{"id":"F2015L01144","name":"Guide to Determining Impairment and Compensation","slug":"guide-to-determining-impairment-and-compensation","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":129005,"registerId":"commonwealth-F2015L01144-current","compilationNumber":null,"startDate":"2026-04-03","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"2","sectionType":"section","heading":"Short Title","content":" 2 Short Title\n\nThe short title for the Guide to Determining Impairment and Compensation is GARP M.\n\n## 3 Commencement\n\n#### 3 Commencement\n\nThis instrument commences on the day after it is registered.\n\n## 4 Authority\n\n#### 4 Authority\n\n This instrument is made under the Military Rehabilitation and Compensation Act 2004.\n\n \n\n## Definitions\n\n(1) In this instrument:\n\nC&T Act means the Military Rehabilitation and Compensation (Consequential and Transitional Provisions) Act 2004.\n\nGARP V means the Guide to the Assessment of Rates of Veterans’ Pensions in force from time to time under section 29 of the VEA.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nMRCC means the Military Rehabilitation and Compensation Commission.\n\nSRCA means the Safety, Rehabilitation and Compensation Act 1988.\n\nVEA means the Veterans’ Entitlements Act 1986.\n\n## Guide determination\n\n(2) For the purposes of section 67 of the MRCA, it is determined by the Military Rehabilitation and Compensation Commission that the following Guide to Impairment and Compensation (the Guide) (comprising pages i to iv for the Introduction and pages 1 to 232 for the remainder of the Guide) applies as the guide for the determination of the degree of impairment and lifestyle ratings when determining the compensation payable to a person under the MRCA.\n\n## Power under C&T Act\n\n(3) Subsection 13(4) of the C&T Act provides that the MRCC may include in the guide under section 67 of the MRCA one or more methods of working out the amount of compensation a person is entitled to under Part 2 of Chapter 4 of the MRCA for a service injury or disease where a person also has:\n\n(a) a separate war-caused injury or war-caused disease or defence-caused injury or defence-caused disease (within the meaning of the VEA); or\n\n(b) a separate injury or disease (within the meaning of the SRCA).\n\nA method may (but does not have to) include a method of offsetting payments made to the person under the VEA or SRCA in respect of the old injury or disease.\n\nGUIDE TO DETERMINING IMPAIRMENT AND COMPENSATION (GARP M)\n\nINTRODUCTION\n\n## Purpose\n\nThis Guide is to be applied to assess the degree of impairment from service injury or disease. Its provisions are binding on the Military Rehabilitation and Compensation Commission, the Veterans’ Review Board, and the Administrative Appeals Tribunal.\n\n## Legal background\n\nThe Military Rehabilitation and Compensation Act 2004 provides for periodic payments to be made to members for impairment resulting from service injuries or diseases as defined in section 5 of the Act.\n\n","sortOrder":0},{"sectionNumber":"Part 2","sectionType":"part","heading":"of Chapter 4 of the Act provides that periodic payments are payable only if certain thresholds are reached as determined by reference to the extent of the veteran’s incapacity as assessed in accordance with this Guide. Subsection 67(1) of the Act provides that the Guide prepared by the Military Rehabilitation and Compensation Commission sets out:","content":"Part 2 of Chapter 4 of the Act provides that periodic payments are payable only if certain thresholds are reached as determined by reference to the extent of the veteran’s incapacity as assessed in accordance with this Guide. Subsection 67(1) of the Act provides that the Guide prepared by the Military Rehabilitation and Compensation Commission sets out:\n\n (a) criteria to be used in deciding the degree of impairment of a person resulting from a service injury or disease; and\n (b) methods by which the degree of that impairment can be expressed in impairment points on a scale from 0 to 100; and\n (c) criteria to be used in assessing the effect of a service injury or disease on a person’s lifestyle; and\n (d) methods by which the effect of a service injury or disease on a person’s lifestyle can be expressed as a numerical rating; and\n (e) methods by which the impairment points of a person, and the effect on a person’s lifestyle, from a service injury or disease can be used to determine the compensation payable to the person under this Part by reference to the maximum compensation that can be payable to a person under this Part.\n In addition the Guide, in accordance with subsection 67(2) of the Act\n (a) specifies different methods under paragraph (1)(e) for:\n (i) service injuries or diseases that relate to warlike service or non‑warlike service; and\n (ii) other service injuries or diseases; and\n (b) specifies a method for determining the compensation payable to a person who has both:\n (i) a service injury or disease that relates to warlike service or non‑warlike service; and\n (ii) another service injury or disease.\n\n## Definitions\n\nIn this Guide, unless a contrary intention appears:\n\naccepted condition means an injury or disease that has been determined to be caused by service.\n\nAct means the Military Rehabilitation and Compensation Act 2004 as amended from time to time.\n\nadd means find the arithmetic sum of two or more numbers.\n\nclinical features includes signs and symptoms.\n\ncombine means produce a result by combining two or more numbers by applying Chart 18.1 (Combined Values Chart) in Chapter 18 in accordance with that Chapter.\n\nCommission means the Military Rehabilitation and Compensation Commission.\n\ncondition means an injury or a disease.\n\ndefence-caused injury and defence-caused disease have the meaning given in section 70 of the VEA.\n\ndisease means:\n\n(a) any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development); or\n\n(b) the recurrence of such an ailment, disorder, defect or morbid condition;\n\nbut does not include:\n\n(c) the aggravation of such an ailment, disorder, defect or morbid condition; or\n\n(d) a temporary departure from:\n\n(i) the normal physiological state; or\n\n(ii) the accepted ranges of physiological or biochemical measures;\n\nthat results from normal physiological stress (for example, the effect of exercise on blood pressure) or the temporary effect of extraneous agents (for example, the effect of alcohol on blood cholesterol levels).\n\nGARP V means the Guide to the Assessment of Rates of Veterans’ Pensions in force from time to time under section 29 of the VEA.\n\nGuide means this Guide to Determining Impairment and Compensation.\n\nimpairment, in relation to a person, means the loss, the loss of the use, or the damage or malfunction, of any part of the person’s body, of any bodily system or function, or of any part of such a system or function.\n\nimpairment rating means a measure of the degree of medical impairment on a scale of 0 to 100.\n\ninjury means any physical or mental injury (including the recurrence of a physical or mental injury) but does not include:\n\n(a) a disease; or\n\n(b) the aggravation of a physical or mental injury.\n\nlifestyle points means the number of points determined using the tables in Chapter 22 of this Guide.\n\nlifestyle averaged points means the total of lifestyle points added together and averaged for each of the tables used.\n\nlump sum means the amount payable after determining the periodic payment for a service injury or disease and converted to a single dollar amount in accordance with the tables provided by the Australian Government Actuary for that purpose.\n\nmember or former member means a member or former member of the Defence Force who serves or served on or after 1 July 2004.\n\nnon-accepted condition means any injury or disease that has not been determined under the Act to be service related or has been determined under the Act not to be service related.\n\nperiodic payment means the amount determined by reference to the tables in this guide for warlike and non-warlike service or for peacetime service and the maximum amount payable under the relevant provision of the Act.\n\nservice means service in the Defence Force which is warlike service, non‑warlike service or peacetime service as determined by the Minister for Defence from time to time.\n\nservice disease has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.\n\nNote: A reference to a service disease being contracted includes a reference to a disease being aggravated by defence service (see section 7 of the Act).\n\nservice injury has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.\n\nNote: A reference to a service injury being sustained includes a reference to an injury being aggravated by defence service (see section 7 of the Act).\n\nSRCA means the Safety, Rehabilitation and Compensation Act 1988.\n\nStatement of Principles means:\n\n(a) a Statement of Principles determined by the Repatriation Medical Authority under section 196B of the VEA and to which section 19 of the C&T Act applies; or\n\n(b) a determination made by the Commission under subsection 340(2) or (3) of the Act.\n\nVEA means the Veterans’ Entitlements Act 1986.\n\nveteran means a member or former member of the Defence Force (including a deceased person) under section 5 of the MRCA in respect of whom an injury or disease has been determined to be caused by that service.\n\nwar-caused injury and war-caused disease have the meaning given in section 9 of the VEA.\n\nworksheet means a page or pages of this Guide, identified as such, that gives a structure by which certain calculations may be set out to assist in determining an impairment rating.\n\nDefinitions of words and phrases that are used in only one chapter are to be found in that chapter.\n\n## Acknowledgment of sources\n\nThe Guide to the Assessment of Rates of Veterans’ Pensions Fifth Edition, Part A Chapters 1–12 and Part B Chapters 13-17 and Part C Chapters 18-21 are the basic tables for this Guide.\n\nThat publication acknowledges that the following published works were found to be useful in the preparation of the VEA Guide (GARP V) and therefore were basic to this Guide as well:\n\nGuides to the Evaluation of Permanent Impairment, 4th edition, American Medical Association, 1993;\n\nInternational Classification of Impairments, Conditions, and Handicaps, World Health Organisation, Geneva, 1980; and\n\nPublication No 118 of the National Acoustic Laboratories, Improved Procedure for Determining Percentage Loss of Hearing, by J. Macrae, Australian Government Publishing Service, Canberra, 1988.\n\n## PART A : SYSTEM SPECIFIC ASSESSMENT\n\n## PART A: SYSTEM SPECIFIC ASSESSMENT\n\n","sortOrder":1},{"sectionNumber":"Part 1","sectionType":"part","heading":null,"content":"CHAPTER 1\n\nCARDIORESPIRATORY IMPAIRMENT\n\nCardiorespiratory impairment results from conditions that affect the function of the heart or lungs. The procedures described in this chapter are to be applied in assessing most conditions of the heart and lungs, and will usually also be appropriate for conditions affecting the function of the thorax or diaphragm, lesions of the nerves that supply the muscles of respiration, and conditions such as anaemia. The principal exception is any condition which is predominantly intermittent in nature and which would be better assessed by applying Chapter 15 (Intermittent Impairment).\n\nDifferent procedures (described in Chapter 2) are to be applied to assess hypertension and non-cardiac vascular conditions (such as aortic aneurysm and varicose veins).\n\nIn general, cardiorespiratory impairment is to be measured by reference to exercise tolerance. Exercise tolerance is quantified in terms of METs (see pages 11–12). However, if a respiratory component is present, measurements of lung function, such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and maximal expiratory flow (MEF 25–75) are to be used in addition to exercise tolerance. FEV1 and FVC are to be measured by spirometry. For the purposes of assessment in accordance with this Guide, the terms “MEF 25–75” and “FEF 25–75” (forced expiratory flow between 25% and 75% of the vital capacity) are to be taken as equivalent.\n\nThe conversion of loss of exercise tolerance and measurements of lung function into an impairment rating is set out in Table 1.2 and Table 1.3.\n\nCertain cardiorespiratory conditions cannot be rated by applying exercise tolerance. These include:\n\n- conditions that do not decrease exercise tolerance;\n- conditions that do not produce symptoms; and\n- intermittent conditions.\n\n“Exercise tolerance” refers to a person’s ability to exercise from a cardiorespiratory point of view rather than to a person’s total ability to exercise. For example, a veteran who has osteoarthritis of both knees may be greatly limited in walking but may still be able to swim a considerable distance. Such a veteran would still have good exercise tolerance from a cardiorespiratory point of view, though total ability to exercise would be reduced.\n\nA veteran whose ability to exercise has been significantly reduced by other conditions (such as musculoskeletal conditions or being grossly overweight), or who no longer has cardiac or respiratory symptoms on exercise, cannot always be given an appropriate impairment rating for reduced exercise tolerance. However, the need to apply Chapter 19 (Partially Contributing Impairment) should always be considered before disregarding exercise tolerance figures.\n\nCalculation of the impairment rating for accepted cardiorespiratory conditions\n\nFollow the steps below to determine the impairment rating for cardiorespiratory conditions:\n\n| Step 1 | Establish what cardiorespiratory conditions are present. | Page 7 |\n| ------ | ------------------------------------------------------------------------------------------------------------------------------ | ------- |\n| Step 2 | Assess the information that is available and decide whether it is reliable and sufficient. | Page 8 |\n| Step 3 | Determine the impairment rating based on effort tolerance. | Page 9 |\n| Step 4 | (Omit this step if no respiratory disease is present.)Determine the impairment rating based on measure­ments of lung function. | Page 13 |\n| Step 5 | Determine the total accepted cardiorespiratory functional impairment rating. | Page 21 |\n| Step 6 | Consider the effects of cardiac failure (if any). | Page 24 |\n| Step 7 | Moderate the total cardiorespiratory functional impairment rating to allow for effects of any non-accepted conditions. | Page 24 |\n| Step 8 | Determine whether any ratings from the relevant Other Impairment tables apply (Tables 1.7, 1.8, 1.9, 1.10). | Page 25 |\n\nStep 1: Establish what cardiorespiratory conditions are present.\n\nFor the purpose of assessing cardiorespiratory impairment, both the accepted and the non-accepted conditions are be taken into account. Both will affect the way in which cardiorespiratory functional impairment is calculated. (Their combined effect is taken into account in the application of Table 1.5 in Step 5.)\n\nAny non-accepted conditions are to be subsequently allowed for by applying Chapter 19 (Partially Contributing Impairment) ­— see Step 7.\n\nWhen considering the question: ‘What cardiorespiratory conditions are present in this veteran?’, it is not appropriate to rely simply on a list of accepted conditions. Both previously claimed but rejected cardiorespiratory conditions and unclaimed cardiorespiratory conditions may also be present.\n\nStep 2: Assess the information that is available and decide whether it is reliable and sufficient.\n\nTo make a reliable cardiorespiratory assessment, there should be an adequate medical history of the veteran’s cardiorespiratory conditions. In addition, there should be information relating to the veteran’s effort tolerance and, if any respiratory disease is present, there should also be one or more sets of spirometry or other physiological measurements of respiratory function. The criteria by which the evaluation of the information is to be made are set out below.\n\n## Medical history\n\nAn adequate history of the veteran’s illness and a description of the current symptoms and details of the current treatment should be available.\n\nThe history should be reviewed at the start of the cardiorespiratory assessment procedure to establish whether any major cardiorespiratory event (for example a myocardial infarction or bypass surgery) has occurred within the period of assessment.\n\nAn examination of the history will indicate whether any Other Impairment ratings (from Tables 1.7, 1.8, 1.9, 1.10) are applicable. For example, in the case of ischaemic heart disease, the history will reveal whether the veteran has had any myocardial infarctions, whether coronary bypass surgery has been performed and the outcome of any such surgery. In other cases, for example when respiratory disease is present, the current treatment will reveal whether any Other Impairment rating for cardiorespiratory conditions is applicable.\n\nIn long-standing respiratory conditions, there will often be a disease complex present that is more extensive than that implied by the original diagnostic label. For example, asthma may lead to chronic obstructive respiratory disease and chronic bronchitis may lead to small airways disease. Such extensions of the disease process are to be assessed as part and parcel of the original condition unless there is clear reason why they should not be — for example, they have been determined to be non-accepted conditions.\n\n## Effort tolerance\n\nEffort tolerance information should always be obtained except if the veteran has a condition that renders the collection of reliable effort tolerance information impracticable.\n\nExamples of conditions that may render the collection of reliable effort tolerance information impracticable include:\n\n- hemiparesis following a stroke;\n- quadriplegia or hemiplegia;\n- severe arthritis of the lower limbs; and\n- certain mental conditions such as dementia (in which the veteran’s ability to co-operate or provide useful information may be restricted).\n\nThe date of the effort tolerance information used must be appropriate to the period of assessment: the effort tolerance information should be not more than six months older than the relevant time in the assessment period to which the information is to be applied.\n\n## Measurements of lung function\n\nSpirometry should always be obtained if any condition affecting the function of the lungs is present unless it is not practicable or appropriate to perform spirometry because:\n\n- the veteran is very old or frail and cannot reasonably attend a clinic where spirometry can be performed; or\n- the veteran lives in a remote locality and cannot reasonably attend a clinic where spirometry can be performed; or\n- the veteran’s impairment from other accepted conditions is of such a degree that it would result in a combined impairment rating of at least 68 points.\n\nThe date of the spirometry used must be appropriate to the period of assessment: the spirometry should be not more than six months older than the relevant time in the assessment period to which the information is to be applied.\n\nThe nature of the spirometry should be appropriate: the nature of the spirometric readings should be consistent with the known conditions affecting the veteran and should also be consistent with such other information (eg, old spirometry) as is available or can reasonably be obtained. There should be no unexplained inconsistencies between the various reports.\n\nIf the nature of the spirometry cannot be reconciled with other relevant information, the spirometry may need to be repeated or the veteran referred to a respiratory physician for clarification of the situation.\n\nIf a veteran has emphysema, as evidenced by diminished carbon monoxide diffusing capacity, and diagnosed by a specialist respiratory physician, assessment can be made on the basis of effort tolerance alone.\n\nStep 3: Determine the impairment rating based on effort tolerance.\n\nTo determine the impairment rating based on effort tolerance follow the substeps below.\n\n| Substep 3A | Determine the symptomatic activity level by applying Table1.1 — Activity Levels (with energy expenditure in METs). | Page 10 |\n| ---------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------- |\n| Substep 3B | Convert that symptomatic activity level into an impairment rating. This step involves consulting either Table 1.2 — Loss of Cardiorespiratory Function: Exercise Tolerance (Males); or Table 1.3 — Loss of Cardiorespiratory Function: Exercise Tolerance (Females). | Page 13 |\n\nAfter both substeps have been completed, a single rating will have been obtained. This rating is known as the impairment rating for effort tolerance.\n\nIf symptoms do not occur, a rating for the condition may be found in Table 1.6 (Cardiac Failure) if applicable, or in the relevant Other Impairment table.\n\nSubstep 3A: Determine the symptomatic activity level.\n\nThe symptomatic activity level is the exercise level (measured in METs) at which symptoms occur. One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen per kilogram of body weight per minute. Table 1.1 lists various activities grouped according to their energy expenditure in METs.\n\nThe symptomatic activity level is the level at which the activities from within any one METs category consistently give rise to symptoms of the accepted cardiorespiratory condition, such as angina, dyspnoea, palpitations, or fatigue. The symptomatic activity level may be determined by reference to a report specifically provided for the purpose as well as by reference to clinical notes and by comparison of the information with the activities listed in Table 1.1. (The symptomatic activity level may be determined by reference to activities other than those contained in Table 1.1 if the energy expenditure (in METs) of those activities is available in the medical or scientific literature.)\n\nIn determining the symptomatic activity level, greater reliance is to be placed on activities that involve steady, as opposed to sporadic, expenditure of energy. Such activities are more reliable as indicators of exercise tolerance. Less reliance is to be placed on activities that can be completed in less than a few minutes, as symptoms may take longer than this to occur.\n\nResponses of the type ‘I cannot do such and such’ or ‘I do not do so and so’ are not useful in assessing the symptomatic activity level. What must be established is that level of exercise that the veteran is able to do but which results in angina, breathlessness, or some other cardiorespiratory symptom.\n\nSymptoms that occur while an activity is performed are not necessarily a result of the energy expenditure occasioned by the activity. Many specific activities can be performed in a way that would mean that they were no longer examples of the METs level in which they are placed in Table 1.1. For example, while driving a car sedately is an example of 2–3 METs, driving a car in a Grand Prix is not.\n\nEstimations of exercise tolerance above the 6-7 METs level should only be made using exercise tests. The activities above the 6-7 METs level are listed for information only.\n\n \nTABLE 1.1![](image.005.png)\n\nCARDIORESPIRATORY IMPAIRMENT: ACTIVITY LEVELS\n\n(with energy expenditure in METs)\n\n| 1-2 METs | Energy expended at rest or minimal activityLying down.Sitting and drinking tea.Using sewing machine (electric).Sitting down.Sitting and talking on telephone.Travelling in car as passenger.Standing.Sitting and knitting.Playing cards.Strolling (slowly).Light sweeping.Clerical work (desk work only). |\n| -------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 2–3 METs | Energy expanded in dressing, washing and performing light household dutiesLight household duties.Walking slowly (3.5 km/h).Playing piano, violin, or organ.Typing.Cooking or preparing meals.Playing billiards.Clerical work which involves moving around.Setting table.Driving power boat.Washing dishes.Playing golf (with power buggy).Bench assembly work (seated).Dressing, showering.Horseback riding at walk.Using self-propelled mower.Light tidying, dusting.Lawn bowls.Polishing silver.Driving car. |\n| 3–4 METs | Energy expended in walking at an average paceWalking at average walking pace (5 km/h).Golf (pulling buggy).Machine assembly.Cleaning car (excludes vigorous polishing).Minor car repairs.Tidying house.Welding.Cleaning windows.Table tennis.Pushing light power mower over flat suburban lawn at slow steady paceVacuuming.Sedate cycling (10 km/h)Shifting chairs.Light gardening (weeding and water).Hanging out washing.Making bed. |\n| 4–5 METs | Moderate activity: encompasses more strenuous daily activities with the exclusion of manual labour and vigorous exerciseMopping floors.Golf (carrying bag).Light carpentry (eg, chiselling, hammering).Scrubbing floors.Ballroom dancing.Beating carpets.Tennis doubles (social, non-competitive).Stocking shelves with light objects.Polishing furniture.Wallpapering.Shopping and carrying groceries (10 kg).Gentle swimming.Painting outside of house.Hoeing (soft soil).Stacking firewood. |\n| 5–6 METs | Heavy exercise: manual labour or vigorous sportsWalking 6.5 km/h (sustained brisk walk, discomfort in talking at the same time).Walking slowly but steadily up stairs.Carpentry (eg. Sawing and planing with hand tools).Swimming laps (non-competitive).Pushing a full wheelbarrow (20 kg).Shovelling dirt (12 throws a minute).Digging in garden. |\n| 6–7 METs | Badminton (competitive)Tennis (singles, non-competitive).Water skiing.Loading truck with bricks.Using a pick and shovel to dig trenches. |\n| 7–8 METs | Very heavy exerciseJogging (8 km/h).Horseback riding (galloping).Carrying heavy objects (30 kg) on level ground.Sawing hardwood with hand tools. |\n| 8–9 METs | Running (9 km/h).Skiing (cross-country.Chopping hardwood.Callisthenics.Squash (non competitive). |\n| 10+ METs | Running quickly (10 km/h).Cycling quickly (25 km/h).Carrying loads (10 kg) up a gradient.Football (any code). |\n\n The activities listed under each heading are examples. There will be other activities that have the same METs expenditure and hence can be used for reference if their METs level is known.\n\nAlternate procedures for establishing the symptomatic activity level\n\n 1. The symptomatic activity level may be determined by exercise tests. These tests include:\n\n use of treadmills; or\n\n cycles; or\n\n rowing machines.\n\nBecause of their greater objectivity, the results of exercise tests (when available) are to be used in preference to the method of calculating exercise tolerance as described above. Moreover, exercise tests must always be used to make an estimate of exercise tolerance above 6–7 METs.\n\n2. If certain levels of activity have been prohibited by the treating doctor, because of the adverse effect the prohibited activity is likely to have on the veteran’s health as a result of the accepted condition, then the level of exercise that has been prohibited may be regarded as the symptomatic activity level.\n\nSubstep 3B: Convert the symptomatic activity level into an impairment rating.\n\nThe symptomatic activity level is used, in conjunction with the veteran’s age, height, and sex, to obtain an impairment rating.\n\nIn the case of a male, Table 1.2 is to be applied.\n\nIn the case of a female, Table 1.3 is to be applied.\n\nFor the purposes of Tables 1.2 and 1.3, a veteran’s age is taken to be his or her age in whole years at the date of the report relating to the exercise tolerance (unless the report is of a retrospective type and clearly refers to some earlier period, in which case the veteran’s age is taken to be his or her age in whole years at the relevant time).\n\nStep 4: (Omit this step if no respiratory disease is present.) Determine the impairment rating based on measurements of lung function.\n\nFEVl, FVC, and MEF 25–75 are the usual physiological measurements of lung function. Determinations of FEVl, FVC, and MEF 25–75 should be conducted by an experienced operator without specific administration of a bronchodilator. The best set of results should be selected, that is, the set of results which indicates the greatest degree of health and, consequently, the lowest degree of impairment.\n\nIf both pre-bronchodilator and post-bronchodilator results are available the pre-bronchodilator results are to be applied in determining the impairment rating based on measurements of lung function.\n\nTo determine the impairment rating based on measurements of lung function, follow the substeps below.\n\n| Substep 4A | Obtain the measured FEVl, FVC, and MEF 25–75 from the data. |\n| ---------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Substep 4B | Work out the predicted FEVl, FVC, and MEF 25–75 for a person of the same age, height, and gender. This can be done either by applying the nomograms Figure 1a (for males) or Figure 1b (for females) or by applying the formula relating to each nomogram. |\n| Substep 4C | Express the measured FEV1 as a percentage of the predicted FEV1, and Express the measured FVC as a percentage of the predicted FVC, and Express the measured MEF 25–75 (if appropriate) as a percentage of the predicted MEF 25–75.These conversions are performed by applying the formula:Measured value as % of predicted value = Actual value x 100Predicted Value |\n| Substep 4D | Determine an impairment rating from a physiological measurement by using the percentage obtained in substep 4C in conjunction with Table 1.4. Separate impairment ratings can be obtained from each physiological measurement (that is, from the FEV1, FVC, and MEF 25–75). |\n| Substep 4E | The final impairment rating is the highest (or equal highest) of the ratings obtained in substep 4D. |\n\n \n\n

Function Loss Table 1.2

\"\"

LOSS OF CARDIORESPIRATORY FUNCTION: EXERCISE TOLERANCE

(Males)

Age

Symptomatic Activity Level

Age

Symptomatic Activity Level

(METs*)

(METs*)

less than

25

1–2

2–3

3–4

4–5

5–6

6–7

7–8

8–9

10+

1–2

2–3

3–4

4–5

5–6

6–7

7–8

8–9

10+

90

80

70

60

50

40

30

20

10

55

80

70

55

40

25

15

10

25

90

80

70

60

50

40

30

20

10

56

80

70

54

39

24

15

9

26

90

80

70

60

50

40

30

20

10

57

80

69

53

38

23

14

8

27

89

80

70

59

48

38

28

19

10

58

80

69

52

37

22

14

7

28

89

80

70

59

47

37

27

19

10

59

80

68

51

36

21

13

6

29

88

80

70

58

46

36

26

18

10

60

80

68

50

35

20

13

5

30

88

80

70

58

45

35

25

18

10

61

80

67

49

34

19

12

4

31

87

80

70

57

44

34

24

17

10

62

80

67

48

33

18

12

3

32

87

80

70

57

43

33

23

17

10

63

80

66

47

32

17

11

2

33

86

80

70

56

42

32

22

16

10

64

80

66

46

31

16

11

34

86

80

70

56

41

31

21

16

10

65

80

65

45

30

15

10

35

85

80

70

55

40

30

20

15

10

66

80

64

44

29

15

9

36

85

80

70

55

39

29

20

15

9

67

79

63

43

28

14

8

37

85

79

69

54

38

28

19

14

8

68

79

62

42

27

14

7

38

85

79

69

54

37

27

19

14

7

69

78

61

41

26

13

6

39

85

78

68

53

36

26

18

13

6

70

78

60

40

25

13

5

40

85

78

68

53

35

25

18

13

5

71

77

59

39

24

12

4

41

85

77

67

52

34

24

17

12

4

72

77

58

38

23

12

3

42

85

77

67

52

33

23

17

12

3

73

76

57

37

22

11

2

43

85

76

66

51

32

22

16

11

2

74

76

56

36

21

11

1

44

85

76

66

51

31

21

16

11

75

75

55

35

20

10

45

85

75

65

50

30

20

15

10

76

75

55

35

19

9

46

85

75

64

49

30

20

15

9

77

75

54

34

18

8

47

84

74

63

48

29

19

14

8

78

75

54

34

17

7

48

84

74

62

47

29

19

14

7

79

75

53

33

16

6

49

83

73

61

46

28

18

13

6

80

75

53

33

15

5

50

83

73

60

45

28

18

13

5

81

75

52

32

14

4

51

82

72

59

44

27

17

12

4

82

75

52

32

13

3

52

82

72

58

43

27

17

12

3

83

75

51

31

12

2

53

81

71

57

42

26

16

11

2

84

75

51

31

11

1

54

81

71

56

41

26

16

11

85

75

50

30

10

above 85

75

50

30

10

*One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen/kg body Weight/min.

\n```\n\n \n\n

Functional Loss Table 1.3

\"\"

LOSS OF CARDIORESPIRATORY FUNCTION: EXERCISE TOLERANCE

(Females)

Age

Symptomatic Activity Level

Age

Symptomatic Activity Level

(METs*)

(METs*)

less than

25

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

10+

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

10+

90

80

70

55

40

30

20

15

10

55

80

65

50

30

20

15

10

25

90

80

70

55

40

30

20

15

10

56

80

65

49

29

20

15

9

26

90

80

69

54

40

30

20

15

10

57

80

64

48

28

19

14

8

27

89

79

68

53

39

29

20

15

10

58

80

64

47

27

19

14

7

28

89

79

67

52

39

29

20

15

10

59

80

63

46

26

18

13

6

29

88

78

66

51

38

28

20

15

10

60

80

63

45

25

18

13

5

30

88

78

65

50

38

28

20

15

10

61

80

62

44

24

17

12

4

31

87

77

64

49

37

27

20

15

10

62

80

62

43

23

17

12

3

32

87

77

63

48

37

27

20

15

10

63

80

61

42

22

16

11

2

33

86

76

62

47

36

26

20

15

10

64

80

61

41

21

16

11

34

86

76

61

46

36

26

20

15

10

65

80

60

40

20

15

10

35

85

75

60

45

35

25

20

15

10

66

80

59

39

20

15

9

36

85

75

60

45

34

25

20

15

9

67

79

58

38

19

14

8

37

85

75

60

44

33

24

19

14

8

68

79

57

37

19

14

7

38

85

75

60

44

32

24

19

14

7

69

78

56

36

18

13

6

39

85

75

60

43

31

23

18

13

6

70

78

55

35

18

13

5

40

85

75

60

43

30

23

18

13

5

71

77

54

34

17

12

4

41

85

75

60

42

29

22

17

12

4

72

77

53

33

17

12

3

42

85

75

60

42

28

22

17

12

3

73

76

52

32

16

11

2

43

85

75

60

41

27

21

16

11

2

74

76

51

31

16

11

1

44

85

75

60

41

26

21

16

11

75

75

50

30

15

10

45

85

75

60

40

25

20

15

10

76

75

49

29

15

9

46

85

74

59

39

25

20

15

9

77

75

48

28

14

8

47

84

73

58

38

24

19

14

8

78

75

47

27

14

7

48

84

72

57

37

24

19

14

7

79

75

46

26

13

6

49

83

71

56

36

23

18

13

6

80

75

45

25

13

5

50

83

70

55

35

23

18

13

5

81

75

44

24

12

4

51

82

69

54

34

22

17

12

4

82

75

43

23

12

3

52

82

68

53

33

22

17

12

3

83

75

42

22

11

2

53

81

67

52

32

21

16

11

2

84

75

41

21

11

1

54

81

66

51

31

21

16

11

85

75

40

20

10

above 85

75

40

20

10

*One MET represents the energy expenditure associated with the consumption of 3.5mL oxygen/kg body weight/min.

\n```\n\nFIGURE 1a ‑ PREDICTION NOMOGRAM: MALE (BTPS)\n\n![](image.006.png)\n\nFIGURE 1b ‑ PREDICTION NOMOGRAM: FEMALE (BTPS)\n\n![](image.007.png)\n\n \n\n

Functional Loss Table 1.4

\"\"

LOSS OF CARDIORESPIRATORY FUNCTION: PHYSIOLOGICAL MEASUREMENTS

Impairment

Rating

FEV1 as a

percentage

of predicted

FVC as a

percentage

of predicted

MEF 25–75 as a

percentage

of predicted

NIL

85

85

85

TWO

84

SIX

84

84

SEVEN

83

EIGHT

83

83

TEN

82

82

ELEVEN

81

82

81

TWELVE

THIRTEEN

80

80

FOURTEEN

79

81

79

FIFTEEN

SIXTEEN

78

80

78

SEVENTEEN

77

77

EIGHTEEN

76

79

76

NINETEEN

TWENTY

75

78

75

TWENTY-ONE

74

74

TWENTY-TWO

73

77

73

TWENTY-THREE

72

72

TWENTY-FOUR

71

76

71

TWENTY-FIVE

TWENTY-SIX

70

75

70

TWENTY-SEVEN

69

74

69

TWENTY-EIGHT

68

68

TWENTY-NINE

67

73

67

THIRTY

66

72

66

THIRTY-ONE

65

71

65

THIRTY-TWO

64

64

THIRTY-THREE

63

70

63

THIRTY-FOUR

62

69

62

THIRTY-FIVE

61

68

61

THIRTY-SIX

60

67

60

THIRTY-SEVEN

59

59

\n```\n\n \n\n

Functional Loss Table 1.4 (continued)

\"\"

LOSS OF CARDIORESPIRATORY FUNCTION: PHYSIOLOGICAL MEASUREMENTS

Impairment

Rating

FEV1 as a

percentage

of predicted

FVC as a

percentage

of predicted

MEF 25–75 as a

percentage

of predicted

THIRTY-EIGHT

58

66

58

THIRTY-NINE

57

65

57

FORTY

64

FORTY-ONE

56

63

56

FORTY-TWO

55

62

55

FORTY-THREE

54

61

54

FORTY-FOUR

53

60

53

FORTY-FIVE

52

52

FORTY-SIX

51

59

51

FORTY-SEVEN

50

58

50

FORTY-EIGHT

49

57

49

FORTY-NINE

48

56

48

FIFTY

47

55

47

FIFTY-ONE

46

54

46

FIFTY-TWO

45

53

45

FIFTY-THREE

44

52

44

FIFTY-FOUR

43

51

43

FIFTY-FIVE

42

50

42

FIFTY-SIX

41

49

41

FIFTY-SEVEN

40

40

FIFTY-EIGHT

39

48

39

FIFTY-NINE

38

47

38

SIXTY

37

46

37

SIXTY-ONE

36

45

36

SIXTY-TWO

35

44

35

SIXTY-THREE

34

43

34

SIXTY-FOUR

33

42

33

SIXTY-FIVE

32

41

32

SIXTY-SIX

31

40

31

SIXTY-SEVEN

30

39

30

SIXTY-EIGHT

29

38

29

SIXTY-NINE

28

37

28

SEVENTY

27

36

27

\n```\n\nRatings derived from this table are age adjusted\n\n \nWhenever the measured parameter is less than 85% of the predicted, Table 1.4 corresponds to the following formulas:\n\n| Impairment rating based on FEV1 | = | 98 - % FEV1 + | 50(% FEV1-90) |\n| ------------------------------------ | --- | ------------- | -------------- |\n| Impairment rating based on FVC | = | 108 - % FVC + | 100(%FVC-88.5) |\n| Impairment rating based on MEF 25–75 | = | 98 - % MEF + | 50(% MEF-90) |\n\nWhen the measured parameter is 85% or more of the predicted, then the impairment rating is defined as NIL\n\n“%FEV1” means measured FEV1 expressed as a percentage of predicted FEV1.\n\n“%FVC” means measured FVC expressed as a percentage of predicted FVC. “%MEF” means measured MEF 25‑75 expressed as a percentage of predicted MEF 25–75.\n\nIn each case the percentage is to be rounded to the nearest integer before the formula is applied.\n\nIf these formulas are applied the resulting impairment rating is always to be rounded to the nearest integer.\n\nStep 5: Calculate the total accepted cardiorespiratory functional impairment rating.\n\nAt this stage there will usually be an impairment rating derived from effort tolerance information and there may also be an impairment rating derived from measurements of lung function. These must be combined into a single cardiorespiratory functional impairment rating. The method by which that is to be done is set out in Table 1.5.\n\nFor the purposes of Table 1.5, the following abbreviations have been used:\n\n| Abbreviation | Meaning |\n| -------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n| “FI” | means cardiorespiratory functional impairment rating. |\n| “No FI” | means a cardiorespiratory functional impairment rating cannot be calculated from either effort tolerance information or measurements of lung function. |\n| “METs” | means the cardiorespiratory functional impairment rating is to be taken as the impairment rating derived from METs alone. |\n| “Spirometry” | means the cardiorespiratory functional impairment rating is to be taken as the impairment rating derived from measurements of respiratory function. |\n| “average of METs and Spirometry” | means the average of the cardiorespiratory functional impairment rating derived from METs alone and the cardiorespiratory functional impairment rating derived from measurements of respiratory function alone — using the ordinary formula for averaging two quantities or by use of the nomogram in Figure 1c. In either case, the result is to be rounded to the nearest integer. |\n\n \n\n

Procedural Table 1.5

\"\"

CARDIORESPIRATORY FUNCTIONAL IMPAIRMENT

Respiratory disease present

No respiratory disease

Spirometry obtainable

Spirometry not obtainable

Cardiac disease present

METs data obtainable

FI = higher of METs and Spirometry

FI = METs

FI = METs

METs data not obtainable

FI = Spirometry

No FI

No FI

No cardiac disease

METs data obtainable

FI = average of METs and Spirometry

FI = METs

METs data not obtainable

FI = Spirometry

No FI

In applying this table, both accepted and non-accepted conditions are to be taken into account.

\n```\n\nFrom Table 1.5 it will be seen that:\n\n- if cardiac conditions exist in the absence of respiratory disease, cardiorespiratory functional impairment should be measured by effort tolerance alone;\n- if respiratory conditions exist in the absence of cardiac disease, the cardiorespiratory functional impairment rating is the rounded average of (i) impairment as measured by effort tolerance, and (ii) impairment as measured by spirometry;\n- if both cardiac and respiratory conditions co-exist, the cardiorespiratory functional impairment rating is the greater of (i) the impairment rating as measured by effort tolerance, and (ii) the impairment rating as measured by spirometry.\n\nIn applying these rules, both accepted and non-accepted cardiac and respiratory conditions are to be taken into account.\n\nOnly one rating for effort tolerance is to be given irrespective of the number of conditions that contribute to the relevant impairment.\n\nOnly one rating is to be given for physiological measurements of lung function irrespective of the number of conditions that contribute to the relevant impairment.\n\nThis single “total cardiorespiratory functional impairment” is due to the combined effect of all cardiorespiratory conditions whether accepted or not.\n\nFIGURE 1c ‑ LOSS OF REPIRATORY FUNCTION RESPIRATORY NOMOGRAM\n\n![](image.008.png)\n\nThis nomogram is to be used in accordance with the instructions in Step 5 and the procedural Table 1.5.\n\nResults from this nomogram are to be rounded to the nearest five points. 2.5 is to be rounded up to 5 and 7.5 is to be rounded up to 10.\n\nThis nomogram corresponds to the formula:\n\n| Impairment Rating = | METs Impairment Rating + Impairment Rating of Physiological Measurement2 |\n| ------------------- | ------------------------------------------------------------------------ |\n\nStep 6: Consider the effects of cardiac failure (if any).\n\nFor the purposes of assessment under this Guide, cardiac failure is considered to be a surrogate measure of cardiorespiratory impairment. When cardiac failure is present, the impairment rating calculated using effort tolerance will usually exceed any possible impairment rating from Table 1.6. Table 1.6 is of particular importance in assessing a veteran who is unable to be rated using effort tolerance because of significant conditions such as hemiplegia.\n\n

Functional Loss Table 1.6

\"\"

CARDIAC FAILURE

Impairment Ratings

Criteria

NIL

No cardiac failure; that is, neither symptoms nor X-ray evidence of cardiac failure.

TEN

  • No symptoms, but X-ray evidence of early cardiac failure.
  • Evidence of right ventricular failure.

FIFTEEN

Left or biventricular cardiac failure demonstrated by ejection fraction of between 40% and 60% and persisting despite therapy.

TWENTY

Left or biventricular cardiac failure demonstrated on X-ray or by ejection fraction of less than or equal to 40% and persisting despite therapy.

Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

\n```\n\nNo age adjustment allowed for this table\n\nA rating from Table 1.6 is to be compared with the total cardiorespiratory functional impairment rating (obtained in Step 5) and the higher of the two is to be chosen.\n\nStep 7: Moderate the total cardiorespiratory functional impairment rating to allow for effects of any non-accepted conditions.\n\n## Partially contributing impairment\n\nIf non-accepted conditions contribute to the impairment, Chapter 19 (Partially Contributing Impairment) is to be applied to determine impairment from the accepted conditions.\n\nIf cardiac conditions exist in the absence of respiratory disease: if there is more than one cardiac condition present (for example ischaemic heart disease and a valvular heart disease) and some are accepted and some are not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition.\n\nIf a respiratory condition exists in the absence of cardiac disease, the symptomatic activity level will generally be the exercise level (in METs) at which dyspnoea occurs. If there is more than one respiratory condition present and at least one is accepted and at least one is not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition or conditions.\n\nIf cardiac and respiratory conditions co-exist, and at least one is accepted and at least one is not accepted, it is necessary to determine the total cardiorespiratory functional impairment rating (as set out in the previous steps), and then to moderate that rating by applying Chapter 19 to determine the impairment due to the accepted condition.\n\nThe result that is then derived is the “total accepted cardiorespiratory functional impairment rating”.\n\nStep 8: Determine whether any ratings from the cardiorespiratory Other Impairment tables apply.\n\n## Cardiorespiratory Other Impairment tables\n\nOnce the total accepted cardiorespiratory functional impairment rating has been determined, it must be compared with the relevant cardiorespiratory Other Impairment tables. For assessment purposes, four categories of cardiorespiratory condition are recognised. These categories are:\n\n- ischaemic heart disease;\n- valvular heart disease;\n- miscellaneous heart disease; and\n- lower respiratory tract conditions.\n\nThere are four cardiorespiratory Other Impairment tables — corresponding to each of the above categories. These tables are:\n\nTable 1.7 — Cardiorespiratory Impairment: Ischaemic;\n\nTable 1.8 — Cardiorespiratory Impairment: Valvular;\n\nTable 1.9 — Cardiorespiratory Impairment: Miscellaneous; and\n\nTable 1.10 — Cardiorespiratory Impairment: Respiratory.\n\nOnly one rating is to be selected from each of these cardiorespiratory Other Impairment tables (Tables 1.7, 1.8, 1.9, and 1.10) for any condition or combination of conditions.\n\nIf accepted conditions belonging to more than one of the four categories of cardiorespiratory disease above are present, then the relative contribution of their effect on the total accepted cardiorespiratory functional impairment must be estimated by applying Chapter 20 (Apportionment). The rating for each condition will be the higher of the cardiorespiratory functional impairment rating attributed to it and its cardiorespiratory Other Impairment rating.\n\nThe cardiorespiratory worksheet (at page 29) should also be consulted.\n\n

Other Impairment Table 1.7

\"\"

CARDIORESPIRATORY IMPAIRMENT: ISCHAEMIC HEART DISEASE

Impairment Ratings

Criteria

NIL

No history of symptoms but evidence of transient ischaemia on exercise ECG testing.

TEN

  • Coronary artery disease, characterised by typical history of angina pectoris.
  • Coronary artery disease, characterised by history of uncomplicated myocardial infarct, with no subsequent evidence of cardiac failure and infrequent or no angina.
  • Coronary artery disease, with single vessel disease (other than left main coronary) demonstrated on angiogram.
  • Coronary artery disease with successful coronary artery surgery, followed by no angina or only infrequent angina but no further infarcts or cardiac failure.

FIFTEEN

Coronary artery disease with multi-vessel disease (not successfully corrected) demonstrated on angiogram.

TWENTY

  • Coronary artery disease characterised by a history of myocardial infarct followed, immediately or after a lapse of time, by continuing angina or further infarcts.
  • Coronary artery disease characterised by left main coronary artery disease (not successfully corrected) demonstrated on angiogram.
  • Coronary artery disease with successful coronary artery surgery, followed, after a lapse of time, by frequent angina or further infarcts or cardiac failure.

Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

\n```\n\n

Other Impairment Table 1.8

\"\"

CARDIORESPIRATORY IMPAIRMENT: VALVULAR HEART DISEASE

Impairment Ratings

Criteria

NIL

  • Mitral valve prolapse with no or minimal symptoms.
  • Aortic sclerosis with no or minimal symptoms.

FIVE

Diagnosed valvular heart disease (other than mitral valve prolapse or aortic sclerosis) with no symptoms and no X-ray evidence of cardiac failure.

TEN

Valvular heart disease with successful valve replace­ment, not requiring anticoagulant medication, with no subsequent symptoms or evidence of cardiac failure.

FIFTEEN

Valvular heart disease with successful valve replace­ment, requiring anticoagulant medication, with no subsequent symptoms or evidence of cardiac failure.

Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

\n```\n\n \n\n

Other Impairment Table 1.9

\"\"

CARDIORESPIRATORY IMPAIRMENT: MISCELLANEOUS

Impairment Ratings

Criteria

NIL

Flow murmurs.

TWO

Chronic asymptomatic arrhythmia, eg. atrial fibril­lation, atrial or ventricular ectopic beats.

FIVE

Need for a permanent pacemaker.

Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

\n```\n\nArrhythmias are usually to be rated by applying Chapter 15 (Intermittent Impairment) unless they cause a permanent restriction of exercise tolerance, in which case they are to be assessed by their effect on effort tolerance.\n\n

Other Impairment Table 1.10

\"\"

CARDIORESPIRATORY IMPAIRMENT: LOWER RESPIRATORY TRACT

Impairment Ratings

Criteria

NIL

Asymptomatic pleural plaques

TWO

  • Recurrent lower respiratory infections (at least 6 per year)
  • Intermittent use of bronchodilator medication.

FIVE

  • Daily use of inhaled steroids required.
  • Regular, daily use of bronchodilator medication.
  • Chronic cough, with production of at least 50mL sputum/day.

TEN

  • Regular, daily use of bronchodilator medication required in addition to daily inhaled steroids.
  • Chronic cough, with production of at least 100 mL sputum/day.

TWENTY

Repeated courses (at least several courses per year) or permanent use of oral steroids required.

Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.

\n```\n\n## Peripheral Vascular Conditions\n\nTables 1.2 and 1.3 are to be applied to assess those conditions that affect exercise tolerance from a cardiorespiratory point of view. Peripheral vascular conditions typically cause loss of function of the lower limbs only and therefore are to be assessed under lower limb impairment (using Chapter 3).\n\nAtherosclerosis frequently causes both a cardiorespiratory condition and a peripheral vascular condition. In such cases, if both types of conditions are accepted conditions, then both conditions are to be rated using the appropriate assessment procedure.\n\n \n\nThe rating of asthma depends on the clinical circumstances. If asthma has caused chronic airways obstruction the method of assessment described in this chapter is to be applied. If there is little fixed obstruction and a large reversible component, the rating is to be based on the occurrence of attacks using the method of intermittent impairment (Chapter 15). Asthma can also be rated, if there is minimal loss of function, from Table 1.10.\n\n![](image.009.png)\n\nCHAPTER 2\n\nHYPERTENSION AND NON-CARDIAC VASCULAR CONDITIONS\n\nThis Chapter contains three parts:\n\nPart 2.1 — Hypertension\n\nPart 2.2 — Vascular Conditions of the Lower Limbs\n\nPart 2.3 — Other Non-Cardiac Vascular Conditions\n\nThis chapter is to be applied in determining impairment ratings for hypertension and non-cardiac vascular conditions. For conditions affecting the heart itself refer to Chapter 1 (Cardiorespiratory Impairment).\n\n## PART 2.1: HYPERTENSION\n\nHypertension, of itself, does not affect effort tolerance. Therefore, uncomplicated hypertension is not to be assessed under Chapter 1 (Cardiorespiratory Impairment) but in the manner set out below.\n\nCalculation of the impairment rating for hypertension\n\nFollow the steps below to calculate the impairment rating for hypertension.\n\n| STEP 1 | Establish whether any target organ damage is present. | Page 30 |\n| ------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ------- |\n| STEP 2 | (Omit this step if there is no target organ damage.)Calculate the total functional impairment for any accepted target organ damage | Page 31 |\n| STEP 3 | Calculate the Other Impairment rating for the accepted hypertension by applying Table 2.1.1. | Page 32 |\n| STEP 4 | (Omit this step if there is no target organ damage.)Compare the rating obtained in Step 2 with the rating obtained in Step 3. Take the higher of these two ratings | Page 32 |\n\nStep 1: Establish whether any target organ damage is present.\n\nFor the purposes of this chapter, “target organ damage” means any of the following:\n\n- hypertensive retinopathy, grade III or IV;\n- hypertensive cardiac disease, with ECG or X-ray evidence of left ventricular hypertrophy;\n- hypertensive nephropathy demonstrated at biopsy, or by presence of proteinuria or elevated serum creatinine level; or\n- hypertensive cerebral haemorrhage.\n\nCertain other conditions have hypertension as a contributing factor in their aetiology (for example: ischaemic heart disease and peripheral vascular disease). Such conditions are not to be regarded as being target organ damage when applying Part 2.1.\n\nStep 2: Calculate the total functional impairment due to any accepted target organ damage.\n\nAccepted hypertensive retinopathy is to be assessed by applying Chapter 8.\n\nIf other ophthalmic conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.\n\nAccepted hypertensive cardiac disease is to be assessed by applying Chapter 1.\n\nIf other cardiorespiratory conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.\n\nAccepted hypertensive nephropathy is to be assessed by applying Chapter 9.\n\nIf other renal conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.\n\nAccepted hypertensive cerebral haemorrhage is to be assessed according to the specific effects of the haemorrhage.\n\nThe impairment ratings attributable to the accepted target organ damage are to be combined by applying Chapter 18 (Combined Values Chart) to obtain the total impairment rating for accepted target organ damage.\n\nTarget organ damage that is not an accepted condition cannot be assessed under this Guide. Target organ damage can be assessed under this Guide only after it has been claimed and has become an accepted condition.\n\nThe criterion in Table 2.1.1 which refers to “hypertension of such a degree that target organ damage is present” is not an assessment of the target organ damage itself but is a measure of the severity of the hypertension.\n\n \n\nStep 3: Determine an impairment rating for hypertension from Table 2.1.1.\n\n

Other Impairment Table 2.1.1

\"\"

HYPERTENSION

Impairment Ratings

Criteria

NIL

Hypertension adequately controlled by diet and weight loss without long-term medication.

TWO

Hypertension requiring long-term medication but without side-effects of the medication and with no evidence of target organ damage.

FIVE

  • Hypertension with diastolic pressure consistently at or greater than 90 mm Hg despite treatment.
  • Hypertension: controlled but frequent minor side effects of medication which cause no loss of function.

TEN

  • Hypertension: diastolic pressure consistently greater than 100 mm Hg.
  • Hypertension of such a degree that target organ damage is present.
  • Hypertension: controlled but with side effects of medication causing a significant and persistent loss of function.

Only one rating is to be selected from this table.

\n```\n\nFor the purpose of determining a rating of 10 impairment points from Table 2.1.1 (dot point 2) target organ damage has to be present either as an accepted condition or as a non-accepted condition.\n\nStep 4: (Omit this step if is there is no target organ damage.) Compare the rating obtained in Step 2 with the rating obtained in Step 3. Take the higher rating.\n\nThe total impairment rating for accepted target organ damage is to be compared with any applicable rating from Table 2.1.1, and the higher of the two is to be taken as the impairment rating for the accepted hypertension.\n\n| Substep 4A | If the impairment rating from Table 2.1.1 is higher than the total rating for accepted target organ damage, the latter rating is to be discarded and its components are not to be used in any further calculations. |\n| ---------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Substep 4B | If the impairment rating for accepted target organ damage is higher than the rating from Table 2.1.1, the rating from Table 2.1.1 is to be discarded and each of the components of the rating for accepted target organ damage is to be included in the final combining of all impairment ratings. |\n\nImpairment ratings from Table 2.1.1 are not routinely compared with ratings from the functional loss tables in Chapter 1 (Cardiorespiratory Impairment) except if hypertensive cardiomyopathy is present. Instead, they are to be compared with the impairment rating for the total loss of function due to target organ damage.\n\nThe total impairment rating for target organ damage is not to be combined with the impairment rating obtained from Table 2.1.1.\n\n \n\n## PART 2.2: VASCULAR CONDITIONS OF THE LOWER LIMBS\n\nEach vascular condition of the lower limbs is characterised as belonging to one or more of three categories. These categories are:\n\n- (arterial) peripheral vascular disease;\n- varicose veins and vascular leg ulcers; and\n- oedema.\n\nEach category is to be assessed by applying a specific table from this part of the Guide. Depending on their effects, vascular conditions of the lower limbs may be rated under one or more of these tables.\n\nDetermination of the impairment rating for vascular conditions of the lower limbs\n\nFollow the steps below to determine the impairment rating for each type of accepted vascular condition of the lower limbs.\n\n| Step 1 | Establish whether any effect on lower limb function is present. | Page 34 |\n| ------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------- |\n| Step 2 | Establish whether any effect on the skin is present. | Page 34 |\n| Step 3 | (Omit this step if there is no effect on lower limb function)Determine the impairment rating for the effects on lower limb function. | Page 34 |\n| Step 4 | (Omit this step if there is no effect on skin)Determine the impairment rating for the effects on the skin. | Page 34 |\n| Step 5 | Determine the Other Impairment rating for the vascular conditions of the lower limbs by applying Tables 2.2.1, 2.2.2, and 2.2.3. | Page 34 |\n| Step 6 | Combine the impairment ratings obtained in Steps 3 and 4. | Page 36 |\n| Step 7 | Combine the impairment ratings obtained in Step 5. | Page 36 |\n| Step 8 | Compare the impairment ratings obtained in Steps 6 and 7. | Page 36 |\n| Step 9 | If the comparison made in Step 8 shows that the impairment rating obtained in Step 6 is greater than the impairment rating obtained in Step 7, then the ratings obtained in Steps 3 and 4 are the final impairment ratings for the vascular condition. | Page 36 |\n| Step 10 | If the comparison made in Step 8 shows that the impairment rating obtained in Step 7 is greater than the impairment rating obtained in Step 6, then the separate ratings that have been combined in Step 5 are the final impairment rating(s) for the vascular condition. | Page 37 |\n\nStep 1: Establish whether any effect on lower limb function is present.\n\nLower limb function may be affected by peripheral vascular disease. If peripheral vascular disease is present, the veteran’s walking distance is likely to be reduced as a result of intermittent claudication (cramplike pain in the calves of the legs).\n\nStep 2: Establish whether any effect on the skin is present.\n\nVaricose veins can affect the skin of the lower limbs. They may cause discolouration or pruritus (itching). Excoriations (scratch marks) may be present.\n\nStep 3: (Omit this step if there is no effect on lower limb function.) Determine the impairment rating for the effects on lower limb function.\n\nLower Limb Function is to be assessed by applying Chapter 3 (Impairment of Spine And Limbs) ­— Part 3.2. If other conditions affecting lower limb function are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.\n\nThe effects of vascular conditions of the lower limbs on lower limb function are taken to be symptoms or manifestations of the condition. Hence, they are to be assessed as part of the vascular condition of the lower limbs.\n\nStep 4: (Omit this step if there is no effect on the skin.) Determine the impairment rating for the effects on the skin.\n\nSkin conditions are to be assessed by applying Chapter 11 (Skin Impairment). If other conditions affecting the skin are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.\n\nThe effects of vascular conditions of the lower limbs on the skin of the lower limbs are taken to be symptoms or manifestations of the condition. Hence, they are to be assessed as part of the vascular condition of the lower limb.\n\nStep 5: Determine the Other Impairment rating for the vascular conditions of the lower limbs by applying Tables 2.2.1, 2.2.2, and 2.2.3.\n\nThere are three Other Impairment tables relating to the effects of vascular conditions of the lower limbs. A condition may be rated under more than one table if appropriate. However, only one rating may be taken from each table irrespective of how many conditions contribute to the type of impairment to which that table relates.\n\nThe three Other Impairment tables are:\n\nTable 2.2.1 — (Arterial) Peripheral Vascular Disease\n\nTable 2.2.2 — Varicose Veins\n\nTable 2.2.3 — Oedema.\n\nAmputations arising from peripheral vascular disease cannot be assessed unless they have been separately accepted. They can then be assessed under Chapter 3 (Impairment of Spine and Limbs).\n\n

Other Impairment Table 2.2.1

\"\"

(ARTERIAL) PERIPHERAL VASCULAR DISEASE

Impairment Ratings

Criteria

NIL

No peripheral vascular disease is present.

TWO

Minor peripheral vascular disease or peripheral vascular disease that has been successfully treated.

FIVE

Moderate peripheral vascular disease is present but causes little restriction of activities.

TEN

Severe peripheral vascular disease, the expected effects of which are masked by a non-accepted condition (eg, masked by restriction on walking due to a musculo­skeletal disorder).

Irrespective of whether one or two legs are affected, only one rating may be selected from this table.

\n```\n\n

Other Impairment Table 2.2.2

\"\"

VARICOSE VEINS

Impairment Ratings

Criteria

NIL

  • Varicose veins which are not greatly disfiguring, which cause only trivial symptoms, and which impose no significant restriction on activities.
  • Superficial, small or transient ulceration.

TWO

Varicose veins which are unsightly or even gross but which impose no significant restriction on activities.

FIVE

Varicose veins, varicose ulcers — causing constant or almost constant symptoms which are not easily tolerated and require medication or therapy.

TEN

Very severe varicose veins or ulceration — difficult to control and requiring periodic confinement or hospital admissions.

Irrespective of whether one or two legs are affected, only one rating may be selected from this table.

\n```\n\n

Other Impairment Table 2.2.3

\"\"

OEDEMA

Impairment Ratings

Criteria

NIL

Mild or transient oedema.

FIVE

Moderate and persistent oedema.

TEN

Marked oedema, that is only partly controlled by treatment or therapy.

Irrespective of whether one or two legs are affected, only one rating may be selected from this table.

\n```\n\nAn impairment rating from this table may be given in addition to an impairment rating from Chapter 1 even when both arise from the same condition (eg, heart failure).\n\nStep 6: Combine the impairment ratings obtained in Steps 3 and 4.\n\nIf ratings were obtained both in Step 3 and in Step 4, then the ratings are to be combined. This combining is for the purpose of the comparison to be made in Step 8. If only one rating has been given in Steps 3 and 4, then the result to be obtained in Step 6 is to be the same as the one rating given in either Step 3 or Step 4.\n\nStep 7: Combine the impairment ratings obtained in Step 5.\n\nIf more than one rating has been given in Step 5 then the ratings are to be combined. This combining is for the purpose of the comparison to be made in Step 8. If only one rating has been given in Step 5, then the result to be obtained in Step 7 is to be the same as the result obtained in Step 5.\n\nStep 8: Compare the impairment ratings obtained in Steps 6 and 7.\n\nStep 9: If the comparison made in Step 8 shows that the impairment rating obtained in Step 6 is higher than the impairment rating obtained in Step 7, then the ratings obtained in Steps 3 and 4 are the final impairment ratings for the vascular condition.\n\nIf more than one rating was obtained in Steps 3 and 4 those ratings are not to be combined at this stage, but each is to be included in the final combining of all ratings.\n\nStep 10: If the comparison made in Step 8 shows that the impairment rating obtained in Step 7 is higher than the impairment rating obtained in Step 6, then the rating(s) obtained in Step 5 are the final impairment rating(s) for the vascular condition.\n\nIf more than one rating was obtained in Step 5 those ratings are not to be combined at this stage, but each is to be included in the final combining of all ratings.\n\n## PART 2.1 : HYPERTENSION\n\n## PART 2.1: HYPERTENSION\n\n## PART 2.2 : VASCULAR CONDITIONS OF THE LOWER LIMBS\n\n## PART 2.2: VASCULAR CONDITIONS OF THE LOWER LIMBS\n\n## PART 2.3 : OTHER NON-CARDIAC VASCULAR CONDITIONS\n\n## PART 2.3: OTHER NON-CARDIAC VASCULAR CONDITIONS\n\nThis Part is to be applied for a variety of vascular conditions not covered elsewhere in the Guide.\n\n

Other Impairment Table 2.3.1

\"\"

ANEURYSMS AND INTRA-VASCULAR CONDITIONS

Impairment Ratings

Criteria

NIL

No aneurysms or intra-vascular conditions present.

TWO

  • Aortic aneurysm of diameter less than 6 cm.
  • Renal artery stenosis.
  • Iliac or femoral or carotid aneurysms.

FIVE

  • Embolus requiring anticoagulant medication.
  • Non-valvular vascular conditions requiring anti-coagulant medication.
  • Aortic aneurysm of 6 cm diameter or more.
  • Aortic aneurysm surgically corrected.

TEN

Other vascular conditions (eg. severe deep venous thrombosis) that are difficult to control.

The impairment from any single condition can only receive one rating from this table. If the impairment from a given condition (eg, an aortic aneurysm) satisfies more than one criterion, it is to be given only the highest applicable rating.

\n```\n\n# Aneurysms, atherosclerosis, and cerebrovascular disease\n\nImpairment from atherosclerosis is to be rated by applying the appropriate tables in Chapter 1, Part 2.2 of Chapter 2, and Chapter 5 (Neurological Impairment) according to the losses of function or other impairments which it causes.\n\nImpairment from cerebral aneurysms and cerebrovascular disease is to be rated by applying Chapter 5 (Neurological Impairment) and any other applicable chapter, according to the other effects of the cerebrovascular disease.\n\n \n\n","sortOrder":2},{"sectionNumber":"Part 3","sectionType":"part","heading":null,"content":"CHAPTER 3\n\nIMPAIRMENT OF SPINE AND LIMBS\n\nThis chapter contains six parts:\n\nPart 3.1 — Upper Limbs\n\nPart 3.2 — Lower Limbs\n\nPart 3.3 — Spine\n\nPart 3.4 — Resting Joint Pain\n\n# Part 3.5 — Ranges of Joint Movement\n\n# Part 3.6 — Spine and Limbs Age Adjustment\n\nThis chapter is used to assess the motor function of the spine and limbs. Sensory loss is to be assessed under Chapter 5 (Neurological Impairment).\n\n## Impairment of limbs\n\nWhen a previously-accepted condition is later removed by an amputation that is also an accepted condition, the rating is to be based on the amputation or the resulting functional deficit, whichever results in the higher impairment rating. The previously accepted condition is not to be given an impairment rating.\n\n## PART 3.1: UPPER LIMBS\n\nFunctional impairment is to be calculated separately for each upper limb. Thus one functional impairment rating may be calculated for the right upper limb and another for the left upper limb.\n\nCalculation of the impairment rating for conditions of each upper limb\n\nFollow the steps below to calculate the impairment rating for accepted conditions of each upper limb:\n\n(Steps 2–8 are elaborated in the following pages.)\n\n| STEP 1 | If accepted condition(s) affect only the right upper limb, follow steps 2–8.If accepted condition(s) affect only the left upper limb, follow steps 2–8 substituting “left” for “right” in the instructions.If accepted condition(s) affect both upper limbs, follow steps 2–8 to assess the right upper limb, and then, to assess the left upper limb, repeat steps 2–8 substituting “left” for “right” in the instructions. | |\n| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------- |\n| STEP 2 | Establish which joints in the right upper limb, if any, have some restriction of movement as a result of accepted conditions affecting the right upper limb. | Page 40 |\n| STEP 3 | (Omit this step if is there is no restriction of joint movement in the right upper limb.)Calculate the functional impairment due to restriction of range of movement of joints in the right upper limb as a result of accepted conditions of the right upper limb. | Page 41 |\n| STEP 4 | Calculate the functional impairment rating for the right upper limb as a whole using Table 3.1.2. | Page 43 |\n| STEP 5 | Compare the functional impairment rating for the right upper limb as a whole with the functional impairment rating from any restricted range of movement. Take the higher of these two as the final functional impairment rating for the right upper limb. | Page 43 |\n| STEP 6 | Make any applicable age adjustment to the final functional impairment rating for the right upper limb by applying Table 3.6.1 in Part 3.6 of this chapter. | Page 43 |\n| STEP 7 | Determine if any Other Impairment rating applies to the right upper limb. | Page 44 |\n| STEP 8 | (Omit this step if no Other Impairment rating applies to the right upper limb.)Compare the final functional impairment rating for the right upper limb with any Other Impairment rating applicable to the right upper limb. Take the higher of these ratings. | Page 45 |\n\nStep 2: Establish which joints in the right upper limb have some restriction of movement as a result of accepted conditions of the right upper limb.\n\nFor the purposes of assessment under the Guide, the major joints of the upper limb are the shoulder, the elbow and the wrist.\n\nIn addition, the joints of the thumb and fingers are also to be considered. However, only one rating is to be given for the total effect of restrictions in all joints of the thumb and fingers considered together.\n\nConditions such as painful arc syndrome and fractured neck of radius may affect the range of movement (ROM) of the shoulder. A condition such as fractured scaphoid will be likely to affect the ROM of the wrist. In cases of fractures, the ranges of movements of the joints proximal to and distal to the fracture site should generally be considered as joints the ROM of which may be affected.\n\nHence, it must be determined which, if any, of\n\n- shoulder;\n- elbow;\n- wrist; and\n- thumb and fingers,\n\npotentially have loss of range of movement due to accepted conditions.\n\nCertain vascular conditions or neurological conditions of the upper limb, such as muscle weakness, tremor, apraxia, and loss of co-ordination, may have an effect on the function of the upper limb without restricting the range of movement of any joint of the limb. The assessment of such conditions is to be made under Step 4 of this Part.\n\nStep 3: Calculate the functional impairment due to restriction of range of movement of joints in the right upper limb as a result of accepted conditions of the right upper limb.\n\nSingle functional impairment ratings may be obtained for each of the following four joints or sets of joints based on restriction of range of movement due to accepted conditions:\n\n- shoulder;\n- elbow;\n- wrist; and\n- thumb and fingers.\n\nThese impairment ratings are to be obtained by applying Table 3.1.1. Such functional impairment ratings are referred to as the functional impairment rating of the upper limb based on restriction of range of movement of the shoulder, elbow, wrist, or thumb and fingers respectively.\n\nThe loss of range of movement is to be estimated to the nearest quarter of the normal range of movement.\n\nThe range of movement relevant to assessment under this Guide is the active range of movement of the joint, that is the range through which the veteran can move the joint by virtue only of those muscles whose normal function it is to do so. The ability of a veteran to flex a joint by use of other, non-affected body parts does not reduce the rating which the impaired joint attracts. (For example, if a veteran cannot flex the right elbow in the normal fashion, by use of the right biceps, but can use the left hand to bend the right elbow, the right elbow should be assessed as having “loss of almost all movement”.)\n\nThe loss of range of movement will usually be provided as a fractional loss of range of movement and such data can be related directly to items within Table 3.1.1. However, sometimes, the measured movements of an affected joint will be available in degrees. In such a case the measured movement must be compared with the average range of movement of a normal joint to obtain the fractional loss of range of movement.\n\nThe average ranges of movement of various normal joints of the upper limb may be obtained from Table 3.5.1 in Part 3.5. These values are to be used in arriving at the fractional loss of range of movement when the actual movements of a joint are known in degrees.\n\nIf non-accepted conditions contribute to the loss of range of movement, Chapter 19 (Partially Contributing Impairment) is to be applied in conjunction with Table 3.1.1.\n\n| For the purposes of this chapter: |\n| --------------------------------------------------------------------------------------------------------------------- |\n| “position of function” means the position that interferes least with the total function of the limb or the spine; and |\n| “unfavourable position” means a position that is significantly different from the position of function; and |\n| “flail joint” means a joint that is completely unstable in all directions. |\n\n## PART 3.1 : UPPER LIMBS\n\n## PART 3.1: UPPER LIMBS\n\n## PART 3.2 : LOWER LIMBS\n\n## PART 3.2: LOWER LIMBS\n\n## PART 3.3 : SPINE\n\n## PART 3.3: SPINE\n\n## PART 3.4 : RESTING JOINT PAIN\n\n## PART 3.4: RESTING JOINT PAIN\n\n## PART 3.5 : RANGES OF JOINT MOVEMENT\n\n## PART 3.5: RANGES OF JOINT MOVEMENT\n\n## PART 3.6 : SPINE AND LIMBS AGE ADJUSTMENT\n\n## PART 3.6: SPINE AND LIMBS AGE ADJUSTMENT\n\n## PART 6.1 : DISEASES OF THE DIGESTIVE SYSTEM\n\n## PART 6.1: DISEASES OF THE DIGESTIVE SYSTEM\n\n## PART 6.2 : ABDOMINAL WALL HERNIAS AND OBESITY\n\n## PART 6.2: ABDOMINAL WALL HERNIAS AND OBESITY\n\n## PART 7.1 : HEARING LOSS AND TINNITUS\n\n## PART 7.1: HEARING LOSS AND TINNITUS\n\n## PART 7.2 : EAR, NOSE, AND THROAT\n\n## PART 7.2: EAR, NOSE, AND THROAT\n\n## PART 8.1 : IMPAIRMENT OF VISUAL FUNCTION\n\n## PART 8.1: IMPAIRMENT OF VISUAL FUNCTION\n\n## PART 8.2 : OTHER OCULAR IMPAIRMENT\n\n## PART 8.2: OTHER OCULAR IMPAIRMENT\n\n## PART 9.1 : RENAL FUNCTION\n\n## PART 9.1: RENAL FUNCTION\n\n## PART 9.2 : LOWER URINARY TRACT FUNCTION\n\n## PART 9.2: LOWER URINARY TRACT FUNCTION\n\n## PART 10.1 : SEXUAL FUNCTION\n\n## PART 10.1: SEXUAL FUNCTION\n\n## PART 10.2 : REPRODUCTION\n\n## PART 10.2: REPRODUCTION\n\n## PART 10.3 : BREASTS\n\n## PART 10.3: BREASTS\n\n## PART 12.1 : THE ENDOCRINE SYSTEM\n\n## PART 12.1: THE ENDOCRINE SYSTEM\n\n## PART 12.2 : THE HAEMOPOIETIC SYSTEM\n\n## PART 12.2: THE HAEMOPOIETIC SYSTEM\n\nConditions of the haemopoietic system include anaemias, leukaemias and polycythaemia.\n\nHaemopoietic conditions usually affect various other body systems, therefore loss of function for the condition is to be established by assessing the effect of the condition on those body systems. Some haemopoeitic conditions are also malignant conditions and may be assessed by applying Chapter 14 (Malignant Conditions). For very severe haemopoietic conditions, where many body systems are affected, Tables 16.1 and 16.2 in Chapter 16 (Activities of Daily Living) are also to be applied to rate the loss of function.\n\nMany anaemias will respond adequately to replacement or supplemental therapy. For example, the hypochromic anaemia of iron deficiency will usually respond to dietary iron supplementation and pernicious anaemia will usually respond to parenteral Vitamin B12.\n\nCalculation of the impairment rating for loss of haemopoietic function\n\nFollow the steps below to calculate the impairment rating due to accepted loss of haemopoietic function:\n\n(Each step is elaborated on the following page.)\n\n| STEP 1 | Establish which body systems are affected by the accepted haemopoietic condition. | Page 164 |\n| ------ | ---------------------------------------------------------------------------------------------------------------------- | -------- |\n| STEP 2 | Determine the impairment rating for functional impairment of the affected body systems. | Page 164 |\n| STEP 3 | Determine the impairment rating for the treatment requirements of the haemopoietic condition by applying Table 12.2.1. | Page 165 |\n\nStep 1: Establish which body systems are affected by the accepted haemopoietic condition.\n\nHaemopoietic conditions may affect the function of other body systems. For example, refractory anaemia may result in reduced effort tolerance.\n\nStep 2: Determine the functional impairment of all body systems affected by the haemopoietic condition.\n\nApply the appropriate functional impairment table elsewhere in this Guide to assess the functional impairment arising from the haemopoietic condition. For example, in the case of refractory anaemia causing reduced effort tolerance, the reduced effort tolerance is to be assessed by use of the Effort Tolerance protocol in Chapter 1.\n\nIf non-accepted conditions have contributed to the impairment rating for any of the affected body systems, Chapter 19 (Partially Contributing Impairment) is to be applied.\n\nThe various functional impairment ratings are not combined at this stage but are to be included in the final combining of all impairment ratings.\n\nStep 3: Determine the impairment rating for the treatment requirements of the accepted haemopoietic condition using Table 12.2.1.\n\nThe ratings obtained in Steps 2 and 3 are not to be combined at this stage but both are to be included in the final combining of all impairment ratings.\n\n

Other Impairment Table 12.2.1

\"\"

THE HAEMOPOIETIC SYSTEM: TREATMENT REQUIREMENTS*

Impairment Ratings

Criteria

NIL

Symptoms in remission and no active therapy indicated.

TWO

Transfusion requirements: 2–3 units per 12–16 weeks.

FIVE

  • Intermittent combination cytotoxic therapy ­­­­— one course every 3–4 weeks.
  • Phlebotomy once every 4 weeks.
  • Transfusion requirements: 2–3 units per 6 weeks.

TEN

  • Phlebotomy more than once every 4 weeks.
  • Transfusion requirements: 2–3 units per 4 weeks.

TWENTY

Transfusion requirements: 2–3 units per 2 weeks.

(*Additional to relevant body system assessment.)

\n```\n\n## Part B : Non-System Specific Assessment\n\n## Part B: Non-System Specific Assessment\n\n","sortOrder":3},{"sectionNumber":"Part 13","sectionType":"part","heading":null,"content":"CHAPTER 13\n\nNEGLIGIBLE IMPAIRMENT\n\nAs every accepted condition is to be assessed, Table 13.1 provides a convenient method of rating any accepted condition which causes negligible impairment. Table 13.1 is to be applied only to conditions that cannot be conveniently classified under other chapters of this Guide and that would not attract a higher rating if they were classified under such chapters.\n\nDetermine the impairment rating for an accepted condition that causes negligible impairment\n\nFollow the step below to calculate the negligible impairment due to an accepted condition.\n\n| STEP 1 | Determine the rating for negligible impairment from Table 13.1. |\n| ------ | --------------------------------------------------------------- |\n\n

Functional Loss Table 13.1

\"\"

NEGLIGIBLE IMPAIRMENT

Impairment Rating

Criteria

NIL

  • An infectious disease from which the veteran has recovered with negligible after effects.
  • An injury from which the veteran has recovered with negligible after effects.
  • A condition causing no current impairment.
  • condition from which the veteran has recovered with negligible after effects.
\n```\n\n \n","sortOrder":4},{"sectionNumber":"Part 14","sectionType":"part","heading":null,"content":"CHAPTER 14\n\nMALIGNANT CONDITIONS\n\nMalignant conditions may affect one or more body systems.\n\nHence, any malignant condition can potentially be assessed by the following methods:\n\n- by applying the system-specific tables contained in Chapters 1 to 12. A number of those tables may have to be consulted if the malignant condition causes multiple losses of function;\n- by applying Chapter 14 which relates specifically to malignancies and which contains both a Functional Loss table and an Other Impairment table. These tables are designed to rate the malignant condition as a whole. The first table relates to loss of function in a general sense. The second table relates to reduced life expectancy which is regarded as an Other Impairment.\n\nIf the impairment rating from Chapter 14 is 70 points on the basis of either the malignant disorders functional table (Table 14.1) or the malignant disorders Other Impairment table (Table 14.2), there is no need to follow the steps set out in the following pages. If the rating from Chapter 14 is below 70 points, the steps are to be followed.\n\nDetermine the impairment rating for an accepted malignant condition\n\nFollow the steps below to calculate the impairment due to an accepted malignant condition.\n\n(Each of these steps is elaborated in the following pages.)\n\n| STEP 1 | Establish which body systems are affected by the malignant condition. | Page 168 |\n| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------- |\n| STEP 2 | Determine the functional impairment ratings for the affected body systems. | Page 168 |\n| STEP 3 | Determine the total combined impairment rating for the various body system impairments attributable to the malignant condition. | Page 168 |\n| STEP 4 | Determine the impairment rating based on Table 14.1 (Malignant Disorders). | Page 168 |\n| STEP 5 | Determine the impairment rating based on Table 14.2 (Life Expectancy). | Page 169 |\n| STEP 6 | Compare the ratings obtained in Steps 4 and 5. Take the higher rating. | Page 170 |\n| STEP 7 | Compare the ratings obtained in Steps 3 and 6. Take the higher rating. | Page 170 |\n| STEP 8 | If the rating obtained in Step 3 is higher than that obtained in Step 6, separate the components of the rating obtained in Step 3 so that each can be included in the final combining of all ratings. | Page 171 |\n\nStep 1: Establish which body systems are affected by the malignant condition.\n\nBefore a malignant condition is assessed, information regarding the extent of the condition must be available. Such information includes the site of the primary, the sites of any secondaries, the effects of any surgery and the effects of any radiotherapy or chemotherapy.\n\nFrom that information the affected body systems can be established and the applicable chapters of this Guide applied.\n\nFor example, in the case of an accepted carcinoma of the rectum, there may be surgical resection of the rectum with a colostomy, secondary spread of the cancer to the lungs and spine, and radiotherapy with some resultant digestive disturbances. In such a case, Chapters 1, 3, and 6 of this Guide will have to be applied in Step 1 to arrive at an appropriate functional impairment rating.\n\nStep 2: Determine the functional impairment ratings for the affected body systems.\n\nDepending on the body systems that are affected by the malignant condition and its treatment, each of the relevant chapters of the Guide is to be used and appropriate ratings obtained.\n\nIf other accepted or non-accepted conditions also affect any of the same body systems, Chapter 19 (Partially Contributing Impairment) or Chapter 20 (Apportionment) may have to be applied depending upon the circumstances.\n\nStep 3: Determine the total combined impairment rating for the various body system impairments attributable to the malignant condition.\n\nThe total combined impairment rating for the various body system impairments associated with the malignant condition is determined by combining the attributable impairment ratings by applying Chapter 18 (Combined Values Chart).\n\nUnless the malignant condition is the only accepted condition, this combined rating is to be regarded as an intermediate rating only.\n\nStep 4: Determine the impairment rating based on Table 14.1 (Malignant Disorders).\n\nApply Table 14.1 and find the relevant impairment rating for the entire set of effects which have arisen from the malignant disorder treatment, including surgical resection, chemotherapy and radiotherapy.\n\nFor the purposes of Table 14.1, “symptoms” encompasses the symptoms of both the malignant condition itself and the symptoms of the effects of its treatment.\n\nIf non-accepted conditions or accepted but non-malignant conditions have contributed to the impairment rating obtained from Table 14.1, Chapter 19 (Apportionment) or Chapter 20 (Partially Contributing Impairment) are to be applied depending on the circumstances of the case.\n\nStep 5: Determine the impairment rating based on life expectancy.\n\nIf an impairment rating has not been determined on any previous occasion by applying Table 14.2 (Life Expectancy) or its predecessor in an earlier edition of this Guide, a rating is to be obtained from Table 14.2. If a rating has been obtained from Table 14.2 or its predecessor in an earlier edition of this Guide, on a previous occasion, that same rating is to be applied again in all further assessments of the condition.\n\nWhenever possible, the rating from Table 14.2 is to be based on an estimate from an oncologist or other treating specialist of the veteran’s survival. If such information is unavailable, data from standard reference texts is to be applied to provide an estimate. Such an estimate is to be based on malignancies of the same type and degree of spread as that affecting the veteran.\n\nEstimated life expectancy is projected from the time of diagnosis, or from any subsequent major staging procedure or operation. Thus, once a rating from Table 14.2 has been made it is not to be changed, unless subsequent findings indicate that the earlier prognosis was based on incorrect clinical information.\n\nIf the assessment is made posthumously, the rating from Table 14.2 is not to be modified to reflect the actual duration for which the veteran survived after diagnosis. The table is only to be used for predicted probability of survival.\n\nRatings from Table 14.2 are not to be updated to account for the natural progression of the disease. However, it is expected that ratings from Table 14.2 will come to be exceeded by ratings from Table 14.1 during this time.\n\nRatings from Table 14.2 are not to be reduced because of favourable response to treatment, or because of better than expected survival. However, if the condition is being rated for the first time more than five years after diagnosis, and the disorder is in remission or appears to be cured, the impairment rating from this table is not to exceed ten.\n\nIf the veteran has more than one malignant condition accepted, Table 14.2 is to be applied to each condition. Table 14.2 is not to be applied to a recurrence of an old (already diagnosed) condition.\n\n \n\n

Functional Loss Table 14.1

\"\"

MALIGNANT DISORDERS

Impairment Ratings

Criteria

NIL

Minor symptoms that are easily tolerated.

TEN

Mild to moderate symptoms that are irritating or unpleasant but rarely prevent completion of any activity. Symptoms may cause loss of efficiency in some activities.

TWENTY

More severe symptoms that are more distressing but prevent few everyday activities. Loss of efficiency is discernible in a good few activities. Self-care is unaffected and independence is retained.

THIRTY-FIVE

Loss of efficiency discernible in many everyday activities. Some elements of self-care are restricted but, in most respects, independence is retained.

FIFTY

Major restrictions in many everyday activities. Capacity for self-care is increasingly restricted, leading to partial dependence on others.

SEVENTY

Most everyday activities are prevented. Dependent on others for most kinds of self-care. Able to be maintained at home with considerable assistance and frequent medical care.

\n```\n\n

Functional Loss Table 14.2

\"\"

LIFE EXPECTANCY

Impairment Ratings

Predicted Survival at the Time of Diagnosis or Staging Procedure

NIL

Normal, or near-normal, five year survival.

TEN

Five year survival less than 75% of normal.

TWENTY

Five year survival less than 50% of normal.

THIRTY-FIVE

Five year survival less than 25% of normal.

FIFTY

One year survival less than 50% of normal.

SEVENTY

One year survival less than 25% of normal.

\n```\n\nStep 6: Compare the ratings obtained in Steps 4 and 5. Take the higher rating.\n\nThe higher of these two ratings will be the rating for the malignant condition on the basis of this chapter.\n\nStep 7: Compare the ratings obtained in Steps 3 and 6. Take the higher rating.\n\nIf the rating obtained in Step 3 is higher than that obtained in Step 6, go to Step 8.\n\nIf the rating obtained in Step 6 is higher than that obtained in Step 3, then the rating obtained in Step 6 becomes the final rating for the malignant condition and is to be included in the final combining of all ratings.\n\nStep 8: If the rating obtained in Step 3 is higher than the rating obtained in Step 6, separate the components of the rating obtained in Step 3 so that each can be included in the final combining of all impairment ratings.\n\nFor example, in the case of an accepted carcinoma of the rectum postulated under Step 1, each of the ratings from Chapters 1, 3, and 6 of the Guide is to be separately included in the final combining of all impairment ratings.\n\n \n\n","sortOrder":5},{"sectionNumber":"Part 15","sectionType":"part","heading":null,"content":"CHAPTER 15\n\nINTERMITTENT IMPAIRMENT\n\nIntermittent disorders are conditions:\n\n- that remain at a low level of impairment between discrete episodes of increased impairment;\n\nor\n\n- where there is one basic type of impairment on which is superimposed episodes of significantly greater impairment of another type.\n\nA sufferer from epilepsy who remains well between “fits” exemplifies the first type of intermittent disorder. A sufferer from Menière’s disease whose condition is characterised by deafness and occasional episodes of vertigo exemplifies the second type of intermittent disorder. The deafness may be regarded as the basic type of impairment and the episodes of vertigo may be regarded as the superimposed intermittent impairment. Both elements of the condition are to be assessed.\n\nIn this chapter, “attacks” refers to the episode may increased or superimposed impairment. Attacks are to be categorised by reference to their severity, duration and frequency:\n\n- “severity of an attack” refers to the degree to which self-care and normal everyday activities are disrupted by the attack;\n- “duration of an attack” refers to the average length of time for which an attack lasts, that is, seconds, minutes, hours or days; and\n- “frequency of an attack” refers to the number of affected days in a year.\n\nIntermittent disorders are also disorders that affect one or more body systems. For example, asthma is both an intermittent condition and a cardio-respiratory condition. Hence, potentially, any intermittent disorder can be assessed by either of two methods:\n\n- by applying the system-specific tables contained in Chapters 1 to 12. Several of those tables should be used if the intermittent disorder causes multiple losses of function; or\n- by applying this chapter.\n\nIn practice, except where the intermittent nature of the condition clearly overwhelms its system specific effects or vice versa, both methods are to be applied for rating the intermittent condition and the higher of those two ratings taken as the final rating for the intermittent condition.\n\nCalculation of the impairment rating for an accepted intermittent condition\n\nFollow the steps below to calculate the impairment rating due to an accepted intermittent condition:\n\n(Each of these steps is elaborated in the following pages.)\n\n| STEP 1 | Establish which body systems are affected by the intermittent condition. | Page 173 |\n| ------- | ---------------------------------------------------------------------------------------------------------------------------------- | -------- |\n| STEP 2 | Determine the functional impairment ratings for the intermittent condition. | Page 173 |\n| STEP 3 | Determine the total combined impairment rating for the various body system impairments attributable to the intermittent condition. | Page 173 |\n| STEP 4 | Determine whether the attacks are of one or more significant types and group them accordingly. | Page 174 |\n| STEP 5 | Determine the rating for intermittent attack severity. | Page 174 |\n| STEP 6 | Determine the rating for the intermittent attack duration. | Page 174 |\n| STEP 7 | Determine the intermittent grading code for the intermittent attack. | Page 175 |\n| STEP 8 | Determine the impairment rating for the intermittent attack by reference to the number of affected days per year. | Page 175 |\n| STEP 9 | Compare the impairment ratings obtained in Step 3 and Step 8. Take the higher rating. | Page 176 |\n| STEP 10 | Determine the rating for the impairment resulting from the avoidance or preclusion of otherwise normal activities between attacks. | Page 176 |\n\nStep 1: Establish which body systems the intermittent condition affects.\n\nBefore an intermittent condition is assessed, information regarding the extent of the condition must be available. From that information, the affected body systems are to be established and the applicable chapters of this Guide applied.\n\nStep 2: Determine the functional impairment ratings attributable to the intermittent condition for each affected body system.\n\nUse the relevant chapters and determine the appropriate rating.\n\n","sortOrder":6},{"sectionNumber":"Part 19","sectionType":"part","heading":"(Partially Contributing Impairment) or Chapter 20 (Apportionment) may also have to be applied to allow for the effect of other accepted conditions or non-accepted conditions respectively.","content":"Chapter 19 (Partially Contributing Impairment) or Chapter 20 (Apportionment) may also have to be applied to allow for the effect of other accepted conditions or non-accepted conditions respectively.\n\nStep 3: Determine the total combined impairment rating for the various body system impairments attributable to the intermittent condition.\n\nCombine the attributable impairment ratings obtained in Step 2 by applying Table 18.1 (Combined Values Chart) in Chapter 18.\n\nThe combined value so obtained is for use only in Step 9.\n\nStep 4: Determine whether the attacks are of one or more significant types and group them accordingly.\n\nIf attacks vary in severity, duration or frequency, an average for each parameter is to be established except when the attacks fall naturally and very clearly into groups. In such cases separate the attacks into one or other of these groups. Determine the average severity, duration and frequency of the attacks in each group.\n\nPerform the following four steps separately for each identified group of attacks.\n\nStep 5: Determine the rating level for intermittent attack severity using Table 15.1.\n\n

Table 15.1

\"\"

INTERMITTENT ATTACK SEVERITY

Level

Criteria

0

Minor symptoms that are easily tolerated.

I

Mild to moderate symptoms that are irritating or unpleasant but that rarely prevent completion of any activity. Symptoms may cause loss of efficiency in some activities.

II

More severe symptoms, that are distressing, but prevent few everyday activities. Loss of efficiency is discernible else­where. Self-care is unaffected and independence is retained.

III

Loss of efficiency is discernible in many everyday activities. Some elements of self-care are restricted but, in most respects, independence is retained. Bed-rest is often necessary during an attack.

IV

Major restrictions in many everyday activities. Capacity for self-care is increasingly restricted, leading to partial dependence on others.

V

Most everyday activities are prevented. Dependent on others for many kinds of self-care. Able to be maintained at home only with considerable difficulty, or hospital admission is required.

VI

Total incapacity. Unconscious or delirious. Self-care is impossible.

\n```\n\nRatings are based on the activities that the veteran is physically unable to perform. For conditions in which it is common practice to lie down during attacks, it may be inappropriate to rate at level III if symptoms are mild and cause little restriction to activity.\n\nAttacks of some intermittent conditions necessitate hospital admission. Hospital admissions commonly, but not invariably, call for level V or VI rating. It is important to rate self-care capacity. To be rated at Level V severity, a condition must render the veteran incapable of caring for himself or herself.\n\nHospital admission for surgery is not to be used as a basis for ratings from Table 15.1.\n\nStep 6: Determine the rating for duration of the intermittent attacks using Table 15.2.\n\nAttacks that last for more than 24 hours are to be classified as prolonged for the purposes of Table 15.2. Because they affect the veteran for more than one day per attack, the number of affected days per year will be greater than the number of attacks.\n\n

Table 15.2

\"\"

INTERMITTENT ATTACK DURATION

Description

Duration

Transient

Lasting up to and including five minutes.

Short

Lasting more than five minutes but less than 30 minutes.

Medium

Lasting from 30 minutes to four hours.

Prolonged

Lasting more than four hours.

\n```\n\nStep 7: Determine the intermittent grading code for the intermittent attack using Table 15.3.\n\n

Table 15.3

\"\"

INTERMITTENT GRADING CODE

Description

Severity Level

0

I

II

III

IV

V

VI

Transient

A

A

A

B

C

C

F

Short

A

A

C

C

D

E

H

Medium

A

B

C

D

E

H

I

Prolonged

A

C

D

F

G

I

J

\n```\n\nStep 8: Determine the impairment rating for the intermittent attack by reference to the number of affected days per year and by using Table 15.4.\n\nUsing the intermittent grading code determined in Step 7, determine the impairment rating appropriate to the intermittent grading code and frequency by applying Table 15.4.\n\n

Functional Loss Table 15.4

\"\"

INTERMITTENT IMPAIRMENT

Frequency (affected days/year)

2+

5+

10+

20+

40+

70+

100+

Intermittent Grading Code

Impairment Rating

A

–

–

–

–

–

2

2

B

–

–

–

–

2

5

5

C

–

–

–

2

5

10

10

D

–

–

2

5

10

15

20

E

–

–

2

5

10

20

30

F

–

2

5

5

10

20

30

G

–

2

5

10

20

25

30

H

–

2

5

10

30

40

50

I

2

5

10

30

50

60

70

J

5

10

20

40

70

80

90

\n```\n\nIf the attacks were separated into groups in Step 4, a separate rating is to be obtained for each group of attacks.\n\nThose ratings are not to be combined at this stage but are to be included in the final combining of all ratings.\n\nStep 9: Compare the impairment ratings obtained in Step 3 and Step 8. Take the higher rating.\n\nIf the attacks were separated into groups in Step 4, the ratings for the various groups of attacks are to be combined by applying Chapter 18 (Combined Values Chart) before being compared with the rating obtained in Step 3. The combined rating determined under Chapter 18 is to be used only for the purpose of this comparison.\n\nIf the combined rating determined under Chapter 18 is higher than the rating obtained in Step 3, then each of the separate ratings for the various groups of attacks is to be included in the final combining of all ratings.\n\nStep 10: Determine the rating for the impairment resulting from the avoidance and preclusion of otherwise normal activities between attacks by using Table 15.5.\n\nPrecluded activities refer to ordinary activities. Ratings are to be given on the basis of having to avoid, or of being precluded from undertaking, activities that are common for the veteran’s age group. Ratings are not to be given on the basis of having to avoid only relatively hazardous activities such as rock-climbing or acrobatics.\n\nTable 15.5 is to be applied only if at least one attack of the condition of severity II or greater has occurred within the last two years.\n\n

Functional Loss Table 15.5

\"\"

INTERMITTENT IMPAIRMENT: PRECLUDED AND AVOIDED ACTIVITIES

Impairment Ratings

Criteria

NIL

Not prevented by fear of an attack from any significant activities. Can lead a normal life between attacks without the need to take long term medication.

TWO

Must avoid relatively few activities for fear of precipitating an attack.

Or

Can lead a fairly normal life between attacks but must take long term medication.

FIVE

Must avoid some activities such as driving a car, using machinery, using public transport, swimming, travelling, being alone except for short periods of time lest an attack occur.

TEN

Must avoid a wide range of activities such as driving a car, using machinery, using public transport, swimming, travelling, being alone except for short periods of time lest an attack occur with possible severe consequences.

Only one rating may be had from this table for any given condition. Intermittent conditions may attract a rating from Table 15.5 as well as a rating or ratings from either Table 15.4 or the system specific tables.

\n```\n\nThe rating obtained in Step 10 is not to be compared with the rating obtained in Step 9, nor are ratings to be combined at this stage. Irrespective of the outcome of Step 9 the rating obtained from Table 15.5 is to be included in the final combining of all ratings.\n\n## Intermittent Impairment Worksheets\n\nA set of Intermittent Impairment Worksheets (pages 178 to 179) is designed to facilitate the calculation of intermittent impairment rating.\n\nIntermittent Impairment Worksheet (1) is to be used in those cases where all the attacks are grouped into a single type of attack.\n\nIntermittent Impairment Worksheet (2) is to be used in those cases where the attacks are grouped into two or three types.\n\nNo worksheet is provided for those cases where more than three types of attacks are involved.\n\n \n![](image.032.png)\n\n![](image.033.png)\n\n","sortOrder":7},{"sectionNumber":"Part 16","sectionType":"part","heading":null,"content":"CHAPTER 16\n\nACTIVITIES OF DAILY LIVING\n\nThe Activities of Daily Living (ADLs) are a defined set of activities necessary for normal self-care. The activities are movement in bed, transfers, locomotion, dressing, personal hygiene, and feeding.\n\nThese six activities are defined as follows:\n\n- “movement in bed” means sitting in, rising from, and moving around in, bed;\n- “transfers” means moving from one seat to another, changing position from sitting to standing, and transferring to and from the toilet and bed;\n- “locomotion” means walking on the level, on gentle slopes and down stairs;\n- “dressing” means putting on socks, stockings, and shoes, as well as clothing the upper and lower trunk;\n- “personal hygiene” means grooming, and washing of face, trunk, extremities and perineum;\n- “feeding” means eating and drinking, but not the preparation of food.\n\n“Effects on ADLs” is to be used to assess conditions for which criteria do not exist in the system specific tables of Chapters 1 to 12, or are inadequate, or for which the application of the tables in Chapter 14 (Malignant Conditions) or Chapter 15 (Intermittent Impairment) is inappropriate.\n\nTable 16.3 (Other Impairment) covers such non-specific indicators of disease as pain, lethargy and prognosis.\n\nThis chapter is to be applied in the assessment of conditions that result in the veteran being bedfast, chairfast, housebound or nearly housebound. Such conditions include the effects of severe strokes, severe Parkinson’s disease, severe heart failure, severe respiratory disease, severe liver failure, severe kidney failure and some dementias.\n\nADLs may be used to rate a single condition if its effects are well-differentiated, or may be used to rate all conditions together if their effects are difficult to differentiate.\n\nWhen ADLs are used to rate a single condition, an impairment rating or ratings from other chapters may be combined with a rating derived from Chapter 16 provided that the ratings relate to different conditions.\n\nWhen ADLs are used to rate all conditions together, no ratings from other chapters are to be combined with the rating from Chapter 16.\n\nCalculation of the impairment rating for an accepted condition using ADLs\n\nFollow the steps below to calculate the impairment rating due to an accepted condition using the ADLs.\n\n| STEP 1 | For each of the six ADLs obtain a grading code for that activity. | Page 181 |\n| ------ | -------------------------------------------------------------------------------------------------- | -------- |\n| STEP 2 | Add up the grading codes for each of the six ADLs. | Page 181 |\n| STEP 3 | Using the sum obtained in Step 2, determine a functional impairment rating by applying Table 16.2. | Page 182 |\n| STEP 4 | Determine an Other Impairment rating for the condition by applying Table 16.3. | Page 183 |\n| STEP 5 | Compare the ratings obtained in Steps 3 and 4. Take the higher rating. | Page 183 |\n\nStep 1: For each of the 6 ADLs, obtain a grading code for that activity using Table 16.1.\n\nFrom Table 16.1 obtain a separate grading code for:\n\n- movement in bed;\n- transfers;\n- locomotion;\n- dressing;\n- personal hygiene; and\n- feeding.\n\n

Table 16.1

\"\"

ACTIVITIES OF DAILY LIVING GRADING CODES

Code

Description

NIL

Independent, and can perform the task as well as peers do, or with minor difficulty only.

ONE

Can complete the task independently, but with considerably more difficulty than peers have.

FOUR

Requires some degree of personal assistance in order to perform the task.

SIX

Requires extensive assistance in order to perform the task.

EIGHT

Unable to contribute towards performance of the task. Completely dependent.

\n```\n\nNo age adjustment permitted for his table\n\nStep 2: Add up the grading codes for each of the 6 ADLs.\n\nAdd up the 6 separate grading codes obtained from Table 16.1 for:\n\n- movement in bed;\n- transfers;\n- locomotion;\n- dressing;\n- personal hygiene; and\n- feeding.\n\nStep 3: Using the sum obtained in Step 2, determine a functional impairment rating by applying Table 16.2.\n\nUse the sum of the grading codes obtained in Step 2 to obtain an impairment rating from Table 16.2.\n\n

Functional Loss Table 16.2

\"\"

LOSS OF FUNCTION: ACTIVITIES OF DAILY LIVING

Impairment Ratings

Sum of Grading Codes

NIL

0

FIVE

1–2

TEN

3–4

TWENTY

5–6

THIRTY

7–8

FORTY

9–11

FIFTY

12–14

SIXTY

15–17

SEVENTY

18+

\n```\n\nApply Chapter 19 (Partially Contributing Impairment) to make any necessary adjustment for non-accepted conditions.\n\nApply Chapter 18 (Apportionment) to make any necessary adjustment for accepted conditions (or groups of conditions) other than the ones that are being assessed by the application of the ADLs tables.\n\nStep 4: Determine an Other Impairment rating for the condition by applying Table 16.3.\n\n

Other Impairment Table 16.3

\"\"

ACTIVITIES OF DAILY LIVING: OTHER IMPAIRMENT

Impairment Ratings

Criteria

NIL

  • No, or negligible, i.e. easily tolerated symptoms.
  • Evidence of disease, but minimal interference with daily tasks.
  • Feeling of good health most of the time.
  • Normal or almost normal life expectancy in spite of disorders.

FIVE

  • Daily (or almost-daily) symptoms that are irritating and not easily tolerated, but which improve with medication.
  • Some daily tasks performed inefficiently because of generalised lethargy.

TEN

  • Daily (or almost-daily) symptoms that are irritating and not easily tolerated. Treatment is not available, or is of little value, or gives only short remission.
  • Noticeable loss of energy, leading to loss of efficiency and avoidance of some tasks previously easily performed.
  • Decreased life expectancy. Five year survival less than 75% of normal.

TWENTY

  • Intense daily (or almost daily) symptoms which are impossible to ignore, but that prevent few daily tasks. Decreased efficiency in most activities.
  • Marked loss of energy leads to avoidance of many daily tasks, most of which can be completed but rapidly cause fatigue.
  • Five year survival less than 50% of normal.

THIRTY- FIVE

Five year survival less than 25% of normal.

\n```\n\nStep 5: Compare the ratings obtained in Steps 3 and 4. Take the higher rating.\n\nThe higher of the impairment ratings obtained in Steps 3 and 4 is the final impairment rating for the accepted conditions under assessment, based on ADLs.\n\n \n\n","sortOrder":8},{"sectionNumber":"Part 17","sectionType":"part","heading":null,"content":"CHAPTER 17\n\nDISFIGUREMENT AND SOCIAL IMPAIRMENT\n\nThis chapter is to be applied when assessing conditions that cause disfigurement and embarrassment.\n\nOnly one rating may be determined by applying this chapter for any condition or combination of conditions. The rating determined by applying this chapter is to be combined with any other ratings for the disfiguring condition or combination of conditions determined under other chapters.\n\nWidespread skin conditions that cause avoidance of ordinary public places should also be assessed under Chapter 11 (Skin Impairment).\n\n“Severe facial disfigurement” and “very severe facial disfigurement” are also mentioned in Chapter 24 (Degree Of Incapacity For Specific Disabilities).\n\nCalculation of the impairment rating for disfigurement.\n\nFollow the steps below to calculate the impairment rating due to disfigurement.\n\n| STEP 1 | Determine the impairment rating from Table 17.1 for the effect of all accepted conditions that cumulatively lead to disfigurement. | Page 184 |\n| ------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------- |\n| STEP 2 | If non-accepted conditions have contributed to the disfigurement, apply Chapter 19 (Partially Contributing Impairment) to adjust the rating determined in Step 1. | Page 186 |\n\nStep 1: Determine the impairment rating from Table 17.1 for the effect of all accepted conditions which cumulatively lead to disfigurement.\n\nFor the purposes of Table 17.1, the following definitions apply:\n\n“disfiguring condition” means any noticeable condition that causes the sufferer embarrassment in ordinary public places and may include, but is not limited to, the following :\n\n- facial scarring;\n- exfoliative skin disorders;\n- disorders of gait or posture;\n- involuntary facial expressions, or unusual or grotesque involuntary bodily movements;\n- disorders of speech;\n- vile odours which cannot be overcome by the use of deodorants or the application of normal oral hygiene;\n- deficits of the visual field which may cause the veteran to lurch into people through not seeing them;\n- painful conditions which may cause the veteran to cry out involuntarily (for example, in response to a sudden pain in a joint); and\n- severe pruritic conditions which cause the veteran to scratch even though normal behaviour in a public place would recommend restraint.\n\n“ordinary public places” includes suburban streets, shopping centres, public transport, theatres, clubs and many sporting venues, but does not include places where a great part of the skin is customarily bared such as swimming pools and beaches.\n\n“avoidance” means the veteran feeling obliged as a result of embarrassment to restrict his or her use of public places to hours when few people are about, or to avoid totally use of public places at certain times, for example, when school children are likely to be about.\n\n

Functional Loss Table 17.1

\"\"

DISFIGUREMENT

Impairment Ratings

Criteria

NIL

  • A visible condition that the veteran does not consider to be disfiguring.
  • A noticeable condition that is not significantly disfiguring and which causes negligible or slight embarrassment such as some acne scars on face, or minor limps, or a slight stoop.

TWO

  • A noticeable condition. For example, severe acne scars, a unilateral squint, an intermittent stutter or stammer.
  • A noticeable condition which causes significant embarrassment and may cause avoidance of some normal activities. For example, an ungainly gait, a gross stoop, a persistent stutter or stammer, or an unsightly skin disorder.

FIVE

A very noticeable condition which causes marked em­barrassment to some people in ordinary social contacts and causes avoidance of some normal activities. For example, a severe skin disorder of the face and/or hands, or a gross and persistent stutter or stammer.

TEN

  • A very noticeable condition which causes marked embarrassment and results in the avoidance of many normal activities. For example, moderate facial disfigurement.
  • A severe and marked condition which causes embarrassment and causes much avoidance of many public places and social intercourse. For example, severe facial disfigurement.

FIFTEEN

A particularly severe and marked condition which causes extreme embarrassment and results in avoidance of public places and social intercourse to as great a degree as possible. For example, very severe facial disfigurement.

Only one rating is to be selected from this table for any condition or group of conditions which contribute to disfigurement.

\n```\n\nBoth the objective and subjective components of a disfiguring condition are to be taken into account when applying Table 17.1. The objective component is the actual physical and/or temporal extent of the disfiguring condition as perceived by others. The subjective component is the veteran’s own emotional and behavioural reactions to the disfigurement.\n\nThe two components will generally be aligned with one another. If the veteran has a noticeable condition that is objectively disfiguring but does not embarrass the veteran to the extent to which an average person of the same age, occupational and residential circumstances would be embarrassed, the assessment should be based on the average person’s degree of embarrassment. The veteran’s denial of his or her condition should not be taken into account when applying Table 17.1.\n\nStep 2: If non-accepted conditions have contributed to the disfigurement, apply Chapter 19 (Partially Contributing Impairment) to adjust the rating determined in Step 1.\n\nIf non-accepted conditions have contributed to the disfigurement, Table 19.1 in Chapter 19 (Partially Contributing Impairment) is to be applied to adjust the impairment rating for the accepted conditions.\n\nThe rating obtained in this step (or in Step 1 if partially contributing impairment is not applicable) is the final rating for disfigurement, and is to be included in the final combining of all impairment ratings.\n\n## Part C Impairment Ratings: Combining, Apportioning, Partially Contributing\n\n## Part C: Impairment Ratings: Combining, Apportioning, Partially Contributing\n\n","sortOrder":9},{"sectionNumber":"Part 18","sectionType":"part","heading":null,"content":"CHAPTER 18\n\nCOMBINED VALUES CHART\n\nAfter impairment ratings have been obtained for all accepted conditions they must be combined to a single value known as the combined impairment rating. The combining is not to be done by simple addition but is to be done by applying Table 18.1 (Combined Values Chart). The values in Table 18.1 (Combined Values Chart) are derived from the formula:\n\n

Combined value of A and B

=

[A + B (1 -

A

)] rounded to nearest integer

100

\n```\n\nwhere “A” and “B” are the impairment ratings to be combined.\n\nThis formula embodies a principle of combining ratings. The principle derives from the concept of whole person impairment (see page X). The following example illustrates the combining principle:\n\n## Example\n\nSuppose a veteran has three accepted conditions. If the first assessed condition attracts 60 points the veteran will get a rating of 60. This rating implies that the whole person is 60% impaired. That leaves 40% to be further apportioned among other conditions. If the second condition assessed attracts 30 points, the total impairment rating will not be 60 + 30 = 90, but 60 + 12 = 72. The 12 represents 30% of the 40 that remained of the whole person after the initial 60 was awarded. Now the whole person of the veteran is 72% impaired. If the third condition assessed attracts 10 points, the total impairment rating will be 60 + 12 + 3 = 75. The 3 represents 10% of the 28 that remained of the whole person after 72 was awarded for the first two conditions. Now the whole person of the veteran is 75% impaired.\n\nCombining two or more impairment ratings into a single value.\n\nFollow the steps below to combine two or more impairment ratings into a single value (the combined impairment rating).\n\n| STEP 1 | Take the highest (or equal highest) of the ratings to be combined. Find that rating in the column on the extreme left hand side of the chart in Table 18.1. The row in which this number is written is “The Row” for purposes of Step 3. |\n| ------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| STEP 2 | Take the next highest (or equal highest) of the ratings to be combined. Find that rating in the very bottom row of the chart. The column above this number is “The Column” for purposes of Step 3. |\n| STEP 3 | Find the intersection of The Row and The Column. The number written on the intersection is the combined value of the two ratings. If only two ratings are to be combined, then this figure is the “Combined Impairment Rating”. |\n| STEP 4 | This step is only to be used if more than two ratings are to be combined.Take the result obtained in Step 3. Find that result in the column on the extreme left hand side of the chart. The row in which this number is written is “The Row” for purposes of Step 6. |\n| STEP 5 | Take the highest (or equal highest) of the remaining ratings to be combined. Find that rating in the very bottom row of the chart. The column above this number is “The Column” for purposes of Step 6. |\n| STEP 6 | Find the intersection of The Row and The Column. The number written on the intersection is the combined value of the three ratings. If only three ratings are to be combined, then this figure is the “Combined Impairment Rating”. |\n| STEP 7 | This step is only to be used if more than three ratings are to be combined.To combine more than three ratings, reapply the instructions in steps 4, 5, and 6 to the remaining ratings. Always take the value obtained by performing Step 6 and combine that with the highest (or equal highest) of the remaining values. Continue until all ratings have been combined into a single value. This figure is the “Combined Impairment Rating”. |\n| STEP 8 | The individual impairment ratings for the various conditions being assessed are not to be rounded before they are combined using the chart in Table 18.1.If the combined impairment rating is not a multiple of five, it should be rounded to the nearest multiple of five. (For purposes of the preceding sentence, “0” is a multiple of five.) Figures ending on “3” or “4” or “8” or “9” should be rounded up, figures ending on “1” or “2” or “6” or “7” should be rounded down. (This also applies when the only impairment rating a veteran obtains = 2. In that case the combined impairment rating = 0.) |\n\n## Example\n\nTo combine 35 and 20, read down the extreme left hand side column of the chart in Table 18.1 until you come to the larger value, 35. In the very bottom row of the chart read from left to right until you come to 20. At the intersection of the row on which 35 is written, and the column above 20, is the number 48.\n\nTherefore, 35 combined with 20 is 48. Due to the construction of this chart, the larger impairment value must be identified at the side of the chart.\n\nApplying the formula to this example gives:\n\n

35 + 20 × (1 -

35

) = 35 + 20 × (1 - 0.35) = 35 + 20 × 0.65 = 35 + 13 = 48

100

\n```","sortOrder":10}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":1903},"content_quality":"ok","complexity_score":9,"scope_assessment":{"changed":false,"description":"The instrument remains strictly within its original purpose of providing a guide for determining impairment and compensation under the MRCA. While highly technical and detailed (particularly regarding cardiorespiratory assessment methodology), this represents the necessary depth of the original legislative scheme rather than expansion beyond its intended scope."},"complexity_factors":["8-step conditional assessment procedure with multiple decision branches","Technical medical terminology requiring specialist knowledge (METs, FEV1, FVC, spirometry, ejection fraction)","Mathematical formulas and nomograms for converting physiological data to impairment ratings","Age and gender-specific rating tables (separate tables for males and females across age ranges 25–85+)","Extensive cross-referencing to other parts of the Guide (Chapters 18, 19, 20 for combining values, partially contributing impairment, and apportionment)","Complex interaction rules for co-existing cardiac and respiratory conditions","23 defined terms including specialised concepts like 'accepted condition', 'lifestyle averaged points', and 'Statement of Principles'","HTML-formatted data tables requiring specific interpretation"],"plain_english_summary":"The Guide to Determining Impairment and Compensation (GARP M) is a binding MRCA technical manual that converts service-related injuries into 0–100 impairment scores to calculate lump sums or periodic payments. It applies to ADF members (from 1 July 2004) and the decision-makers who must use it.\n\nThis excerpt covers Chapter 1 (cardiorespiratory): an 8-step process using exercise tolerance (METs), spirometry and formulas to turn clinical findings into impairment ratings that directly determine compensation."}},"importantCases":[],"_links":{"self":"/api/acts/guide-to-determining-impairment-and-compensation","history":"/api/acts/guide-to-determining-impairment-and-compensation/history","analysis":"/api/acts/guide-to-determining-impairment-and-compensation/analysis","conflicts":"/api/acts/guide-to-determining-impairment-and-compensation/conflicts","importantCases":"/api/acts/guide-to-determining-impairment-and-compensation/important-cases","documents":"/api/acts/guide-to-determining-impairment-and-compensation/documents"}}