Functional Loss Table 4.7 Combined male and female symbol
LEISURE ACTIVITIES
Impairment Ratings General description and outcome
NIL Minimal or no effect on leisure activities.
ONE Some loss of interest in activities previously enjoyed.
TWO Some reduction in recreational activities.
THREE Significant reduction in recreational activities.
FIVE Loss of interest in most recreational pursuits.
SIX Substantial reduction in most recreational pursuits.
EIGHT Virtually all recreational activities abandoned.
One rating is to be selected from this table for the recreational effects of the accepted psychiatric condition being assessed.
No age adjustment permitted for this table
Leisure activities. This table relates to the effect of the psychiatric condition on the veteran’s ability to enjoy previously pleasurable activities.
Relevant factors include decreased ability to concentrate, decreased ability to understand complex activity (for example how to do crossword puzzles, how to play cards and sports, or to follow the plot of a movie or book), loss of interest in games and sports, perhaps even the inability to remember the purpose or rules of a game. (Inability to concentrate or remember may lead to embarrassment with avoidance of the activity.)
Functional Loss Table 4.8 Combined male and female symbol
CURRENT THERAPY
Impairment Ratings General description and outcome
NIL No regular treatment sought or recommended.
ONE Medical therapy or some supportive treatment from LMO may be required, and if not commenced, may be recognised as being of use.
TWO Psychiatric treatment, at least in the form of medication or psychotherapy, has been tried (or recommended), and/or some occasional supportive therapy given at an outpatient level or by an LMO or specialist and/or a friend or other person (eg a member of the clergy) has acted in a supportive role or as a sounding board.
THREE Psychiatric treatment, at least in the form of medication or psychotherapy, has been used (or deemed necessary), and/or periods of regular supportive therapy at an outpatient level or similar.
FIVE Need for intensive specialist psychiatric treatment on an outpatient basis, including medication and/or in‑patient hospital care for short periods.
SIX Longer periods of in‑patient hospital care are necessary. Long term psychotropic drug regimes or ECT is being undertaken.
EIGHT Continuous psychiatric treatment is essential, with a need for long periods in hospital and marked social support.
Section full-source-retrieval-0010 - Guide to Determining Impairment and Compensation 2016 - Document excerpt 10 | Zoe
One rating is to be selected from this table for the treatment effects of the accepted psychiatric condition being assessed.
No age adjustment permitted for this table
Current therapy is the treatment that is being given or has been recommended for the veteran’s psychiatric condition.
Such treatment includes but is not limited to medication such as hypnotics and sedatives, counselling, group therapy, hospitalisation, or ECT. The treatment may be administered or overseen by a psychiatrist, a general practitioner, a psychologist or other health workers. The term “therapy” also includes assistance to the veteran given by his or her spouse, or other close relatives, or friends, or clergy.
An emotional and behavioural worksheet to note various assessment detailsPage 2 of the emotional and behavioural worksheet to note various assessment details
CHAPTER 5
NEUROLOGICAL IMPAIRMENT
INTRODUCTION
Loss of function tables (Tables 5.1–5.5)
Neurological impairment is measured by reference to multiple functions, many of which are rated using tables in other chapters. The additional functions considered in this chapter are:
cognitive function (Table 5.1);
communication (Tables 5.2 and 5.3); and
sensory function (Table 5.4).
Ratings from one functional loss table are to be combined with ratings from any other table for a different loss of function from the same condition. Ratings from functional loss tables are not to be combined with ratings from Other Impairment tables for the same condition.
Other Impairment table (Table 5.6)
Table 5.6 lists specific impairment ratings for a variety of neurological conditions which are based on prognosis and, in some cases, pain. When ratings for the same condition can be made from Table 5.6 and a functional loss table, the higher rating is to be chosen.
Calculation of the impairment rating for an accepted neurological condition
Follow the steps below to determine the impairment rating for neurological conditions:
(Each step is elaborated in the following pages.)
STEP 1
Determine an impairment rating for functional loss from the accepted neurological condition, by applying Tables 5.1, 5.2, 5.3, 5.4, and 5.5, as applicable.
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STEP 2
Determine an impairment rating for functional loss from the accepted neurological condition, by applying other applicable chapters of this Guide.
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STEP 3
Determine a rating for Other Impairment from the accepted neurological condition, by applying Table 5.6 as applicable.
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STEP 4
(Omit this step if no rating was given in Step 3.)<br>Combine the ratings obtained in Step 1 and Step 2, by applying Chapter 18 (Combined Values Chart). Compare the resultant combined rating with the rating obtained in Step 3. Take the higher rating.
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Step 1: Determine an impairment rating for functional loss from the accepted neurological condition, by applying Tables 5.1, 5.2, 5.3, 5.4, and 5.5, as applicable.
Cognitive function
“Cognition” means “the faculty of knowledge”. The cognitive function deals with such aspects of knowledge as acquisition (learning), retention and recall (memory), and use (reasoning and problem‑solving).
Table 5.1 is applied only if an organic brain condition has been diagnosed. It is not to be applied to assess general mental capacity in a veteran with a condition of another body system unrelated to the brain condition. The impairment rating must relate only to cognitive deficits that were not present before the onset of the condition. Psychiatric conditions are to be assessed by applying Chapter 4 (Emotional and Behavioural).
Self‑reports of deteriorating mental function must be interpreted with caution. Organic brain disease is often associated with a lack of insight or a tendency to deny failing abilities. Self‑reported complaints about poor memory may be more closely related to depressive symptoms than to true memory deficits. If there is doubt about the nature or extent of the deficit, formal psychometric testing may be required.
Table 5.1 addresses memory and new learning ability as well as reasoning and problem‑solving abilities. This requires:
adequate levels of motivation and attention;
restraint of impulsive tendencies;
ability to organise, categorise and shift responses;
use of feedback to modify behaviour; and
capacity to evaluate final performance.
The ratings reflect increasing grades of severity.
Functional Loss Table 5.1 Combined male and female symbol
LOSS OF NEUROLOGICAL FUNCTION: COGNITION
Impairment Ratings Criteria
NIL Negligible impairment: reasoning is comparable with that of peers.
Memory similar to that of peers: written notes, etc., used in the manner of busy people of all ages.
TEN Mild impairment: appropriate use is made of accumulated knowledge and reasonable judgement is shown in routine daily activities most of the time. Difficulties are apparent in new circumstances. Mild but demonstrable impairment of memory: misplaces objects, and has increased difficulty in remembering names and appointments. Can learn, although at a slower rate than previously. Impairment has little impact on everyday activity because of compensation through reliance on written notes, schedules, checklists and spouse.
TWENTY‑ FIVE Moderate impairment of memory: has frequent difficulty in recalling details of recent experiences; frequently misplaces objects; fails to follow through with intentions or obligations; tends to get lost more easily in unfamiliar areas. Compensation through use of aids, eg. lists and diaries, is adequate. Moderate impairment of problem solving ability, relies on accumulated knowledge. Suffers significant disadvantage in circumstances requiring complex decision‑making or non‑routine activities, i.e. when past decision‑making is not directly relevant. Has reduced initiative, spontaneity, and capacity for abstract thinking.
FORTY Symptoms as above, but more frequent and severe. Is partially able to compensate, but unable to function with complete independence, and needs some supervision.
SIXTY Severe impairment: has difficulty in carrying out basic activities such as sequencing the steps needed for dressing and for preparing meals. Planning/organisational ability is reduced. Is unable to function independently in new or complex situations. Shows markedly reduced initiative and spontaneity, and perseverative thinking. Severe memory deficiency: is unable to retain any information about recent experiences. New learning is not possible after attention has been directed elsewhere. Is unable to work or live independently, needing supervision to avoid harm, e.g. from fire caused by forgetting to put out cigarettes or to turn off appliances. Has extreme difficulty in keeping track of finances, scheduled activities, social relationships, etc.
SEVENTY Gross impairment: is unable to initiate and sustain activities without supervision. Supervision and prompting are required for virtually all daily activity. Is unable to plan a course of action for the simplest activity. Gross amnesic syndrome: is unable to acquire or recall new information. Constant supervision and care are required. Unable to recognise family, own reflection in mirror, etc. Is disoriented in familiar surroundings.
No age adjustment permitted for this table
Communication
Communication has two elements: comprehension and expression. “Comprehension” means “understanding”. It includes understanding of speech and gestures, recognition of sights and sounds, spatial and temporal orientation. “Expression” is the capacity to convey the content of one’s mind to others.
Comprehension and expression are to be rated separately, by applying Tables 5.2 and 5.3 respectively. Impairment ratings from these tables are to be combined when criteria from both are applicable. Impairment ratings from these tables are not to include communication deficits that were present before the onset of the condition.
Tables 5.2 and 5.3 are to be applied to rate neurological or neuromuscular conditions as well as local lesions involving the mechanisms of speech production. Communication may also be restricted by vision loss, hearing loss, or loss of hand function. Ratings are then to be made from Chapter 8, Chapter 7, or Chapter 3 respectively, instead of Tables 5.2 and 5.3.
Comprehension
Table 5.2 is to be applied to rate limitation of auditory or visual comprehension. Only one impairment rating is to be given from this table. If more than one criterion is applicable that which results in the higher rating is to be chosen.
Expression
Table 5.3 is to be applied to rate limitation of speech production, as well as written and unspoken methods of expression. Only one impairment rating is to be made from this table. If more than one criterion is applicable, that which results in the higher rating is to be chosen.
Evaluation of speech production takes into account:
audibility: the ability to speak loudly enough to be heard;
intelligibility: the ability to articulate and to link phonetic units of speech with sufficient accuracy to be understood;
functional efficiency: the ability to speak quickly enough, and to sustain the rate for a period; and
retrieval and manipulation of language elements: expression of ideas.
Functional Loss Table 5.2 Combined male and female symbol
LOSS OF NEUROLOGICAL FUNCTION: COMPREHENSION
Impairment Ratings Criteria
NIL Normal or nearly normal comprehension.
FIVE Can understand movies, radio programs or group discussions, but with some difficulty. Comprehension is good in most situations, but understanding is difficult in large groups, or when tired and upset. Has difficulty coping with rapid changes of topic.
TEN Can understand speech face‑to‑face, but confusion or fatigue occurs rapidly in any group. Is unable to cope with rapid change in topic, or with complex topics: is able to grasp the meaning of TV serials, but not more complex ideas. Mild dyslexia: is able to grasp the meaning of basic newspaper and magazine articles, but has difficulty understanding details. Is unable to follow the storyline in books.
TWENTY‑ FIVE Can understand only simple sentences, and follow simple conversion when some points are repeated Moderate dyslexia: reading comprehension is limited to sentences and short paragraphs. Can follow simple two‑to‑three line instructions, and cope with shopping (and other) lists, but nothing more complex.
FORTY Can understand only single words. Shows some understanding of slowly‑spoken simple sentences from context and gesture, although frequent repetition is needed. Severe dyslexia: is able to read single words, to match words to pictures and to read labels and signs, but is unable to read instructions.
FIFTY Unable to understand simple instructions or yes/no questions, even with gesture. Unable to read single words, labels or signs.
Ratings from one Functional Loss table may be combined with ratings from any other table for a different loss of function. Ratings from Functional Loss tables are not to be combined with ratings from Other Impairment tables for the same condition.
No age adjustment permitted for this table
Functional Loss Table 5.3 Combined male and female symbol
LOSS OF NEUROLOGICAL FUNCTION: EXPRESSION
Impairment Ratings Criteria
NIL Normal or nearly normal expression.
FIVE Speech is of sufficient intensity and vocal quality for most everyday needs, eg: normal speech, but unable to shout; or needs to repeat self at times; or is unable to produce some phonetic units; or speech is sustained over a 10‑minute period, but with difficulty that includes hesitation and word‑retrieval problems; or is permanently hoarse.
TEN Speech is of sufficient intensity and vocal quality for many of the needs of everyday speech, eg: is adequate with low background noise, but is heard with some difficulty in vehicles or public places; or has many inaccuracies, but is easily understood by strangers; or is slow or discontinuous, conveying the distinct impression of difficulty. Converses in simple sentences on familiar topics, although word‑finding problems are frequent, and has difficulty in explaining long or complex ideas. Has mild dysgraphia: is unable to cope with more than short letters (about five lines) or postcards, which show both grammatical and spelling errors.
TWENTY Speech is of sufficient intensity and vocal quality for some of the needs of everyday speech, eg: is adequate under quiet conditions, but is heard with great difficulty against any background noise; voice fades rapidly; or is understood by family and friends, but is difficult for strangers; or needs frequent repetition; or speech is sustained for short period only: fatigues rapidly. Has moderate dysgraphia: is unable to write more than short sentences which include frequent spelling errors, eg. has difficulty filling in bank forms.
THIRTY Speech is of sufficient intensity and vocal quality for only a few of the needs of everyday speech, eg: is reduced to a whisper at best: inaudible over the telephone; or can produce only a few phonetic units approximating some words, but these are not intelligible if the context is unknown; or can produce only short phrases or single words: speech flow is not maintained, or is too slow to be useful. Is unable to initiate conversation, but, with considerable effort, is able to respond in short simple sentences or phrases. Has severe dysgraphia: is able to write only some recognisable words, eg: items for a shopping list, or names of family.
FORTY Has no speech production, but is able to use non‑verbal means of expression. Is limited to single words or familiar social or stereotyped phrases requiring considerable listener inference. Has agraphia: no functional writing ability, although is able to copy or write much‑practiced sequences, such as own name.
Ratings from one Functional Loss table may be combined with ratings from any other table for a different loss of function. Ratings from Functional Loss tables are not to be combined with ratings from Other Impairment tables for the same condition.
No age adjustment permitted for this table
“Total Loss of Speech” is also mentioned in Table 24.1 (Degree of Incapacity for Specific Disabilities) in Chapter 24.
Sensory function
Table 5.4 is to be applied to rate sensory loss only. Lesions of nerves or nerve roots may also cause motor loss, which is to be rated independently by applying Chapter 3. Ratings may be made for sensory loss in the distribution of either a dermatome or a peripheral nerve, but not both for the same loss.
“Partial loss” refers either to a loss of less than the complete distribution of the nerve, or to altered sensation. Peripheral neuropathies with a “glove and stocking distribution” and “happy feet” are examples of this.