In applying this 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 the veteran is to be taken as “blind” in the eye so affected.
No age adjustment permitted for this table
PART 8.2: OTHER OCULAR IMPAIRMENT
Other Impairment
Table 8.2.1 lists impairment ratings for a variety of ocular conditions. The ratings are based on the presence of symptoms and of inconvenience. Ratings from Table 8.2.1 are not to be combined with ratings from Table 8.1.3 for the same condition. If the same condition can be rated from both tables, the higher rating is to be chosen.
Other Impairment Table 8.2.1 Combined male and female symbol
OCULAR IMPAIRMENT
Impairment Ratings Criteria
NIL Occasional conjunctivitis.
TWO Intermittent conjunctivitis ‑ at least 6 separate episodes per year.
FIVE Constant but mild irritation of eyes resulting in symptoms and signs, eg, chronic conjunctivitis or blepharoconjunctivitis, persistent photo‑phobia, epiphora. Disorders resulting in dry eyes necessitating regular, daily use of eye drops. Uncorrected ectropion or entropion. Ptosis or tarsorrhaphy resulting in continuous but partial closure of the eye.
TEN Symptoms and signs of severe eye irritation, present all of the time.
Ratings from this table are not to be combined with ratings from Table 8.1.3 for the same condition. When the same condition can be rated from both tables, the higher rating is to be chosen.
No age adjustment permitted for this table
A visual impairment worksheet to note various assessment details
CHAPTER 9
RENAL AND URINARY TRACT FUNCTION
This chapter contains two parts:
Part 9.1 — Renal Function
Part 9.2 — Lower Urinary Tract Function
INTRODUCTION
Renal function and urinary tract function are to be assessed separately. Only one rating is to be given for impairment of renal function. If appropriate, two ratings may be given for lower urinary tract conditions — one for conditions of urinary excretion and one for lower urinary tract infections.
PART 9.1: RENAL FUNCTION
Renal impairment is to be assessed under Tables 9.1.1 and 9.1.2. If an impairment may be assessed from both tables, the higher of the two is to be selected.
Loss of kidney function may also be assessed by applying Chapter 16 (Activities of Daily Living), which may sometimes be more appropriate than applying Table 9.1.1 and Table 9.1.2.
Calculation of the impairment rating for loss of renal function
Follow the steps below to calculate the impairment rating due to an accepted loss of renal function.
(Each step is elaborated in the following pages.)
STEP 1
Determine a functional impairment rating for renal impairment by applying Table 9.1.1.
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STEP 2
Determine an Other Impairment rating for renal impairment.
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STEP 3
Compare the ratings obtained in Steps 1 and 2. Take the higher rating.
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STEP 4
If the renal disease is causing generalised effects, apply Chapter 16 (Activities of Daily Living) to determine a rating.
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STEP 5
If a rating has been obtained in Step 4, compare it with the rating obtained in Step 3. Take the higher rating.
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Step 1: Determine a functional impairment rating for renal impairment using Table 9.1.1.
Functional Loss Table 9.1.1 Combined male and female symbol
LOSS OF RENAL FUNCTION
Impairment Ratings Criteria
NIL Normal or insignificantly impaired renal function.
TWENTY Chronic renal failure with creatinine clearance of less than 20 mL/min.
THIRTY Chronic renal failure with creatinine clearance of less than 10 mL/min.
SIXTY Ongoing peritoneal dialysis or haemodialysis.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
Creatinine clearance may be estimated either by analysis of a 24 hour urine collection or from the serum creatinine level by applying the following formulae.
Males:
Start formula, creatinine clearance in millilitres per minute equals, start fraction, open parentheses, 140 minus age, close parentheses, times weight in kilograms, over 800 times serum creatinine level in millimoles per litre, end fraction, end formula
Females:
Start formula, creatinine clearance in millilitres per minute equals, start fraction, open parentheses, 140 minus age, close parentheses, times weight in kilograms times 0.85, over 800 times serum creatinine level in millimoles per litre, end fraction, end formula
Direct measurements of creatinine clearance are more accurate than estimates of creatinine clearance by applying the appropriate formulae. If both measurements are available that which better reflects the current status of the veteran’s health during the period of assessment is to be used.
Step 2: Determine an Other Impairment rating for renal impairment using Table 9.1.2.
Other Impairment Table 9.1.2 Combined male and female symbol
RENAL OTHER IMPAIRMENT
Impairment Ratings Criteria
NIL Glomerulonephritis, or other kidney disease, with good prognosis. Acute pyelonephritis with no current symptoms.
TWO Asymptomatic renal stones.
FIVE Nephrectomy. Glomerulonephritis likely to cause chronic renal failure in 5–10 years. Any disorder of upper urinary tract resulting in recurrent pyelonephritis, or hydronephrosis within past 12 months.
TEN Glomerulonephritis likely to cause chronic renal failure in less than five years.
TWENTY Renal transplant. Glomerulonephritis likely to progress to chronic renal failure in less than six months.
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
Step 3: Compare the ratings obtained in Steps 1 and 2. Take the higher rating.
Step 4: If the renal disease is causing generalised effects, apply Chapter 16 (Activities of Daily Living) to determine a rating.
Step 5: If a rating has been obtained in Step 4, compare it with the rating obtained in Step 3. Take the higher rating.
PART 9.2: LOWER URINARY TRACT FUNCTION
A rating for urinary excretion and one for lower urinary tract infections may be determined under this Part.
Calculation of the impairment rating for loss of lower urinary tract function
Follow the steps below to calculate the impairment rating due to an accepted loss of lower urinary function.
(Each step is elaborated in the following pages.)
STEP 1
Determine an impairment rating for impairment of urinary excretion if appropriate by applying Table 9.2.1.
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STEP 2
Determine an impairment rating for lower urinary tract infections impairment if appropriate.
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STEP 3
If the lower urinary tract condition causes impairment of an intermittent nature, combine the ratings determined in Steps 1 and 2, by applying Chapter 18 (Combined Values Chart).
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STEP 4
If the lower urinary tract condition causes impairment of an intermittent nature, determine a rating for the condition by applying Chapter 15 (Intermittent Impairment).
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STEP 5
If the lower urinary tract condition causes impairment of an intermittent nature, compare the ratings obtained in Steps 3 and 4. Take the higher rating.
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Step 1: Determine an impairment rating for impairment of urinary excretion if appropriate by applying Table 9.2.1.
Step 2: Determine an impairment rating for lower urinary tract infections impairment if appropriate by applying Table 9.2.2.
The ratings obtained in Steps 1 and 2 are not to be compared or combined at this stage but are to be included in the final combining of all ratings, except if the condition causes impairment of an intermittent nature.
If the condition does not cause impairment of an intermittent nature, the assessment of an impairment rating for the condition ceases at this point. If the condition causes impairment of an intermittent nature, proceed to Step 3.
Step 3: If the lower urinary tract condition causes impairment of an intermittent nature, combine the ratings determined in Steps 1 and 2 by applying Chapter 18 (Combined Values Chart).
Step 4: If the lower urinary tract condition causes impairment of an intermittent nature, determine a rating for the condition by applying Chapter 15 (Intermittent Impairment).
Step 5: If the lower urinary tract condition causes impairment of an intermittent nature, compare the ratings obtained in Steps 3 and 4. Take the higher rating.
If the rating obtained in Step 3 is higher than that obtained in Step 4, the impairment rating obtained in Step 1 and the impairment rating obtained in Step 2 are to be included in the final combining of all impairment ratings.
Functional Loss Table 9.2.1 Combined male and female symbol
URINARY EXCRETION
Impairment Ratings Criteria
NIL Occasional stress incontinence; infrequent and small amounts of urine lost, and incontinence pad not needed. Mild symptoms of bladder outlet or urethral obstruction, eg. hesitancy, or poor stream.
FIVE Bladder outlet or urethral obstruction as above, but with more severe symptoms such as urge frequency, nocturia, or recurrent urinary tract infections. Minor stress incontinence, needing use of 1–2 incontinence pads a day. Mild urge incontinence, but rarely unable to find a toilet in time. Any disorder of lower urinary tract resulting in recurrent pyelonephritis, or hydronephrosis within past 12 months.
TEN Moderate stress incontinence, needing several incontinence pads a day. Urethral stricture, necessitating passage of sounds at internals of three months or less.
FIFTEEN Frequent and severe stress incontinence causing significant embarrassment and some avoidance of social activities and public places. Loss of voluntary control of bladder, but satisfactory emptying achieved by triggering of reflex activity, suprapubic pressure or Valsalva manoeuvre. No incontinence aid needed.
TWENTY Loss of voluntary control of bladder necessitating intermittent catheterisation.
THIRTY Urinary diversion, eg, ileal conduit, sigmoid conduit, ureterosigmoidostomy. Dribbling incontinence needing frequent change of incontinence pads, or a collection device, eg. condom catheter.
FORTY Incontinence needing a permanent indwelling catheter.
No age adjustment permitted for this table
Functional Loss Table 9.2.2 Combined male and female symbol
LOWER URINARY TRACT INFECTIONS
Impairment Ratings Criteria
NIL Occasional urinary tract infections.
FIVE Recurrent cystitis causing frequent symptoms.
No age adjustment permitted for this table
CHAPTER 10
SEXUAL FUNCTION, REPRODUCTION, AND BREASTS
This chapter contains three parts:
Part 10.1 — Sexual Function
Part 10.2 — Reproduction
Part 10.3 — Breasts
INTRODUCTION
Each part of this chapter contains separate tables for males and females. Ratings may be obtained from one or more parts, depending on the conditions to be assessed.
Many conditions of the female reproductive system, such as premenstrual tension and dysmenorhoea, occur on a cyclical basis and should be rated by applying Chapter 15 (Intermittent Impairment). When such conditions are successfully controlled by use of the contraceptive pill, a rating of zero is to be given.
It is also recognised that servicewomen may use the contraceptive pill to free themselves from such cyclical problems. In itself this is not a condition. However, if the use of the contraceptive pill causes significant side effects and if these side effects are accepted as being war‑caused or defence‑caused conditions, they should be rated from whatever section applies to them according to their nature.
Some conditions related to the reproductive organs, or to the effects of the sexual hormones, or which are more common in one sex than the other (such as osteoporosis), are not specifically mentioned in this chapter. Such conditions should be rated from the relevant part of the Guide according to their nature.
PART 10.1: SEXUAL FUNCTION
Calculation of the impairment rating for loss of sexual function
Follow the steps below to calculate the impairment rating due to an accepted loss of sexual function.
(Each step is elaborated in the following pages.)
STEP 1
(Omit this step if you are assessing an accepted condition of a female veteran.)<br>Determine a functional impairment rating for loss of sexual function from Table 10.1.1.
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STEP 2
(Omit this step if you are assessing an accepted condition of a male veteran.)<br>Determine a functional impairment rating for loss of sexual function from Table 10.1.2.
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STEP 3
(Omit this step if you are assessing an accepted condition of a male veteran.)<br>Determine a functional impairment rating for loss of sexual function from Table 10.1.3.
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Step 1: (Omit this step if you are assessing an accepted condition of a female veteran.) Determine a functional impairment rating for loss of sexual function in male veterans from Table 10.1.1.
Although impotence may be a symptom or effect of more than one accepted condition, only one rating is to be given for impotence.
The rating from Table 10.1.1 is the final rating for loss of sexual function in male veterans. The rating obtained from Table 10.1.1 is not to be compared or combined with any other rating at this stage, but is to be included in the final combining of all ratings.
Functional Loss Table 10.1.1 Male symbol
SEXUAL FUNCTION: MALE
Age at onset Less than 30 30 to 39 40 to 64 65 to 74 75 to 84 85 and older
Loss of part of penis without significant interference with function 5 5 5 5 5 5
Only one rating is to be selected from this table.
No age adjustment permitted for this table
For the purposes of Table 10.1.1
“Impotence” means the persistent inability to attain an erection of sufficient strength to achieve intromission.
“Severe post‑ejaculatory pain” means post‑ejaculatory pain of such a degree as to cause complete or almost complete avoidance of sexual activity.
Step 2: (Omit this step if you are assessing an accepted condition of a male veteran.) Determine a functional impairment rating for loss of sexual function in female veterans from Table 10.1.2.
Functional Loss Table 10.1.2 Female symbol
SEXUAL FUNCTION: FEMALE
Impairment Ratings Criteria
NIL Persistent inability to participate in vaginal intercourse onset at age 75 or older.
FIVE Persistent inability to participate in vaginal intercourse onset at age 65–74.
TEN Persistent inability to participate in vaginal intercourse onset at age 40–64.
TWENTY Persistent inability to participate in vaginal intercourse onset at age less than 40.
TWENTY‑ FIVE Persistent inability to participate in vaginal intercourse onset at age less than 30.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
For the purposes of Table 10.1.2:
“persistent inability” means the woman is unable to participate in vaginal intercourse on most occasions because of physical obstruction of the vagina or its entrance or because of vaginismus or because of dyspareunia.
Ratings may be given from each of Tables 10.1.2 and 10.1.3 if appropriate. The rating obtained from Table 10.1.2 is not to be compared or combined with any other rating at this stage, but is to be included in the final combining of all ratings.
Step 3: (Omit this step if you are assessing an accepted condition of a male veteran.) Determine a functional impairment rating for loss of sexual function in female veterans from Table 10.1.3.
Functional Loss Table 10.1.3 Female symbol
SEXUAL FUNCTION: FEMALE
Impairment Ratings Criteria
NIL No impairment of sexual sensation.
TWO Diminished sexual sensation.
FIVE Inability to achieve a climax at age less than 40.
TEN Inability to achieve a climax at age less than 30.
Clitoridectomy at age less than 40.
FIFTEEN Vulvectomy at age less than 40.
TWENTY Clitoridectomy at age less than 30.
TWENTY‑ FIVE Vulvectomy at age less than 30.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
Section full-source-retrieval-0015 - Guide to Determining Impairment and Compensation 2016 - Document excerpt 15 | Zoe