In some cases, two other impairment ratings are to be given. In such cases, the functional impairment for the limbs should be apportioned into three parts:
one part corresponding to the impairment due to any amputation of the right leg;
one part corresponding to the impairment due to any amputation of the left leg; and
one part corresponding to all other causes.
Substep 7B
When the only Other Impairment rating relates to joint replacements and realignments.<br>Ratings from Table 3.2.4 are to be given only if both the following conditions apply:<br> the predominant cause of loss of lower limb function is a vascular condition (such as peripheral vascular disease); and<br> the rating obtained from Table 3.2.2 is higher than the highest rating obtained from Table 3.2.1.<br>Other Impairment rating or ratings from Table 3.2.4 are to be included in the final combining of all impairment ratings. Unlike Other Impairment ratings from most other tables, ratings from Table 3.2.4 are not to be compared with a functional impairment rating.
Example:
A veteran has osteoarthritis of both knees as an accepted condition and has had bilateral knee replacements resulting in reasonably good function. The veteran also has peripheral vascular disease as an accepted condition which limits walking distance to about 200 metres.
By following steps 1 to 6 inclusive, a rating will have been selected:
from Table 3.2.2:
20 impairment points; and
two ratings will have been selected from Table 3.2.4:
10 impairment points for the right knee replacement; and
10 impairment points for the left knee replacement.
The veteran receives all three impairment ratings. The three ratings are to be included in the final combining of all impairment ratings.
The following conditions, whether alone or in combination, are to be assessed by applying Table 3.2.5 if they have no effect on lower limb function. If these conditions have an effect on lower limb function they are to be assessed by applying Table 3.2.2.
Other Impairment Table 3.2.5 Combined male and female symbol
MINOR DISORDERS OF THE LOWER LIMBS
Impairment Ratings Criteria
NIL Pes planus with no symptoms. Hammer toes with no symptoms. Claw toes with no symptoms. Hallux valgus with no symptoms. Calcaneal spurs with no symptoms. Genu varum with no symptoms. Genu valgum with no symptoms.
TWO Pes planus with minor symptoms. Hammer toes with minor symptoms. Claw toes with minor symptoms. Hallux valgus with minor symptoms. Calcaneal spurs with minor symptoms. Genu varum with minor symptoms. Genu valgum with minor symptoms.
Where applicable a rating is to be selected from this table for each condition.
No age adjustment permitted for this table
A Lower Limbs Worksheet is provided on page 69.
A single Lower Limbs Worksheet is to be used for both lower limbs together. The Lower Limbs Worksheet is designed to facilitate calculation of the functional impairment of the lower limbs. That functional impairment is to be compared with any Other Impairment ratings in accordance with this Guide.
PART 3.3: SPINE
Part 3.3 of Chapter 3 is to be applied in assessing impairment of the spinal column, not of the spinal cord. Impairments of the spinal cord are to be assessed by applying Chapter 5 of this Guide.
For the purposes of assessment under Part 3.3 the spine consists of two parts — the cervical spine and the thoraco‑lumbar spine — each of which is to be given a separate impairment rating if appropriate.
Determination of the impairment rating for conditions of the spine.
Follow the steps below to determine the impairment rating from accepted conditions affecting the function of the spine. Because the cervical spine and the thoraco‑lumbar spine are each to be separately assessed, this set of steps is to be followed twice (if applicable): once for the cervical spine and once for the thoraco‑lumbar spine.
(Each step is elaborated in the following pages.)
STEP 1
Calculate the functional impairment due to restriction of range of movement of the spine as a result of accepted conditions.
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STEP 2
(Omit this step if you are not assessing an impairment of the thoraco‑lumbar spine.)<br>Determine the impairment rating applicable to the thoraco‑lumbar spine by applying Table 3.3.2.
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STEP 3
(Omit this step if you are not assessing an impairment of the thoraco‑lumbar spine.)<br>Compare the rating obtained in Step 1 in respect of impairment of the thoraco‑lumbar spine with the rating obtained in Step 2. Take the higher rating.
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STEP 4
Make any applicable age adjustment to the functional impairment rating for the spine by applying Table 3.6.1.
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STEP 5
Determine if any Other Impairment rating applies to the spine.
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STEP 6
Compare the impairment rating obtained in Step 4 with the impairment rating obtained in Step 5. Take the higher rating.
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Step 1: Calculate the functional impairment due to restriction of range of movement of the spine as a result of accepted conditions.
Table 3.3.1 is to be applied to rate spinal function. It is based on range of movement of the spine. Two ratings may be given from this table — one for the cervical spine and one for the thoraco‑lumbar spine. Only one rating is to be given for the cervical spine for any condition or combination of conditions which contribute to the loss of range of movement of the cervical spine. Only one rating is to be given for the thoraco‑lumbar spine for any condition or combination of conditions that contribute to the loss of range of movement of the thoraco‑lumbar spine.
It is not practicable to measure range of movement of the thoracic spine independently of that of the lumbar spine. If only the thoracic spine is to be rated, all movements are to be measured, but emphasis is given to rotation. If only the lumbar spine is to be rated, all movements are to be measured, but emphasis is given to forward flexion. However, even if conditions of both the thoracic and lumbar spine are to be assessed, only one rating is to be made from the thoraco‑lumbar spine column of Table 3.3.1.
The loss of range of movement should be estimated to the nearest quarter of the normal range of movement.
The loss of range of movement will usually be provided as a fractional loss of range of movement and such data can be used directly in Table 3.3.1. However, sometimes, the measured movements of the affected part of the spine will be available in degrees. In such a case the measured movement is to be compared with the average range of movement of the normal spine to obtain the fractional loss of range of movement.
The average ranges of movement of the normal spine may be obtained from Table 3.5.1 in Part 3.5. These values are to be used in arriving at the fractional loss of range of movement when the actual movements of the spine are known in degrees.
If a functional impairment rating obtained from Table 3.3.1 has been contributed to by any non‑accepted conditions, then that rating is to be moderated by applying Chapter 19 (Partially Contributing Impairment).
Step 2: (Omit this step if you are not assessing an impairment of the thoraco‑lumbar spine.) Determine the impairment rating applicable to the thoraco‑lumbar spine by applying Table 3.3.2.
Table 3.3.2 is to be applied to assess functional loss of the thoraco‑lumbar spine that is not adequately measured by loss of range of movement. Ratings obtained from Table 3.3.2 are not to be combined with any ratings obtained from Table 3.3.1 in respect of the thoraco‑lumbar spine. Ratings obtained from Table 3.3.2 are compared with ratings obtained from Table 3.3.1 in respect of the thoraco‑lumbar spine in Step 3.
If a functional impairment rating obtained from Table 3.3.2 has been contributed to by any non‑accepted conditions, then that rating is to be moderated by applying Chapter 19 (Partially Contributing Impairment).
Functional Loss Table 3.3.1 Combined male and female symbol
LOSS OF MUSCULOSKELETAL FUNCTION: SPINAL MOVEMENT
Impairment Ratings Criteria
Cervical spine Thoraco‑lumbar spine
NIL X‑ray changes only. Normal or nearly normal range of movement. X‑ray changes only. Normal or nearly normal range of movement.
FIVE Loss of about one‑quarter of normal range of movement.
TEN Loss of about half of normal range of movement Loss of about one‑quarter normal range of movement.
FIFTEEN Loss of about three‑quarters of normal range of movement.
TWENTY Loss of almost all movement, or complete ankylosis in position of function Loss of about half of normal range of movement.
THIRTY Ankylosis in an unfavourable position. Loss of about three‑quarters of normal range of movement.
FORTY Loss of almost all movement, or complete ankylosis in position of function.
FIFTY Ankylosis in an unfavourable position, or unstable joint.
Where applicable, two ratings are to be selected from this table — one for the cervical spine and one for the thoraco‑lumbar spine.
Ratings from this table are age adjusted (see Table 3.6.1)
Functional Loss Table 3.3.2 Combined male and female symbol
LOSS OF MUSCULOSKELETAL FUNCTION: THORACO‑LUMBAR SPINE (BASED ON USE OF SPINE)
Impairment Ratings Criteria
NIL Thoraco‑lumbar spine condition causes no difficulty in sitting or standing or other normal activities.
TWO Thoraco‑lumbar spine condition causes occasional difficulties in prolonged sitting or standing.
FIVE Thoraco‑lumbar spine condition causes difficulties in sitting or standing that generally result in pain or undue fatigue by the end of the day.
TEN Thoraco‑lumbar spine condition generally causes pain or undue fatigue within half an hour, and so requires frequent changes of posture.
FIFTEEN Thoraco‑lumbar spine condition generally causes pain or undue fatigue within five minutes, and so requires very frequent changes of posture.
One rating may be selected from this table in respect of the thoraco‑lumbar spine. No rating is to be selected from this table in respect of the cervical spine.
Ratings from this table are age adjusted (see Table 3.6.1)
Step 3: (Omit this step if you are not assessing an impairment of the thoraco‑lumbar spine.) Compare the rating obtained in Step 1 in respect of impairment of the thoraco‑lumbar spine with the rating obtained in Step 2. Take the higher rating.
Step 4: Make any applicable age adjustment to the functional impairment rating for the spine by applying Table 3.6.1.
The functional impairment rating obtained in Step 4 is to be age adjusted by applying Table 3.6.1. Unlike the situation which applies to the upper and lower limbs there is no maximum value of the impairment rating of the spine. Hence whatever the rating obtained by application of Table 3.6.1 is the rating to be given. (The reason is that the maximum rating for limbs is determined by reference to the rating given for amputation of the limb, but there is no such thing as amputation of the spine.)
Step 5: Determine if any Other Impairment rating applies to the spine.
The Other Impairment ratings of the spine are those due to crush fractures of the vertebrae.
Other Impairment Table 3.3.3 Combined male and female symbol
CRUSH FRACTURES OF THE VERTEBRAE
Impairment Ratings Criteria
NIL No fracture of the vertebrae.
TWO Crush fracture with minor compression (less than 25%) only.
FIVE Crush fracture of one vertebra (compression of 25%‑50%).
TEN Crush fracture of a single vertebra with more than 50% compression. Crush fracture of two or more vertebrae with more than 25% compression of each.
Where applicable, two ratings are to be selected from this table — one for the cervical spine and one for the thoraco‑lumbar spine.
No age adjustment permitted for this table
Step 6: Compare the impairment rating obtained in Step 4 with the impairment rating obtained in Step 5. Take the higher rating.
After applying Chapter 19 (Partially Contributing Impairment), the functional impairment rating due to loss of range of movement of the spine is to be compared with the functional impairment due to any crush fractures.
The higher of these two ratings is the final functional impairment rating for the cervical or thoraco‑lumbar spine, as the case may be.
The assessment of other effects of spinal conditions.
If a spinal condition causes an effect on limb function, then that effect on limb function is also to be assessed under Parts 3.1 or 3.2 of this chapter (together with the effect of any other accepted conditions contributing to loss of function of the same limb); and if a spinal condition causes a sensory loss, then that sensory loss is also to be assessed under Table 5.4 (together with the effect of any other accepted conditions contributing to that sensory loss).
For example, if a spinal condition which causes a reduced range of spinal movement also interferes with the proper function of the limbs, then a rating from Table 3.3.1 may be combined with a rating from Table 3.1.2 or 3.2.2.
A Cervical Spine Worksheet is provided at page 71.
A Thoraco‑Lumbar Spine Worksheet is provided at page 72.
PART 3.4: RESTING JOINT PAIN
An additional rating is to be given from Table 3.4.1 for certain joint pain. This table is to be applied only for frequent joint pain that continues to affect a joint when the joint is no longer in use: for example, pain in the knees continuing for a significant period after ceasing walking and standing, or pain in the shoulders persisting for a significant period after ceasing some task such as hanging out the washing. Pain that limits range of movement or distance that can be walked is already assessed elsewhere (Tables 3.2.1 and 3.2.2).
Table 3.4.1 may be applied for pain in both the upper limbs and lower limbs and intervertebral joints. Only one selection may be made from this table for pain in any joint or combination of joints. However, the table is not to be applied to rate sciatic pain. Sciatic pain is to be rated by applying Table 3.2.2.
Other Impairment Table 3.4.1 Combined male and female symbol
RESTING JOINT PAIN
Impairment Ratings Criteria
NIL Pain in any joint, or combination of joints, that is not usually present at rest.
TWO Pain in any joint, or combination of joints, that is often present at rest but which is mild. Pain in the back that limits comfortable sitting to less than 30 minutes at a time.
FIVE Pain in any joint, or combination of joints, that is often present at rest but which improves after several hours rest or responds to medication or to therapeutic measures. Pain in the back that limits comfortable sitting to less than 10 minutes at a time.
TEN Severe pain in any joint, or combination of joints, that is often present at rest but which does not respond adequately to medication or to therapeutic measures.
FIFTEEN Severe pain in any joint, or combination of joints, that is always present at rest but which does not respond adequately to medication or to therapeutic measures and which regularly interferes with sleep.
Only one selection is to be made from this table for pain in any joint or combination of joints.
No age adjustment permitted for this table
PART 3.5: RANGES OF JOINT MOVEMENT
Table 3.5.1 is a table of “average” or “normal” values. It is to be used to assist in the estimation of loss of range of joint movement. Range of movement is usually measured by simple visual assessment, and is based on active joint movement. Because estimates of range of movement are required only to the nearest quarter of normal full range of movement, the use of a goniometer is not essential.
A global assessment is based on the measurement and averaging of movements in all planes. Functionally more important planes of movement (Table 3.5.1) are given more emphasis in this assessment. The total loss of range of movement should be estimated to the nearest quarter of the normal range of movement.
Estimates of range of movement may be made using the joint on the opposite side for comparison, provided that the opposite side is not affected by injury or disease. If both sides are affected the accepted normal range of movement given in Table 3.5.1 can be used as a reference.
The angles in brackets represent the position of function. This information is required when considering whether an ankylosis is in a favourable position or not.
Procedural Table 3.5.1 Combined male and female symbol