Results from Formula 7.1 are to be rounded to the nearest integer (whole number). Thus 2.4 would be rounded to 2, and 2.6 would be rounded to 3. If the calculation gives an answer exactly half way between two integers, the answer is rounded up, for example 2.5 is to be rounded to 3.
If the paired organs policy (see page 123) does not apply, Formula 7.1 gives the final impairment rating for loss of hearing. To determine whether the paired organs policy applies, proceed to Step 6.
A diagram depicting the structures of the inner ear, including the ear canals, vestibule and cochlea
Step 6. Determine if the paired organs policy applies. If it applies, calculate the adjusted impairment rating.
Use Table 7.1.10 to determine if the paired organs policy applies.
Procedural Table 7.1.10 Combined male and female symbol
PAIRED ORGANS POLICY
Accepted Hearing Loss Does the Paired Organs Policy apply?
Type 1 Bilateral mixed deafness No
Type 2 Right mixed deafness Yes
Type 3 Left mixed deafness Yes
Type 4 Bilateral sensorineural deafness No
Type 5 Bilateral sensorineural deafness with right conductive deafness No
Type 6 Bilateral sensorineural deafness with left conductive deafness No
Type 7 Bilateral conductive deafness No
Type 8 Bilateral conductive deafness with right sensorineural deafness No
Type 9 Bilateral conductive deafness with left sensorineural deafness No
Type 10 Left conductive deafness with right sensorineural deafness No
Type 11 Right conductive deafness with left sensorineural deafness No
Type 12 Right conductive deafness Yes
Type 13 Right sensorineural deafness Yes
Type 14 Left sensorineural deafness Yes
Type 15 Left conductive deafness Yes
No age adjustment permitted for this table
The paired organs policy is to be applied by doubling the impairment rating for the age‑adjusted PLH for the accepted hearing loss and comparing that with the impairment rating equivalent to the total bilateral hearing loss. The lesser of the two is to be taken as the impairment rating (adjusted for the paired organs policy) for the accepted hearing loss.
The paired organs policy is the subject of Chapter 21.
TINNITUS
Tinnitus is to be assessed if:
tinnitus is an accepted condition in its own right; or
tinnitus is present and any of the fifteen types of hearing loss is an accepted condition for the ear in which tinnitus is present.
Tinnitus is not to be assessed when it is a rejected condition.
Irrespective of whether there are any non‑accepted conditions contributing to the tinnitus, the rating is not to be moderated by applying Chapter 19 (Partially Contributing Impairment).
If impairment ratings are obtained for hearing loss and tinnitus both are to be included in the final combining of all impairment ratings by applying Chapter 18 (Combined Values Chart).
To assess tinnitus, make the appropriate selection from Table 7.1.11 below.
Functional Loss Table 7.1.11 Combined male and female symbol
TINNITUS
Impairment Ratings Criteria
NIL No tinnitus or occasional tinnitus.
TWO Very mild tinnitus: not present every day.
FIVE Tinnitus every day, but tolerable for much of the time.
TEN Severe tinnitus, eg of similar severity to that requiring a masking device, present every day.
FIFTEEN Very severe tinnitus, present every day, causing distraction, loss of concentration and extreme discomfort, and regularly interfering with sleep.
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
PART 7.2: EAR, NOSE, AND THROAT
The three tables in this Part are all Other Impairment tables.
Impairment of speech is to be assessed by applying Chapter 5 (Neurological Impairment).
Loss of balance is commonly paroxysmal and is usually best rated by applying Chapter 15 (Intermittent Impairment).
Loss of taste and loss of smell are to be assessed by applying Chapter 5 (Neurological Impairment).
Other Impairment Table 7.2.1 Combined male and female symbol
EARS
Impairment Ratings Criteria
NIL Intermittent otalgia, intermittent otorrhoea, or both.
TWO Otitis externa.
FIVE Otalgia every day, but tolerable for much of the time. Continuous otorrhoea.
TEN Frequent severe otalgia.
Only one rating is to be selected from this table for any condition or combination of conditions.
No age adjustment permitted for this table
If accepted conditions affect both ears, they are to be rated together and only a single rating is to be given for them.
Chapter 15 (Intermittent Impairment) may be applied for more severe or frequent aural conditions.
UPPER RESPIRATORY TRACT AND NASAL CONDITIONS
Other Impairment Table 7.2.2 Combined male and female symbol
FIVE Symptoms of rhinitis and sinusitis or both which are not relieved by medication and which occur for more than 4 months every 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
Chapter 15 (Intermittent Impairment) may be applied for upper respiratory tract and nasal conditions which are sufficiently severe or frequent.
THROAT
Other Impairment Table 7.2.3 Combined male and female symbol
THROAT
Impairment Ratings Criteria
NIL No tracheostomy.
TWO A tracheostomy that has been closed.
TWENTY Permanent tracheostomy.
No age adjustment permitted for this table
INDEX TO HEARING IMPAIRMENT WORKSHEETS
Worksheet Numbers
Type No Total accepted hearing loss Air alone Air & Bone
1 Bilateral mixed deafness 2 N/A
2 Right mixed deafness 3 N/A
3 Left mixed deafness 3 N/A
4 Bilateral sensorineural deafness SND SND
5 Bilateral sensorineural deafness with Right conductive deafness 2 N/A
6 Bilateral sensorineural deafness with Left conductive deafness 2 N/A
7 Bilateral conductive deafness 2 4
8 Bilateral conductive deafness with Right sensorineural deafness 2 N/A
9 Bilateral conductive deafness with Left sensorineural deafness 2 N/A
10 Left conductive deafness with Right sensorineural deafness 2 NWP
11 Right conductive deafness with Left sensorineural deafness 2 NWP
12 Right conductive deafness 3 5
13 Right sensorineural deafness 3 NWP
14 Left sensorineural deafness 3 NWP
15 Left conductive deafness 3 5
SND
=
sensorineural deafness
N/A
=
not applicable
NWP
=
no worksheet provided
The Type Numbers in the left hand column refer to types of accepted hearing loss as defined in Table 7.1.1 of the Guide.
A hearing impairment worksheet to note various assessment details for type 4 bilateral sensorineural deafness
A second hearing impairment worksheet to note various assessment details for hearing loss types 1, 8 and 9 and when bone conduction figures are not being used, for types 4, 5, 6, 7, 10 and 11
A third hearing impairment worksheet to note various assessment details for total calculation of hearing loss for a determined type
A fourth hearing impairment worksheet for noting assessment details in relation to hearing loss type 7
A fifth hearing impairment worksheet for noting assessment details in relation to hearing loss types 12/15
CHAPTER 8
VISUAL IMPAIRMENT
This chapter contains two parts:
Part 8.1 — Impairment of Visual Function
Part 8.2 — Other Ocular Impairment
INTRODUCTION
Part 8.1 is to be applied to assess:
any condition, such as refractive error, that is actually affecting visual function; and
any condition, such as glaucoma or cataracts, that in the normal course of its progression would be likely to affect visual function.
Part 8.2 is to be applied to assess such conditions of the eye and the surrounding structures as may lead to discomfort or inconvenience, such as conjunctivitis and conditions of the eyelid, without actually or usually affecting visual function.
PART 8.1: IMPAIRMENT OF VISUAL FUNCTION
Loss of function
Visual function is to be measured by reference to:
corrected visual acuity (Table 8.1.1 or Table 8.1.3); and
visual field defects (Figures 8a and 8b); and
miscellaneous function (Table 8.1.2).
The following steps take into account the fact that normal vision is a binocular function.
Calculation of the impairment rating for loss of visual function
Follow the steps below to calculate the impairment rating due to accepted loss of visual function.
(Each step is elaborated in the following pages.)
STEP 1 If there is any accepted refractive error, determine the monocular assessment for each eye based on corrected visual acuity. Page 133
STEP 2 If there is any accepted condition causing a visual field defect, determine the monocular assessment for each eye affected by the accepted condition. Page 133
STEP 3 Determine the monocular assessment for each eye from the Miscellaneous Visual Function Table (Table 8.1.2) as the result of any accepted condition. Page 134
STEP 4 For each eye separately, combine the ratings obtained in Steps 1, 2, and 3 by applying Chapter 18 (Combined Values Chart). Page 134
STEP 5 Combine the two combined monocular impairment ratings obtained in Step 4 by applying Table 8.1.3. Page 135
Step 1: If there is any accepted refractive error, determine the monocular assessment for each eye based on corrected visual acuity.
All assessments of visual acuity are to be based on corrected visual acuity, that is, the visual acuity as measured when the veteran is wearing glasses or contact lenses correctly prescribed. No additional impairment rating is to be given for the need to wear corrective lenses.
A separate monocular assessment is to be determined for each eye.
If only one eye has a refractive error, or if only one eye is to be assessed, the monocular assessment of the eye is to be determined by applying Table 8.1.1 and the assessment for visual acuity for the other eye is to be taken as nil. (These assessments will ultimately be combined by applying Table 8.1.3.)
Functional Loss Table 8.1.1 Combined male and female symbol
In applying the above table, if the veteran’s visual acuity in either eye is such that he or she is only capable of counting fingers or of perceiving the difference between light and darkness with that eye, then he or she is to be taken as “blind” in the eye so affected.
No age adjustment permitted for this table
Step 2: If there is any accepted condition causing a visual field defect, determine the monocular assessment for each eye affected by the accepted condition.
Any condition (such as glaucoma) which could cause loss of visual field is to be assessed by measuring that loss. For glaucoma without field loss refer to Table 8.1.2.
Loss of visual field is to be measured either by a manual or a computerised method, using the Esterman grid (Figures 8A and 8B).
Methods of measuring visual field loss
If the field has been defined by a manual method such as a Bjerrum screen with a 5/1000 white target or a Humphrey bowl at 10dB or less, a transparency of the Esterman grid is placed over the map of the visual field. Those dots that fall wholly or partially within the area of field loss are counted, and the number of dots so counted is to be taken as the monocular assessment for the field loss of that eye.
If the field has been defined by the Humphrey computerised method, a transparency of the appropriate Esterman grid is placed over the graytone field map of the eye being assessed. The graytones represent varying degrees of diminished response to visual stimuli. Count those dots that fall wholly or partially within the area of the graytone field map corresponding to the three darkest intensities of the set of ten graytones in the key accompanying the field map. The number of dots so counted is to be taken as the monocular assessment of the field loss of that eye.
If the field has been defined by a computerised method other than the Humphrey method, a transparency of the appropriate Esterman grid is placed over the graytone field map of the eye being assessed. The graytones represent varying degrees of diminished response to visual stimuli. Count those dots that fall wholly or partly within the area of the graytone field map corresponding to the equivalent of 10dB or less of the intensities of the set of ten graytones in the key accompanying the field map. The number of dots so counted is to be taken as the monocular assessment of the field loss of that eye.
Step 3: Determine the monocular assessment for each eye from Table 8.1.2 as the result of any accepted condition.
Only one criterion is to be selected from Table 8.1.2. If more than one criterion could be selected, the criterion resulting in the higher or highest monocular assessment is to be chosen. The single assessment is then included in both monocular assessments. (See below.)
As the criteria in Table 8.1.2 refer to binocular functions, the assessment is included in both monocular assessments. For example, the assessment for unilateral aphakia is to be included in both monocular assessments.
Step 4: For each eye separately, combine the ratings obtained in Steps 1, 2 and 3 by applying Chapter 18 (Combined Values Chart).
Having followed Steps 1, 2 and 3, up to three monocular assessments will have been obtained for each eye depending on the particular accepted visual conditions affecting the veteran.
For example, there may be for the right eye:
an assessment for corrected visual acuity;
an assessment for a visual field defect; and
an assessment for a miscellaneous visual defect.
For each eye separately, these three assessments are to be combined as if they were impairment ratings, by applying Chapter 18 (Combined Values Chart) in accordance with the steps in that chapter. The resulting value is to be rounded to the nearest multiple of 5. This is known as the combined monocular impairment rating for that eye.
Step 5: Combine the two combined monocular impairment ratings obtained in Step 4 by applying Table 8.1.3.
Binocular impairment rating
After a combined monocular impairment rating has been made for each eye, the two ratings are to be combined by applying Table 8.1.3. The value obtained is known as the binocular impairment rating.
Figure 8a ‑ ESTERMAN GRID: LEFT EYE
A depiction of an Esterman grid for assessment of the left eye
Figure 8b ‑ ESTERMAN GRID: RIGHT EYE
A depiction of an Esterman grid for assessment of the right eye
Functional Loss Table 8.1.2 Combined male and female symbol
MISCELLANEOUS VISUAL FUNCTION
Visual Disturbance Monocular Assessment
Heterophoria 0
Nystagmus without diplopia 0
Cataract with no loss of visual acuity 2
Glaucoma without loss of visual fields 2
Bilateral intraocular lens 5
Unilateral intraocular lens 5
Bilateral aphakia 5
Unilateral aphakia 10
Loss of stereopsis in absence of heterotropia 5
Heterotropia with diplopia one quadrant of upward gaze 5
Heterotropia without diplopia near vision only 5
Heterotropia with diplopia one quadrant of downward gaze 10
Heterotropia without diplopia all directions of gaze 10
Heterotropia with diplopia one direction of sideways gaze 10
Heterotropia with diplopia all directions of upward gaze 10
Heterotropia with diplopia all directions of downward gaze 15
Heterotropia with diplopia both directions of sideways gaze 15
Heterotropia with diplopia all range of near vision 15
Heterotropia with diplopia all directions of gaze 25
Gaze defects vertical 10
Gaze defects horizontal 10
Gaze defects vertical and horizontal 25
Only one criterion may be selected from this table. If the accepted condition satisfies more than one criterion, the criterion resulting in the higher rating is to be chosen. The single rating is then included in both monocular assessments.
No age adjustment permitted for this table
The combined monocular impairment ratings obtained in Step 4 are those values found in the shaded area of Table 8.1.3. The values for the better and worse eye are to be taken from the values in the shaded regions along the horizontal and vertical axes respectively.
For convenience, Table 8.1.3 incorporates Table 8.1.1 along both its axes. The figures in italics give the possible losses of visual acuity. The values in the shaded area immediately beside or above the figures in italics give the corresponding monocular assessment.
If the only condition affecting visual function is decreased visual acuity, the visual acuities for the better and the worse eye respectively can be read from the values in italics along the horizontal and vertical axes respectively.
Paired organs policy
If an accepted condition affects one eye only, the paired organs policy may apply (see Chapter 21).
Visual Impairment Worksheet
To ensure a consistent and clear record of the use of the tables, the Visual Impairment Worksheet (at page 141) should be used when assessing visual impairment.
A Visual Impairment Worksheet is used when assessing impairment involving visual field or miscellaneous visual conditions.