If other renal conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
Accepted hypertensive cerebral haemorrhage is to be assessed according to the specific effects of the haemorrhage.
The 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.
Target 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.
The 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.
Step 3: Determine an impairment rating for hypertension from Table 2.1.1.
Other Impairment Table 2.1.1 Combined male and female symbol
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.
No age adjustment permitted for this table
For 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.
Step 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.
The 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.
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.
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.
Impairment 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.
The total impairment rating for target organ damage is not to be combined with the impairment rating obtained from Table 2.1.1.
PART 2.2: VASCULAR CONDITIONS OF THE LOWER LIMBS
Each vascular condition of the lower limbs is characterised as belonging to one or more of three categories. These categories are:
(arterial) peripheral vascular disease;
varicose veins and vascular leg ulcers; and
oedema.
Each 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.
Determination of the impairment rating for vascular conditions of the lower limbs
Follow the steps below to determine the impairment rating for each type of accepted vascular condition of the lower limbs.
(Each step is elaborated in the following pages.)
Step 1
Establish whether any effect on lower limb function is present.
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Step 2
Establish whether any effect on the skin is present.
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Step 3
(Omit this step if there is no effect on lower limb function)<br>Determine the impairment rating for the effects on lower limb function.
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Step 4
(Omit this step if there is no effect on skin)<br>Determine the impairment rating for the effects on the skin.
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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.
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Step 6
Combine the impairment ratings obtained in Steps 3 and 4.
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Step 7
Combine the impairment ratings obtained in Step 5.
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Step 8
Compare the impairment ratings obtained in Steps 6 and 7.
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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.
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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.
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Step 1: Establish whether any effect on lower limb function is present.
Lower 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).
Step 2: Establish whether any effect on the skin is present.
Varicose veins can affect the skin of the lower limbs. They may cause discolouration or pruritus (itching). Excoriations (scratch marks) may be present.
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.
Lower 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.
The 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.
Step 4: (Omit this step if there is no effect on the skin.) Determine the impairment rating for the effects on the skin.
Skin 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.
The 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.
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.
There 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.
Amputations 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).
Other Impairment Table 2.2.1 Combined male and female symbol
(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.
No age adjustment permitted for this table
Other Impairment Table 2.2.2 Combined male and female symbol
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.
No age adjustment permitted for this table
Other Impairment Table 2.2.3 Combined male and female symbol
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.
No age adjustment permitted for this table
An 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).
Step 6: Combine the impairment ratings obtained in Steps 3 and 4.
If 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.
Step 7: Combine the impairment ratings obtained in Step 5.
If 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.
Step 8: Compare the impairment ratings obtained in Steps 6 and 7.
Step 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.
If 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.
Step 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.
If 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.
PART 2.3: OTHER NON‑CARDIAC VASCULAR CONDITIONS
This Part is to be applied for a variety of vascular conditions not covered elsewhere in the Guide.
Other Impairment Table 2.3.1 Combined male and female symbol
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.
No age adjustment permitted for this table
Aneurysms, atherosclerosis, and cerebrovascular disease
Impairment 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.
Impairment 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.
CHAPTER 3
IMPAIRMENT OF SPINE AND LIMBS
This chapter contains six parts:
Part 3.1 — Upper Limbs
Part 3.2 — Lower Limbs
Part 3.3 — Spine
Part 3.4 — Resting Joint Pain
Part 3.5 — Ranges of Joint Movement
Part 3.6 — Spine and Limbs Age Adjustment
INTRODUCTION
This chapter is used to assess the motor function of the spine and limbs. Sensory loss is to be assessed under Chapter 5 (Neurological Impairment).
Impairment of limbs
When 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.
PART 3.1: UPPER LIMBS
Functional 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.
Calculation of the impairment rating for conditions of each upper limb
Follow the steps below to calculate the impairment rating for accepted conditions of each upper limb:
(Steps 2–8 are elaborated in the following pages.)
STEP 1
If accepted condition(s) affect only the right upper limb, follow steps 2–8.<br>If accepted condition(s) affect only the left upper limb, follow steps 2–8 substituting “left” for “right” in the instructions.<br>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.
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.
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STEP 3
(Omit this step if is there is no restriction of joint movement in the right upper limb.)<br>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.
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STEP 4
Calculate the functional impairment rating for the right upper limb as a whole using Table 3.1.2.
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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.
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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.
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STEP 7
Determine if any Other Impairment rating applies to the right upper limb.
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STEP 8
(Omit this step if no Other Impairment rating applies to the right upper limb.)<br>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.
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Step 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.
For the purposes of assessment under the Guide, the major joints of the upper limb are the shoulder, the elbow and the wrist.
In 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.
Conditions 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.
Hence, it must be determined which, if any, of
shoulder;
elbow;
wrist; and
thumb and fingers,
potentially have loss of range of movement due to accepted conditions.