{"id":"F2005L01293","name":"Guide to Determining Impairment and Compensation (GARP M)","slug":"guide-to-determining-impairment-and-compensation-garp-m","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":35006,"registerId":"commonwealth-F2005L01293-current","compilationNumber":null,"startDate":"2026-04-01","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"PART A","sectionType":"part","heading":": SYSTEM SPECIFIC ASSESSMENT","content":"## PART A: SYSTEM SPECIFIC ASSESSMENT\n\nCHAPTER 1\n\nCARDIORESPIRATORY IMPAIRMENT\n\n# INTRODUCTION\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(Each step is elaborated in the following pages.)\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(Each step is elaborated in the following pages.)\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\nRatings derived from METs are age adjusted\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```html\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\nRatings derived from METs are age adjusted\n\n \n\n```html\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\nRatings derived from METs are age adjusted\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```html\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```html\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```html\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\nNo age adjustment permitted for this table\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```html\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```html\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\nNo age adjustment permitted for this table\n\n```html\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\nNo age adjustment permitted for this table\n\n \n\n```html\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\nNo age adjustment permitted for this table\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```html\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\nNo age adjustment permitted for this table\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\n# INTRODUCTION\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```html\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\nNo age adjustment permitted for this table\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(Each step is elaborated in the following pages.)\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```html\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\nNo age adjustment permitted for this table\n\n```html\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\nNo age adjustment permitted for this table\n\n```html\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\nNo age adjustment permitted for this table\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.","sortOrder":0},{"sectionNumber":"PART 2.1","sectionType":"part","heading":": HYPERTENSION","content":"## PART 2.1: HYPERTENSION","sortOrder":1},{"sectionNumber":"PART 2.2","sectionType":"part","heading":": VASCULAR CONDITIONS OF THE LOWER LIMBS","content":"## PART 2.2: VASCULAR CONDITIONS OF THE LOWER LIMBS","sortOrder":2},{"sectionNumber":"PART 2.3","sectionType":"part","heading":": OTHER NON-CARDIAC VASCULAR CONDITIONS","content":"## 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```html\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\nNo age adjustment permitted for this table\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.","sortOrder":3}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":3107},"content_quality":"ok","complexity_score":8,"scope_assessment":{"changed":false,"description":"This document remains strictly within its intended scope as Chapter 1 of a specialised medical assessment guide. It focuses exclusively on cardiorespiratory impairment assessment methodology without expanding into unrelated compensation areas or medical systems."},"complexity_factors":["8-step procedural framework with conditional branching based on data availability","Multiple cross-referenced assessment tables (Tables 1.1 through 1.10) with age and gender-specific variants","Mathematical formulas and nomograms (Figures 1a, 1b, 1c) for converting medical measurements to impairment points","Integration of two distinct data streams: exercise tolerance (METs) and physiological measurements (spirometry)","Cross-references to external chapters (15, 19, 20) governing intermittent impairment, partially contributing impairment, and apportionment","Complex conditional logic distinguishing between cardiac-only, respiratory-only, and combined conditions","Requirement to distinguish between 'accepted' and 'non-accepted' conditions requiring moderation calculations","Dense technical medical terminology and abbreviations (FEV1, FVC, MEF 25-75, BTPS, ejection fraction)"],"plain_english_summary":"This technical guide converts exercise-tolerance (METs) and lung-function (spirometry) test results into a points-based impairment rating that determines veterans’ cardiorespiratory compensation. It prescribes an 8-step assessment, different calculation methods for heart, lung or combined disease, and special tables for conditions like heart failure, valve disease and ischaemia. \n\nRatings are adjusted for age and gender, and include apportionment rules to separate service-related from non-service-related contributions so payments reflect actual loss of cardiorespiratory function."}},"importantCases":[],"_links":{"self":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m","history":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m/history","analysis":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m/analysis","conflicts":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m/conflicts","importantCases":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m/important-cases","documents":"/api/acts/guide-to-determining-impairment-and-compensation-garp-m/documents"}}