestibular apparatus)

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the cause of the capabilities, type

dizziness, ' factors, the progress and

the duration of the attacks, relationship or addiction

the position of the body and movement, the presence of

the accompanying symptoms, IE. nystagmus, crashes

(Romberg), deviations of the upper extremities

(Hautant), vegetative symptoms. Functional

the disorder must be demonstrated audiologickým

(the tonal and verbal audiogram

nadprahovou audiometrií, impedance

audiometrií, testing stapediálního

reflex, objective audiometrií)

examination píštělového and flag

otoneurologickým examination

(elektronystagmometrie, kalorizace,

videookulografie, kraniokorporografie,

posturography).

---------------------------------------------------------------

8A light failure, 10

slight uncertainty, lighter dizziness when

the day's load, stronger uncertainty

with symptoms of dizziness when higher mental and

body loads (greater than

normal, medium-sized), sparse presence of

seizures, with a shorter duration, attack

neinterferuje with working activities

---------------------------------------------------------------

8B moderate disorders, 20-35

significant uncertainty and Vertigo when

the day's load, repeated sharp

dizziness with vegetal plant speeches, vomiting

in the ordinary (middle) mental and

the physical load, the more frequent occurrence of

seizures of a longer duration, attack affects

work activity

---------------------------------------------------------------

8 c hard to fault, 50-70

sudden dizziness several times a month, a considerable

the uncertainty and difficulties in walking, standing, with

due to the fact that vegetative

discourse occurs when normal (medium)

or the low load or even at rest

---------------------------------------------------------------

9 the disability of the middle ear and the mastoid

the tip of the

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed, in particular,

long-term, the frequency or the permanence of the effluent

from the ear, whether the transaction is present, or

combined type of hearing loss and how to

heavy, the eventual total speeches

chronic inflammation, taking into account

the result of the possible operating solutions.

If the dominant hearing disorder,

functional disorder and drop rate working

capacity shall be determined according to a comparably

hearing disorders, in case of perilymfatických

fistulas comparably with balance disorders

under item 8, section A, Chapter VIII.

---------------------------------------------------------------

9A protracted inflammation often recidivujícím 10

discharge vzdorujícím treatment

---------------------------------------------------------------

9B conditions after operations with open trepanning 25-40

cavity with permanent outlet vzdorujícím

the treatment, according to the extent of the complications

---------------------------------------------------------------

10 Complications accompanying ear affections,

tinnitus, tinnitus

The medical aspect:

When determining the rate of decline in employment

capabilities should be detailed

audiometrickým examination objectify

localization, volume, height and duration

tinnitus, whether murmur camouflage tone

or noise-close to the tinnitus,

State the function of the inner ear, activities, and

reactivity of equilibrium mechanism, or

determine whether the combined incidence of

the symptoms. At the same time is a must for heavy

tinnitů to evaluate whether they are impaired and

mental functions, function sleep quality,

keeping the attention of, the pain and take into account

as to whether surgical treatment is possible.

---------------------------------------------------------------

10A stabilized forms, 10

light & control neinterferující
with work activities

---------------------------------------------------------------

10B, functionally severe forms, in particular breaches of 25-35

attention, sleep, disorders of hearing,

balance disorder

---------------------------------------------------------------

11 malignant tumors in the head and neck

(tonsils, larynx, salivary glands, tongue,

the pharynx, lip)

The medical aspect:

Disability and the rate of decline in the

capacity to work shall be determined according to the

Chapter II. Decisive for the determination of

rate of decline in the capacity to work in the States

stabilized functional manifestations and

the consequences, in particular the eating disorders,

swallowing problems, neurological disorders

with disabilities, cranial nerves, pain,

trismus, a disorder of the momentum of the tongue, inflammation

Airway and ventilation, impact

on blowing nose and sense of smell, voice disorders, and

speaking, kanylonosičství, permanent loss of

voice distortion synchronization swallowing,

abdominal disorders, mutilující and press

aesthetic (hyzdící) the consequences, affecting the

sensory functions of hearing, vision, momentum

the neck and limbs. In doing so, it is necessary to

to take account of the type and extent of the operating

the procedure.

---------------------------------------------------------------

SECTION B-SPEECH DISORDERS

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

critical range limits of speech and speaking ability

communication.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Tracheotomy, kanylonosičství other than the 35-50

Cancer etiology

The medical aspect:

The rate of decline in the capacity to work shall be

According to the level of communication skills, status,

Airway and ventilation.

---------------------------------------------------------------

2 reversible nerve, nerve Palsy

---------------------------------------------------------------

2A compensated with good voice 5

---------------------------------------------------------------

2B with partial restore voice features 15-30

---------------------------------------------------------------

2 c double sided with afonií disorders, with stenosis of 50

the respiratory tract, with the rest or námahovou

shortness of breath, swallowing disturbance synchronization

---------------------------------------------------------------

3 Disturbances of articulation, the stutterers ', cluttering, 5-30

dysarthria, acoustic agnozie speech rinolálie

The medical aspect:

Disability and the labour intensity

capacity is determined by the extent and gravity

pronunciation and communication disorders.

---------------------------------------------------------------

SECTION C-HLUCHOSLEPOTA

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

critical range limitations of sensory function of vision and hearing, and

impact on the ability of orientation and communication.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Hluchoslepota

---------------------------------------------------------------

1A lighter form, 35-45

in the range of two-sided medium hard

hearing loss (loss of hearing by Fowler

40 to 65 percent) and two-sided strong

slabozrakosti (vizus 6/60-3/60) or

double-sided concentric restriction of the field of

in the range of 30 to 10 degrees, even though the Central

the sharpness is not affected by the

---------------------------------------------------------------

1B heavy form, 60-70

in the range of two-sided hard of hearing loss to

double-sided deafness and hard slabozrakosti

---------------------------------------------------------------

1 c hluchoslepota with disabilities intellect (according to 70-90

the weight of disability)

---------------------------------------------------------------

1 d the practical or complete deafness with practical or 90

full nevidomostí

---------------------------------------------------------------



Chapter IX-



THE AFFECTION OF THE HEART AND CIRCULATORY SYSTEM

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work based on the

from a functional disability, and treatment options, and the development and

forecasts of disability. For the evaluation is the most important assessment

a functional State, based on how the assessment of subjective

criteria (3, CCS, questionnaires, scoring systems),

of the identified criteria (objectively the value of ejection fraction-EF,

plasma concentrations of natriuretických peptides-NP, result

Holterova monitoring, metabolic equivalent values-MET,

oxygen consumption, a burdens-VO2max. relative to body weight

-W/kg body weight). For inclusion into the appropriate functional

Group 3 or must be fulfilled. even more criteria. For the determination of

rate of decline in the capacity to work is a decisive impact

the observed functional limitations on the overall performance and the ability to

to perform daily activities. During the evaluation, the reporting period,

applicable to the assessment of the rate of decline in the capacity to work,

take typically one year. When the assessment is to be taken into account

the fact that a series of warmly vascular impairment may result

in the syndrome of chronic heart failure.

---------------------------------------------------------------

SECTION A-DISABILITY OF HEART

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Chronic heart failure

Diastolická dysfunction as systolic and

the resulting series of cardiovascular status

disability.

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the intensity of

subjective problems according to classification

3, objective indicators for

systolic dysfunction ejection assessed

fraction of the left ventricle, event. cardiac index;

for diastolické dysfunction transmitrální

diastolic flow rate (the ratio of the speed of the E/A),

the flow of blood in the Pulmonary veins (Vs: Vd),

diastolic movement mitrálního ring

(TDI), the size of the left atrium, event. filling

left ventricular pressure (when dysfunction is rising

over 12 mmHg) and the impact of the identified functional

disorders on overall performance.

For inclusion into the appropriate functional group

3 criteria must be met.

---------------------------------------------------------------

1A without significant performance limitations in 5-10

a typical workload,

3. Also, the legal burden of 2W/kg and more

METS 7 and greater, VO2 max. 20 and larger

normal systolic function of the left ventricle,

EF greater than 0.50, normal or light

diastolická dysfunction of the left ventricle, the BNP,

NT proBNT (b) normal or slightly elevated

---------------------------------------------------------------

with a slight decrease in performance of the 1B, 20-40

3 (II), the legal burden 1-2W/kg, METS

5-7, VO2 max. 16-20, light systolic

dysfunction of the left ventricle, EF 0.35-0.50,

light diastolická dysfunction of the left ventricle,

The BNP, NT proBNT (b) slightly increased

---------------------------------------------------------------

1 c is medium heavy decline in performance, 50-60

3 (III), the legal burden around 1W/kg,

METS 3-5, 12-15, VO2 medium difficult

systolic dysfunction of the left ventricle, EF

approx 0.30, medium-heavy diastolická

dysfunction of the left ventricle, the BNP, NT proBNT (b)

significantly increased

---------------------------------------------------------------

1 d the inability of any burdens, 70-80

3 (IV), the legal burden is less than

1W/kg, METS 2 and less, VO2 max. L0 and

less severe systolic dysfunction, left

the Chamber, the EF 0.25 and less severe

diastolická dysfunction of the left ventricle, the BNP,

NT proBNT (b) significantly increased

---------------------------------------------------------------

2 ischemic heart disease, ISCHEMIC HEART DISEASE

Asymptomatic form of HEART DISEASE, stable

Angina pectoris, stocks held

myocardial infarction.

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the intensity of

subjective problem by functional

classification of 3, or CCS, the objective

the indicators value of EF, plasma

the concentration of the natriuretických peptide (NP)

stress ECG, VO2, W/kg, the MET,

the result of the echokardiografického examination,

event. selective coronary angiography.

Znevýhodňujícím factor is a serious

koronarografický award, which is

nerevaskularizovatelný, dysfunction of the left

Chamber with low value of EF or serious

dysrytmie.

The rate of decline in the capacity to work for ISCHEMIC HEART DISEASE
shall be assessed in accordance with item 1, section A,

Chapter IX.

The rate of decline in the capacity to work for

dysrytmické forms of HEART DISEASE are evaluated with the

under item 7, section A, chapter IX.

---------------------------------------------------------------

3 Cardiomyopathy

Expansion, hypertrophic, restrictive,

Cardiomyopathy of the right ventricle.

The medical aspect:

In assessing the extent of the downturn of the working

skills must be based on the

the fact that different types of

Cardiomyopathy differs impact on functional

status and decrease working capacity.

Dilated cardiomyopathy results

in systolickou dysfunction LK, restrictive

cardiomyopathy in diastolickou dysfunction

LK. The rate of decline in the capacity to work with

referred to disability provides a comparably

According to item 1, section A, chapter IX.

Hypertrophic cardiomyopathy and

Cardiomyopathy right ventricle is

characterized by severe komorovými

heart rhythm disorders leading to

to sudden death, and the rate of decline of the working

capacity shall be determined according to a comparably

item 7, section A, chapter IX.

---------------------------------------------------------------

4 heart transplantation

The medical aspect:

When determining the rate of decline in employment

skills must be based on the

the fact that the long-term prognosis and

impact on working ability is

conditional on the response of the immune system and

serious side effects permanent

immunosuppressive treatment and environmental impact

the overall performance. In the assessment of the

based on the evaluation of the function of the graft, using the

echocardiography, the result

endomyokardiální biopsy (chronic

rejection), koronarografického examination

(development of vaskulopatie graft), Holterova

ECG monitoring, determination of the functional class

According to the classification and its 3.

objectification of bicyklovou ergometrií.

---------------------------------------------------------------

4A to stabilize health 70

---------------------------------------------------------------

4B after stabilisation of health with 20-40

decline in the performance of the

---------------------------------------------------------------

4 c after stabilisation of health is 50-60

moderate decline in performance

---------------------------------------------------------------

4 d the inability of any of the load, the presence of the 70-80

repeated episodes of rejekčních, the incidence of

serious infections, complications during

immunosuppressive treatment, the development of obstructive

vaskulopatie graft

---------------------------------------------------------------

5 acquired and congenital heart defects, defects

large blood vessels

The medical aspect:

In assessing the extent of the downturn of the working

the ability of

hemodynamic significance of defects set

echokardiograficky (for the worse evaluated

vyšetřitelných transezofageálně),

where appropriate, the outcome of invasive examinations,

(that is if you cannot grade

failure to objectify and clinical findings

witness for a major defect), evaluation of the

functional status on the basis of the classification

3 objectified bicyklovou

ergometrií or ballast

echokardiografií, forecast that at the

hemodynamics of significant defects in primary

way affects the surgical treatment. For

the adverse prognostic indicators

be considered a disability in several

valves, the simultaneous presence of HEART DISEASE,

severe pulmonary hypertension,

trikuspidalizaci defect, mitral or

Aortic regurgitaci with significantly

dilatovanou left ventricle ejection fraction,

decreasing stress, serious arrhythmias. For

significant gradient at the point of constriction of the

considers 40 mmHg and higher.

For inclusion in functional subgroups must

the decisive criteria to be met 3

specifying the hemodynamickou significance of defects-

index area above the estuary, gradient, degree

regurgitation, the size of the short circuit and

at least 2 other criteria such as.

the value of the ejection fraction of the left ventricle,

the achieved performance bicyklové stress test,

the METS, the VO2 max values, classification, 3.

performance and speed and range

walk.

As we evaluate the aortic Koarktaci

stenotic defects.

---------------------------------------------------------------

5A without substantial reduction performance 10

the usual physical load

---------------------------------------------------------------

with a slight decrease in performance of the 5b in the ordinary 25-45

the physical load

---------------------------------------------------------------

5 c a substantial decrease in performance when less 50-60

than the normal load

---------------------------------------------------------------

5 d decline in performance with a minimum load of 70-80

or difficulties in peace

---------------------------------------------------------------

6 Disability after operating and intervention

procedures on the heart and great vessels

And the States after cardiac intervention)

procedures and Surgical Revascularization

infarction

The medical aspect:

When determining the rate of decline in employment

the ability is based on the determination of EF

the left ventricle, echokardiograficky

stress tests (bicyklová ergomentrie,

dynamic stress echocardiography)

functional classification of 3, CCS. Worse

the forecast have the States of

residual ischemia stretches

systolickou dysfunction of the left ventricle and the

with a greater number of risk factors.

The rate of decline in the capacity to work after

performances on the coronary arteries, according to the

the result of the procedure, evaluated according to items

2, section A, chapter IX, in the case of

persistent or rozvinuvšího is

chronic heart failure by

item 1, the persistence of arrhythmias by

item 7.

Angioplasty in the coronary arteries,

the introduction of the stent, balloon

valvuloplasty valvular stenosis,

alcohol septální ablation for

Hypertrophic obstructive cardiomyopathy

catheter closure of atrial defect

the septum themselves shall fall

working abilities.

(B) the operating conditions after correction) of the heart

defects, defects of large arteries and aneurysms

The medical aspect:

In the assessment of functional status and extent

decline in working ability is

from the result of echocardiography

transtorakální and transezofageální,

3. classification of objectified

bicyklovou ergometrií, Holterova

ECG monitoring. The evaluation of the success of the

the procedure and the resulting condition is carried out

with the passage of three months after the operation,

rehabilitation and readjustment, with

the decisive factors for the impact on the working

ability and functional status shall be

the degree of correction in hemodynamic disorders,

the presence of residual defects associated with

defects and their postoperative evolution, status

the function of the left ventricle of the heart, the presence and

the degree of pulmonary hypertension.

For the factors that adversely affect the

functional status is considered to be the emergence of infectious

endocarditis, exacerbation of rheumatoid

carditis, the presence of HEART DISEASE, which cannot be

addressed surgically, the presence of serious

arrhythmias.

---------------------------------------------------------------

6a, without degradation of performance in the ordinary physical 10

load,

a full correction of the defects, the good function of the left

the Chamber, a good performance in the bicyklové

stress test

---------------------------------------------------------------

6B light performance degradation when the usual 25-40

the physical load,

almost complete correction of defects, slightly reduced

the function of the left ventricle, decreased performance when

bicyklové stress test

---------------------------------------------------------------

with a significant decrease in the performance of 6 c in the medium 50-60

a heavy load, a partial correction of the defects,

significantly reduced performance when bicyklové

stress test

---------------------------------------------------------------

6 d decrease in performance during light load, the difficulties of 70-80

in peace,

Advanced defect late indicated

the operating procedure or defects that

It could not be satisfactorily corrected, heavy

the failure of the function of the left ventricle, difficulties in

any physical activity

---------------------------------------------------------------

7 the arrhythmia, syncope

And supraventricular tachycardia)

tachycardia (sine tachycardia, AV

nodal reentry tachycardia, AV reentry

tachycardia, ectopic atrial

tachycardia, atrial fibrillation, fluttery

fibrillation), ventricular tachycardia, atrial flutter

the ventricles, ventricular fibrillation

The medical aspect:

The rate of decline in working capacity depends

on the severity of tachycardia, on its type

and ventricular rate, on the presence of

structural cardiovascular

disability, the frequency and intensity of symptoms.

To assess the subjective problems can be

use classification according to 3, peace

functional limitations can objectify

bicykloergometrií. From the perspective of an

the pharmacological effect and is critical

non-pharmacological treatment (cath lab

ablation). Functionally significant are primarily

ventricular tachycardia with significantly reduced

EF of the left ventricle. Tachycardia without
organic disability of heart or primary

electrical disorders infarction have

usually a good prognosis.

(B)), Bradycardia, cardiac pacemakers,

implantable cardioverter-defibrillators

The medical aspect:

In assessing the extent of the downturn of the working

the ability of cardiac constraint

the features and overall performance.

Asymptomatic bradycardia do not lead to

the reduction in working capacity.

Symptomatic bradycardia leads

for low-minute manifestations of heart

picking and require pharmacotherapy

(introduction bradykardizujících drugs) or

implantation of Permanent pacemaker.

After the implantation of a pacemaker,

where not present organic heart

disability, do not lead to a decline in the working

abilities. When the guest is to be taken in the

consider whether the indications for implantation was

primarily or secondarily preventive.

C) Syncope

The medical aspect:

Most of the neurokardiogenních is synkop

satisfactorily compensated lifestyle changes

measures and does not fall in the working

the inability of the. Crucial is to determine

the risk of further relapses and their

the severity. The rate of decline in employment

capacity shall be determined in particular by the

decline in the performance of the heart.

---------------------------------------------------------------

7A States without limits heart function and 10

overall performance during normal load,

isolated syncope without structural

heart disease, neurokardiogenní

Syncope with a sufficiently long prodromy,

cardiogenic syncope resolved implantation

pacemaker or catheter ablation

---------------------------------------------------------------

7B the States with restrictions, heart function, and a total of 30-60

performance in medium-heavy (normal)

the load according to the extent of the restrictions

recurrent syncope with neurokardiogenní

injuries and with minimal or no

prodromy

---------------------------------------------------------------

7 c the States with restrictions, heart function, and a total of 70-80

performance in a lightweight or minimal

load,

recurrent cardiogenic syncope

persistent even after the introduction of targeted

therapy

---------------------------------------------------------------

8 arterial hypertension

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the functional capabilities

the damage of target organs, the answer to the

treatment, the presence of other risk

factors including the risk of a fatal

cardiovascular events (rated according to

SCORE) and the impact on overall health

the performance and the ability to perform daily

activity.

The assessment is based on the monitoring of

the blood pressure values, results

biochemical blood tests and urinalysis, ECG,

Echo examination of the eye,

of sonographic examination of carotid arteries and

the kidney. In the case of secondary hypertension

It is necessary to take into account the nature of the

the underlying condition.

---------------------------------------------------------------

8A the minimum disability, 5

no objectively demonstrable organ

morphological and functional changes, without the impact of the

on the overall performance and the ability to

to carry out daily activities

---------------------------------------------------------------

8B light organ damage, 10-20

renal impairment creatinine rise,

a slight decline in clearence, kreatininové

mikroalbuminemie, normal heart

the function changes the eye background in stage

angiopatie or angiosklerózy, no restrictions

overall performance under normal load

---------------------------------------------------------------

8 c moderate functional and morphological 35-45

the changes,

a serious decline in clearence, kreatininové

hypertrophy of the left ventricle with the decrease

heart performance and overall performance

medium heavy loads, some day

activities performed with difficulty

---------------------------------------------------------------

8 d heavy functional disability, 50-60

with a decrease in cardiac output and total

performance in a lighter load, some

daily activities are limited

---------------------------------------------------------------

8e manifestní organ disabilities, 70-80

the heavy drop in the clearence, kreatininové

significant proteinuria, systolic dysfunction

the left ventricle or left

cardiac insufficiency, the changes to the eye

background in stage exudátů on the retina,

recent stroke on the

the basis of bleeding into the brain with heavy

the functional consequences of hypertensive

encephalopathy

---------------------------------------------------------------

9 Cor pulmonale chronicum

The medical aspect:

When determining the rate of decline in employment

skills must be based on disability,

that led to the development of cor pulmonale,

presence or absence of the circulatory

the insufficiency of detection marks

pulmonary hypertension in echokardiografickém

the award event. from the values of pressure in her doctor,

the effect of the treatment, the weight of the brass

the insufficiency of the State and of the impact on the

the overall performance. To objectification

functional disability used test 6

minute walk (value to 350 m suggests

for a poor prognosis, values above 350 m

prognosticky are more favourable).

---------------------------------------------------------------

9A long-term flow compensation, 30-60

According to the degree of reduction of the overall performance and

impact on the ability to perform daily

activities

---------------------------------------------------------------

9B mark sided cardiac insufficiency 70-80

persistent despite a sufficient

comprehensive treatment, the inability of any

load

---------------------------------------------------------------

SECTION B-DISABILITY OF BLOOD VESSELS

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Atherosclerosis

The medical aspect:

When determining the rate of decline in employment

the ability of the extent and gravity

degenerative process, the adequacy of

flow and supply to the target organ,

the affection of his function, the manifestations of ischemia and

the impact on the overall performance and health

the ability to perform daily activities. When

the assessment is based on the outcome of the duplex

ultrasonography, recorded speed

the flow, the relevance of the stenosis of the card

ischemia.

---------------------------------------------------------------

1A stadium with mild ischemia, 10-20

without limiting the overall performance during normal

load some of the activities carried out

with difficulty

---------------------------------------------------------------

1B stadium with medium-severe ischemia, 30-45

with a decrease in overall performance in the medium

a heavy load, some daily activities

performed with difficulty

---------------------------------------------------------------

1 c stadium with heavier ischemia, 50-60

with a decrease in overall performance when lighter

load some of the daily activities are limited

---------------------------------------------------------------

1-d stadium with severe organ damage, 70-80

the inability of any of the load

---------------------------------------------------------------

2 Reconstruction (stenosis, occlusion) carotid

artery/arterial

Functional disabilities after operating and

the intervention procedures on karotických

the arteries

The medical aspect:

The rate of decline in the capacity to work with

determined on the basis of the vascular and

Neurological findings (bearing changes on

CT and MR, disability of both carotid arteries) and by

the range of functional disability.

---------------------------------------------------------------

2A simple reconstruction or 10

status after carotid endarterektomii (or

another performance)

the minimum functional consequences

---------------------------------------------------------------

2B reconstruction accompanied by lighter disorders 35-45

circulation,

a transient ischemic attack, short-term

lapses of consciousness, lighter psychological changes

or

the above conditions, which have been

into intervention or operationally satisfactory

corrected, some daily activities

limited

---------------------------------------------------------------

2 c reconstruction accompanied by serious disorders 50-60

circulation,

functionally significant neurological findings

significant psychological changes and disturbances or

the States, which could not be into intervention

or operationally correct satisfactorily,

some of the daily activities greatly reduced

---------------------------------------------------------------

3 Reconstruction of arteries of the lower limbs

Functional disabilities after operating and

the intervention procedures of the pelvic

the arteries and veins of the lower extremities

The medical aspect:

When determining the rate of decline in employment

the ability of the evaluation

functional stages according to Fontaine fables or
Called Rutherford. It takes into account the

speed the emergence of the problem, the extent of the disability,

co-morbidity and present value

the index, introduced the contribution of the ischemic

therapy, including the outcome of the

revaskularizačního the procedure.

---------------------------------------------------------------

3A stadium asymptomatic (Fontain I), 5-10

without any impact on the overall performance in

current load or

After operating or intervention

procedure with the miminálními functional implications

---------------------------------------------------------------

3B stadium klaudikací, gentle 15-25

klaudikační the interval of 200 m and more

(Fontain IIa) or

a good correction and function after

revaskularizačním procedure

some of the daily activities carried out

with difficulty or limited

---------------------------------------------------------------

3 c stadium moderate klaudikací, 30-40

klaudikační the interval below 200 m (Fontain

IIB) or

a partial correction and satisfactory function after

revaskularizačním procedure, considerable restrictions

the function of a limb/limbs, large

limit the overall performance and some

daily activities

---------------------------------------------------------------

3D stadium of heavy klaudikací, 50-60

klaudikační the interval below 50 m, (Fontain

IIC) or

the State, which could not be satisfactorily

revaskularizačně correct, serious

limits of the legs/extremities,

most of the daily activities are limited

---------------------------------------------------------------

3E stadium quiet ischemic pain, 70-80

Ischemic skin defects, gangrene

(Fontain III and IV), the inability to load

the limbs

---------------------------------------------------------------

4 Reconstruction of the arteries of the upper extremities

Functional disabilities after operating and

the intervention procedures on the arteries

upper limbs

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the functional consequences

the process of atherosclerotic arteries of upper

the legs, which are manifested analogies

claudication, especially pain in muscles

the arm when it loads, more often when

elevation of the limb, and impaired function

the limb. Disability of the arteries of the forearm can

lead to the formation of ischemic defects on the

his fingertips.

4A asymptomatic stadium, 5-10

---------------------------------------------------------------

gap systolických pressures at the upper

the limbs are already greater than 10 mmHg or

After operating or intervention

procedure with the mininálními functional implications,

without any impact on performance in the current

load

---------------------------------------------------------------

4B loads induced by pain, or 30-40

a good correction and function after

revaskularizačním procedure restriction

the function of a limb/limbs

---------------------------------------------------------------

4 c severe disturbances of blood circulation and the function or 50

a partial correction and satisfactory function after

revaskularizačním surgery, serious

limits of the legs/extremities

---------------------------------------------------------------

4 d heavy disorders of blood circulation, 60-70

the rest of the pain until the emergence of skin defects,

gangrén or

the State, which could not be satisfactorily

revaskularizačně correct, failure to

load the limb/limbs

---------------------------------------------------------------

5 Functional disorders of the circulation of the character

Raynaud's syndrome

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the functional consequences

ischemia of the fingers of a certified chladovým test

or pletysmografickým examination.

---------------------------------------------------------------

5A stadium I, 5-15

light failure, reversible changes,

occasional bouts of affecting the toes

---------------------------------------------------------------

5B stadium II, 25-35

Occasional attacks affecting distal and

the Middle phalanges, double-sided medium

heavy disorders of circulation without the disorders

trofiky

---------------------------------------------------------------

5 c stadium III, 45-60

frequent seizures affecting all articles

the fingers, standing and vazospastické disorders

vazoparalytické trofiky skin disorder,

but without defects, limitation of function of limbs,

According to the impact on the overall performance and

the ability to perform daily activities

---------------------------------------------------------------

5 d stage IV, 70-80

closures of the digital arteries, trophic skin

changes with defects, failure to load

the limbs

---------------------------------------------------------------

6 Aneurysms visceral arteries, aneurysm

aortic aneurysm

Functional disabilities after operating procedures

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the localization and

the size of the aneurysm,

posudkově major is considered to be increased

the risk of rupture of the visceral aneurysms

the arteries of a diameter of 2-2.5 cm, the aneurysm

the aorta with a diameter of 5 cm or more and the impact

status on the overall performance.

---------------------------------------------------------------

6a without functional disorders (a small peripheral 10-15

aneurysms),

without reducing overall performance during normal

load

---------------------------------------------------------------

6B aneurysms larger diameters or 20-40

multiple,

with the decrease in performance during normal load

---------------------------------------------------------------

Aortic abdominal aneurysms, 6 c United and 50-70

large pelvic arterial disease, conditions after

the operations of the aneurysms with a constraint function

authority and to the reduction of the total

performance in a light load, with another

the parallel circulation or severe disabilities

complications associated with treatment

7 of aortic dissection

Functional disabilities after operating procedure

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the degree of extension of the

the aorta, functional disability of organs, above

blood pressure, the result of any

the operating procedure and the impact on the overall

performance and event. other complications.

---------------------------------------------------------------

7A without a significant enlargement of the aorta, and 20-30

organ dysfunction,

without limiting the overall performance

current load

---------------------------------------------------------------

7B extension aorta, light organ 40-60

dysfunction,

the reduction in overall performance when the light

load

---------------------------------------------------------------

7 c with organ disabilities, 70-80

cerebrovascular or coronary

insufficiency, ischemia of the extremities,

paralysis, renal insufficiency, dysfunction

gastrointestinal system, high

the risk of other complications

---------------------------------------------------------------

8 Illness from oppression in the upper chest

Aperture-thoracic outlet syndrome

(TOS), Neurovascular compression

the shoulder girdle syndrome, syndrome

cervical rib

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the severity of functional

disorders, the severity of the vascular and

neurodevelopmental disability, especially-

If the dominant limb and restrictions

the overall performance.

---------------------------------------------------------------

8A light functional limitations, 10-15

without reduction in performance during normal

load

---------------------------------------------------------------

8B moderate functional consequences, 25-40

reduced overall performance during normal

load

---------------------------------------------------------------

8 c hard work consequences, 60-70

to limit the total capacity to light

load

---------------------------------------------------------------

9 Lymph edema on one or both legs

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the stadium disability,

the scope and gravity of the limb function, disability

the impact on the overall performance and health

mobility.

---------------------------------------------------------------

9A stadium I, 10

without substantial restrictions

legs/extremities

---------------------------------------------------------------

9B stadium II, 30-40

with a slight limitation of momentum

legs/extremities

---------------------------------------------------------------

9 c stage III, 50-60

with a distinct disorder momentum

legs/extremities, significantly reduced

mobility

---------------------------------------------------------------

9 d of stage IV, 70

with the loss of motor function

legs/extremities, severe restrictions

overall performance and mobility

---------------------------------------------------------------

10 varicose veins, posttrombotický syndrome,
recurrent tromboflebitidy

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the severity of functional

disorders on the basis of pletyzmografického

volumových record changes to the extremities,

flebografie, varikografie, direct measurement

venous pressures. The assessment is based on

CEAP classification and the impact of the State on the

the function of a limb/limbs, mobility and

the overall performance.

---------------------------------------------------------------

10A stadium I, 10

without substantial restrictions, stadium

C0-1 by CEAP

---------------------------------------------------------------

10B stadium II, 20-30

with a slight restriction function

legs/extremities, stadium C2-3

CEAP

---------------------------------------------------------------

10 c stadium III, 40-50

with a medium heavy restriction function

legs/extremities, significantly reduced

overall performance and mobility,

Stadium C4-5 by CEAP

---------------------------------------------------------------

10 d stage IV, 50-70

with severe limitations of function of limbs, severe

by limiting the overall performance and

the mobility of the C6 CEAP, the stadium by

---------------------------------------------------------------

11 Arteriovenous fistula with disorders

peripheral blood circulation

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the momentum and features

limbs, the presence of lymphatic swelling

and its complications, the presence of klaudikací

and thromboembolic complications, the impact

status on the overall performance. When

significant arteriovenózním short circuit can be

the project capped manifestations of heart

the insufficiency. Account should be taken of

the physical demands of the work.

---------------------------------------------------------------

11A without disturbances, 5-10

the scope of the anomalous tissue is small and flow

short circuiting insignificant

---------------------------------------------------------------

11B light functional disorder, 20-25

light limbs, without restrictions

the reduction in overall performance during normal

load

---------------------------------------------------------------

11 c moderate functional disability, 40

considerably reduced function of legs,

greatly reduced the overall performance and

mobility

---------------------------------------------------------------

11 d hard working disability, 60-70

manifestations of cardiac insufficiency

---------------------------------------------------------------



Chapter X-



THE AFFECTION OF THE RESPIRATORY SYSTEM

---------------------------------------------------------------

General medical principles:

The rate of decline in the capacity to work shall be determined according to the

location, the extent and gravity of the frequency of relapses, disability, respectively.

chronicity, the effectiveness of treatment, complications (particularly inflammation,

septic States), any co-morbidity (cardiovascular)

the degree of limitation of lung function by spirometry. According to the

Beige pletysmografie, hemoglobin oxygen saturation testing

(SaO2 were studied), event. blood gases, the alteration of the overall status and

the impact of the identified functional disorders on overall condition, performance and

the ability to handle daily activities. In assessing the degree of

decline in working capacity reference period applicable to

assessment of the rate of decline in the capacity to work, should take

usually one year, in the case of chronic obstructive pulmonary

disease and asthma as a rule two years ago.

---------------------------------------------------------------

SECTION A-THE UPPER RESPIRATORY TRACT

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Functional consequences after operations of the lips, jaw,

the palate, tongue

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the intensity and

the extent of disability, i.e.. disorder articulation,

chewing, mimic, disorder of language features

the defect of the jaws, achieving the shape and functional

axle and the impact on the overall health and

performance.

---------------------------------------------------------------

1A light functional disability, 10-15

with satisfactory shape and functional treatment

rinolálie

---------------------------------------------------------------

1B moderate functional disability, 30-50

limits of the authorities in the affected area,

the effect on mastikačních, polykacích,

brass, voice and speech functions,

recurrent inflammation, disorders of innervation,

the vascular and lymphatic supply to affected

the region, according to a range of disorders

---------------------------------------------------------------

1 c heavy functional disability, 70

the inability of the processing of food (mastikace,

transport), severe disorders of swallowing,

replacement food intake, severe disturbances

breathing, voice, speech and hinder the

adequate communication, a devastating disability

---------------------------------------------------------------

2 the narrowing of nasal passes 5

with chronic inflammation, the deformations of the nasal

septum, nasal polyposis

---------------------------------------------------------------

3 Allergic or vasomotor rhinitis 5

persistent or intermittent,

with the reduction of the nasal průdušnosti, with restrictions

olfactory features, without allergic or

non-allergenic respiratory co-morbidities

---------------------------------------------------------------

4 Chronic sinusitis

infectious, chronic rhinosinusitis

dental, allergic, combined,

sinorinopatie

---------------------------------------------------------------

4A minimum functional disability, 5

local and general symptoms

---------------------------------------------------------------

4B moderate functional disability, 35-50

with the complications of intracranial, eye, according to the

the range of functional disability

---------------------------------------------------------------

5 Loss of smell, taste 5

---------------------------------------------------------------

6 of Tracheal stenosis

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed for leaks

stenosis; for the functionally significant shall be

stenosis in half and less than half of the

normal blockages. At the proximal stored

stenosis occurs to limit the sources of

functions for the combined caudally stored

breathlessness.

---------------------------------------------------------------

6a light functional disability, 10-15

stenosis less than half normal

blockages, without impact on the spirometrický find

---------------------------------------------------------------

6B moderate functional disability, 25-35

with a good or slightly reduced spirometrickým

finding, a reduction in performance when

medium/normal load

---------------------------------------------------------------

6 c severe functional disability, 40-50

substantially impaired spirometrický award, a considerable

reduction in performance when the normal load

---------------------------------------------------------------

SECTION B-LOWER AIRWAY

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 chronic obstructive pulmonary disease (COPD)

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate how the lung

folder of disability (bronchial obstruction,

an inflammatory component) and extrapulmonary. For

determination of the rate of decline in employment skills

degree of disability is critical to pulmonary

functions, assessment of progression of (the decline in

lung function), with the most appropriate

is considered to be at least three years

the two-year monitoring of ventilation, event.

respiration in a stable period of exacerbation,

the need for institutional care in a hospital or

vocational therapeutic Institute, the level of necessary

treatment. The clinical picture is an auxiliary criterion

(shortness of breath, cough, expektorace). Bronchial

obstruction of the proof spirometrickým

the examination after test, i.e. bronchodilatačním.

Of FEV1/FVC less than 0.7 and inclusion in

the stage (I-IV) specifies of FEV1 expressed

in percentage of the relevant values.

In the event that the reference period only lasts

one year, it is to be in a stable period

make at least two spirometrická

examination.

---------------------------------------------------------------

1A light functional disability, stadium and 5-10

Of FEV1/FVC < 0.70, of FEV1 > 80% good values,

the States without the need for hospitalization,

When not respected the recommendations of

stop smoking

---------------------------------------------------------------

1B moderate functional disability, stadium II 15-30

Of FEV1/FVC < 0.70,
50% of FEV1 80% < < values, appropriate

two and more exacerbations per year, without

the need for hospitalization

---------------------------------------------------------------

1 c heavy functional disability, stage III 40-60

Of FEV1/FVC < 0.70,

30% of FEV1 of 50% < < values, appropriate

two and more exacerbations per year,

with the occasional necessity of hospitalization

---------------------------------------------------------------

1 d especially severe functional disability, stage IV 70-80

Of FEV1/FVC < 0.70,

30% of FEV1 < values or relevant of FEV1 <

50% of the respective values + chronic

respiratory failure

---------------------------------------------------------------

2 Bronchiectasis

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capabilities of the anatomical

range (localized, generalized

bronchiectasis), symptoms (dry, wet-

with or without chronic respiratory infection

paths, event. hemoptýzu, the complications-inflammation

the lungs, sepsis or septic States, the deterioration of the

lung function (obstrukčního type)

event. respiratory insufficiency.

---------------------------------------------------------------

2A light form, 10-20

localized bronchiectasis symptoms

usually within 3 months of the year, pulmonary

ventilation outside the statistical period normal

---------------------------------------------------------------

2B moderate form, 25-40

generalized bronchiectasis symptoms

usually 4-6 months in the year, pulmonary

ventilation limited slightly to moderately, without

disorders of the blood gases

---------------------------------------------------------------

2 c heavy form, 60-80

generalized bronchiectasis, recurrent

exacerbations of lung infections, complications,

Chronic bacterial positivity, pulmonary

the features below 50% of the relevant values, with or without

impaired blood gases

---------------------------------------------------------------

3 Asthma

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the level of ability

control of asthma (management), and

the cover of the daily symptoms, limitations

daily activities, nighttime symptoms, Lung

function (PEF, of FEV1), exacerbations, event.

hospital admissions. In doing so, account should be taken

also complicating factors, secondary

the effects of treatment, sleep apnea syndrome,

respiratory infections, depression. Spirometry

It is necessary for the assessment of the příznakového and

bezpříznakového period of asthma; While

takes into account the current treatment. Spirometrii

is to be made in the course of one year

at least 2 x the asthma under control;

in the case of partial or inadequate

control 1 x for three months. For the determination of

rates of decline in working ability is

decisive impact on overall health

the performance and the ability to perform daily

activity.

---------------------------------------------------------------

3A asthma under control, 5-10

no restrictions on daily activities, functions, PEF,

Normal daily symptoms of FEV1, not more than 2 x

a week, usually no night symptoms

need úlevových medication no more than twice a week,

as a rule, no exacerbations. one to

two per year

---------------------------------------------------------------

3B under the partial control of asthma, 20-40

restrictions on daily activities only in the presence of

symptoms and exacerbation of FEV1, PEF, < 80%

appropriate values or personal best

values, daily symptoms more than twice a week,

night symptoms, need more úlevových medicines

than twice a week, three or more exacerbations in

year

---------------------------------------------------------------

3 c asthma under a lack of control, 50-60

three or more characters partial checks

in week one exacerbation at any

week of FEV1 usually in the range of 60-70%

appropriate values

---------------------------------------------------------------

3D hard-to-treat asthma (OLA), 70-80

the presence of the three main and two side

diagnostic criteria of FEV1 < 50%

appropriate values, the need for institutional care

in a hospital or specialized treatment Institute

---------------------------------------------------------------

4 dust on the lungs (pneumoconiosis)

Silicosis, asbestosis, pneumokonióza uhlokopů

The medical aspect:

When determining the rate of decline in employment

capabilities must be taken into account that

Pneumoconiosis (silicosis, collagen

uhlokopská pneumokonióza, asbestosis)

usually progredují even after the end of exposure

fibrogennímu the dust. For the determination of the extent

decline in working ability is crucial

demonstrate the extent and gravity of disability (according to the x-ray

the image and the classification, according to the

vysokorozlišující tomography-HRCT)

the dynamics of the development of disability, the findings

lung function and transfer factor (TLCO)

examination of blood gases and blood counts,

the presence of chronic inflammation of the Airways

paths.

A benign pneumoconiosis does not nekolagenní

the decline in work skills.

The rate of decline in the capacity to work with silicosis

infection with Mycobacterium tuberculosis (M.

TB) is defined as disorders of lung

features a comparably under item 1, section

(B) of chapter X.

---------------------------------------------------------------

4A silicosis simple pneumokonióza simple, 10-15

asbestosis in the initial stage (s2),

without substantial restrictions on lung function

---------------------------------------------------------------

4B silicosis complicated, pneumokonióza 20-25

complicated, more advanced stadium

asbestosis (s3, t2-above), States without

a significant limitation of lung function or

simple silicosis with pulmonary disorder

features

---------------------------------------------------------------

4 c silicosis, asbestosis, the moderate 35-50

impaired lung function

---------------------------------------------------------------

4 d with silicosis, asbestosis a severe disorder 60-70

lung function

---------------------------------------------------------------

4E moderate or severe pulmonary disorder 75

functions with cardiovascular complications,

with pulmonary hypertension, cor pulmonale

---------------------------------------------------------------

5 Other disability of the lung, pleura

Birth defects, pulmonary embolism,

interstitial fibrosis, Lung impairment in the

System disabilities, scar adhesions

the pleura, Lung operations.

The medical aspect:

When determining the rate of decline in employment

in particular, it is necessary to evaluate the ability of x-ray

the lung HRCT of the lung-function tests,

ventilation, pulmonary transfer factor

pliability, blood gases at rest and after

physical stress and others. For the determination of the extent

decline in working ability is crucial

failure of ventilation and respiration.

---------------------------------------------------------------

5A light functional disability, 10

restriction, obstructive or mixed disorder

ventilation without changes the saturation of the arterial

blood oxygen (SaO2 were studied), the reduction of values

lung function 10-34% good values

---------------------------------------------------------------

5B medium hard functional disability, 30-50

the reduction of lung function of 35-50% of the relevant

values, and higher, SaO2 were studied 92 normal

the value of blood gases, reduction or SaO2 were studied

PaO2 after physical stress (e.g., 6 min

walk test), according to the degree of reduction of the pulmonary

features

---------------------------------------------------------------

5 c heavy functional disability, 70-80

lung function reduced below 35% relevant

values, or the values below 50% of the relevant

in the case of deterioration of the blood gases already in

peace

---------------------------------------------------------------

6 tuberculosis (TB)

The medical aspect:

When determining the rate of decline in employment

ability is a crucial presence

extensive residual lesions on the lungs and

the decline in lung function and adverse impact

on the overall performance and the ability to perform

the day's activities. The rate of decline in employment

the ability for pulmonary forms of TB with the disorder

lung function shall be determined comparably

According to item 1, section B, chapter X.

Pulmonary forms of TB, in the case of M.

TB sensitive to medications (antituberkulotika),

usually do not lead to a decline in the working

the ability, as the neinfekčnosti and restore

functional State is achieved in a few

weeks (or months).

The rate of decline in the capacity to work with

extrapulmonary TB, determined in accordance with the residual

damage to the function of the affected authority

equally in accordance with the health

disability.

---------------------------------------------------------------

6a pulmonary form of TB 5

with slight residual x-ray changes

without the disorders of the lung function

---------------------------------------------------------------

6B on the treatment of resistant TB, MDR, XDR, when 70

the treatment is to take or lasts longer than one year

---------------------------------------------------------------

7 Sarcoidosis

The medical aspect:

When determining the rate of decline in employment
the capabilities you need to evaluate the localization,

range and chargeable to the disability, whether they are affected by

intrathoracic lymph nodes, lungs and other organs-

the central nervous system, the uvea, myocardium,

kidney, small joints and salivary glands.

---------------------------------------------------------------

7A hilových lymph nodes enlarge, without limits 5

lung function, in remission

---------------------------------------------------------------

7B with a light impaired lung function 10

(restriction)

---------------------------------------------------------------

7 c disability in stage II, 30-50

disability and the lung parenchyma, lymph nodes

with moderate impairment of lung function,

the reduction of lung function of 35-50% of the relevant

values, according to the degree of fault

---------------------------------------------------------------

7 d disability in stage III, 60-70

extensive disability pulmonary parenchyma

with extensive fibrózními changes, with severe

impaired lung function or with the cor

pulmonale

---------------------------------------------------------------

8 Lung Transplantation

---------------------------------------------------------------

8A to stabilize health 70

---------------------------------------------------------------

8B after State, 40-60

According to the degree of lung function and limitations

the overall performance

---------------------------------------------------------------

8 c the failure of transplantovaného authority, 70-80

---------------------------------------------------------------



Chapter XI-



IMPAIRMENTS OF THE DIGESTIVE SYSTEM

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work for

organic and functional disability of the gastrointestinal tract

It is critical the extent and gravity of organ disorders, their impact on the

the overall health, nutrition and overall performance. When weight loss

and malnutrici is based on the BMI (body mass index-mass

index), levels of blood proteins (albumins) and the influence of deficiency

food on the erytropoezu. Food allergies cause a decrease of

capacity to work only if they have an effect on the nutritional status and

the overall performance.

---------------------------------------------------------------

SECTION A-DISABILITY OF THE ORAL CAVITY AND ESOPHAGUS

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 the States after operations of cleft lip, jaw and 15-25

floor

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the persistence of disorder

swallowing, eating, speech and the possible

cosmetic defect.

---------------------------------------------------------------

2 function of language Disorder, defect of the jaw,

articulation disorders, chewing and mimic

with the event. the need to receive a liquid diet

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the extent of functional

the implications and the impact on overall performance.

Functional disability and the degree of a decline in work

capacity shall be determined in accordance with item 1, section

And, chapter X.

---------------------------------------------------------------

3 Achalazie

---------------------------------------------------------------

3A without significant eating disorders, dysphagia 10

---------------------------------------------------------------

3B with a distinct eating disorder 20-40

(regurgitation of undigested food, vomiting,

the pressure behind the breastbone) and by reducing the overall

the performance, by the extent of the restrictions

---------------------------------------------------------------

4, gastroesophageal reflux disease, reflux esophagitis

---------------------------------------------------------------

4A, slizničními erozemi 20-30

---------------------------------------------------------------

4B cirkulárními erozemi sweeping up ulcers 35-50

on the lining of a significant decrease in weight, and

the overall performance

---------------------------------------------------------------

5 hiatal hernia

---------------------------------------------------------------

5A with dyspeptickými problems, 10-20

---------------------------------------------------------------

5B with passages, erozemi, foot ulcers, 35-50

lossy anemií, considerable overall

the performance of the

---------------------------------------------------------------

6 esophageal Diverticula

---------------------------------------------------------------

6a with pressure pain, dysfagií, regurgitací 10-20

---------------------------------------------------------------

6B with a restriction of food intake, a fatal disorder 35-50

nutrition, anemií, a significant decrease in weight

(if not, maybe the surgical treatment), and the total

the performance of the

---------------------------------------------------------------

7 Benign stenosis of esophagus

---------------------------------------------------------------

7A without significant barriers to eating 10

---------------------------------------------------------------

7B with functionally significant obstruction, dysfagií, 25-40

odynofagií, with an extension of the time meals,

limiting forms of the diet, according to the impact on the

the overall performance

---------------------------------------------------------------

7 c with a severe obstacle to food intake, 50-70

vomiting, aspiration, malnutricí, an important

a decrease in weight, with a severe reduction in

the overall performance, some daily activities

substantially limited

---------------------------------------------------------------



SECTION B-AFFECTION OF STOMACH AND DUODENUM

---------------------------------------------------------------

The rate of

The item type of disability decline

Working

ability

in%

---------------------------------------------------------------

1 Ulcer Disease of the stomach and duodenum

caused by Helicobacterem pylori (HP), HP

negative ulcer caused by nesteroidními

antirevmatiky, stress ulcer

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed by the positive

Endoscopic examination with biopsy, HP

and HP, HP-negative acute gastritis ulcer

in connection with the treatment of steroids and the impact

status on the overall performance.

---------------------------------------------------------------

1A seasonal repeated recurrences of clinically 5-10

proven, conservatively treated, with variations

the weight of the

---------------------------------------------------------------

1B often recurrent disability, in the meantime, 15-20

with erosive gastritis, repeated

dyspeptickými, with a slight decrease in

the weight of the

---------------------------------------------------------------

1 c States with complications, a fatal disorder 30-50

nutrition and decrease in weight and

the overall performance

---------------------------------------------------------------

2 States after operations of the stomach

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate whether the

functional or organic disorder, for example. the gully

in přívodné loop hole and regurgitaci bile,

reflux from the přívodné loops, and the related syndrome

the impact of status on the overall performance.

---------------------------------------------------------------

2A lightweight functional disorders 10-15

---------------------------------------------------------------

2B moderate functional disorders of 20-40

---------------------------------------------------------------

2 c organic disorder coupled with karenčním 50-70

syndrome with significant weight loss,

anemií, metabolic osteopatií, with a heavy

by reducing overall performance, some day

the activity substantially limited

---------------------------------------------------------------

3 Functional gastric dyspeptický syndrome (, 5-15

intestinal)



---------------------------------------------------------------

SECTION C-DISABILITY OF THE SMALL INTESTINE AND KOLOREKTA

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Malasimilační syndrome

The medical aspect:

The rate of decline in the capacity to work shall be

comparably, according to disability,

that is the cause of malasimilace.

---------------------------------------------------------------

2 Céliakie, malabsorpční States (in particular the

due to the deficit of enzymes of enterocytes)

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the level of

serum autoantibodies, the result of the biopsy

the lining of the small intestine, nutritional status, weight loss

weight and impact on overall performance.

---------------------------------------------------------------

2A conditions stabilized, without the essential 10

subsequent speeches while adhering to the gluten free

diets

---------------------------------------------------------------
2B with a significant reduction in overall performance and 30-40

the State of nutrition through compliance with the dietary

policy

---------------------------------------------------------------

2 c with complications-advanced malnutricí, 50-70

metabolic osteopatií, polyneuropathy,

ataxia, depression, ulcerative jejunoileitidou and

a severe reduction in overall performance

---------------------------------------------------------------

3 Other disability of the small intestine

Syndrome of the small intestine

(blind loop syndrome), intestinal

lipodystrophy (Whipple's disease).

---------------------------------------------------------------

3A form, 10-20

with diarrhea and steatoreou

---------------------------------------------------------------

3B moderate forms, 30-40

with diarrhea, and steatoreou, the anemií, with considerable

by reducing the overall performance

---------------------------------------------------------------

3 c severe forms, 60-70

with diarrhea, artritidami, disabilities

lymph nodes, seróz, septic States,

with severe reduction in overall performance

---------------------------------------------------------------

4 idiopathic inflammatory bowel diseases

Crohn's disease, idiopathic proktokolitida.

---------------------------------------------------------------

4A States sufficiently stabilized, 10-20

occasional aggravation with diarrhea, mild laboratory

activity

---------------------------------------------------------------

4B moderate forms, 30-40

frequent diarrhea, considerable variation

in the laboratory findings, significant changes to the

Endoscopic, x-ray, radionuclide,

a significant reduction in overall performance

---------------------------------------------------------------

4 c severe forms, 60-70

with complications (abscesses, intestinal stenosis,

fistulas), mimostřevními (joint, skin,

eye, hepatobiliárními, kidney) and

nutritional (malnutrition, metabolic

osteopathy, anemia), hard to reduce the total

the performance of the

---------------------------------------------------------------

5 Colitis with a known etiologic agents

Radiation enteritis, colitis, ischemic

other colitis.

---------------------------------------------------------------

5A light forms with nausea, slight diarrhea 10-20

---------------------------------------------------------------

5B medium hard form, 30-40

with abdominal pain, diarrhea,

constipation, weight loss, with considerable

by reducing the overall performance

---------------------------------------------------------------

5 c severe forms, 60-70

with complications such as. stenosis of the intestine,

adhezemi, abscesses, píštělemi, with a heavy

by reducing the overall performance

---------------------------------------------------------------

6 Diverticular disability bowel syndrome, syndrome

irritable bowel, other functional intestinal

disorders

---------------------------------------------------------------

6a light problem-bloating, 5-10

irregular stool

---------------------------------------------------------------

6B with stronger permanent symptoms, 25-35

with diarrhea, spasms, several times a day

by reducing the State of nutrition, anemií, by reducing the

the overall performance

---------------------------------------------------------------

6 c with significant permanent symptoms, 40-60

with the reduction of the State of nutrition, disorders of the passage,

anemií, bleeding, recurrent infections or

narrowing of the bowel, a substantial reduction in the total

the performance of the

---------------------------------------------------------------

7 the perianal fistulas

---------------------------------------------------------------

7A with occasional secretion 10

---------------------------------------------------------------

7B heavily exuding 2nd degree, the local manifestations of 40-50

chronic inflammation

---------------------------------------------------------------

7 c permanently heavily exuding 2nd degree, the total acts of 60-70

chronic inflammation, with significant influence on the

the overall condition and performance

---------------------------------------------------------------

8 bowel incontinence 70

---------------------------------------------------------------

9, Adhesions of the peritoneum

---------------------------------------------------------------

9A without significant influence on intestinal passage 10

---------------------------------------------------------------

9B with repeated passages disorders 20-30

---------------------------------------------------------------

10 Artificial outlet of the digestive tract on the surface of 35-45

the body (nonmalignant etiology), by function

---------------------------------------------------------------

11 Other disability the anus and rectum, hemorrhoids, 10-20

According to the impact on the emptying and overall

the performance of the

---------------------------------------------------------------

SECTION D-HERNIA

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Inguinal, Femoral, umbilical hernia or white 10-15

the line (according to the size and reponovatelnosti),

diaphragmatic hernia reflux acting ezofagitidu

---------------------------------------------------------------

2 Abdominal hernia scar

---------------------------------------------------------------

2A with impaired function of the abdominal organs (in the 10-15

disorders of passages)

---------------------------------------------------------------

2B with a larger eventerací the bowels from the abdominal wall, 35-50

mechanically limiting the performance, without the possibility of

the operating solution

---------------------------------------------------------------

2 c with an extensive eventerací the bowels before belly 60-70

the wall, with the significant limitations of the overall

the performance, without the possibility of operating solutions

---------------------------------------------------------------

SECTION E-PANCREATIC CANCER, GALL BLADDER AND BILE DUCTS

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Chronic disability of the pancreas

An alcoholic, tropical, hereditary,

hyperkalcemická, autoimmune, idiopathic

pancreatitis, conditions after surgical

performances on pancreatic cancer.

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the clinical skills

image examination results exokrinního

(cholecystokinin, sekretinový test) and

the results of the examination of the endocrine (C peptide,

determination of insulin in serum), morphological

examination (abdominal ultrasonography, CT

abdomen, ERCP and endoscopic that,

ultrasonography), and the impact of disability on the

the overall performance.

---------------------------------------------------------------

1A diarrhea only when dietary errors, without 5-10

significant deviations in the biochemickém and

morfologickém examination

---------------------------------------------------------------

1B dyspeptické problems, diarrhea and pain in 15-25

dietary errors, reduce light nutrition

and overall performance, the light of the derogation

in the biochemickém and morfologickém examinations

---------------------------------------------------------------

1 c diarrhea with a distinctive steatoreou, 35-50

the State of nutrition, some symptoms

malasimilačního syndrome, a significant decline in

weight, a serious deviation in the biochemickém and

morfologickém examination, inability to manage

the normal load

---------------------------------------------------------------

1 d malasimilační syndrome, 60-70

severe reduction in nutrition and overall

performance accompanied by complications. for example.

pankreatickou pseudocystou, obstruction

the bile ducts, ascites, pleurálním

výpotkem, lienální vein thrombosis, daily

the activity substantially limited

---------------------------------------------------------------

2 chronic diseases of the gallbladder and bile

paths

Litiáza, chronic relapsing inflammation,

After performances on the biliary,

postcholecystektomický syndrome.

The medical aspect:

When determining the rate of decline in employment

the ability must be assessed by how much the frequency

or inflammations, presence of complications within the meaning of

acute biliary pancreatitis, acute

cholangoitidy, biliárního the ileum, gangrene

the gallbladder and the impact on overall health

performance.

---------------------------------------------------------------

2A with kolikami at intervals of months, including 5

inflammation, without complications

---------------------------------------------------------------

2B with a more frequent kolikami (once a month), 10-20

with more frequent infections without complications,

postcholecystektomický syndrome

---------------------------------------------------------------

2 c States after repeated performances on the papilla, 40-50

Biliary, with complications,

severe functional disorders, disorders
nutrition, considerable reduction in overall performance

When the normal load

---------------------------------------------------------------

SECTION F-DISABILITY LIVER

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Autoimmune hepatitis, hepatopatie, other

than a viral etiology, non-alcoholic

steatohepatitida, primary biliary

cirrhosis, primary sclerosing

cholangoitida, alcoholic disability

the liver, the hepatic steatosis, liver

steatofibróza, liver cirrhosis, toxic

liver damage, damage to the chemical

substances

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the functional capabilities

the capacity of the liver (by the biochemical and

histological inflammatory activity and

fibrotické), the extent and activity of the

process, the speed of progression, disorders

metabolism, possible mimojaterní

speeches, nutritional status, fatigue, tolerance

burdens, the impact on the overall performance and

the ability to perform daily activities. For

evaluation of liver cirrhosis is used

The child Pughova the classification, for the

alcoholic hepatitis DF discriminatory

function or Glasgow Alcoholic Hepatitis

score.

---------------------------------------------------------------

1A light disorders, 15-20

without complications, without mimojaterních

expressions, with slightly reduced performance, with

fatigue

---------------------------------------------------------------

1B moderate disorders, 30-45

with reduced functional capacity of the liver,

compensated liver cirrhosis, lighter

mimojaterní, significant long-term

fatigue, with a substantial reduction in the total

performance at normal load, some

the daily activities carried out with difficulty or

limited by the extent of the failures and limitations

---------------------------------------------------------------

1 c heavy breakdowns, 60

the capacity of the liver disorder, heavy

metabolism, nutrition, development of liver

cirrhosis Child-Pugh classification-and,

functionally significant speeches, mimojaterní

substantial reduction of overall performance

a light load, inability to perform

some of the daily activities

---------------------------------------------------------------

1 d especially severe disorders, 70-80

dekompenzovaná liver cirrhosis-

Child-Pugh classification (B), (C),

hard mimojaterními speeches or final

stages, liver insufficiency, Terminal

phase of hepatic failure

---------------------------------------------------------------

2 Wilson's disease

The medical aspect:

When determining the rate of decline in employment

the ability is necessary to assess whether the

form neurologicko-psychiatric, where

the rate of decline in employment skills

determined in accordance with chapter V or VI, or

the form of the liver, where the rate of decline in the

work provides a comparably

According to item 1, section F, chapter XI.

---------------------------------------------------------------

3 of Hereditary hemochromatosis

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the capability forms

manifestation. The forms of the hepatic rates

the decline in work provides

comparably, according to item 1, section F,

Chapter XI, on forms with the manifestation of the

Diabetes according to item 2, chapter IV,

forms with the prevailing symptoms

cardiomyopathy in accordance with chapter IX.

---------------------------------------------------------------

4 Porphyria

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability

and borne by the liver damage. Drop rate

capacity to work shall be

comparably, according to item 1, section F,

Chapter XI.

---------------------------------------------------------------

5 liver transplantation

---------------------------------------------------------------

5a to stabilize health and 70

liver function

---------------------------------------------------------------

5B after reaching stabilization health 40-60

the State, in stabilizing the liver function,

by limiting the overall performance, the range

and the degree of possible complications

---------------------------------------------------------------

5 c the failure of transplantovaného authority, 70-80

---------------------------------------------------------------



Chapter XII-



SKIN AND SUBCUTANEOUS TISSUE

---------------------------------------------------------------

General medical principles:

The rate of decline in the capacity to work shall be determined according to the

location and extent of the disability, the degree of alteration of the overall

State, accompanying symptoms, the frequency of relapses or chronicity

and severity of the adverse effects of long term therapy. It is necessary to

assess also the accompanying organ or system changes

infectious complications, movement restrictions and the impact of the

functional disorders on the overall status, performance, and the ability to

to perform daily activities. In assessing the extent of the downturn of the working

the ability for diseases of the skin and subcutaneous tissue would be tracked

period applicable to the assessment of the degree of a decline in work

the skills should take usually one year.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 infection of the skin and subcutaneous tissue (a chronic

Pyoderma)

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and

the intensity of the disability and the impact on the overall condition of the

and performance.

---------------------------------------------------------------

1A light functional disability, 10-15

bounded processes with slightly extended

inflammation of the skin and subcutaneous tissue

---------------------------------------------------------------

1B moderate functional disability, 30-40

significant skin changes with the reaction of the internal

environment, the overall symptoms of inflammation

---------------------------------------------------------------

1 c heavy functional disability, 50-60

extensive forms of long-term strongly active

inflammation, without adequate response to therapy,

a significant reduction in the ordinary performance

load

---------------------------------------------------------------

1 d especially severe functional disability, 70

forms with recurrent septickými States,

the inability of any of the load

---------------------------------------------------------------

2 Puchýřnatá disease (Pemphigus, Pemphigoid)

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability

sowing, localization and activity of the process and

the impact on the overall health and performance.

---------------------------------------------------------------

2A lightweight functional disability, 10-15

bounded by the processes of slight expansion

---------------------------------------------------------------

2B moderate functional disability, 30-40

significant speeches with mokváním, or

system changes

---------------------------------------------------------------

2 c heavy functional disability, 50-60

extensive long term highly active forms

with the side effects of treatment, a considerable reduction

performance at normal load

---------------------------------------------------------------

2D functional disabilities particularly hard, 70

hardly influenced forms with distinct

superinfekcí or extensive and functionally

heavy side effects long term

kortikoidní therapy

---------------------------------------------------------------

3 skin inflammation on iritačním, alergickém or

konstitucionálním basis (Dermatitis,

Eczema)

The medical aspect:

When determining the rate of decline in employment

It is necessary to evaluate the range of skills,

localization and activity of the process and the impact on

the overall condition and performance.

---------------------------------------------------------------

3A light functional disability, 5-15

bounded by the speeches in predilekčních

localisation but also elsewhere on the skin or

stabilized forms of long-term ekzémových

changes in low degree of exacerbations

---------------------------------------------------------------

3B moderate functional disability, 25-35

significant speeches with frequent exacerbacemi on the

larger areas of skin or

generalized stabilized forms,

reduction in performance under normal load

---------------------------------------------------------------

3 c hard functional disability, 40-50

extensive and repeated relapsing forms of

or generalized form without good

answers to local or general treatment,

a significant reduction in the ordinary performance

load

---------------------------------------------------------------

3D functional disability, particularly hard, 70
forms with the generalisation of

remain on the skin for several years without any changes,

complicated side effects of therapy

---------------------------------------------------------------

4 Disease with inflammation of the skin and impaired rohovění

(psoriasis, lichen, keratodermie)

---------------------------------------------------------------

4A light functional disability, 5-10

symptoms affecting the predilekční

localization of small intensity of inflammation or

rohovění

---------------------------------------------------------------

4B moderate functional disability, 20-35

symptoms affecting the localization predilekční

with greater intensity of inflammation or rohovění, with

frequent exacerbacemi or larger

disability in other than predilekční

Localization with long-term activity

---------------------------------------------------------------

4 c heavy functional disability, 40-50

extensive skin involvement with long-term

high activity, difficult to treat,

reduction in performance when the normal load

---------------------------------------------------------------

4 d particularly severe functional disability, 70

extensive skin involvement with massive inflammation

and the formation of scales, extensive permanent

articular changes the nature of the mutilujícího

---------------------------------------------------------------

5 Urtikarie and angioedema

---------------------------------------------------------------

5A minimum functional disability, 5

recurrent urtikarie and angioedema without

the permanent functional consequences

---------------------------------------------------------------

5B medium hard functional disability, 25-40

angioedema permanent major

reziduálními consequences

---------------------------------------------------------------

6 chronic exposure to harmful effects of external

environment (mechanical, thermal, physical,

including radiation)

---------------------------------------------------------------

6a light functional disability, 15

smaller skin areas or

stabilized forms with a wide-exacerbacemi

---------------------------------------------------------------

6B moderate functional disability, 25-35

clear manifestations on the exposed parts of the

the body or generalized stabilized

forms with a wide-exacerbacemi

---------------------------------------------------------------

6 c severe functional disability, 40-50

generalized symptoms with adverse

progress or speeches in places only

exposed, the considerable decrease of performance in

the normal load

---------------------------------------------------------------

6 d especially severe functional disability, 70

generalized symptoms, accompanied by the emergence of

necrosis and ulceration

---------------------------------------------------------------

7 Diseases of skin appendages (nails, hair, Sebaceous

gland, etc.)

---------------------------------------------------------------

7A light functional disability, 10-25

affected more than 8 nails on the upper

the limbs or on the lower limbs,

where appropriate, with the separation of the nail discs;

and in terms of the impact on the working

the ability is more significant disability nails

the hands of the

---------------------------------------------------------------

7B alopecia, regardless of the scope and the etiology of 10

---------------------------------------------------------------

7 c serious or extensive forms of acne vulgaris, 10-25

rosacei and other folikulárně-bound

processes

---------------------------------------------------------------

7 d hard to functional disability, 40-60

very severe forms of Acne (acne conglobata

Acne fulminans) with total manifestations,

fevers, artralgiemi, with the formation of fistulas

and the limitations of momentum, a considerable reduction

performance at normal load, according to the

the extent of disability

---------------------------------------------------------------

8 Other diseases of the skin and subcutaneous tissue

---------------------------------------------------------------

8A the minimum functional disability, 5

Vitiligo, scars, pigmentation disorders, and more

---------------------------------------------------------------

8B hard working disability,

extensive elephantiasis legs/extremities

The rate of decline in the capacity to work shall be

comparably by 9, section B,

Chapter IX.

---------------------------------------------------------------

9 Malignant skin tumors

The rate of decline in the capacity to work shall be

comparably under Chapter II.

---------------------------------------------------------------



Chapter XIII-



DISABILITY, MUSCLE AND SKELETAL SYSTEM

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in the capacity to work with

based on the functional disabilities of locomotor system. While it is

need to evaluate whether it is inflammatory, system or

a degenerative disability, its localization, scope and gravity

activity, the degree of structural handicap, whether it is affected by the

one or more joints, disability, presence of a function of the joints

mimokloubních symptoms, degree of alteration of the overall condition. Is

necessary to take into account developments of disability, i.e.,. speed

progression, response to treatment and the event. complications of treatment. For

determination of the rate of decline in the capacity to work is a decisive impact

information on the overall performance, movement

skills, the ability to manage the daily activities and quality of

of life. For the evaluation of functional disability used

questionnaires on the evaluation function, quality of life, algofunkční

indexes, etc. and an assessment of the functional consequences of the disability movement

and the supporting organs and functional capabilities in accordance with the international

the classification of functional ability, disability and health. Itself

degenerative changes without malfunctions or operation

the kinematic system, which has a good functional outcome,

shall decrease working capacity.

---------------------------------------------------------------

SECTION A-ARTHROPATHY

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Osteoarthritis

Primary localized or

generalized, secondary arisen

as a result of trauma, congenital or developmental

defects due to a mechanical overload

or as a result of another illness,

Erosive (involving the hands, with multiple

expressed inflammatory component).

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the functionally significant

the affection of joints, the localization of osteoarthritis

the worsening mobility (knee and hip

the joints, in particular in relation to the achievement of the

critical values for mobility and common

life), whether it is affected by the dominant top

limb and hand, or whether it is a

rapidly progressive or erosive

osteoarthritis. Take into account also possible

complications such as necrosis of bone,

instabilita joint. For the impact on the working

the ability of disability is critical

mobility, the ability of standing, sitting,

changes in body position, standing up and usedání,

bending, the ability to perform

coordinated action in handling

with articles, the impact on the overall performance and

the ability to perform daily activities.

---------------------------------------------------------------

1A light forms, 10

with a slight impact on the function of joints and

the limbs, mobility and overall

the performance of the

---------------------------------------------------------------

1B moderate disability, 20-35

with functionally significant impairment of two and

more large/bearing joints or

most significant restrictions with a functionally

the small joints of the hands or feet, preserved

motor skills, decreased the total

the performance, some of the daily activities

performed with difficulty or with the use of

compensatory mechanisms or funds

---------------------------------------------------------------

1 c of heavy disability, 40-50

with functionally severe disabilities of two and more

large/bearing joints or with severe

disabilities most of the small joints of the hands

(especially the disruption of the grip) or feet,

considerable limitation of motor skills and

overall performance in medium-heavy

load some of the daily activities are limited

---------------------------------------------------------------

1 d especially difficult disability, 60-70

severe disability, motor skills,

the overall performance, some day

activities greatly reduced

---------------------------------------------------------------

2 Rheumatoid arthritis (RA)

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the overall symptoms and

the activity of the disability established clinically and

in the laboratory, the morphological development of the stadium

disability rate of progression, the development
phase, structural damage, accompanied by the

contractures, deformitami, atrofiemi

the muscles. Evaluate whether or not the duration,

early forms of (less than 2 years duration)

to be taken into account, that there is a greater chance for

remission and functional changes are effective

treatment of reversible. At the same time it is necessary to

take into account and to respond to treatment,

the presence of mimokloubních speeches (e.g..

pulmonary fibrosis, Vasculitis), the presence of

Joint complications (necrosis, ankylosis,

instability) and systemic complications

(osteoporosis, amyloidosis, anemia,

depression) and complications of treatment (stomach

sores, organ toxicity). From

imaging methods to evaluate X-RAY as

the basic imaging method and, in certain

indications can be used and the magnetic

resonance-MRI or ultrasound. To

evaluation of basic indicators at the RA is

appropriate use of the numeric valorizované

indicators, i.e.. for the activity of the DAS 28

(Disease activity score) and for the assessment of

the function of the Health Assessment questionnaire (HAQ

Questionnare).

---------------------------------------------------------------

2A form, 10-15

rarely, recurrent, with continuous light

impaired function of multiple joints, HAQ 0-

0.5, in remission, without significant

signs of activity (DAS 28 less than 2.6)

---------------------------------------------------------------

2B slowly progressive forms, 20-35

light to medium malfunction, HAQ >

0.5 and 1.0, daily < some activities carried out with difficulty, with the use of compensatory mechanisms and resources, activity permanently low, DAS 28 < 3.2, maybe an occasional outbreaks, states without organ damage and systemic manifestations, transitional minimum x-ray progression---------------------------------------------------------------2 c moderate forms, 40-60 HAQ > 1.0 and < 1.5, medium to more pronounced malfunction of the upper and/or lower limbs, the substantial reduction of overall performance, some of the daily activities are limited, the present joint deformity and distortion, muscle atrophy, tendon problems, typically medium to high activity, DAS 28 > 3.2, persistent x-ray

the progression

---------------------------------------------------------------

2D severe forms, 70

severe malfunction, HAQ > 1.5, hard

the reduction in overall performance, most of the

daily activities are limited, destruction and

deformity of the joints, complications (necrosis,

subluxation, ankylózy, destruction),

x-ray progression, activity high, DAS

28 > 5.1 (for late forms may no longer

the activity of the fall)

---------------------------------------------------------------

3 Reactive arthritis

Aseptic, immunologically conditional inflammation

the joints, which arise in connection to the

Remote infection.

The medical aspect:

When determining the rate of decline in employment

skills must be based on the

the fact that it is mostly about disability

prognosticky, short-term and

temporary.

If the progress of chronic, lasting longer

than one year, the functional consequences and the rate of

decline in the capacity to work shall be

comparably by rheumatoid arthritis

According to item 2, section A, chapter XIII.

---------------------------------------------------------------

4 Infectious arthritis

Bacterial arthritis (negonokoková,

gonokoková, borrelióze, Lyme disease

specific), viral (retrovirové including

HIV), parasitic and induced by fungi.

To artritidám related to infection include

and rheumatic fever.

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the malfunction

(restrictions on the mobility of the affected

joints), activity and the scope of the process,

the structural impact of the disability and disability

on the overall performance and movement

abilities. Functional consequences are assessed and

the rate of decline in the capacity to work with

provides for a comparably by item 2,

section A, chapter XIII.

---------------------------------------------------------------

5 Dna

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the malfunction

(restrictions on the mobility of the affected

joints), activity and the scope of the process,

structural impairments (destruction

the joint tissues, deformities, bone erosion

on the X-RAY) and mimokloubní manifestations of days

(especially kidney impairment) and the impact of

disability on the overall performance and

motor skills.

---------------------------------------------------------------

5A light forms, 10-15

with the thinness of the frequency of attacks, with the minimum

by limiting the mobility of the joints

---------------------------------------------------------------

5B progressive forms, 20-35

with a common frequency of seizures, the

structural changes in multiple joints,

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

5 c chronic tofózní gout, 40-60

serious structural and functional disability

multiple joints, a substantial reduction in the total

the performance, some of the daily activities

limited

---------------------------------------------------------------

5 d severe forms, 70

heavy duty structural impairment (deformity)

and functional disability of multiple joints,

the presence of mimokloubních expressions, hard

the reduction in overall performance, most of the

daily activities are limited

---------------------------------------------------------------

6 of psoriatic arthritis

Seronegative arthritis combined

with psoriasis, asymmetrical forms,

oligoartikulární, symmetrical, distal,

mutilující, axial.

The medical aspect:

When determining the rate of decline in employment

based on the capabilities of the structural

changes according to the RADIOGRAPHIC findings that are

the character of destructive arthritis to

with akroosteolýzou, the presence of

periostitid, entézopatií and ankylóz, the changes

on the spine, the functional capabilities of the aker

the upper and lower limbs, and the impact of

the established facts on motion

capabilities, the overall performance and

the ability to perform daily activities.

At the same time it is necessary to take into account the answers

on the treatment.

---------------------------------------------------------------

6a light forms, 10-15

rarely, recurrent, with mild disorder

the function of several joints, HAQ 0-0.5, without

significant signs of activity, up to a maximum of 1

the active joint

---------------------------------------------------------------

6B slowly progressive forms, 20-35

with moderate impairment of the function

several joints,

HAQ > 0.5 and < 1.0, ranging from how mimokloubními speeches, the number of active joints 1-3, some of the daily activities carried out with difficulty---------------------------------------------------------------6 c moderate forms, 40-60 is a considerable disorder features upper and/or lower limbs, with a significant reduction in overall performance, with frequent relapses, HAQ > 1 and < 1.5, 3 and more active joints, some daily activities are limited---------------------------------------------------------------6 d severe forms, 70 progressive, medically hard to be influenced, with destructive changes to akroosteolýzou, ankylózami, polyarticular disability or the final destruction of several joints, HAQ > 1.5,

as a rule, high activity, but can be

already extinct, States with severe impaired

the function of the upper and/or lower limbs,

the thrust forms the development restrictions

the spine, chest, desk kyphosis of the spine,

with mimokloubními,

a severe reduction in overall performance,

most of the daily activities are limited

---------------------------------------------------------------

SECTION B-OSTEOPATHY AND CHONDROPATIE

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Osteoporosis

The medical aspect:

When determining the rate of decline in employment

skills are assessed repeatedly

denzitometricky (T score) on pathology

more bones, reducing the total bone

the masses, bone architektoniky disorder,

the total extent of the disability and the incidence of

fractures associated with osteoporosis,

in particular, the fractures of the distal forearm,

compression fractures of the vertebral bodies and the

fractures of the proximal femur, adverse

functional consequences of fractures and the answer

on the treatment. In the case of osteoporosis without

suffered fractures, account shall be taken, and to

specified to the individual at risk for

its establishment. For the determination of the extent of the downturn

incapacitation is a decisive impact

the established facts on motion

capabilities, the overall performance and

the ability to perform daily activities.

---------------------------------------------------------------
1A light form, 10

osteopenia, with restrictions for long standing,

walking and heavy physical work, whole-body

bone density (DXA) decreased by 10 to

25%, Tskóre to-1.0 2.5 SD

---------------------------------------------------------------

1B moderate form, 20-35

with a reduction in overall performance when

the normal load, whole-body bone

density (DXA) decreased by more than 25%,

Worse than 2.5 Tskóre-SD

---------------------------------------------------------------

1 c heavy form, 40-60

with the presence of at least one fracture on

the basis of osteoporosis, with substantial

by reducing the overall performance and generally

significant impacts on mobility,

whole-body bone density (DXA)

decreased by more than 25%, Tskóre worse

than-3.5 SD

---------------------------------------------------------------

1 d especially severe form, 70-80

Tskóre worse than 3.9 SD, daily activities

severely limited

---------------------------------------------------------------

2 complex regional pain syndrome

Algodystrofický syndrome, Morbus Sudeck,

shoulder-hand syndrome

The medical aspect:

When determining the rate of decline in employment

the ability to assess the extent, the gravity and

localization of the disability, the frequency and the gravity

pain, vasomotor dysfunction,

dystrofické or atrophic changes

demineralisation bone, trophic changes

skin, muscles atrophy, joint mobility,

the presence of nerve lesions (type without

defined the nerve lesion, II. the type of the

with a defined neural lesions) and impact

the infringement on the ability to

to perform daily activities and on disability

motor skills, walking, standing,

the ability to maintain and change of body position,

the ability to perform coordinated action

When moving and handling objects,

the need for the use of compensatory mechanisms and

AIDS. Functional status is evaluated using the

therapeutic testing, muscle

the test, the vascular examination, EMG and markers

bone turnover.

---------------------------------------------------------------

2A light local disorder 10

---------------------------------------------------------------

2B medium difficult disorder, 20-35

with the restriction function of the limb, some

daily activities are performed with difficulty

or with the use of compensatory mechanisms

and AIDS

---------------------------------------------------------------

2 c heavy disorder, 40-50

the inability of the current load, some

daily activities are limited

---------------------------------------------------------------

2D difficult disorder, 60-70

the inability of most of the daily load

activities limited

---------------------------------------------------------------

3 chronic osteomyelitis

Exogenous type, type of Hematogenous including

spondylodiscitid, osteomyelitis

related to a disorder of the blood supply (e.g..

Diabetic Gangrene).

The medical aspect:

When determining the rate of decline in employment

ability to evaluate functional disabilities

arising from the location, the extent of

disability, the frequency of attacks, laboratory

signs of activity, disability of other authorities

the influence of chronic infection and impact

information on the overall

performance and skills.

---------------------------------------------------------------

3A light grade, 10

localized, with little activity, without

the decline in the overall performance of

---------------------------------------------------------------

3B the Middle degree, 30-40

the greater the scope of the process, the mild persistent

secretion of inflammatory fistula, mark

activities in the laboratory findings, considerable

reduce the overall performance of the

---------------------------------------------------------------

3 c heavy grade, 60-70

more extensive chronic ulceration of trespassing

to the bone, laboratory signs of long-term and

significant activities, frequent heavy attacks with

fever, infiltration of the soft

tissues, suppuration, and excretion of sekvestrů, with

alteration of the overall condition and severe

by reducing overall performance, with signs

the secondary disability of organs, for example.

anemia, Amyloidosis

---------------------------------------------------------------

4 disorders of growth with a focus on system

diseases of the skeleton

Congenital skeletal system diseases

(Achondroplasia, dysostosis

cleidocranialis), metabolic diseases

by changing the strength of the bones (Marfan

syndrome, mukopolysacharidózy, rarely

osteogenesis imperfecta), obtained

systemic diseases of the skeleton (rachitis).

The medical aspect:

When determining the rate of decline in employment

skills are assessed, whether it is a simple

growth failure, or if the associated

with deformitami, disproporcemi, disorder

ventilation, cardiac performance, movement

capabilities and reducing the overall performance.

---------------------------------------------------------------

4A body height proportional, after their 35-50

growth not exceeding 120 cm, with regard to the

physical ability and overall performance

---------------------------------------------------------------

4B growth failure associated with functionally 60-70

major deformitami of the limbs and

the chest, impaired mobility,

ventilation and cardiac performance,

with a significant reduction in overall performance

---------------------------------------------------------------

SECTION C-SOFT TISSUE

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Idiopathic inflammatory myopathies

Heterogeneous group acquired chronic

disability dermatomyozitidy,

polymyozitidy, myozitidy, in the framework of the

pop-up syndromes, myozitidy United

with malignant disease, myozitidy

with bodies corpuscles.

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the degree of muscle

weakness (according to Kendall, Janda)

the presence of extramuskulárních expressions,

the activity of the disability, the presence of

contractures, skin and joint symptoms

disability of the muscles of the larynx, disability

the myocardium and the effect of the established facts

on the physical ability and overall

performance.

---------------------------------------------------------------

1A light failure, 10

local disability, retained the ability to

to manage the normal load limits for the

long standing and walking

---------------------------------------------------------------

1B moderate disorders, 20-30

with a slight limitation of mobility and overall

the performance of the

---------------------------------------------------------------

1 c heavy disorders, 40-60

with a major reduction in overall performance

When a light burden and significant disorders

mobility, substantial activity in the long term

---------------------------------------------------------------

1 d particularly severe disorder, 70-80

hard to reduce the total performance,

mobility, the presence of mimosvalového

disability, severe respiratory disorders,

swallowing, disability of heart performance,

long-term high activity

---------------------------------------------------------------

2 Epicondylitis and other entézopatie

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate whether the disorder

úponová (pain in the area of the radial or

ulnárního epicondyle disorders) unilateral or

double-sided and the impact of the disorder on the identified

load capacity of the limbs work.

---------------------------------------------------------------

2A unilateral impairment with a light impaired 5-10

the function of the limb

---------------------------------------------------------------

2B unilateral impairment is severe 15-25

impaired limb function, in particular

the dominant

---------------------------------------------------------------

2 c double sided disability, according to the range and 15-35

gravity

---------------------------------------------------------------

3 of fibromyalgia

The medical aspect:

When determining the rate of decline in employment

ability to evaluate local find with

the presence of pain during palpation of at least

11 of the 18 points, fibromyalgických

mimokloubní symptoms-stiffness,

chronic fatigue, a feeling of exhaustion,

headaches, sleep disorders, and the impact of

the observed State of the overall performance.

---------------------------------------------------------------

3A local find without total symptoms, 5-10

maintain the ability to handle normal

load

---------------------------------------------------------------

3B local find, with the overall symptoms, 15-25

decrease in performance during middle load

---------------------------------------------------------------

4 Úžinové syndromes, syndrome carpal
the tunnel

The medical aspect:

When determining the rate of decline in employment

the ability to evaluate the limit function

the limbs, especially the hand weight

zánikových neuromuscular manifestations

with regard to EMG findings and dominance

limb and in the case of motor

the deficit outcome ergodiagnostického

testing (functional test). Itself

the extension of the distal motor latency

or sensitive speed the management found

without limitation on the EMG does not

the decline in work skills.

---------------------------------------------------------------

4A disability of one limb with light 10

impaired function of the hand, the restrictions

load capacity of a limb or part of a

---------------------------------------------------------------

4B disability of one limb with moderate 15-20

severe impairment of sensitive and

motor functions, in particular the function of the hand

---------------------------------------------------------------

4 c disability of one limb with severe 20-30

impaired sensory and motor

features a heavy hand with the function disorder

atrofiemi small muscles, thenaru

with regard to the dominance of the

---------------------------------------------------------------

4 d disability of both legs with a slight 15-20

disruption of the fine motor skills, with light

impaired function of the hands

---------------------------------------------------------------

4E disability both limbs with moderate 35-45

impaired function of the hands

---------------------------------------------------------------

4F disability both limbs with severe disorder 50-60

the function of the hands, in particular the violation of the grip and

the significant decrease in strength,

with the small muscles of the atrofiemi thenaru

---------------------------------------------------------------

SECTION D-SYSTEM DISABILITY BINDERS

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 systemic lupus erythematosus (SLE),

systemic sclerosis, polyarteritis nodosa,

polymyositis, Dermatomyositis,

Vasculitis, Sjogren's syndrome

The medical aspect:

When determining the rate of decline in employment

skills are assessed according to the scale and status

the weight of the disability of the connective tissue (arthritis,

myocarditis, Pneumonitis, mark

séropozitivity), presence of vascular

syndrome (with the symptoms on the skin in the kidneys,

the central nervous system, retina)

manifestations of catabolism (fever, weight

weight loss) and the results of laboratory examination

(high FW, leukopenia, lymfopenie,

thrombocytopenia, activity B lymphocytes

with the formation of autoantibodies,

hyperimunoglobulinemie, proteinuria and

microscopic hematuria). Is evaluated

also the amount and severity of individual

organ impairment (e.g., for

dermatomyozitidy disability especially skin

and striated muscle, in SLE

the affection of the skin, cardiovascular

system, kidneys, joints, Central

the nervous system and lung) and the impact of

information on the overall

performance.

---------------------------------------------------------------

1A light forms, 10-15

rarely, recurrent, without significant

signs of activity

---------------------------------------------------------------

1B protracted, slowly progressive forms, 20-35

with the volatile activity, with a slight reduction in

overall performance under normal load

---------------------------------------------------------------

1 c moderate forms, 40-60

permanently (medium) active, with a more pronounced

impaired function of some organs and

systems, with a major reduction in the total

performance under normal load, with frequent

relapses

1 d severe forms, 70-80

consistently highly active, progressive,

hardly aeromedical influenced, with severe

impaired function of some organs and

systems, the inability of any load

---------------------------------------------------------------

SECTION E-DORZOPATIE AND SPONDYLOPATIE

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Painful spine syndrome including status after

Surgery of the spine or spinal injuries after

degenerative changes of the spine, výhřezy

intervertebral discs

The medical aspect:

When determining the rate of decline in employment

ability to evaluate functional disabilities

the spine and the resulting restrictions

overall performance and mobility and the impact of

the ability to perform daily activities.

It is based on the extent and location of

disability (monosegmentální,

plurisegmentální disorders), time

during the functionally significant

structural changes (compression, location map

and instability, osteoporosis, degenerative

changes), operationally significant neurological

clinical presentation (usually up to a hypo

areflexie, sensation disturbances, irritations

speeches, paresis, decreased muscle tone disorders

trofiky in the segment, muscle atrophy,

long-term pain in the segment

with reflexive changes), the award of the EMG,

muscle imbalance, etc. Chargeable to the peripheral

muscle paresis is necessary to establish the test.

It is equally necessary to objectify

any malfunction of sphincters.

---------------------------------------------------------------

1A with a minimum functional disabilities, 5

disability of one or more sections of the spine

intermittent blockades with transitional restrictions

the mobility of the spine, muscle imbalance,

without root irritation

---------------------------------------------------------------

1B with a light functional disabilities, 10-20

disability typically more segments of the spine,

polytopní blockade with restrictions

mobility, muscle imbalance, disorder

statics and dynamics of the spine with occasional

symptoms of root irritation,

with slight neurological recidivujícím

finding, no signs of damage to the nerve,

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

1 c is medium-severe functional disabilities, 30-40

severe disability of one or more sections

the spine, a serious disorder and statics

the dynamics of the spine, muscle insufficiency

corset, with often recidivujícími symptoms

root irritation with functionally significant

Neurological findings with damage

nerve, respectively. clinical presentation neurogenního

the bladder, with a major reduction in

overall performance during normal load,

some of the daily activities are limited

---------------------------------------------------------------

1 d with severe functional disabilities, 50-70

severe disability more segments of the spine,

with permanent displays of the root irritation,

Permanent functionally significant neurological

the discovery, with severe damage to the nerves,

severe paresis, muscle atrophy, disorders

momentum of the limbs, severe disorders of functions

sphincters, in the overall performance

a light load, some daily activities

greatly reduced

---------------------------------------------------------------

2 congenital or acquired deformities of the spine

Scoliosis, spondylolysis, spondylolisthesis,

posture deformity

in connection with these kompresivními

vertebrae, Klippel-Feilův syndrome (fusion

the cervical vertebrae), degenerative

diseases of the spine, stenosis of the vertebral

channel, kyphosis, gibus.

The medical aspect:

When determining the rate of decline in employment

the ability to assess the scope and gravity

disability, severity of the offset

Mayerdingovy classification, according to the angle of the

Cobb, presence of neurological

the deficit, or the lung

cardiovascular impairments. The rate of

decline in the capacity to work shall be

under the impact of the State to limit the functional

capabilities, in particular on the overall

performance, mobility, ability to walk,

standing and ability to cope with daily activities.

---------------------------------------------------------------

2A with statics and dynamics of disorder of the spine, 10

occasional root irritation, making

long walk, standing, sitting, bending,

maintain the ability to handle normal

load some of the daily activities

performed with difficulty

---------------------------------------------------------------

2B combination of serious disability more sections 40-50

with adverse neurological

symptomatologií, permanent root irritation

or serious, serious výpadové phenomena

disability of the nerves. speeches

neurogenního bladder

with a major reduction in overall performance

under normal load, some day

activities limited

2 c with severe impairment of function, 60-70
for example. by hardening the large sections

the spine, scoliosis, created an extremely

spondylolisthesis with manifestations of irritation or

compression of the spinal cord, the decline in the overall performance of

When a light load, some day

activities greatly reduced

---------------------------------------------------------------

3 ankylosing spondylitis

Form of axial, affecting only the backbone

structure, form of peripheral affecting (i)

the peripheral joints, a form of rhizomelická

affecting joints (hip, root

the shoulders).

The medical aspect:

When determining the rate of decline in employment

the ability to assess the scope and gravity

disability (clinically and X-RAY), activity

the process, functional disorder of the spine and

joint pain, disability, overall performance,

mobility, walking, sitting, standing,

the ability to manipulate objects,

deformity, destructive changes. While

account of the extraskeletálním organ

expressions (eye, skin, mucous,

the cardiovascular, pulmonary, neurologic

etc.). The evaluation function is used

HAQ, to evaluate the activities of BASDAI (Bath

Ankylosing Disease Activity Index);

in doing so, shall take into account and to respond to treatment.

---------------------------------------------------------------

3A with a minimum functional disabilities, 10

the affection of one section of the spine

with a minimum reduction in mobility or

the combined minimum impairment of the spine and

joint pain or disability of more than two

joints with minimal restrictions

mobility, HAQ 0-0.5, the BASDAI permanently

< 4.0---------------------------------------------------------------3b with a light functional disabilities, 15-20 disability more than two segments of the spine with limitation of mobility or disability of one section of the spine with limitation of mobility and disability more than two joints with minimal to slight limitation of mobility or disability of more than two joints with a light, slightly limiting the mobility of the active process, HAQ > 1.0 0.5 1, 0 and >

1.5, the BASDAI > 4.0

---------------------------------------------------------------

3D with severe functional disabilities, 45-60

the solidified several sections of the spine, strongly

active process or

disability of all the sections of the spine with very

severe mobility restrictions, or

States, by hardening one section of the spine,

the limited development of the chest, fixed

thoracic kyfózou, and with functionally significant

disabilities more than two large joints,

States with medium-heavy restrictions

momentum,

long-term active process, HAQ > 1.5,

BASDAI > 4.0

---------------------------------------------------------------

3E very heavy functional restrictions, 65-75

solidification of all segments of the spine, on the x-ray findings

bamboo spine, or

States with serious disabilities of the spine and

with the functionally disabled more than

two joints or

heavy destructive changes more than two

joints with very severe limitations

mobility up to ankylózou or

States with functionally serious

ventilation, with a permanent high

activity process, severe restrictions

mobility,

HAQ > 1.5, the BASDAI > 4.0 (but it can also

die)

---------------------------------------------------------------

4 Diffuse Idiopathic Skeletal

HYPEROSTOSIS (ankylosing Hyperostosis,

Forestierova disease)

The medical aspect:

When determining the rate of decline in employment

ability to evaluate functional disabilities

the spine, the limitations of momentum, the presence of

entézopatií, neurological complications

from the pressure of the surrounding structures, osifikací

in the later stages of the complications of type

dysphagia, dyspnea, and impact of the

the facts on overall performance and

mobility.

---------------------------------------------------------------

4A restrictions of the spine with mild disorder momentum 10

---------------------------------------------------------------

4B the rigidity of the spine with moderate 20-30

disorder of momentum and reducing overall

performance under normal load

---------------------------------------------------------------

4 c fatal disorder of momentum with neurological 40-50

complications, dysfagií, námahovou

shortness of breath

---------------------------------------------------------------



Chapter XIV-



THE AFFECTION OF GENITOURINARY SYSTEM

---------------------------------------------------------------

SECTION A-DISABILITY URINARY SYSTEM

---------------------------------------------------------------

General medical principles:

The rate of decline in the capacity to work shall be determined according to the

the extent and gravity of the degree of disability, activity, process failures

features of the uropoethican system, which is necessary to determine the

special functional tests (e.g. by specifying the creatinine and

urea testing glomerular filtration and concentration

skills testing, isotope, urografií, urodynamickým

examination, endoscopy, sonografií). It is necessary to take into

account of any disability of the other institutions. For the determination of the extent

decline in working ability is a crucial impact of disorders

on the overall status, performance, and the ability to handle daily

activity. In assessing the extent of the downturn to work for

disorders of the urinary system, the reference period applicable to

assessment of the rate of decline in the capacity to work, should take

usually one year.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Congenital defects of the urinary system, other defects

Cyst of kidney, multiple cysts, kidney

polycystóza, hydronefróza, solitary kidney

kidney, urinary tract defects, stricture

ureteru, megaureter,

reconstruction surgery of kidney or

bladder and other.

The medical aspect:

The rate of decline in the capacity to work shall be

According to the scale and gravity of disabilities, disorders

features of the uropoethican system, the range of

inflammatory complications and disability discharge

urine.

In the case where the birth defect will result

in chronic kidney failure, or

incontinence, the rate of decline in employment

capacity shall be determined according to a comparably

relevant items of chapter XIV.

---------------------------------------------------------------

1A defects well functionally compensated or 5-15

with minimal or slight impact on function

the outflow of urine, kidney or lighter inflammatory

complications

---------------------------------------------------------------

1B light disturbances, 25-35

States with kidney function and urinary disorders

paths, reduction of the function of more than one-third,

disorders of the outflow of urine with recidivujícími

inflammatory complications

---------------------------------------------------------------

1 c moderate disorders, 45-50

reduction of kidney function by more than half,

ureterostomie, cystostomie

---------------------------------------------------------------

2 Inflammatory affection of urinary system

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and the kind of

disability (chronic relapsing

cystitis, interstitial cystitis,

chronic pyelonephritis, chronic

Interstitial nephritis), laboratory

significant findings (bakteriurie, pyuria,

proteinuria, leukocytosis, other total

signs of inflammation), malfunction and possible

the complications.

In the case where the inflammatory affections will result

in chronic kidney failure, the rate of decline in the

working ability shall be equally

under item 6, chapter XIV.

---------------------------------------------------------------

2.1 the chronic or recurrent bacterial inflammation of the 10

the lower urinary tract,

minimum or light find in functional

the tests

---------------------------------------------------------------

2.2 the interstitial cystitis, 20-40

reduction of the function of more than one-third in the

functional tests, a significant reduction

performance at normal load

---------------------------------------------------------------

2.3 the chronic pyelonephritis, chronic 20-40

Interstitial nephritis,

reduction of the function of more than one-third in the

functional tests, a significant reduction

performance at normal load

---------------------------------------------------------------

3 Urolithiasis

The medical aspect:
Urolithiasis in itself without a functional disorder or

carried out the operation (removal of nephrolithotomy)

with a good functional result, does not make the

the decline in work skills.

In the event that the disability is complicated by

Interstitial nefritidou, the rate of decline in the

capacity to work shall be determined according to the

the extent of the complications of comparably according

item 2 or 6, chapter XIV.

---------------------------------------------------------------

4 Glomerulopatie (primary, secondary)

other kidney, regardless of disability

the etiology of

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the extent of the ability and

the severity of the changes, degree of activity, disorder

renal function on the basis of the laboratory

file examination, markers of inflammation,

proteinuria, coagulation, immunological

examination, ultrasonography, where appropriate,

biopsy of the kidney. It is necessary to take into

account of the possible complications of renal

disability (anemia, coagulation disorders,

kalciofosfátového disorder of metabolism,

hypertension, hyperlipidemias and others) and

side effects of the treatment.

---------------------------------------------------------------

4A minimum functional disability, 10-15

achieving remission, decline, decrease in activity

or disappearance of proteinuria, normalization, or

improvement of renal function and urinary findings

the decline or disappearance of the titre of antibodies,

the absence of a functional impairment of the kidney

without complications, or just a light

complications, increased unavitelnost

---------------------------------------------------------------

4B light functional disability, 20-30

reduction of renal function (medium hard

reduction in glomerular filtration), chronic

forms with disabilities tubulointersticia,

the presence of functionally significant

chronic complications, slowing down the progression

functional and morphological disability,

securing the long-term renoprotektivní and

immunosuppressive treatment, according to the scale

functional limitations

---------------------------------------------------------------

4 moderate disability, 40-50

reduction of renal function on III. to (IV).

According to KDOQI, degree of Glomerular filtration

below 30 ml/min/1,73 m², at present

other chronic complications, a considerable reduction

performance at normal load, some

daily activities are limited by range

functional limitations

---------------------------------------------------------------

4 d hard working disability, 70-80

significantly reduced renal function in.

According to KDOQI, chronic complications are serious

functional disabilities of the other institutions and

systems, United nefrotická proteinuria, fully

developed, persistent nephrotic syndrome,

Advanced chronic renal insufficiency,

some of the daily activities heavily restricted

---------------------------------------------------------------

5 Polycystická kidney disease autosomal

the dominant type (PCHLAD)

The medical aspect:

The rate of decline in the capacity to work shall be

According to the severity of chronic renal

insufficiency and associated complications

(a disorder of the metabolism, fosfokalciového

bleeding, infection) and extrarenálních expressions

(disability liver) comparably by item

6, chapter XIV.

---------------------------------------------------------------

6 chronic renal failure/chronic renal

insufficiency

The medical aspect:

When determining the rate of decline in employment

the capabilities you need to evaluate the speed

the progression of the failure, the stadium, the complications of

associated with renal insufficiency, in particular

cardiovascular complications, infectious

complications, damage to the central nervous

system, anemia, bleeding, renal

osteopatii/bone disease, the effect

transplantation or complications associated with it

and the impact on the overall performance and health day

activity.

---------------------------------------------------------------

6a light functional disability, 20-30

Stadium I or II, some daily activities

performed with difficulty

---------------------------------------------------------------

6B moderate functional disability, 40-50

stage III. to IV., functionally severe

chronic complications, a considerable reduction

performance at normal load, some

daily activities are limited

---------------------------------------------------------------

6 c severe functional disability, 60-80

Stadium of chronic kidney failure,

irreversible kidney failure, stadium, in.

Glomerular filtration is reduced to less

than one-eighth the physiological values, i.e.,

under 0.16 ml/s, with or without uremickými

symptoms (neuropathy, encephalopathy,

pleuritis, pericarditis, malnutrition,

haemorrhagic Diathesis) or with multiple

complications, daily activities heavily restricted

---------------------------------------------------------------

6 d chronic kidney failure treated with dialysis 60-80

with multiple heavy complications

---------------------------------------------------------------

6E chronic kidney failure treated with dialysis 50-60

with or without lighter complications, according to the

the extent of the restrictions

---------------------------------------------------------------

7 Kidney Transplantation

The medical aspect:

If there is a deterioration of the function of the graft and

the function of transplanted kidneys, the degree of

decline in the capacity to work shall be

equally according to the extent of functional disability

According to section 6a, 6e, and chapter

XIV.

---------------------------------------------------------------

7A State after transplantation to reach 70

stabilization of renal function

---------------------------------------------------------------

7B State after a kidney transplant in a good 10-20

stabilization of renal functions, and without the presence of

complications

---------------------------------------------------------------

7 c status after combined transplant kidneys and 35-50

pancreas in stabilizing the renal and

pancreatic function and without the presence of

complications

---------------------------------------------------------------

8 urine Incontinence in women

---------------------------------------------------------------

8A occasionally and unique escape of urine when you load 5-10

in several ml (need small inserts)

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

loss of urine when stressed 8B maneuvers are 20-30

less than 30 ml (urine leakage when coughing,

laughing, sneezing, or lifting heavy

objects, use of assistive devices

irregular), some of the daily activities

limited

---------------------------------------------------------------

8 c medium stress incontinence, 40-50

loss of urine during stressful maneuvers are

between 30-80 ml, leakage of urine occurs when you change the

position, running, walking, lighter physical jobs,

the use of the equipment is usually permanent,

some of the daily activities significantly limited

---------------------------------------------------------------

8 d heavy incontinence of urine, complete incontinence 70

loss of urine during stressful maneuvers are

greater than 80 ml, urine leakage occurs when

the minimum rise nitrobřišního pressure

urine leaks out permanently, use of assistive devices

incontinence is a constant necessity

---------------------------------------------------------------

9 Incontinence of urine in men after Prostatectomy

The medical aspect:

The rate of decline in the capacity to work shall be

equally according to the extent functional disorders

under item 8, section A, chapter XIV.

---------------------------------------------------------------

10 of Neurogenic bladder

The medical aspect:

When determining the rate of decline in employment

ability to evaluate clinical findings including

Basic reflexes anogenitální area

Voiding cards, urinalysis,

ultrasonography the kidneys and bladder,

uroflowmetrie event. a comprehensive

urodynamického examination.

---------------------------------------------------------------

10A States with frekventní mikcí (polakisurie), 25-40

urgent of urination, nocturia, referred to in the scope of

disability

---------------------------------------------------------------

10B complete incontinence

The rate of decline in the capacity to work shall be

comparably by 8, section A,

Chapter XIV or according to the causes of disability.

---------------------------------------------------------------

11 Chronic fistula urinary and genital

tract, veziko-vaginal, uretero-

vaginal

The medical aspect:

When determining the rate of decline in employment

the ability to hodnotní the clinical finding,

disorders of urination, urine leakage, the activity range

the infectious process, any disorder

renal function, vulvitidy, kolpitidy,

Decubitus ulcers and impact on overall health

performance and daily activities.

---------------------------------------------------------------

11A chronic fistula with persistent mild secretion, 30-50

local inflammation, frekventní or urgent

urination, some daily activities are limited

---------------------------------------------------------------

11B chronic fistula with a hearty secretion, 70

with the overall response, extrauretrální
incontinence of urine total, permanent,

some of the daily activities significantly limited

---------------------------------------------------------------

stenosis of the urethra Stricture, 12

---------------------------------------------------------------

12A with satisfactory draining 10

---------------------------------------------------------------

12B poradiační poradiační cystitis, accompanied by 35-50

and proktitidou, algickým syndrome

---------------------------------------------------------------

13 kidney malignant tumors, bladder,

urinary tract

The medical aspect:

The rate of decline in the capacity to work shall be

comparably under Chapter II.

---------------------------------------------------------------

14 Loss or swipe function of one kidney in 10

good second kidney function

---------------------------------------------------------------

15 Loss or swipe one kidney function when

impaired function of the other kidney

The medical aspect:

The rate of decline in the capacity to work shall be

under items 4 or 6, chapter XIV.

---------------------------------------------------------------

16 nephrotic syndrome

The medical aspect:

When determining the rate of decline in employment

skills you need to evaluate the size of the

proteinuria, hypoproteinemie,

hypoalbuminemie, hyperlipidemias and

associated complications, especially infection,

thromboembolic complications, the disorder

the metabolism of lipids and protein malnutrici

and the impact of the condition on the overall performance.

---------------------------------------------------------------

16A light degree, 20-40

proteinuria 3-4 g/24 hours, mild

hypoproteinemie, hypoalbuminemie,

moderate hypercholesterolemia, sparsely infectious

the complications are not signs of protein

malnutrition, reduce the overall performance

the normal load, according to the extent of the restrictions

---------------------------------------------------------------

16B middle grade, 50

approx. 5 g/24hours proteinuria, considerable

hypoproteinemie and hypoalbuminemie,

hypercholesterolemia, occasional infectious

complications, usually are not signs

protein malnutrition, the significant reduction

performance at normal load, some

daily activities are limited

---------------------------------------------------------------

16 c heavy grade, 60-70

proteinuria over 6 g/24 hours, heavy

hypoproteinemie, hypoalbuminemie,

hypercholesterolemia, permanent or often

recurrent swelling, infection, and

thromboembolic complications, signs

malnutrition, some of the daily activities of the heavily

limited

---------------------------------------------------------------

SECTION B-DISABILITY SEXUAL SYSTEM

---------------------------------------------------------------

General medical principles:

The rate of decline in the capacity to work shall be determined according to the

location and extent of the disability and the functional disorders and complications

resulting therefrom (total, local, urinary, bowel, and other) and

the impact on the overall condition of the identified faults and performance.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Malignant tumors

Prostate cancer, penile, testicular tumor

The medical aspect:

The rate of decline in the capacity to work with

be determined comparably under Chapter II.

Decisive for the determination of the extent of the downturn

work in the States

stabilized functional manifestations and

the consequences, in particular, incontinence, poradiační

cystitis, proctitis, poradiační

lymfedémy, mental health problems and others.

---------------------------------------------------------------

2 Chronic inflammatory process appendages, 10

parametrial or uterus

chronic inflammatory conditions, often

recurrent

---------------------------------------------------------------

3 Disability after the removal of the uterus for benign

the process of

The medical aspect:

Hysterectomy-surgical removal of the uterus

for the benign process does not make the drop

working abilities. The decline in the working

skills may be just late

complications, in particular of the uropoethican injuries

and the gastroinstestinálního tract and

postoperative fistulas.

The rate of decline in the capacity to work with

in such cases, according to the type

functional disorders and disability

comparably under Chapter XI or XIV.

---------------------------------------------------------------

4 Endometriosis a heavy degree of

4A functional disorders associated with a painful 10

symptomatologií, disorders of urination (urge to use,

nocturia, polakisurie)

---------------------------------------------------------------

(4B) a very advanced form of endometriosis, 20-35

functional organ complications, in particular

stenosis, the emergence of the present as hydronephrosis, ureteru

kidney damage or

functional disorders as a result of surgical treatment,

in particular of the uropoethican and

gastroinstestinálního tract, post-operative

bladder fistulas, hypotonia,

retention of urine.

The rate of decline in the capacity to work with

be determined according to the type of functional disorders and

disability comparably according

Chapter XI or XIV.

---------------------------------------------------------------

5 the menopausal and perimenopauzální disorders, 10

Climacteric syndrome

6 decline in the walls of the vagina, prolapse of the vagina or

the uterus

The medical aspect:

When determining the rate of decline in employment

It is necessary to assess the severity of abilities

clinical staging of the descent, the functional

disorders (local, urinary, bowel) and impact

the identified functional disorders on the overall

performance.

---------------------------------------------------------------

6a light functional disability, 15

No incontinence or with slight

stress incontinence, local and

intestinal symptoms, or

status after the operation with satisfactory functioning

the result of the

---------------------------------------------------------------

6B severe functional disability, 60-70

a significant descent to prolapse, accompanied by a

severe urinary incontinence, stage III.

and (IV)., a condition that is not possible to solve

surgically

---------------------------------------------------------------

7 disability of female Incontinence

genital organs

The medical aspect:

When assessing the degree of a decline in work

the ability to assess the severity of the need

incontinence.

The rate of decline in the capacity to work with

provides for a comparably by item 8, section

And, chapter XIV.

---------------------------------------------------------------

8 Malignant tumors of the vulva, vagina, uterine

the neck, cervical body (endometrial cancer),

the fallopian tubes, ovary, gestational

choriokarcinom the medical aspect:

The rate of decline in the capacity to work with

be determined comparably under Chapter II.

Decisive for the determination of the extent of the downturn

work in the States

stabilized functional manifestations and

the consequences, in particular cystitis, poradiační

poradiační, lymfedémy, proctitis, if any

vesico-urethral fistula or lesions

rectovaginální, disorders of the intestinal passages,

algický syndrome, psychological problems and

the other.

---------------------------------------------------------------



Chapter XV-



FUNCTIONAL DISORDERS, DISABILITY AFTER INJURIES, OPERATIONS

---------------------------------------------------------------

General medical principles:

When assessing the extent of the downturn to work based on the

from a functional disability, which is involved in how disability

the carrier and the musculoskeletal system, and disability function other

organs and systems. It assesses in particular disability

performance, mobility (walking, standing), ability to coordinate

movements, and the manipulation of objects, the ability to exercise

the day's activities. Impact on working ability to scope and gravity

disability features organs or body systems, anatomical or

functional loss of limbs or parts of musculoskeletal

changes, disruption of the mobility of the joints and limbs, Lymphedema,

neuropathy, speaking disorders, receiving food, digestion,

urination, defecation, chronic pain, psychological changes, failure of

the senses, the operating result or performance. the aesthetic of the disability.

Itself having suffered loss or injury, surgery, implantation of the joint refund

with a good functional result does not fall in the working

abilities.

---------------------------------------------------------------

SECTION A-DISABILITY, HEAD, NECK, BODY,

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 functional disorders after injuries of the head, Arch

or the skull base, brain

The medical aspect:

For the determination of the rate of decline in employment

the ability is crucial and the weight range

Neurological symptomatology, restrictions

mental abilities and intellect,

communication, respectively. the extent of Visual impairment or

hearing.

---------------------------------------------------------------

1A minimum functional disorders of 5-10
---------------------------------------------------------------

1B States with functional disabilities, 15-25

some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

1 c moderate disability, 30-45

the performance of some of the daily activities limited

---------------------------------------------------------------

1 d heavy disability, 50-60

the performance of some of the daily activities significantly

limited

---------------------------------------------------------------

1E difficult disability, 70-80

the combined heavy mental disability,

sensory and motor capabilities, performance

most daily activities heavily restricted

---------------------------------------------------------------

2 functional disorders after injuries of the orofacial

area

The medical aspect:

For the determination of the rate of decline in employment

ability to evaluate disorders of opening

disorders of the mouth, chewing, changes to the occlusion,

the aesthetic deformities, ankylosis

mandibulárního joint, changes the position of the eye

bulbu, limitation of movement or souhybu eye

bulbu, disorders of binocular vision,

the throughput of the nose.

---------------------------------------------------------------

2A light fault 10

---------------------------------------------------------------

2B moderate disorders 30

---------------------------------------------------------------

2 c heavy disorders, 50-70

limited speaking, inability to chew,

the need for the consumption of the mixed diet,

facial disfigurement, according to a range of disorders

---------------------------------------------------------------

3 functional disorders after injuries of the neck

The medical aspect:

Rate of decline in the capacity to work shall be

According to the predominant functional disability,

the extent and gravity the symptomatology in particular

comparably, according to item 1, section E,

Chapter XIII.

---------------------------------------------------------------

4 functional disorders after injuries to the chest, ribs,

the breast bone and of intrathoracic organs

The medical aspect:

For the determination of the rate of decline in employment

ability to evaluate deformation and loss

the mobility of the thoracic wall, nervous disorders

-neuralgia, nerve paresis, interkostálních

the status of the wind features and performance of the heart,

the scope of the limitation of overall performance and impact

the ability to perform daily activities.

---------------------------------------------------------------

4A light disorders, 10-15

reduction of mobility of chest wall

---------------------------------------------------------------

4B moderate disorders, 25-35

light reduction of the cardiac output and breathing

features

---------------------------------------------------------------

4 c difficult disorder, 50-70

a serious decline in the heart with a functionally

the performance and functions of the wind, by weight

disorders

---------------------------------------------------------------

5 functional disorders after injuries of the abdomen,

intra-abdominal organs, kidneys

The medical aspect:

For the determination of the rate of decline in employment

the ability to evaluate the extent of the residual

disability of the abdominal wall, digestion disability

and passages, the disability function intra-abdominal

organs, metabolism, and excretion.

---------------------------------------------------------------

5A light disorders 10-15

---------------------------------------------------------------

5B medium hard disorder 25-35

---------------------------------------------------------------

5 c heavy disorders, 50-70

According to the extent of the affected functions and authorities

---------------------------------------------------------------

6 functional disorders after injuries of the pelvis,

fractures of the pelvic bone, mandible,

sacrum and tailbone fractures

The medical aspect:

For the determination of the rate of decline in employment

the ability to assess whether the violation occurred

the integrity of the pelvic ring, disability

the function of the bladder, voiding disorders,

disorders of defecation, the extent of the limitations of the physical

performance and mobility and the impact on

the ability to perform daily activities.

---------------------------------------------------------------

6a light disorders, 10-20

intermittent neurological symptomatology,

statics and dynamics of disorders of the lower section of the

the spine

---------------------------------------------------------------

6B moderate disorders, 30-40

functionally significant features of the pelvic floor disorder

Plaits and residual neurologic manifestations

on the lower limbs (recurrent

root irritation, slight paresis)

---------------------------------------------------------------

6 c severe disorders, 50-60

substantial reduction of physical performance,

mobility, moderate paresis, impaired

the House, some of the daily activities significantly

limited

---------------------------------------------------------------

6 d especially severe disorders, 70-80

the minimum mobility, where appropriate, reliance

on the wheelchair, the complete disability

sfinkterů

---------------------------------------------------------------

7 functional disorders after polytraumatu

with multiple poúrazovými effects

(in particular the combined disability of the head,

the chest and limbs)

The medical aspect:

For the determination of the rate of decline in employment

the ability to assess the scope and gravity

the disability of the individual organs and systems,

in particular, in relation to the total performance,

mobility and ability to perform daily

activity.

---------------------------------------------------------------

7A light fault 10

---------------------------------------------------------------

7B moderate disorders 25-40

---------------------------------------------------------------

7 c hard disorders 50-60

---------------------------------------------------------------

7 d especially severe disorders of 70-80

---------------------------------------------------------------

SECTION B-DISABILITY, LIMB

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 Loss of limbs, their parts

The medical aspect:

The rate of decline in the capacity to work shall be

According to the limitations of physical performance,

mobility, walking, standing, ability to

the coordination of movements, functional disability

hand, handling and transferring articles,

impact on the ability to perform daily

activities, with regard to the dominance of the top

the limb.

---------------------------------------------------------------

1A anatomical loss of one limb or 70

loss of limbs with short thighs stump

or arms, without the possibility of compensation of the prosthesis

---------------------------------------------------------------

1B lower extremity anatomical loss in 50-60

thigh or

the loss of the upper limb in the arm with regard to

the dominance of the

---------------------------------------------------------------

1 c anatomical loss of lower limbs in amputees, 35-45

or

the loss of the upper limb in the forearm with a

regard to the dominance of the

---------------------------------------------------------------

1 d anatomical loss of hand or 35

partial loss of the hand with the complete loss of

with regard to the dominance of the grip, or

and the loss of legs

---------------------------------------------------------------

1E the loss the hand anatomy with regard to 25-30

dominance in the partially preserved function

grip or

loss of thumb with regard to the dominance of the

When partially preserved function of grip or

the loss of part of the instep or the

the loss of the leg in the metatarsus

---------------------------------------------------------------

1F anatomical loss of several fingers of one hand of 5-15

grip or screen magnification

the loss of several toes legs or feet

(in addition to inches feet)

---------------------------------------------------------------

1 anatomical loss of several toes on both 15-25

hands grip or screen magnification

the loss of an inch or two inches on the legs or

the loss of several toes foot and inch

legs

---------------------------------------------------------------

1 the combined loss of anatomical parts of two 40-70

the essential parts of limbs or extremities

According to the scale and severity of the loss, loss

the dominant upper limb, the impact

on the function of limbs, on

mobility, the ability to walk, stand,

the coordination of movements, handling and carrying

the subjects of the

---------------------------------------------------------------

1I the anatomical loss of two limbs or parts of 80

the three limbs

---------------------------------------------------------------

1john anatomical loss of both upper limbs 70-80

in the wrist and above or

both lower limbs in your shins and above

---------------------------------------------------------------

2 hip replacements on the upper extremities,

Endoprosthesis of the shoulder joint, elbow

Joint
The medical aspect:

The rate of decline in the capacity to work shall be

just when demonstrating the limitations of range of motion,

muscle strength and function of limbs for

handling and carrying objects and daily

activities by a range of functional disorders.

---------------------------------------------------------------

2A light weight disorders, 10

the lightweight limit of momentum and features

---------------------------------------------------------------

2B moderate disorders, 25-35

with impaired motor function of limbs,

muscle atrofiemi, significant restrictions

momentum in the joint, some daily activities

limited with regard to the dominance of the limbs

---------------------------------------------------------------

2 c heavy disorders, 50-70

release of inflammatory complications, severe

movement disorders of the arm

---------------------------------------------------------------

3 Turning or movement restrictions in the shoulder

the joint, the elbow/kloubech

The medical aspect:

The rate of decline in the capacity to work shall be

with regard to the fact whether it is affected by the

one or two joints, according to the scale

the movement restrictions, limit physical performance,

the coordination of movements, handling and carrying

subjects.

---------------------------------------------------------------

3A light limitation of momentum one or two 10

joints

---------------------------------------------------------------

3B moderate restriction of momentum one or 15-25

the two joints,

limits of the limbs for manipulation and

carry heavy objects

---------------------------------------------------------------

3 c stiff elbow or shoulder, taking into account 25-35

to the position,

some of the daily activities are limited

---------------------------------------------------------------

3D has solidified the two joints, 50

a significant reduction in overall performance, some

daily activities greatly reduced

---------------------------------------------------------------

4 Stiff or restrict the movement of the wrist

Joint/joints

---------------------------------------------------------------

4A momentum constraints 10

---------------------------------------------------------------

4B stiff 15-20

---------------------------------------------------------------

5 the Deformity of the fingers of the hands

---------------------------------------------------------------

5A grip 10 screen magnification

---------------------------------------------------------------

5B in partially preserved grasping capabilities 20

hand

---------------------------------------------------------------

5 c in the complete loss of the ability of the hand grip, 30-35

According to the dominance of the

---------------------------------------------------------------

6 Functional Impairments after fractures of the bones

the upper limb

---------------------------------------------------------------

6a minimum functional disorders of 5-10

---------------------------------------------------------------

6B light function of the limb disability, 15-20

reduction of the load capacity of the limb, the performance

some of the daily activities with the use of

compensatory mechanisms and resources

---------------------------------------------------------------

6 c severe disability, 30-40

a significant limitation of the function of a limb for

the manipulation of objects, heavy restrictions

momentum in the two large joints, reduction

muscle strength on 3, muscle atrophy, severe

deformity of the arm or forearm, performance

some of the daily activities despite limited

the use of compensatory mechanisms and

resources

---------------------------------------------------------------

7 functional disorders after stroke of muscles and tendons

the upper limb

---------------------------------------------------------------

7A light failure, 10

the restriction of load capacity of the limb

---------------------------------------------------------------

7B pronounced disorder, 20

with the restriction function of limbs for manipulation

and carrying heavy objects

---------------------------------------------------------------

8 replacements are on the lower limbs,

Hip, knee,

the ankle joint

The medical aspect:

The rate of decline in the capacity to work shall be

just when demonstrating the limitations of range of motion,

muscle strength, function of the limb and the total

mobility, walking, standing, and the impact on

the overall performance and the ability to perform

the day's activities.

---------------------------------------------------------------

8A light disorders, 10-15

the lightweight limit of momentum and features one

or two major joints of the lower limbs

or severe restriction of the ankle joint,

the only restriction for longer walking and standing

---------------------------------------------------------------

8B moderate disorders, 30-40

with impaired motor function of limbs,

muscle atrofiemi, significant restrictions

momentum in the knee and/or hip

the joint, with a substantial reduction in the total

mobility, some daily activities

limited

---------------------------------------------------------------

8 c hard to fault, 70

with the release of one or both of the components or the

with the progression of deformation or with incomplete

fractured shaft or with full fractured

or with recurrent subluxací or luxací

implants or contaminated with

or

States with severe postoperative disorders

motor functions on both the lower

the limbs

---------------------------------------------------------------

9 Turning or movement restrictions in the hip

or the knee joint/joints

The medical aspect:

The rate of decline in the capacity to work shall be

by limiting the range of motion, muscle strength,

the function of a limb/limbs and the total

mobility, walking, standing, and the impact on

the overall performance and the ability to perform

the day's activities.

---------------------------------------------------------------

9A light limitation of momentum one or more 5-10

joints or legs/extremities

---------------------------------------------------------------

9B moderate restriction of momentum one or 15-30

more joints or limbs/limbs, according to the

the range of functional disability

---------------------------------------------------------------

9 c hard limits of momentum one or more 35-50

the joints or limbs/limbs, according to the

the range of functional disability

---------------------------------------------------------------

9 d stiff one with regard to the 30-50

localization, favouring or nepříznivost

the position in the affected joint and the impact on the

the function of the limbs

---------------------------------------------------------------

9e solidification two joints with regard to 60-70

localization, favouring or nepříznivost

the position in the affected joints, and impact

on the function of the legs/extremities

---------------------------------------------------------------

Damage to the ligament apparatus 10 knee/knee

---------------------------------------------------------------

10A the instability, the need for compensatory AIDS, 10-15

restrictions for a longer walking and standing

---------------------------------------------------------------

10B considerable instability despite the use of 20-30

compensatory aids/devices,

violation of the stereotype of the function

limb/limbs for walking and standing

---------------------------------------------------------------

11 Solidified or movement restrictions in the ankle 10-20

Joint/joints

According to the extent of the restrictions

---------------------------------------------------------------

12 foot Deformity of fingers or legs/feet

The medical aspect:

The rate of decline in the capacity to work shall be

under the impact of the disability on the physical

performance and mobility.

---------------------------------------------------------------

12A light deformity and disorders of the legs/feet, 10-20

one-sided or two-sided, with the disruption of the

the stereotype of the walk, with the need for compensatory

AIDS

---------------------------------------------------------------

12B significant deformity and disorders of the legs/feet, 20-30

one-sided or two-sided, serious

disorders of the stereotype of the walk, limit the reach of the

walk despite the compensatory AIDS

---------------------------------------------------------------

12 c deformity of the fingers foot unilateral or 5-10

double-sided,

with the need for compensatory AIDS

---------------------------------------------------------------

13 Functional Impairments after fractures of the bones

lower limb

The medical aspect:

The rate of decline in the capacity to work shall be

by limiting the range of motion, muscle strength,

the function of the limb and the overall mobility and

the impact on the overall performance and the ability to

to perform daily activities.

---------------------------------------------------------------

13A light disability, 10-15

a slight deformity of the lower leg or thigh, light

hypotrophy of muscle, limitation of the function of the limb

For more walking and standing

---------------------------------------------------------------

13B moderate disability, limb function, 30-35

significant deformity of the legs or thighs, muscle

atrophy, a significant limitation of the function of the limb,
some of the daily activities carried out with the

the difficulties

---------------------------------------------------------------

c heavy disability, 50

severe deformity, a substantial reduction of the function

limbs and total mobility, some

daily activities are limited

---------------------------------------------------------------

14 Pseudoartrózy-paklouby limb

The medical aspect:

The rate of decline in the capacity to work shall be

According to the localization of pakloubu, physical constraints

performance and mobility, the impact on

ability to coordinate movements, migration and

the manipulation of objects.

At the same time it is necessary to take into account whether the

vital signs or avitální pseudoarthrosis.

---------------------------------------------------------------

14A of the serious limitations of the function of the limb, 35-50

According to the degree of static load limit

limbs and the dominance of the upper limb,

the vital signs of pseudoarthrosis

---------------------------------------------------------------

14B heavy disability, 50-70

significantly limited ability to an inability to

walking and standing or an inability to transmit and

handling, pseudoarthrosis, avitální

According to the location and the inability of the static and

the mechanical load

---------------------------------------------------------------

15 Posttraumatic affections of the nerves, the nerve roots

and the nerve of knitting

The medical aspect:

The rate of decline in the capacity to work shall be

with regard to the localization, the range, and borne by the

functional disability under comparably

Chapter VI.

---------------------------------------------------------------

16 a shunt legs

---------------------------------------------------------------

a short circuit in the range of 16 legs 3-5 cm 5-10

---------------------------------------------------------------

a short circuit in the range of 16 legs 6-10 cm 20-25

---------------------------------------------------------------

16 c shunt legs by more than 10 cm, by 35-50

the range of functional disorders

---------------------------------------------------------------

SECTION C-BURNS, CHEMICAL BURNS

---------------------------------------------------------------

General medical principles:

When assessing the degree of decline in working ability is

the decisive range, gravity and the localization process, damage functions

some organs or systems as a result of the treatment, the physical constraints

performance, limiting the mobility of the limbs, the ability

the coordination of movements, functional disability, the hand with the influence on

handling and carrying, the impact on the ability to perform

the day's activities. In the case of damage to the function of the eye and vision, unemployment

the decline in work provides a comparably under Chapter

VII, when the disability of the respiratory system in accordance with chapter X,

in the case of damage to other internal organs, according to the relevant

organ damage.

---------------------------------------------------------------

The item type of the disability Rate

the decline in

Working

ability

in%

---------------------------------------------------------------

1 burns and burns.

---------------------------------------------------------------

1A burns or burns on localized, 5-15

the smaller the scale, the lower the grade,

with the subsequent light functional disabilities,

According to the extent of the disability

---------------------------------------------------------------

1B burns or burns more body parts, 20-30

higher degree, with a major functional

by limiting the functions of the parts of the body or bodies and the

the overall performance, some daily activities

performed with difficulty

---------------------------------------------------------------

1 c of heavy burns or burns more parts 40-60

the body, the greater disability, disability

higher degree with complications, with damage

the function of certain organs or systems,

with the significant decline in the overall performance of the

under normal load, some daily activities

limited by a range of functional disability

---------------------------------------------------------------

1 d especially difficult disability, multiple hard 70

disability, with severe functional consequences

---------------------------------------------------------------



1) Act No. 435/2004 Coll., on employment, as amended,

regulations.



§ 8 paragraph 2). 3 (b). f) of Act No. 582/1991 Coll., on the organisation and

the implementation of social security, as amended by law no 479/2008 Sb.