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hereamp;#39;s what doctors base permanent impairment on a permanent impairment rating can be a major factor in your injury case especially if itamp;#39;s workers come to give you a rating doctors refer to an American Medical Association guide which instructs them to base your rating on four things hereamp;#39;s a little more about each one the most important factor is your diagnosis diagnosis defines your injury which also defines the disability doctors expect you to have as a result the next factors can determine the rating from the range of ratings available in the guide functional history is your reports of symptoms and limitations from your injury sometimes doctors refer you for a functional capacity evaluation to help score this exam findings are based on the results of the exam the doctor does on you these exam findings can confirm the diagnosis and its severity clinical studies or medical tests like x-rays and MRIs that confirm the diagnosis and also its severity so w