Severe cases of dumping syndrome may be rated by applying Chapter 15 (Intermittent Impairment).
Other Impairment Table 6.1.8 Combined male and female symbol
DISORDERS OF THE LARGE AND SMALL BOWEL
Impairment Ratings Criteria
NIL Bowel disorder, eg. irritable bowel, diverticulosis: infrequent and minor symptoms such as constipation, or intermittent diarrhoea and abdominal cramps which respond to dietary treatment.
FIVE Bowel disorder: frequent moderate symptoms necessitating regular medication.
TEN Bowel disorder: marked symptoms, such as regular diarrhoea and frequent abdominal pain, partially controlled by full‑dose medication.
TWENTY Bowel disorder: diarrhoea and abdominal pain on most days, with no response to medication and considerable interference with daily routine.
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 6.1.9 Combined male and female symbol
DISORDERS OF THE ANUS AND RECTUM
Impairment Ratings Criteria
NIL Anal disorder: infrequent and minor symptoms, eg. haemorrhoids, anal fissures, controlled by medication. Mild to moderate pruritus ani.
FIVE Anal disorder: moderate symptoms on most days, necessitating regular medication for control. Marked pruritus ani, with daily symptoms and evidence of excoriation.
TEN Anal disorder: marked to severe symptoms despite regular treatment.
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 6.1.10 Combined male and female symbol
LIVER
Impairment Ratings Criteria
NIL Abnormality of liver function tests, but otherwise asymptomatic. Acute hepatitis (resolved).
TWO Chronic persistent hepatitis.
FIVE Signs of chronic liver disease, but no evidence of portal hypertension.
TEN Chronic liver disease with evidence of portal hypertension. Chronic active hepatitis.
TWENTY Chronic liver disease with history of variceal bleeding or encephalopathy.
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.
Section full-source-retrieval-0012 - Guide to Determining Impairment and Compensation 2016 - Document excerpt 12 | Zoe
No age adjustment permitted for this table
Other Impairment Table 6.1.11 Combined male and female symbol
PANCREAS
Impairment Ratings Criteria
NIL Pancreatic disease, with no symptoms.
TWO Pancreatic disease, with mild infrequent symptoms.
TEN Chronic pancreatitis with ongoing intermittent attacks of abdominal pain and/or steatorrhoea.
TWENTY Chronic pancreatitis with frequent attacks of abdominal pain and steatorrhoea, or two or more admissions to hospital within the past year.
No age adjustment permitted for this table
More frequent exacerbations of pancreatic disease can be rated by applying Chapter 15 (Intermittent Impairment).
Other Impairment Table 6.1.12 Combined male and female symbol
GALL‑BLADDER
Impairment Ratings Criteria
NIL Gall‑bladder disease with no symptoms. Cholecystectomy currently asymptomatic.
TWO Gall‑bladder disease with mild infrequent symptoms.
FIVE Post‑cholecystectomy syndrome. Two or more attacks of gall‑bladder disease necessitating hospital admission within the past year.
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
More frequent exacerbations of gall bladder disease can be rated by applying Chapter 15 (Intermittent Impairment).
Step 3: Compare the functional impairment rating with the relevant Other Impairment rating. Take the higher rating.
This step determines the final impairment rating for the gastrointestinal condition. Select one of the following substeps depending on the circumstances:
Substep 3A
If, for any condition, only one rating has been obtained in Step 1 and only one rating has been obtained in Step 2, compare the ratings. Take the higher rating. This is the final rating for that gastrointestinal condition.
Substep 3B
If, for any condition, only one rating has been obtained in Step 1 but more than one rating has been obtained in Step 2, combine the ratings for that condition obtained in Step 2 using Chapter 18 (Combined Values Chart). Compare the rating for that condition obtained in Step 1 with the combined value of the ratings for that condition obtained in Step 2. Take the higher rating. This is the final rating for that gastrointestinal condition.<br>For the purpose of the final combining of all values, if the higher value is made up of a combination of ratings, then the component ratings are to be used.
Substep 3C
If, for any condition, more than one rating has been obtained in Step 1 but only one rating has been obtained in Step 2, combine the ratings for that condition obtained in Step 1 by applying Chapter 18 (Combined Values Chart). Compare the combined value of the ratings for that condition obtained in Step 1 with the rating obtained in Step 2. Take the higher rating. This is the final rating for that gastrointestinal condition.<br>For the purpose of the final combining of all values, if the higher value is made up of a combination of ratings, then the component ratings are to be used.
Substep 3D
If, for any condition, more than one rating has been obtained in Step 1 and more than one rating has been obtained in Step 2, combine the ratings for that condition obtained in Step 1 by applying Chapter 18 (Combined Values Chart) and separately combine the ratings for that condition obtained in Step 2 by applying Chapter 18 (Combined Values Chart). Compare the combined value of the ratings for that condition obtained in Step 1 with the combined value of the ratings for that condition obtained in Step 2. Take the higher rating. This is the final rating for that gastrointestinal condition.<br>For the purpose of the final combining of all values, if the higher value is made up of a combination of ratings, then the component ratings are to be applied.
PART 6.2: ABDOMINAL WALL HERNIAS AND OBESITY
Impairment ratings obtained from Tables 6.2.1 and 6.2.2 are not to be compared with any other tables but are to be included in the final combining of all ratings.
Functional Loss Table 6.2.1 Combined male and female symbol
ABDOMINAL WALL HERNIAS
Impairment Ratings Criteria
NIL Inguinal or ventral hernia surgically repaired.
TWO Inguinal or ventral hernia easily reducible.
FIVE Inguinal or ventral hernia not easily reduced and resulting in mild symptoms.
TEN Large inguinal or ventral hernia resulting in frequent symptoms.
An impairment rating is to be selected from this table for each accepted inguinal and ventral hernia.
No age adjustment permitted for this table
Functional Loss Table 6.2.2 Combined male and female symbol
OBESITY
Impairment Ratings Criteria
NIL Body mass index equal to or below 30.
FIVE Body mass index above 30.
No age adjustment permitted for this table
Body mass index is given by the formula:
Start formula, body mass index equals, start fraction, open parentheses, weight in kilograms, close parentheses, over, open parentheses, height in meters, close parentheses, superscript 2, end fraction, end formula
Table 6.2.2 is to be applied only if obesity is an accepted condition or if obesity is an integral feature of an accepted condition.
CHAPTER 7
EAR, NOSE, AND THROAT IMPAIRMENT
This chapter contains two parts:
Part 7.1 — Hearing Loss and Tinnitus
Part 7.2 — Ear, Nose, and Throat
PART 7.1: HEARING LOSS AND TINNITUS
Because it causes a single loss of function, accepted hearing loss is to be assessed as if it were a single condition even if the loss is described under several diagnostic terms. For example, a veteran who has accepted conditions of both “right conductive deafness” and “left conductive deafness” will have them rated as if the conditions had been described as “bilateral conductive deafness”.
A diagram depicting the structures of the outer, middle and inner ear
Only a single impairment rating may be made from Part 7.1 for accepted hearing loss irrespective of how many diagnostic terms have been used in describing the hearing loss.
However, a second impairment rating may be made from Part 7.1 (Table 7.1.11) for tinnitus if appropriate.
Definitions
For the purposes of this chapter:
“Air Conduction”
is the manner in which sound transmitted through the air reaches the inner ear in the normal way.
“APHL” or “Accepted Percentage Hearing Loss”
is the percentage of total hearing that the veteran has lost due to accepted deafness. It is found by summing the losses at each of 6 important frequencies.
“Bone conduction”
is the manner in which sound is heard when the source of sound is placed directly over any bony part of the hearer’s cranium. In such a case the sound is conducted to the inner ear through the bones of the skull.
“HTL” or “Hearing Threshold Level”
is, for any given frequency, the volume (loudness) of the faintest sound that the veteran can hear. For each frequency, there will be a hearing threshold level for the right ear and a hearing threshold level for the left ear. Hearing threshold levels can be determined using either bone or air conduction information.
“Presbyacusis”
is the normal loss of hearing which accompanies ageing.
“TBHL” or “Total Bilateral Hearing Loss”
is the percentage of total hearing which the veteran has lost from all conditions whether accepted or not.
Calculation of the impairment rating for accepted hearing loss
Follow the steps below to calculate the accepted hearing loss.
(Each of these steps is elaborated in the following pages.)
STEP 1
Apply Table 7.1.1 to determine the type of accepted hearing loss.
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STEP 2
Determine whether the audiogram is reliable and suitable for hearing loss calculations.
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STEP 3
Calculate the APHL.
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STEP 4
Determine what age adjustment (if any) must be subtracted from the APHL. Subtract it.
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STEP 5
Determine the functional impairment rating by applying Formula 7.1. If the paired organs policy does not apply, this will be the final impairment rating for loss of hearing.
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STEP 6
Determine if the paired organs policy applies by applying Table 7.1.10. If the policy applies, calculate the adjusted impairment rating.
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Hearing Worksheets
A set of Hearing Worksheets, at the end of this chapter (pages 127 to 131), is designed to facilitate the calculation of impairment due to accepted hearing loss. When performing a hearing loss assessment, the assessor should use the appropriate worksheet.
These worksheets may also be of assistance in gaining an understanding of the procedures set out in this chapter.
Step 1: Use Table 7.1.1 to determine the type of accepted hearing loss.
For the purpose of assessment, every type of accepted hearing loss is considered to consist of one or more of the following four components:
right sensorineural deafness;
left sensorineural deafness;
right conductive deafness; and
left conductive deafness.
Fifteen different types of accepted hearing loss are recognised. Each consists of one or more of the above four components. The 15 types of possible accepted hearing loss are listed in Table 7.1.1 below. Every accepted hearing loss or combination of hearing losses will be found to be equivalent to one of the types of hearing loss listed in Table 7.1.1.
Procedural Table 7.1.1 Combined male and female symbol
TYPES OF ACCEPTED HEARING LOSS
Type 1 Bilateral mixed deafness
Type 2 Right mixed deafness
Type 3 Left mixed deafness
Type 4 Bilateral sensorineural deafness
Type 5 Bilateral sensorineural deafness with right conductive deafness
Type 6 Bilateral sensorineural deafness with left conductive deafness
Type 7 Bilateral conductive deafness
Type 8 Bilateral conductive deafness with right sensorineural deafness
Type 9 Bilateral conductive deafness with left sensorineural deafness
Type 10 Left conductive deafness with right sensorineural deafness
Type 11 Right conductive deafness with left sensorineural deafness
Type 12 Right conductive deafness
Type 13 Right sensorineural deafness
Type 14 Left sensorineural deafness
Type 15 Left conductive deafness
A single selection to cover the veteran’s accepted hearing loss is to be made from this table, ignoring the non‑accepted hearing losses at this stage.
No age adjustment permitted for this table
Step 2: Determine whether the audiogram is reliable and suitable for hearing loss calculations.
The audiogram
Assessment of hearing impairment requires a pure tone audiogram. For the purposes of assessment of impairment, hearing loss is to be measured without the benefit of any hearing aid. Measurements of the hearing threshold level (HTL) should be taken at each of the following frequencies:
Ideally, the audiogram should include both air conduction HTLs and masked bone conduction HTLs at each of these frequencies.
The four criteria for a reliable audiogram
1. The date of the audiogram must be appropriate to the period of assessment.
The audiogram should not be more than six months older than the relevant time in the assessment period to which the information is to be applied. If there is a specific assertion that the veteran’s hearing has deteriorated within the last six months, then the audiogram should not be more than six weeks old at the time of assessment.
2. The frequencies tested should be appropriate.
Measurements of HTL should be available for each of the frequencies mentioned above (that is, 500 Hz, 1000 Hz, 1500 Hz, 2000 Hz, 3000 Hz, and 4000 Hz).
If HTL measurements are missing at one or two frequencies, the missing values can be estimated (interpolation) by inspection of the audiogram, by applying knowledge of the type of hearing loss, and by examination of other audiograms. If the nature and extent of missing information in an audiogram are considered to be such that interpolation would not be sufficiently accurate, the audiogram should be repeated. If the deficient audiogram is recent, the new audiogram is to be used in its place. The new audiogram may also be used to assist in interpolation of an older, deficient audiogram.
3. Bone conduction HTLs should be available when necessary.
An audiogram showing both bone conduction and air conduction HTLs should be used for the assessment of all types of accepted hearing loss unless the total accepted hearing loss is equivalent to:
Bilateral mixed deafness;
Right mixed deafness;
Left mixed deafness;
Bilateral conductive deafness with right sensorineural deafness; or
Bilateral conductive deafness with left sensorineural deafness,
for each of which only air conduction HTLs are required; or unless it is not practicable or appropriate to obtain bone conduction HTL values.
Reasons why it may not be practicable or appropriate to obtain bone conduction HTL values include the following:
the veteran cannot reasonably attend a clinic where bone conduction HTL values can be measured;
the veteran’s other conditions are of such a degree that it will make no appreciable difference to the final assessment; or
an ENT specialist or an audiologist has reported that:
no air‑bone gap is present;
no conductive hearing loss is present; or
Rinné’s test is positive.
In such circumstances only air conduction HTLs need to be obtained.
4. The nature of the audiogram should be appropriate.
The nature (that is, general shape) of the audiogram should be consistent with the known hearing loss affecting the veteran and should also be consistent with other information (eg, old audiograms) concerning the veteran.
If the nature of the audiogram is not appropriate, the audiogram should be repeated or the veteran referred to an ENT specialist to clarify the situation.
Step 3: Calculate the APHL.
There are six scales labelled 7.1.3 to 7.1.8. Each scale corresponds to a different frequency of sound. Table 7.1.3 relates to 500 Hz, Table 7.1.4 relates to 1000 Hz, Table 7.1.5 relates to 1500 Hz, and so on according to their labels.
Look up HTLs for 500Hz in Table 7.1.3 to give the loss at 500 Hz.
Look up HTLs for 1000Hz in Table 7.1.4 to give the loss at 1000 Hz
Look up HTLs for 1500Hz in Table 7.1.5 to give the loss at 1500 Hz
Look up HTLs for 2000Hz in Table 7.1.6 to give the loss at 2000 Hz
Look up HTLs for 3000Hz in Table 7.1.7 to give the loss at 3000 Hz
Look up HTLs for 4000Hz in Table 7.1.8 to give the loss at 4000 Hz
This process gives rise to six frequency‑specific losses. These six frequency‑specific losses are summed to give the APHL for the relevant type of accepted deafness.
The calculations are best set out in a tabular form as below:
Accepted Hearing Loss
FREQ Hearing Levels (dB) Loss
(Hz) Right Left (%)
500
1000
1500
2000
3000
4000
APHL =
The figures to be entered in the columns headed “Right” and “Left” will be obtained from the audiogram.
The figures to be entered in the column headed “Loss (%)” are to be obtained by applying Tables 7.1.3 to 7.1.8. (A different scale is used for each row of the calculation.)
The figures in the column headed “Loss (%)” are then to be added up to give the APHL.