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MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No.: 27/2006/QD-BYT

Hanoi, September 21, 2006

 

DECISION

ON SUPPLEMENTING 04 OCCUPATIONAL DISEASES IN THE LIST OF COVERED OCCUPATIONAL DISEASES

MINISTER OF HEALTH

Pursuant to Article 106 of the Labour Code dated June 23,1994 promulgating the list of occupational diseases;

Pursuant to Decree No. 49/2003/ND-CP dated May 15, 2003 of the Government defining the functions, tasks, powers and organizational structure of the Ministry of Health;

After obtaining the consent of the Ministry of Labour - Invalids and Social Affairs in the official dispatch No.2550/LDTBXH-ATLD dated July 26, 2006;

After consultation from Vietnam General Federation of Labor in the official dispatch No. 1188/TLD dated July 20, 2006;

At the proposal of the Director of Vietnam Department of preventive medicine;

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Article 1. Supplementing 04 occupational diseases (with diagnosis and inspection standard) in the list of covered occupational diseases:

1. Occupational bronchial asthma (Diagnosis and inspection standard spciefied in Appendix 1).

2. Occupational carbon monoxide intoxication disease (Diagnosis and inspection standard spciefied in Appendix 2).

3. Occupational black acne disease (Diagnosis and inspection standard spciefied in Appendix 3).

4. Occupational skin ulcer, onychia and paronychia (Diagnosis and inspection standard spciefied in Appendix 4).

Article 2. The laborers inspected to suffer from diseases specified in Article 1 of this Decision shall be entitled to the benefits specified in the Labor Code and guiding documents guiding the implementation of the Labor Code.

Article 3. This Decision takes effect 15 days after its publication on Official Gazette;

Article 4. The Chief of Office, Director of Vietnam Department of preventive medicine and the departments and administrations of the Ministry of Health, the Heads of the units under the Ministry of Health, Directors of Service of Health of provinces and centrally-affiliated cities, the Heads of Health sectors and the Heads of units concerned are liable to execute this Decision. /.

 

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FOR THE MINISTER
DEPUTY MINISTER





Trinh Quan Huan

 

ANNEX 1

OCCUPATIONAL BRONCHIAL ASTHMA
(Issued together with Decision No. 27/QD-BYT September 21, 2006)

I. Pathogens

All occupations and jobs involving exposure to or breath of perceptive agents or stimulants existing in the working environment.

1. Essential perceptive agents:

1.1. Agents from botanical origin : grains, flour, coffee, tea, tobacco ...

1.2. Agents from animal origin: wool, dust from experimental animals, from mites, insects, ...;

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1.4. The organic compounds: formaldehyde, phenylen diamine, isocyanates, especially toluene, diisocyanat, phthalic anhydride, eppoxyresin, ...;

1.5. Antibiotics, enzymes such as detergent, ...

2. Stimulant

Chemical stimulant causing asthma: these are strong acids and alkalis, strong oxidizing agents (ammonia, chlorine, hydrogen chloride, phosgen, nitrous oxide or SO2 ...).

II. Diagnostic instruction

1. Diagnostic subject: Laborers working in environment with perceptive agents or stimulant;

2. Exposure time: Longer or equal to 2 weeks

3. Diagnostic standard:

3.1. Clinical:

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- Asthma recurs when exposed to allergens in the working environment.

- Entity (auscultatory): musical rales and sonorous rale.

3.2. Sub-clinical:

a) Measurement of respiratory function: The forced respiratory volume in the first second (FEV1) after working shift decreases by ≥15% compared to the previous shift.

b) Positive allergen testing (when the medical facility has adequate medical equipment and emergency resuscitation)

III. Inspection instruction

1. Guarantee time: 07 days

2. Occupational asthma without complication of cor pulmonale

2.1. Level 1: Loss of working capacity from 5 -10%

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≥ 2 asthma episodes at night 1 month

b) Sub-clinical: Measurement of respiratory function

FEV1 parameters in the normal range (≥ 80%) and change in FEV1 <20%

2.2. Level 2: Loss of working capacity from 11 - 20 %

a) Clinical: More than 01 asthma episode / 1 week but < 1 episode/ 1 day

Asthma episode at night > 2 episodes / 1 month

b) Sub-clinical: Measurement of respiratory function

FEV1 parameters in the normal range (≥ 80%) and change in FEV1 from 20 - 30%

2.3. Level 3: Loss of working capacity from 21 - 30 %

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Nighttime asthma episode > 2 episodes / 1 month

b) Sub-clinical: Measurement of respiratory function

FEV1 parameters from 60% - 80% and change in FEV1 > 30%

2.4. Level 4: Loss of working capacity from 31 - 40%

a) Clinical: Daytime asthma episodes occur regularly

Nighttime asthma episodes > 1 episode / 1 week

b) Sub-clinical: Measurement of respiratory function

FEV1 parameters from 50 %- 59% and change in FEV1 > 30%

2.5. Level 5: Loss of working capacity from 41 - 50%

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Nighttime asthma episodes occur regularly

b) Sub-clinical: Measurement of respiratory function

FEV1 parameters < 50 % and change in FEV1 > 30%

3. Occupational asthma with complication of cor pulmonale

3.1. Heart failure class I

51 - 60 %

3.2. Heart failure class II

61 - 70 %

3.3. Heart failure class III

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3.4. Heart failure class IV

81 - 90 %

Note: Change in FEV1 applicable in inspection standard is the increase of FEV1 value ​​compared with baseline after the use of bronchodilator (Measured in working days).

 

ANNEX 2

OCCUPATIONAL CARBON MONOXIDE INTOXICATION DISEASE
(Issued together with Decision No. 27/QD-BYT September 21, 2006)

I. Pathogens

Working environment with average CO concentration in 8 hours is 20mg/m3 of air or 40mg/m3 of air air for each time of exposure.

II. Diagnosis instruction

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The laborers working in environments with average CO concentration in 8 hours is 20mg/m3 or 40mg/m3 of air for each exposure time and recruitment medical examination record with conclusion of no clinical symptoms in the organs and parts such as cardiovascular and neurological and other symptoms like CO intoxication symptom.

2. Exposure time:

Depending on disease and CO in the environment.

2.1. Acute disease : exposure to high CO concentration in a short time.

2.2. Chronic disease : exposure to CO concentration higher than the permitted concentration.

3. Diagnosis standard

3.1. Clinical: chronic symptoms: headache, asthenia, dizziness or acuteness: coma

3.2. Sub clinical: Tested before and during examination

Blood HbCO concentration ≥ 7.5%

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Note: If the laborers are smokers and similar products, they should stop using them for at least 24 hours before the test.

III. Inspection standard

No.

Clinical and sub-clinical symptom

Guarantee time

Rate of loss of working capacity (%)

A.

Cardiovascular disease:

 

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1.

* Coronary artery disease:

 

 

1.1.

Ischemic heart disease: Electrocardiogram changes upon stress test, meeting the treatment well.

30 days

20 - 25

1.2.

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30 days

31 - 35

1.3.

Ischemic heart disease: Electrocardiogram changes upon rest, episodes still existing although being treated.

30 days

41 - 45

1.4.

Ischemic heart disease: history of myocardial infarction, no heart failure

30 days

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1.5.

Ischemic heart disease: history of myocardial infarction with complication of heart failure

30 days

70 - 80

2.

* Arrhythmia

 

 

2.1.

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a)

Paroxysmal supraventricular tachycardia or ventricle under treatment and stable

30 days

20 - 25

b)

Supraventricular tachycardia, episodes still existing although being treated

30 days

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c)

Ventricular tachycardia, episodes still existing although being treated

30 days

41 - 45

d)

Atrial fibrillation treated and stable

30 days

35 - 40

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30 days

51 - 55

e)

Atrial fibrillation treated without success but complication

30 days

71 - 75

2.2.

Slow beat:

 

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a)

Sick sinus syndrome without faint complication, no pacemaker indication

30 days

15 - 20

b)

Sick sinus syndrome with faint complication, pacemaker indication or under placement

30 days

31 - 35

c)

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30 days

20 - 25

d)

Second-degree atrioventricular block

30 days

31 - 35

dd)

Third-degree atrioventricular block

30 days

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2.3.

Ventricular extrasystoles (ventricular or supraventricular):

30 days

 

a)

Atrial ventricular extrasystoles to be treated

30 days

10 - 15

b)

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30 days

25 - 30

B.1.

Neuropathy

* Cardiasthenia syndrome (without accompanying physical lesion):

 

 

1.1.

Mild degree, good response to treatment, low impact on living and working

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15 - 20

1.2.

Moderate degree, limited response to treatment, low impact on living and working

30 days

21 - 25

1.3.

Heavy degree, frequent recurrence although being treated, affecting labor productivity and living

30 days

31 - 35

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* Monoplegia (a hand or a leg) (Degree of paralysis determined by the Scoring of Muscle Strengh)

 

 

2.1.

Mild

30 days

15 - 20

2.2.

Moderate

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31 - 35

2.3.

Heavy (Losing almost entire function)

30 days

51 - 55

2.4.

Complete paralysis (Losing entire function)

30 days

61 - 65

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* Paralysis of upper limbs

 

 

3.1.

Mild

30 days

31 - 35

3.2.

Moderate

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61 - 65

3.3.

Heavy (Losing almost entire function)

30 days

81 - 85

3.4.

Complete paralysis (Losing entire function)

30 days

86 - 91

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* Paralysis of lower limbs

 

 

4.1.

Mild

30 days

31 - 35

4.2.

Moderate

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61 - 65

4.3.

Heavy (Losing almost entire function)

30 days

81 - 85

4.4.

Complete paralysis (Losing entire function)

30 days

86 - 91

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* Lesion of the nerves V, VII peripheral, IX, X, XI, XII, sciatica on one side (the lesion rate is based on the inpsection standard of loss of working capacity - 1995).

 

 

6.

* Extrapyramidal syndrome

 

 

6.1.

Mild

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31 - 35

6.2.

Moderate

30 days

51 - 55

6.3.

Heavy

30 days

61 - 65

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Extremely heavy

30 days

81 - 85

C.

Dysfunction of the digestive, respiratory and renal organs and the senses (based on the rate of lesion of viscera according to the inpsection Standard of loss of working capacity - 1995).

 

 

 

ANNEX 3

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I. Pathogens

All occupations and jobs involving direct exposure to industrial oil and grease and petroleum and oily products.

II. Diagnosis instruction

1. Diagnosis subjects:

The laborers performing jobs with direct exposure to industrial oil and grease and petroleum and oily products.

2. Exposure time: Longer or equal to 02 years

3. Diagnosis standard:

3.1. Clinical:

a) Body: Having fatigue, headache, sleeping less, eating less, reducing memory loss

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- Hair breaking off or falling out and sometimes hair not growing on skin surface but curling in hair follicles;

- Hair pores having black spots, the size of a grain of millet or sharp. There is sebum when prised off with oily smell;

- Dry skin desquamated and lichenification

- Skin darkening

3.2. Sub-clinical:

a) There are corns and oil grains ( + ). When squeezing the pore, there are grain with size equal to a millet, somewhat solid, dark color with oily smell;

b) Clear prick test ( + );

c) Alkaline neutralization test by the Burchardt method: neutralizing capacity from 7 minutes or more.

Techniques of determining corns and oil grains (+) and clear prick test ( + ) are essential;

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No.

Clinical and sub-clinical symptom

Guarantee time

Rate of loss of working capacity (%)

A.

1.

Dry skin desquamated and lichenification, oily grain in the pores. Skin darkening may occur or not on body areas such as:

* Neck and face area: having symptoms and sequelae of black acne disease but:

 

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1.1.

- Lesions <50% of the neck and face area but without skin darkening, skin thickening and dry skin.

15 day

15 - 20

1.2.

- Lesion <50% of the neck and face area but with skin darkening or skin thickening or dry skin or

- Lesion ≥50% of neck and face area but without skin darkening, skin thickening or dry skin

15 day

21 - 25

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- Lesion ≥50% of neck and face area but with skin darkening, skin thickening or dry skin

15 day

26 - 30

2

* Back of hand and finger: Having symptoms and sequelae of black acne disease but:

 

 

2.1.

- Lesion in one side but without skin darkening, skin thickening or dry skin

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5 - 10

2.2.

- Lesion in one side but with skin darkening, skin thickening or dry skin or

- Lesion in both sides but without skin darkening, skin thickening or dry skin

15 day

11 - 15

2.3.

- Lesion in both sides but one side with skin darkening, skin thickening or dry skin and one side without skin darkening, skin thickening or dry skin

15 day

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2.4.

- Lesion in both sides with skin darkening, skin thickening or dry skin

15 day

21 - 25

3

* Forearm: Having symptoms and sequelae of the black acne disease but:

 

 

3.1.

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15 day

3 - 5

3.2.

-Lesion<1/2 area of 01 forearm but with skin darkening, skin thickening or dry skin or

- Lesion ≥1/2 area of 01 forearm but without skin darkening, skin thickening or dry skin

15 day

6 - 10

3.3.

- Lesion ≥1/2 area of 01 forearm with skin darkening, skin thickening or dry skin or

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15 day

11 - 15

3.4.

- Lesion in both forearms but one side with skin darkening, skin thickening or dry skin and one without skin darkening, skin thickening or dry skin

15 day

16 - 20

3.5.

- Lesion in both forearms with skin darkening, skin thickening or dry skin

15 day

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4

* Arm: Having symptoms and sequelae of the black acne disease but:

 

 

4.1.

- Lesion <1/2 area of 01 arm but without skin darkening, skin thickening or dry skin

15 day

3 - 5

4.2.

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- Lesion ≥1/2 area of 01 arm but without skin darkening, skin thickening or dry skin

15 day

6 - 10

4.3.

- Lesion ≥1/2 area of 01 arm but without skin darkening, skin thickening or dry skin or

- Lesion in both arms but without skin darkening, skin thickening or dry skin

15 day

11 - 15

4.4.

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15 day

16 - 20

4.5.

- Lesion in both arms but with skin darkening, skin thickening or dry skin

15 day

21 - 25

5

* Back of foot or toe: Having symptoms and sequelae of the black acne disease but:

15 day

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5.1.

- Lesion in one side but without skin darkening, skin thickening or dry skin

15 day

5 - 10

5.2.

- Lesion in one side with skin darkening, skin thickening or dry skin or

- Lesion in both sides but without skin darkening, skin thickening or dry skin or

15 day

11 - 15

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- Lesion in both sides but one side with skin darkening, skin thickening or dry skin and one side without skin darkening, skin thickening or dry skin

15 day

16 - 20

5.4.

- Lesion in both sides with skin darkening, skin thickening or dry skin

15 day

21 - 25

6.

* Shin: Having symptoms and sequelae of the black acne disease but:

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6.1.

- Lesion <1/2 area of 01 shin but without skin darkening, skin thickening or dry skin

15 day

3 - 5

6.2.

- Lesion <1/2 area of 01 shin but with skin darkening, skin thickening or dry skin or

- Lesion ≥1/2 area of 01 shin but without skin darkening, skin thickening or dry skin

15 day

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6.3.

- Lesion ≥1/2 area of 01 shin but with skin darkening, skin thickening or dry skin or

- Lesion in both shins but without skin darkening, skin thickening or dry skin

15 day

11 - 15

6.4.

- Lesion in both shins but one side with skin darkening, skin thickening or dry skin and one side without skin darkening, skin thickening or dry skin

15 day

16 - 20

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- Lesion in both shins but with skin darkening, skin thickening or dry skin

15 day

21 - 25

7.

* Thigh: Having symptoms and sequelae of the black acne disease but:

 

 

7.1.

- Lesion <1/2 area of 01 thigh but without skin darkening, skin thickening or dry skin

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6 - 9

7.2.

- Lesion <1/2 area of 01 thigh but with skin darkening, skin thickening or dry skin or

- Lesion 1/2 area of 01 thigh but without skin darkening, skin thickening or dry skin

15 day

10 - 15

7.3.

- Lesion 1/2 area of 01 thigh with skin darkening, skin thickening or dry skin or

-Lesion in both thighs but without skin darkening, skin thickening or dry skin

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16 - 20

7.4.

- Lesion in both thighs but one side with skin darkening, skin thickening or dry skin and one side without skin darkening, skin thickening or dry skin

15 day

21 - 25

7.5.

- Lesion in both thighs with skin darkening, skin thickening or dry skin

15 day

26 - 30

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* Area of shoulder, back, chest and stomache and other positions: Having symptoms and sequelae of the black acne disease but:

 

 

8.1.

- Lesion 18% area of body but without skin darkening, skin thickening or dry skin

15 day

15 - 20

8.2.

- Lesion ≤18% area of body but without skin darkening, skin thickening or dry skin or

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15 day

21 - 25

8.3.

- Lesion from 19-30% area of body but with skin darkening, skin thickening or dry skin or

- Lesion from 31-36% area of body but without skin darkening, skin thickening or dry skin

15 day

26 - 30

8.4.

- Lesion from 31-36% area of body but with skin darkening, skin thickening or dry skin

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15 days

31 - 35

Note:

- If the area of lesion is 20% of body area affects the regulatory function, it is permitted to add back by 10%

- Persons who are unmarried youth and women ... are added by 5-10% (back addition) due to aesthetic effect.

 

ANNEX 4

OCCUPATIONAL SKIN ULCER, ONYCHIA AND PARONYCHIA
(Issued together with Decision No. 27/QD-BYT September 21, 2006)

I. Pathogens

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II. Diagnosis instruction

1. Dignosis subjects: Laborers working in the prolonged humid or cold or both prolonged humid and cold environment.

2. Exposure time: Longer or equal to 06 months

3. Diagnosis standard:

3.1. Clinical:

a) Skin with heterogeneous clusters of lesion, namely: skin at the tip of limb is thin and glossy, the skin folds on palm and sole is prominent, dirty gray thick skin or dark skin, red and exfoliated skin, papules with oozing crust, edema papules, vesicles, pustules, ulcer with rough edge at positions: tip of limb, finger skin, palm, back of hand, forearm, arm, toe, sole, back of foot, shin, thigh, dorsum nasi and earloble

b) Red inflammation between fingers and toes with ambient yellow and decayed ulcer;

c) Fingernails and toenail: Swelling red around fingernails and toenails, scaly skin with pus at times. Fingernails and toenails lose the glossiness and become dirty gray; there are on the nail surface with concave white dots with vertical and horizontal stripes. The nails become thick, rough, slow growth, nail separated from nail bed and nail loss;

d) Other symptoms: feeling sore or itching in the lesion area and hot tense, tingling, painful and numbed at fingers, forearm and shin,

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a) Measurement of skin pH: Forearm pH ≥ 5.5

Back of hand pH ≥ 5.3

b) Direct dermatophyte and nail fungus tests: (+) clear (in case of fungus infection)

c) Alkaline neutralization test by the Burchardt method: neutralizing capacity from 7 minutes or more.

The skin pH and dermatophyte and nail fungus tests are essential

III. Diagnosis instruction

No.

Clinical symptoms

Guarantee time

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A.

Skin with heterogeneous clusters of lesion: skin at the tip of limb is thin and glossy, the skin folds on palm and sole is prominent, dirty gray thick skin or dark exfoliated skin, papules with oozing crust, edema papules, vesicles, pustules, ulcer; red inflamation between fingers and toes with ambient yellow and decayed ulcer at body areas such as:

 

 

1.

Dorsum nasi with symptoms and sequelae of skin ulcer but

 

 

1.1.

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≤ 3 months

3 - 5

1.2.

- Lesion of dorsum nasi and fungus test (+)

≤ 3 months

6 - 10

2.

Earlobe with symptoms and sequelae of skin ulcer but:

 

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2.1.

- Lesion at one side with fungus test (-)

≤ 3 months

1 - 3

2.2.

- Lesion at one side with fungus test (+) or

- Lesion at both sides with fungus test (-)

≤ 3 months

4 - 7

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- Lesion at both sides with fungus test (+)

≤ 3 months

8 - 10

3

There are symptoms and sequelae of skin ulcer on hands, fingers and between fingers but:

 

 

3.1.

Lesion in 01 side and fungus test (-) if:

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+ Lesion in 3 - 5 fingers and between 3 - 4 fingers

≤ 3 months

5 - 9

10 - 15

3.2.

- Lesion in only one side and fungus test (+) or

- Lesion in both sides and fungus test (-)

≤ 3 months

16 - 20

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- Lesion in both sides but: 01 side with fungus test (-) and 01 side with fungus test (+)

≤ 3 months

21 - 25

3.4.

Lesion in both sides with fungus test (+)

≤ 3 months

26 - 30

4.

Forearm with symptoms and sequelae of skin ulcer but:

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4.1.

- Lesion only <1/3 area of 01 forearm and fungus test (-)

≤ 3 months

3 - 5

4.2.

- Lesion only <1/3 area of 01 forearm and fungus test (+) or

- Lesion only >1/3 area of 01 forearm and fungus test (-)

≤ 3 months

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4.3.

- Lesion only ≥1/3 area of 01 forearm and fungus test (+) or

- Lesion in both forearms and fungus test (-)

≤ 3 months

11 - 15

4.4.

- Lesion in both forearms but 01 forearm with fungus test (-) and 01 forearm with fungus test (+)

≤ 3 months

16 - 20

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- Lesion in both forearms with fungus test (+)

≤ 3 months

21 - 25

5.

Arm with symptoms and sequelae of skin ulcer but:

 

 

5.1.

- Lesion <1/2 area of 01 arm and fungus test ( - )

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3 - 5

5.2.

- Lesion <1/2 area of 01 arm and fungus test ( + ) or

- Lesion ≥1/2 area of 01 arm and fungus test ( - )

≤ 3 months

6 - 10

5.3.

- Lesion ≥1/2 area of 01 arm and fungus test ( + ) or

- Lesion in both arms and fungus test ( - )

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11 - 15

5.4.

- Lesion in both arms but 01 arm with fungus test

(-) and 01 arm with fungus test (+)

≤ 3 months

16-20

5.5.

- Lesion in both arms and fungus test (+)

≤ 3 months

...

...

...

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6.

There are symptoms and sequelae of skin ulcer on foot, toes and between toes but:

 

 

6.1.

Lesion only in 01 side and fungus test (-) if:

 

 

a)

...

...

...

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≤ 3 months

5 - 9

b)

+ Lesion in 3 - 5 fingers and between 3 - 4 fingers

≤ 3 months

10 - 15

6.2.

- Lesion in one side and fungus test(+) or

- Lesion in both sides and fungus test(+)

...

...

...

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16 - 20

6.3.

Lesion in both sides but one side with fungus test (-) and one side with fungus test (+)

≤ 3 months

21 - 25

6.4.

Lesion in both sides with fungus test (+)

≤ 3 months

26 - 30

...

...

...

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Shin with symptoms and sequelae of skin ulcer but:

 

 

7.1.

Lesion < 1/3 area of 01 shin with fungus test (-)

≤ 3 months

3 - 5

7.2.

- Lesion < 1/3 area of 01 shin with fungus test (+) or

...

...

...

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≤ 3 months

6 - 10

7.3.

- Lesion ≥ 1/3 area of 01 shin with fungus test (+) or

-Lesion in both shins with fungus test (-)

≤ 3 months

11 - 15

7.4.

- Lesion in both shins but: 01 shin with fungus test (-) and 01 shin with fungus test (+)

...

...

...

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16 - 20

7.5.

- Lesion in both shins with fungus test (+)

≤ 3 months

21 - 25

8.

Thigh: with symptoms and sequelae of skin ulcer but:

 

 

...

...

...

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- Lesion <1/2 area of 01 thigh and fungus test (-)

≤ 3 months

7 - 10

8.2.

- Lesion =1/2 area of 01 thigh and fungus test (+) or

- Lesion in 01 thigh and fungus test (-)

≤ 3 months

11 - 15

8.3.

...

...

...

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- Lesion in both thighs and fungus test (-)

≤ 3 months

16 - 20

8.4.

- Lesion in both thighs but one side with fungus test (-) and one side with fungus test (+)

≤ 3 months

21 - 25

8.5.

- Lesion in both thighs and fungus test (+)

...

...

...

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26 - 30

B.

Fingernail and toenail:

 

 

1.

Fingernail and toenail of a limb: change in color or rough with vertical and horizontal stripes or inflamation around nail but without truncated or lost nail:

 

 

...

...

...

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- From 1 – 3 nails

≤6 months (fingernail)

≤9 months (toenail)

1 - 4

1.2.

- From 4 - 5 nails

≤6 months (fingernail)

≤9 months (toenail)

5 - 10

...

...

...

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Fingernail or toenail of a limb is truncated or lost:

 

 

2.1.

- From 1 - 3 fingers

≤6 months (fingernail)

≤9 months (toenail)

5 - 10

2.2.

...

...

...

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≤6 months (fingernail)

≤9 months (toenail)

11 - 15

3.

Note:

- If there is lesion in any limbs, the rate of loss of working capacity is added directly

- If there is lesion of nail from 03 limbs or more, the rate of loss of working capacity is added directly in any two limbs, the third limb onwards must be back added.

≤6 months (fingernail)

≤9 months (toenail)

...

...

...

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Note:

- If the area of skin lesion is >20% of the body area, it is permitted to add back 10% due to effect of regulatory function.

- Persons who are unmarried youth and women ... are added by 5-10% due to aesthetic effect for the truncation of ≥ 5 fingernails.