There has been no previous systematic research on the pain-related impairment (PRI) system of the AMA Guides. The objective was to examine the emotional distress (ED) status of COPD patients with chronic pain using responses from the Ratings Determining Impairment Associated With Pain (RDIP), a formal assessment for rating PRI by the AMA Guides to Evaluation of Permanent Impairment, Fifth Edition. The PHQ-9 identified 30 of 100 elderly outpatient COPD subjects afflicted with ED. The RDIP and Physical Performance Tests scores (PPT: 6-Minute Walk, Berg Balance, & Dynamic Gait Index), were recorded. The RDIP consisted of 5 items (Pain Severity, Activity Interference <Al>, Emotional Distress, Pain Behavior, & Credibility subscales) scored for a maximum 80 and was subcategorized: 69% mild, 25% moderate, 3% moderately-severe and 3% severe PRI. The ED scores ranged 1.6 to 9/10 with an average 7.2/10. Comparing the effect of ED over AI component revealed that 12.5% of the total RDIP score (range 2–11%) was due to ED. The RDIP rating demonstrated a close trend relationship between the PRI scores and low PPT scores. The majority scored in the mild PRI, which still had a high trend effect on ED. Pain effect on mood had also a close trend with the little variation in PPT. These findings suggest that the pain disability status of COPD patients, regardless of severity, results in significant increase in their ED. Further research on the AI & ED and their correlations to decreased physical performance would be beneficial.