All editions of the American Medical Association (AMA) guides rate impairment based on static deviations from population or personal norms in addition to rating based on interferences in activities of daily living (ADLs). The burden of treatment compliance (BOTC) method of impairment rating was developed as a stand-alone model to help overcome difficulties when rating internal medicine conditions, when normative metrics may be lacking and impacts on ADLs are not readily determined. With the sixth edition of the AMA guides, the BOTC model has been adapted to provide alternative operational metrics for functional losses associated with these conditions.