Hand-arm vibration syndrome is a complex condition with vascular, sensorineural, and musculoskeletal components. Workers who handle vibratory tools suffer from it, and the severity of this syndrome is now graded internationally using the Stockholm classification. For compensation purposes the severity must be translated into impairment and this paper proposes how this may be done using the AMA Guides to the Evaluation of Permanent Impairment. The case history of a typical claimant is presented to demonstrate how an impairment rating might be derived.