Ratings may be given from each of Tables 10.1.2 and 10.1.3 if appropriate. The rating obtained from Table 10.1.3 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.
PART 10.2: REPRODUCTION
Calculation of the impairment rating for loss of reproductive function
Follow the steps below to calculate the impairment rating due to an accepted loss of reproductive 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 reproductive function from Table 10.2.1.
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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 10.2.2.
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For the purposes of this chapter:
“infertility” means:
for females —
the condition in which a woman is unable to achieve a pregnancy resulting in a viable infant because of a gynaecological condition that prevents her becoming pregnant or maintaining a pregnancy to term; or
the situation of a woman who has been given medical advice that she should not become pregnant and who consequently does not give birth to a viable child either because of risk to her life; or the danger of seriously compromising her health; or serious and significant risk to the potential child. (The latter circumstance may arise if the woman has had radiotherapy for a malignant condition.)
for males —
the condition in which a man is unable to achieve a pregnancy in a woman.
“reduced fertility” means:
for females —
the situation of a woman who has sought medical help in order to become pregnant and who has been given such help in the form of IVF, GIFT, or a similar procedure or hormonal stimuli and who as a result of such procedures does become pregnant; or
the situation of a woman who has been advised that she is infertile and who, as a result, has adopted a child and who then, and only after that, has conceived.
(A woman is to be taken to be infertile if, despite such procedures, she remains unable to become pregnant. She will also be taken to be infertile until such time as she gives birth to a viable infant.)
for males —
the situation of a man who has sought medical help in order to enable him to father a child as a result of conditions such as a low sperm count or impotence or other related condition and who, with his partner, has been given such help in the form of IVF, GIFT, or a similar procedure or hormonal stimuli and who as a result of such procedures does succeed in becoming the biological father of a viable infant; or
the situation of a man who has been advised that he is infertile and who, as a result, with his partner, has adopted a child and who then, and only after that, has become the biological father of a viable infant in the normal way.
The impairment rating for reduced fertility is given to compensate veterans for the delay they and their partners will have incurred in starting their family as a result of waiting for investigations and in undergoing the procedures and for the stress of hormone therapy which places a considerable emotional stress on both partners and a specific physiological stress on the female.
The fertility problem should only be assessed as “infertility” under this Guide if it prevents the veteran from having children that the veteran would otherwise have had. It is for a medical practitioner to diagnose whether a fertility condition is present. The veteran must advise whether the fertility condition prevented the birth of a child that otherwise the veteran would have parented.
If the veteran is of the opinion that the fertility condition did not actually prevent the veteran from having a child, the condition is to be assessed at the same rate as reduced fertility.
Cervical incompetence is to be rated in the same way as are problems of fertility.
Step 1: (Omit this step if you are assessing an accepted condition of a female veteran.) Determine a functional impairment rating for loss of reproductive function in male veterans from Table 10.2.1.
Functional Loss Table 10.2.1 Male symbol
REPRODUCTIVE FUNCTION: MALE
Impairment Ratings Criteria
NIL Varicocele or hydrocele, associated with no or negligible symptoms.
TWO Infertility with onset at age 55 or older.
FIVE Varicocele or hydrocele sufficient to cause enlargement of scrotum, and daily symptoms. Loss of one testis at any age. Infertility with onset at age 45–54. Reduced fertility with onset at age less than 45.
TEN Infertility with onset at age less than 45. Loss of both testes at age 45 or older.
FIFTEEN Loss of both testes at age 31 to 45. Infertility with onset at age 30 or less.
TWENTY Loss of both testes at age 30 or less.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
This is the final rating for loss of reproductive function in male veterans. The rating obtained from Table 10.2.1 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.
While impotence would render it difficult for a man to father a child in the normal way, it would neither necessarily nor usually render him infertile.
Step 2: (Omit this step if you are assessing an accepted condition of a male veteran.) Determine a functional impairment rating for loss of reproductive function in female veterans from Table 10.2.2.
Functional Loss Table 10.2.2 Female symbol
REPRODUCTIVE FUNCTION: FEMALE
Impairment Ratings Criteria
NIL Elective tubal ligation. Infertility with onset at or after natural menopause.
TWO Amenorrhoea in a pre‑menopausal woman. Infertility with onset at age 45 or older in a pre‑menopausal woman.
FIVE Reduced fertility with onset at age less than 45 in a pre‑menopausal woman. Removal of one ovary at age less than 45. Recurrent salpingitis. Cervical incompetence. Endometriosis. Severe menorrhagia.
TEN Infertility with onset at age less than 45 in a pre‑menopausal woman. Removal of ovaries without hysterectomy at age less than 45.
FIFTEEN Hysterectomy without removal of ovaries at age less than 45. Infertility with onset at age 30 or less in a pre‑menopausal woman.
TWENTY Hysterectomy with removal of ovaries at age less than 45.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
Amenorrhoea by itself is to be rated at 2 points. However amenorrhoea will generally be a symptom of some other condition, such as infertility, in which case a rating is to be given for infertility and that rating is to be compared with the rating for amenorrhoea. The higher rating is to be taken.
Endometriosis may be assessed by applying Table 10.2.2, or by assessment of its effect on fertility or sexual function, or by applying Chapter 15 (Intermittent Impairment). If ratings are given from both this chapter and Chapter 15, the ratings are to be compared and the higher is to be taken.
This is the final rating for loss of reproductive function in female veterans. The rating obtained from Table 10.2.2 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.
For those conditions of the female reproductive system that occur on a cyclical basis, Chapter 15 (Intermittent Impairment) is to be applied.
PART 10.3: BREASTS
A rating given for mastectomy under this Part is not the final rating for cancer of the breast. The steps to be followed in assessing cancer of the breast are given below, for convenience. In following these steps it is essential to apply both Chapter 14 and the tables in this Part.
Calculation of the impairment rating for cancer of the breast
Follow the steps below to calculate the impairment rating due to breast cancer.
Steps 2 to 6 are elaborated in Chapter 14 (Malignant Conditions).
STEP 1
Find the applicable rating for the relevant mastectomy or other surgical procedure (Tables 10.3.1 or 10.3.2).
STEP 2
Determine any applicable ratings for other effects of surgery (for example, effects on the use of the arm).
STEP 3
Determine any applicable ratings for the effects of any chemotherapy or radiotherapy.
STEP 4
Determine any applicable ratings due to the effects of spread of the cancer.
STEP 5
Combine all the above ratings by applying Chapter 18 (Combined Values Chart).
STEP 6
Find the applicable rating from Chapter 14 (Malignant Conditions).
STEP 7
Compare the rating obtained in Step 5 with the rating obtained in Step 6. Take the higher rating. This is the final rating for cancer of the breast.
Functional Loss Table 10.3.1 Female symbol
BREASTS: FEMALE
Impairment Ratings Criteria
NIL No significant breast condition.
FIVE Persistent mammary discharge. Total loss of sensation of one nipple. Partial bilateral loss of sensation over T4&5 dermatome. Lumpectomy. Partial unilateral mastectomy.
TEN Total loss of sensation of both nipples. Total bilateral loss of sensation over T4&5 dermatome.
FIFTEEN Unilateral mastectomy.
THIRTY Bilateral mastectomy.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
Functional Loss Table 10.3.2 Male symbol
BREASTS: MALE
Impairment Ratings Criteria
NIL No significant breast condition.
TWO Gynaecomastia. Unilateral mastectomy.
FIVE Persistent mammary discharge. Bilateral mastectomy.
Only one rating is to be selected from this table.
No age adjustment permitted for this table
CHAPTER 11
SKIN IMPAIRMENT
INTRODUCTION
This chapter is to be applied in assessing skin conditions. Chapter 17 (Disfigurement and Social Impairment) is also to be applied to the assessment of skin conditions if appropriate.
For any relatively minor skin condition, the major consideration is whether it occurs on a more or less permanent basis or whether it occurs intermittently. If the condition occurs on an intermittent basis, the application of Chapter 15 (Intermittent Impairment) is to be considered.
For a more noticeable skin condition, consideration must also be given to whether it affects function or causes disfigurement. If the skin condition is responsible for a discrete loss of function in another system, the appropriate system‑specific table is to be applied. For example, if there were loss of hand function as the result of a skin condition, Chapter 3 (Spine and Limbs) is to be applied.
For very severe skin conditions, loss of function is generally measured by reference to the whole person and may need to be rated under Table 16.2 in Chapter 16 (Activities of Daily Living).
Other Impairment (Table 11.1)
Table 11.1 lists specific impairment ratings for a variety of skin conditions based on inconvenience. One rating only is to be made from this table for any combination of conditions. When more than one criterion is applicable, that associated with the higher rating is chosen.
Impairment ratings from Table 11.1 are not to be combined with ratings from tables for loss of function for the same condition. If ratings can be made from more than one table the higher rating is to be chosen.
Reference to disfigurement is found in Chapter 17 (Disfigurement and Social Impairment).
Calculation of the impairment rating for skin conditions
Follow the steps below to calculate the impairment rating from accepted skin conditions:
(Each step is elaborated in the following pages.)
STEP 1
Establish whether the skin condition causes any loss of function.
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STEP 2
(Omit this step if is there is no relevant functional impairment.)<br>Calculate the total functional impairment due to any accepted skin condition.
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STEP 3
Calculate the Other Impairment rating for the accepted skin condition by applying Table 11.1.
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STEP 4
(Omit this step if there is no relevant functional impairment.)<br>Compare the impairment rating obtained in Step 2 with the impairment rating obtained in Step 3. Take the higher rating.
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Step 1: Establish whether the skin condition causes any loss of function.
Skin conditions may cause loss of function of hands by interfering with movement or sensation. They may cause loss of function of joints as a result of scarring and contractions which may limit or interfere with the movement at the joint. Skin conditions may cause conditions of the eyelids (for example, ectropion or entropion, or difficulties in closing or opening the eyes).
If any such effect of the accepted skin condition exists, this should be confirmed before applying Table 11.1.
Step 2: Calculate the impairment rating for the total functional loss from any accepted skin condition.
Depending on its nature and extent, functional loss may be assessed by:
applying Chapter 16 (Activities of Daily Living);
applying Chapter 15 (Intermittent Impairment), or
applying one or more system specific tables.
The rating obtained from the table applied in assessing functional loss may need to be modified by:
applying Chapter 19 (Partially Contributing Impairment) if there is some contribution from a non‑accepted condition; or
applying Chapter 20 (Apportionment) if there is some contribution from another accepted condition.
If ratings from Chapter 16, Chapter 15 and one or more system specific tables are possible, all three are not to be given. Instead, all attributable system specific ratings are to be combined and compared with any attributable rating from Chapter 16 and from Chapter 15. The veteran is to be given the highest of the attributable ratings from Chapter 16, Chapter 15 or the combined system specific ratings as the functional impairment rating for accepted skin conditions.
Step 3: Establish the Other Impairment rating for the accepted skin condition using Table 11.1.
Only one rating is to be given from Table 11.1 for any condition or combination of conditions.
Step 4: Compare the impairment rating obtained in Step 2 with the impairment rating obtained in Step 3. Take the higher rating.
This step determines the final impairment rating for accepted skin conditions.
At Step 2 allowance was made for the effect of any non‑accepted skin condition and of any accepted condition which is not a skin condition on the functional loss from the accepted skin conditions. Compare the result obtained in Step 2 with the result obtained in Step 3. Take the higher of the two ratings. This is the final impairment rating for the accepted skin condition.
Other Impairment Table 11.1 Combined male and female symbol
SKIN DISORDERS
Impairment Ratings Criteria
NIL Skin disorder causing symptoms which are easily tolerated, or are present only for a short time each day. Skin disorder that is symptomatic for less than one week of the year. Asymptomatic skin disorder without need for medication. Solar skin lesions not requiring removal during the year. Male pattern baldness.
TWO Skin disorder than is symptomatic for less than four months of the year. Asymptomatic skin disorder but with need for medication. Solar skin lesions necessitating surgical removal (including cryotherapy and/or cautery) at least once in the year but less than four times a year.
FIVE Any skin disorder, or combination of disorders, causing symptoms that are not easily tolerated, and that are present for a significant part of the day for at least four months a year, eg. Psoriasis; eczema; tinea with persistent pruritus, despite treatment. Noticeable skin disorder, or combination of disorders, on face or hands, of such degree as would cause embarrassment to most people in unfamiliar social contexts. Visible skin disorder, or combination of disorders, on a part of the body other than face and hands, of such degree as would cause embarrassment or considerable inconvenience to most people in domestic or intimate situations or as would cause them to curtail sporting or recreational activities. Solar skin lesions necessitating surgical removal (including cryotherapy and/or cautery) three times a year or more, or the removal of at least ten lesions over the year. Alopecia (other than male pattern baldness).
TEN Skin disorders, or combination of disorders, resulting in significant loss of structural integrity of face, eg. total loss of pinna, skin graft, scar following trauma or burns. Severe and persistent pruritus causing difficulty in concentrating and loss of sleep. Persistent skin disorder, or combination of disorders, resulting in continuous signs and significant symptoms of moderate degree, present for most of the time.
FIFTEEN Permanent or persistent skin disorder or combination of disorders causing gross loss of structural integrity of face and extensive or extreme facial disfigurement. Severe and persistent ulcerative, weeping or suppurative skin disorders involving the greater part of both the face and the hands.
Only one rating is to be selected from this table for any combination of conditions.
No age adjustment permitted for this table
CHAPTER 12
ENDOCRINE AND HAEMOPOIETIC IMPAIRMENT
This chapter contains two parts:
Part 12.1 — Loss of Endocrine Function
Part 12.2 — Loss of Haemopoietic Function
INTRODUCTION
Part 12.1 is to be applied to assess loss of function of the endocrine system. The endocrine system consists of all the glands and tissues which secrete hormones and the mechanisms by which the secretion of those hormones is regulated. The functions of the endocrine system are very diverse and include control of growth, of sexual function, of calcium metabolism and of the uptake of glucose by body cells.