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Legal background

The 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.

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:

(a) criteria to be used in deciding the degree of impairment of a person resulting from a service injury or disease; and
(b) methods by which the degree of that impairment can be expressed in impairment points on a scale from 0 to 100; and
(c) criteria to be used in assessing the effect of a service injury or disease on a person’s lifestyle; and
(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
(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.

In addition the Guide, in accordance with subsection 67(2) of the Act (a) specifies different methods under paragraph (1)(e) for: (i) service injuries or diseases that relate to warlike service or non‑warlike service; and (ii) other service injuries or diseases; and (b) specifies a method for determining the compensation payable to a person who has both: (i) a service injury or disease that relates to warlike service or non‑warlike service; and (ii) another service injury or disease.

Definitions

In this Guide, unless a contrary intention appears:

accepted condition means an injury or disease that has been determined to be caused by service.

Act means the Military Rehabilitation and Compensation Act 2004 as amended from time to time.

add means find the arithmetic sum of two or more numbers.

clinical features includes signs and symptoms.

combine 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.

Commission means the Military Rehabilitation and Compensation Commission.

condition means an injury or a disease.

defence-caused injury and defence-caused disease have the meaning given in section 70 of the VEA.

disease means:

(a) any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development); or

(b) the recurrence of such an ailment, disorder, defect or morbid condition;

but does not include:

(c) the aggravation of such an ailment, disorder, defect or morbid condition; or

(d) a temporary departure from:

(i) the normal physiological state; or

(ii) the accepted ranges of physiological or biochemical measures;

that 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).

GARP V means the Guide to the Assessment of Rates of Veterans’ Pensions in force from time to time under section 29 of the VEA.

Guide means this Guide to Determining Impairment and Compensation.

impairment, 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.

impairment rating means a measure of the degree of medical impairment on a scale of 0 to 100.

injury means any physical or mental injury (including the recurrence of a physical or mental injury) but does not include:

(a) a disease; or

(b) the aggravation of a physical or mental injury.

lifestyle points means the number of points determined using the tables in Chapter 22 of this Guide.

lifestyle averaged points means the total of lifestyle points added together and averaged for each of the tables used.

lump 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.

member or former member means a member or former member of the Defence Force who serves or served on or after 1 July 2004.

non-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.

periodic 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.

service 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.

service disease has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.

Note: 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).

service injury has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.

Note: 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).

SRCA means the Safety, Rehabilitation and Compensation Act 1988.

Statement of Principles means:

(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

(b) a determination made by the Commission under subsection 340(2) or (3) of the Act.

VEA means the Veterans’ Entitlements Act 1986.

veteran 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.

war-caused injury and war-caused disease have the meaning given in section 9 of the VEA.

worksheet 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.

Definitions of words and phrases that are used in only one chapter are to be found in that chapter.

Acknowledgment of sources

The 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.

That 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:

Guides to the Evaluation of Permanent Impairment, 4th edition, American Medical Association, 1993;

International Classification of Impairments, Conditions, and Handicaps, World Health Organisation, Geneva, 1980; and

Publication No 118 of the National Acoustic Laboratories, Improved Procedure for Determining Percentage Loss of Hearing, by J. Macrae, Australian Government Publishing Service, Canberra, 1988.

PART A : SYSTEM SPECIFIC ASSESSMENT

PART A: SYSTEM SPECIFIC ASSESSMENT

CHAPTER 1

CARDIORESPIRATORY IMPAIRMENT

INTRODUCTION

Cardiorespiratory 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).

Different procedures (described in Chapter 2) are to be applied to assess hypertension and non-cardiac vascular conditions (such as aortic aneurysm and varicose veins).

In 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.

The 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.

Certain cardiorespiratory conditions cannot be rated by applying exercise tolerance. These include:

• conditions that do not decrease exercise tolerance;
• conditions that do not produce symptoms; and
• intermittent conditions.

“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.

A 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.

Calculation of the impairment rating for accepted cardiorespiratory conditions

Follow the steps below to determine the impairment rating for cardiorespiratory conditions:

(Each step is elaborated in the following pages.)

Step 1: Establish what cardiorespiratory conditions are present.

For 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.)

Any non-accepted conditions are to be subsequently allowed for by applying Chapter 19 (Partially Contributing Impairment) ­— see Step 7.

When 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.

Step 2: Assess the information that is available and decide whether it is reliable and sufficient.

To 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.

Medical history

An adequate history of the veteran’s illness and a description of the current symptoms and details of the current treatment should be available.

The history should be reviewed at the start of the cardiorespiratory assessmen

This is an opening excerpt, not the complete document.