Functional Loss Table 5.4 Combined male and female symbol
LOSS OF NEUROLOGICAL FUNCTION: SENSORY NERVES
Impairment Ratings
Partial Unilateral Loss Total Unilateral or Partial Bilateral Loss Total Bilateral Loss
Dermatome
C2‑3 (together) 0 5 10
C6&7 (together) 5 10 20
C8 0 5 10
L5&S1 (together) 0 5 10
S2&3&4 (together) 0 5 10
Hemianaesthesia (central) 15 30 —
Peripheral Nerve
Greater auricular 0 5 10
Median 5 10 20
Ulnar 0 5 10
Radial 0 0 0
Posterior femoral cutaneous 0 5 10
Sciatic 0 5 10
Tibial (medial popliteal) 0 5 10
Pudendal 0 5 10
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
Cranial nerves
Although related anatomically, cranial nerves represent diverse functions which are to be rated elsewhere in most cases. Sometimes no alternative tables exist, and a rating relating to loss of motor or sensory function is given.
Ratings from Table 5.5 can be combined with ratings from other tables relating to neurological function, but not with ratings from Table 5.6 for the same condition. The ratings listed are for complete loss of function. If partial losses exist the ratings are to be reduced proportionately.
Functional Loss Table 5.5 Combined male and female symbol
LOSS OF NEUROLOGICAL FUNCTION: CRANIAL NERVES
Cranial Nerve Function Assessment to be made by application of: Complete Unilateral Loss Complete Bilateral Loss
I Smell 0 5
II Vision Chapter 8
III, IV, VI Eye movement Chapter 8
V Trigeminal (sensory) Ophthalmic
division 5 10
Maxillary
division 5 10
Mandibular
division 5 10
Chewing Chapter 6
Speech Table 5.3
VII Taste 0 5
Facial expression 10 20
Chewing Chapter 6
Speech Table 5.3
VIII Hearing Chapter 7
Balance Chapters 15 or 16
IX, X, XI, XII Swallowing Chapter 6
Speech Table 5.3
XI Shoulder Elevation 5 10
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
Step 2: Determine an impairment rating for functional loss from the accepted neurological condition, by applying other applicable chapters of this Guide.
Assessment of conditions of the central and peripheral nervous system may require the application of tables from Chapter 3 (upper and lower limb function), Chapter 6 (eating and swallowing, faecal continence), Chapter 7 (hearing), Chapter 8 (vision), Chapter 9 (urinary continence), and Chapter 10 (sexual function). A neurological rating may involve the combination of multiple ratings, each relating to the loss of a different function. Cerebrovascular accidents, for example, may require ratings for hemiparesis of the upper limb, hemiparesis of the lower limb, hemianopia and dysphasia.
Step 3: Determine a rating for Other Impairment from the accepted neurological condition, by applying Table 5.6 as applicable.
Neurological Other Impairment
Most neurological conditions are associated with a readily identifiable functional deficit. Table 5.6 is to be applied to rate those conditions where such deficit is minimal, and yet a significant neurological condition exists. Many of the conditions referred to in Table 5.6 may result in significant loss of function. Ratings from Table 5.6 and the functional loss table are to be compared, and the higher rating is to be chosen.
Functional Loss Table 5.6 Combined male and female symbol
NEUROLOGICAL OTHER IMPAIRMENT
Impairment Ratings Criteria
NIL Headaches of any type, infrequent and easily controlled. History of epilepsy no longer necessitating medication.
FIVE Documented cerebrovascular disease, eg. history of transient ischaemic attacks; cerebrovascular accident with good return of function; pathological narrowing of arteries demonstrated with Doppler studies or angiography (but not calcification shown on plain X‑ray). Aneurysms (not surgically corrected). Tics, hemifacial spasm. Epilepsy requiring daily medication.
TEN Progressively deteriorating neurological disorders associated with significantly reduced life expectancy, eg. multiple sclerosis, Alzheimer’s disease. Tic douloureux occurs intermittently.
TWENTY Rapidly progressive neurological disorders associated with significantly reduced life expectancy, eg. motor neurone disease. Tic douloureux occurs frequently.
Ratings from this table and the Functional Loss table are to be compared and the higher rating is to be chosen — see Step 4.
No age adjustment permitted for this table
Chapter 15 (Intermittent Impairment) may be applied to rate cases with more frequent or severe episodes.
Step 4: (Omit this step if no rating was given in Step 3.) Combine the ratings obtained in Steps 1 and 2, by applying Chapter 18 (Combined Values Chart). Compare the resultant rating with the rating obtained in Step 3. Take the higher. This is the final impairment rating for the accepted neurological condition.
CHAPTER 6
GASTROINTESTINAL IMPAIRMENT
This chapter consists of 2 parts:
Part 6.1 — Diseases of the digestive system
Part 6.2 — Abdominal wall hernias and obesity
PART 6.1: DISEASES OF THE DIGESTIVE SYSTEM
Diseases of the digestive system include conditions of the alimentary tract and of the accessory organs of digestion: liver, pancreas and gall bladder.
Loss of function (Tables 6.1.1, 6.1.2 and 6.1.3)
Gastrointestinal impairment is measured by loss of the abilities to ingest food, to maintain nutrition and to excrete the waste products of digestion. Impairment of these functions will be manifested by:
difficulty in chewing and swallowing;
nutritional deficiency and loss of weight; and
faecal incontinence or constipation.
Impairment of each function is to be rated independently of the others. Separate ratings are to be given for each affected function.
If the gastrointestinal loss of function is due to a malignant condition, the step‑by‑step instructions in Chapter 14 (Malignant Conditions) are to be followed.
If the gastrointestinal loss of function is intermittent in nature or has a significant intermittent component, Chapter 15 (Intermittent Impairment) is to be applied.
If the gastrointestinal loss of function is very severe or causes marked debility, Chapter 16 (Activities of Daily Living) is to be applied.
In particular, severely impaired liver function is to be rated by reference to Chapter 16 (Activities of Daily Living).
Other Impairment (Tables 6.1.4 to 6.1.12)
Tables 6.1.4 to 6.1.12 give specific impairment ratings for various gastrointestinal conditions, based largely on the presence of symptoms. Each of the nine tables refers to a different region or aspect of the gastrointestinal tract or to one of the associated organs of digestion. If, for the same gastro‑intestinal condition, ratings can be given both from one of the Functional Loss tables and from a gastrointestinal Other Impairment table, the higher rating is to be chosen.
If multiple accepted conditions contribute to any of the ratings obtained from any of Tables 6.1.1, 6.1.2 or 6.1.3, Chapter 20 (Apportionment) is to be applied as required before making any comparison with a rating from one of the gastrointestinal Other Impairment tables.
Calculation of the impairment rating for gastrointestinal conditions
Follow the steps below to calculate the impairment due to accepted gastrointestinal conditions.
(Each step is elaborated in the following pages.)
STEP 1
Determine one or more ratings for loss of gastrointestinal function.
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STEP 2
Determine any Other Impairment ratings that are applicable.
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STEP 3
Compare the functional impairment rating with the relevant Other Impairment rating. Take the higher rating.
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Step 1: Determine one or more ratings for loss of gastrointestinal function.
There are three tables relating to gastrointestinal functional loss:
Table 6.1.1
Loss of gastrointestinal function: ingestion of food
Table 6.1.2
Loss of gastrointestinal function: maintenance of nutrition
Table 6.1.3
Loss of gastrointestinal function: faecal excretion
A gastrointestinal condition may cause a loss of function under more than one of the above tables. In that case a rating is to be selected from each applicable table.
If more than one condition is present, a rating is to be selected from each of the applicable tables. However, only one rating is to be selected from each table irrespective of the number of conditions that contribute to the functional impairment that is being assessed by applying that table.
If a non‑accepted condition or non‑accepted conditions contribute to the rating selected from a table, Chapter 19 (Partially Contributing Impairment) is to be applied.
Functional Loss Table 6.1.1 Combined male and female symbol
LOSS OF GASTROINTESTINAL FUNCTION: INGESTION OF FOOD
ImpairmentRatings Criteria
NIL Some difficulty in chewing or swallowing, but only minor or occasional restriction of diet and there is no weight loss.
FIVE Significant difficulty in chewing or swallowing, but diet is not grossly restricted and there is no weight loss.
TEN Difficulty in chewing or swallowing that limits diet to soft or semi‑solid foods. Constant dysphagia requiring dilation two or three times a year.
TWENTY Diet limited to liquid or to pureed food because of difficulty in chewing or swallowing.
THIRTY Constant dysphagia necessitating dilation six times or more a year.
Only one rating is to be selected from this table for any condition or combination of conditions.
No age adjustment permitted for this table
To calculate the percentage loss of weight for the purposes of Table 6.1.2 follow the substeps below.
Substep 1A
Determine the veteran’s weight before the beginning of the gastro‑intestinal condition (irrespective of when the condition was first diagnosed or accepted). This is the “premorbid weight”.
Substep 1B
Determine the veteran’s weight at the relevant time in the assessment period.
Substep 1C
If the weight obtained in substep 1B is equal to, or greater than, the premorbid weight, no impairment rating based on involuntary weight loss can be given from Table 6.1.2.<br>If the weight obtained in substep 1B is less than the premorbid weight, express the difference as a percentage of the premorbid weight. The result is the “percentage loss of weight”.
Substep 1D
Determine whether the percentage loss of weight is due to the accepted gastrointestinal condition being assessed. If it is, then the percentage loss of weight may be used in applying Table 6.1.2.<br>If the percentage loss of weight is not due to the accepted gastro‑intestinal condition being assessed, then no impairment rating based on involuntary loss of weight can be given from Table 6.1.2.
Substep 1E
If non‑accepted conditions contribute to the percentage loss of weight, Chapter 19 (Partially Contributing Impairment) is to be applied.
Functional Loss Table 6.1.2 Combined male and female symbol
LOSS OF GASTROINTESTINAL FUNCTION: MAINTENANCE OF NUTRITION
Impairment Ratings Criteria
NIL Minor or no modification to diet, eg. high fibre diet or necessity to avoid certain foodstuffs.
TWO Malabsorption well controlled with appropriate replacement therapy.
FIVE Prescribed exclusion diet or major dietary restrictions, eg. gluten‑free diet. Laboratory evidence of malabsorption or nutritional deficiency despite therapy (including dietary restriction), but no signs or symptoms.
TEN Laboratory evidence of malabsorption together with some signs or symptoms.
TWENTY Involuntary weight loss of 10% or more with evidence of active disease and minor symptoms only.
THIRTY Involuntary weight loss of 10% or more with evidence of active disease and associated with local symptoms or mild systemic symptoms.
FORTY Involuntary weight loss of 20% or more with evidence of active disease. Ileostomy, jejunostomy, oesophagostomy or gastrostomy.
SIXTY Involuntary weight loss of 20% or more with evidence of active disease and associated with severe, frequent local symptoms and systemic symptoms, eg. fever, malaise, anaemia.
Only one rating is to be selected from this table for any condition or combination of conditions.
No age adjustment permitted for this table
Functional Loss Table 6.1.3 Combined male and female symbol
LOSS OF GASTROINTESTINAL FUNCTION: FAECAL EXCRETION
Impairment Ratings Criteria
NIL Intermittent constipation.
TWO Persistent constipation.
FIVE Minor faecal incontinence associated with occasional soiling.
TEN Faecal soiling necessitating frequent changes of underwear, or a precautionary incontinence pad.
TWENTY Faecal incontinence necessitating use of incontinence pads on most days.
THIRTY Faecal incontinence necessitating several changes of incontinence pads on most days. Colostomy.
FIFTY Complete faecal incontinence.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
Step 2: Determine any Other Impairment ratings that are applicable.
Determine which of the Other Impairment tables apply to the accepted gastrointestinal condition and select the appropriate impairment rating from each.
There are nine gastrointestinal Other Impairment tables:
Table 6.1.4
Oral cavity and oesophagus
Table 6.1.5
Non‑ulcer dyspepsia, nausea and vomiting
Table 6.1.6
Peptic ulcers: duodenal or gastric ulcers
Table 6.1.7
Effects of past gastric surgery
Table 6.1.8
Disorders of the large and small bowel
Table 6.1.9
Disorders of the anus and rectum
Table 6.1.10
Liver
Table 6.1.11
Pancreas
Table 6.1.12
Gall bladder
A gastrointestinal condition may attract an Other Impairment rating under more than one of the above tables. In that case a rating is to be selected from each applicable table.
Only one impairment rating is to be selected from each of the gastrointestinal Other Impairment tables for each condition or combination of conditions. If more than one rating from any table is applicable, the higher or highest rating is to be selected.
Other Impairment Table 6.1.4 Combined male and female symbol
ORAL CAVITY AND OESOPHAGUS
Impairment Ratings Criteria
NIL Oral disorders causing no problems or minimal difficulties in chewing. Asymptomatic hiatus hernia. Halitosis.
TWO Reflux, mild or occasional symptoms with or without prophylactic treatment.
FIVE Reflux, with or without oesophagitis: frequent minor symptoms necessitating frequent use of antacids or use of H2 receptor antagonist medication.
TEN Oesophagitis: active disease with moderate symptoms on most days, despite regular use of H2 receptor antagonist medication.
TWENTY Oesophagitis, proven endoscopically: active disease with complications, eg. Barrett’s epithelium, blood loss, aspiration or stricture.
Only one rating is to be selected from this table for any condition or combination of conditions. If more than one rating is applicable, the higher rating is to be selected.
No age adjustment permitted for this table
Other Impairment Table 6.1.5 Combined male and female symbol
NON‑ULCER DYSPEPSIA, NAUSEA AND VOMITING
Impairment Ratings Criteria
NIL Non‑ulcer dyspepsia, nausea or vomiting: infrequent and mild.
FIVE Non‑ulcer dyspepsia, nausea or vomiting: mild to moderate, necessitating some medication on most days.
TEN Non‑ulcer dyspepsia, nausea or vomiting: moderate symptoms, necessitating daily full‑dose medication.
TWENTY Non‑ulcer dyspepsia or vomiting: severe, not controlled despite medication, and causing weight loss of 10% or more.
Only one rating is to be selected from this table for any condition or combination of conditions. If more than one rating is applicable, the higher rating is to be selected.
No age adjustment permitted for this table
Other Impairment Table 6.1.6 Combined male and female symbol
PEPTIC ULCERS: DUODENAL OR GASTRIC ULCERS
Impairment Ratings Criteria
NIL Past history of peptic ulcer: currently inactive and asymptomatic, with or without maintenance treatment.
FIVE Peptic ulcer: with intermittent symptoms necessitating ongoing maintenance treatment.
TEN Peptic ulcer: active disease with moderate symptoms on most days, despite regular H2 receptor antagonist or proton pump inhibitor medication.
TWENTY Peptic ulcer: proven endoscopically: active disease with complications and troublesome daily symptoms, eg. bleeding or outlet obstruction.
Only one rating is to be selected from this table for any condition or combination of conditions. If more than one rating is applicable, the higher rating is to be selected.
No age adjustment permitted for this table
For a gastric ulcer that has been surgically removed apply Table 6.1.7.
Other Impairment Table 6.1.7 Combined male and female symbol
EFFECTS OF PAST GASTRIC SURGERY
Impairment Ratings Criteria
NIL Past gastric surgery, currently asymptomatic.
FIVE Past gastric surgery with intermittent dyspepsia and/or mild dumping syndrome.
TEN Past gastric surgery with frequent dyspepsia and/or dumping syndrome.
TWENTY Past gastric surgery with severe dyspepsia and/or dumping syndrome on most days.
Only one rating is to be selected from this table for any condition or combination of conditions. If more than one rating is applicable, the higher rating is to be selected.