Claude Sonnet 4.5 on Guides 5 Ex 17-7 - Webflow Ecommerce website template

Performance Overview

Claude Sonnet 4.5 performed worse than its predecessor Sonnet 4 on this example. Sonnet 4 on the same prompt had 36% error. Sonnet 4.5 had a 45% error.

The initial prompt yielded a summary plan. We followed up with a second prompt in this case to ask it to perform the calculation recommended in the summary plan. The AI made several incorrect references to the wrong Table or Section. It also made medical terminology errors. It made several errors at toe and ankle levels and in mistakenly combining muscle weakness, atrophy, and range of motion impairment ratings.

This dialog was created with the free tier October 1, 2025. Your results will vary if you want to try this prompt; AI chat algorithms are generally designed for variety. The text was unedited, the text was reformatted for clarity and consistency. The original source text is available here as a Word document.

How to read the report below

The right hand column is the dialog. It starts with the user's prompt followed by the AI response. The left hand column is our analysis of the response compared to the published Example's rating of 11% WPI. The errors in are highlighted in red. Where appropriate, a reference to the Gudies 5 with page numbers is available.

Best viewed on a tablet or desktop to see the dialog text and annotations side-by-side. On mobile the annotations will follow the dialog text in a separate block. In both layouts, an additional text block of annotation details follows at the bottom.

LLM5 17-7 Claude Sonnet 4.5

This is the initial request to the LLM. Note the specific reference to the AMA Guides 5th edition

Text from Example 17-7, page 538

Incorrect. Ankle Motion Impairment is not Table 17-10, it is Table 17-11

Error 1

Incorrect. Muscle Atrophy is not Section 17.2e, it is Section 17.2d

Error 2

Incorrect. Here, dorsiflexion is muscle extension not flexion.

Error 3

Multiple errors with ankle impairment calculations

See Error 4 footnote

Wrong table reference and incorrect terminology

See Error 5 footnote

Multiple toe impairment errors

See Error 6 footnote

Incorrect atrophy calculation and table reference

See Error 7 footnote

Muscle weakness estimation not recommended

See Error 8 footnote

Cannot combine muscle weakness, atrophy, and ROM

See Error 9 footnote

Incorrect. The 28% LEI multiplied by 0.4 to convert to WPI, according to Section 17-2a, Table 17-3 results in 11% WPI, not 16% WPI.

Error 10

User prompt:

I'm working with a friend on the Independent Medical Exam market. This is a sample patient narrative. Can you help me create an impairment rating according to the AMA Guides 5th edition?

Subject: 45-year-old woman.
History: Sustained a tibia fracture in a motor vehicle accident.
Current Symptoms: No pain; stiffness about the ankle and foot, with some swelling of the foot and ankle toward evening. Cannot stand for long periods and cannot use shoes with elevated heels.
Physical Exam: Ankle flexion is 6°; ankle extension is 5°. Toe extension is less than 10° for all toes. 1-cm atrophy of the left calf. It is difficult to determine the strength of the ankle and toe extensors, but a mild weakness is noted.
Clinical Studies: X-rays: healed tibia fracture with no malalignment.
Diagnosis: Healed tibia fracture.

Claude response:

I can help you work through an impairment rating using the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition. However, I need to provide some important caveats:

Important Disclaimers:

I'm not a physician and cannot provide medical advice or official impairment ratings
Actual IME ratings must be performed by qualified physicians trained in impairment rating
This is for educational/reference purposes only
State-specific workers' compensation systems may have modifications to the AMA Guides

Analysis Based on AMA Guides 5th Edition

Based on the narrative provided, here are the relevant impairment considerations:

Primary Impairments to Rate:

Ankle Range of Motion Deficit (Chapter 17 - Lower Extremity)
- Normal ankle dorsiflexion: 20°
- Patient's dorsiflexion: 6°
- Loss: 14°
- Normal ankle plantarflexion: 45°
- Patient's plantarflexion: 5°
- Loss: 40°
- Using Table 17-10 (Ankle Motion Impairment), these ROM deficits would be converted to lower extremity impairment, then to whole person impairment.
Toe Extension Deficit
- Less than 10° extension for all toes (normal is typically 40°)
- Would use Table 17-13 or applicable toe motion tables
Muscle Atrophy (1 cm calf atrophy)
- Section 17.2e addresses muscle atrophy
- Would contribute additional impairment
Mild Weakness of Ankle/Toe Extensors
- Would be evaluated using strength grading and relevant tables

Combining Impairments:

Multiple impairments of the lower extremity are typically combined using the Combined Values Chart (p. 604)
Lower extremity impairment is then converted to whole person impairment using Table 17-3

What's Needed for Complete Rating:

More specific strength measurements (typically 0-5 grading scale)
Precise ROM measurements with goniometer
Assessment of gait abnormalities if present
Any additional functional limitations
Determination of Maximum Medical Improvement (MMI)

Would you like me to walk through the specific table lookups and calculations for any particular component, or do you have questions about the rating methodology?

User prompt:

Please do the lookups and calculations.

Claude response:

I'll work through the impairment rating calculations systematically using AMA Guides 5th Edition.

Impairment Rating Calculation

1. Ankle Range of Motion Impairment

Ankle Dorsiflexion (Flexion):

Normal: 20°
Patient: 6°
Lost motion: 14°
Using Table 17-10 (p. 541): 14° loss of dorsiflexion = 7% lower extremity impairment (LEI)

Ankle Plantarflexion (Extension):

Normal: 45°
Patient: 5°
Lost motion: 40°
Using Table 17-10 (p. 541): 40° loss of plantarflexion = 20% LEI

Combined ankle ROM impairment:

Combine 7% with 20% using Combined Values Chart (p. 604)
Combined: 26% LEI

2. Toe Extension Deficit

All five toes with <10° extension (assuming ~30-35° loss per toe from normal 40°):

Using Table 17-13 (p. 543) for toe motion impairments
Great toe: severe extension loss ≈ 6% LEI
Lesser toes (4 toes): each approximately 1% LEI = 4% LEI
Combined toe impairment: approximately 10% LEI

3. Muscle Atrophy

1 cm calf atrophy:

Using Section 17.2e and Table 17-6 (p. 532)
1 cm atrophy = 7% LEI

4. Muscle Weakness

Mild weakness of ankle/toe extensors:

Without specific strength grade, estimating Grade 4/5 (good)
Mild weakness typically contributes 3-5% LEI
Using conservative estimate: 4% LEI

Combining All Lower Extremity Impairments:

Starting values:

Ankle ROM: 26% LEI
Toe motion: 10% LEI
Atrophy: 7% LEI
Weakness: 4% LEI

Sequential combination using Combined Values Chart:

26% + 10% = 34% LEI
34% + 7% = 39% LEI
39% + 4% = 41% LEI

Total Lower Extremity Impairment: 41% LEI

Convert to Whole Person Impairment (WPI):

Using Table 17-3 (p. 527): Relationship of Lower Extremity Impairment to Whole Person Impairment

41% LEI = 16% WPI

FINAL IMPAIRMENT RATING: 16% Whole Person Impairment

Notes:

This assumes Maximum Medical Improvement has been reached
Actual rating would require precise goniometric measurements
Strength testing should use standardized manual muscle testing
Some jurisdictions may rate diagnosis-based rather than ROM-based
The healed fracture itself may warrant additional consideration under certain rating methodologies

Would you like me to explore alternative rating approaches or discuss any specific component?

Error Footnotes

Further Details

Error 4 - Ankle Impairment: The ankles are part of the foot and should be considered at the foot level before converting them to Lower Extremity Impairment (LEI). According to Table 17-11, plantarflexion is 21% Foot and dorsiflexion is 10% Foot. Adding them together yields 31% Foot. The LEI given for plantarflexion (20%) is not correct. The foot impairment, if converted, would be 15% LEI.

Error 5 - Terminology: Plantarflexion is not extension. As previously noted, Ankle Motion Impairment is Table 17-11 on p. 537 (not 17-10 p. 541).

Error 6 - Toe Impairment: The Toe Impairments on Table 17-14, page 537 (not 17-13 p. 541) states that the great toe impairment would be 7% Foot Impairment and the lesser toes impairment would be 7% Foot Impairment (per the footnote limiting lesser toe impairments to 2% WPI, which converts to 7% Foot Impairment). Combining both using the CVC formula yields 13.51% Foot. The toes are also part of the foot and should be considered at the foot level before converting them to LEI.

Error 7 - Muscle Atrophy: 1 cm calf atrophy would be 3% LEI per Table 17-6 (p. 530 not p. 532). As noted, Muscle Atrophy is not Section 17.2e, it is Section 17.2d.

Error 8 - Muscle Weakness: The estimation of muscle weakness is not recommended. The text of Example 17-7 states: "Manual muscle testing is difficult to perform when close to normal because of the lower leg muscles' limited excursion about the ankle and toes when motion is severely restricted."

Error 9 - Combination: Muscle weakness, atrophy, and ROM cannot be combined per Table 17-2, page 526. Recalculating the CVC combinations with the correct Foot impairment values 31% (Ankle ROM) and 13.31% (Foot) results in 40% Foot which multiplied by 0.7 per Section 17-2a results in 28% LEI. This is higher than the atrophy impairment, so we select the 28% LEI for this impairment. This, multiplied by 0.4 to convert to WPI according to Section 17-2a, results in 11% WPI.

Error 7 - Final Calculation: