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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This technical guide converts exercise-tolerance (METs) and lung-function (spirometry) test results into a points-based impairment rating that determines veterans’ cardiorespiratory compensation. It prescribes an 8-step assessment, different calculation methods for heart, lung or combined disease, and special tables for conditions like heart failure, valve disease and ischaemia.
Ratings are adjusted for age and gender, and include apportionment rules to separate service-related from non-service-related contributions so payments reflect actual loss of cardiorespiratory function.
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Direct links to the current provisions in Guide to Determining Impairment and Compensation (GARP M).
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
CHAPTER 1
CARDIORESPIRATORY IMPAIRMENT
Cardiorespiratory impairment results from conditions that affect the function of the heart or lungs. The procedures described in this chapter are to be applied in assessing most conditions of the heart and lungs, and will usually also be appropriate for conditions affecting the function of the thorax or diaphragm, lesions of the nerves that supply the muscles of respiration, and conditions such as anaemia. The principal exception is any condition which is predominantly intermittent in nature and which would be better assessed by applying Chapter 15 (Intermittent Impairment).
Different procedures (described in Chapter 2) are to be applied to assess hypertension and non-cardiac vascular conditions (such as aortic aneurysm and varicose veins).
In general, cardiorespiratory impairment is to be measured by reference to exercise tolerance. Exercise tolerance is quantified in terms of METs (see pages 11–12). However, if a respiratory component is present, measurements of lung function, such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and maximal expiratory flow (MEF 25–75) are to be used in addition to exercise tolerance. FEV1 and FVC are to be measured by spirometry. For the purposes of assessment in accordance with this Guide, the terms “MEF 25–75” and “FEF 25–75” (forced expiratory flow between 25% and 75% of the vital capacity) are to be taken as equivalent.
The conversion of loss of exercise tolerance and measurements of lung function into an impairment rating is set out in Table 1.2 and Table 1.3.
Certain cardiorespiratory conditions cannot be rated by applying exercise tolerance. These include:
“Exercise tolerance” refers to a person’s ability to exercise from a cardiorespiratory point of view rather than to a person’s total ability to exercise. For example, a veteran who has osteoarthritis of both knees may be greatly limited in walking but may still be able to swim a considerable distance. Such a veteran would still have good exercise tolerance from a cardiorespiratory point of view, though total ability to exercise would be reduced.
A veteran whose ability to exercise has been significantly reduced by other conditions (such as musculoskeletal conditions or being grossly overweight), or who no longer has cardiac or respiratory symptoms on exercise, cannot always be given an appropriate impairment rating for reduced exercise tolerance. However, the need to apply Chapter 19 (Partially Contributing Impairment) should always be considered before disregarding exercise tolerance figures.
Calculation of the impairment rating for accepted cardiorespiratory conditions
Follow the steps below to determine the impairment rating for cardiorespiratory conditions:
(Each step is elaborated in the following pages.)
| Step 1 | Establish what cardiorespiratory conditions are present. | Page 7 |
|---|---|---|
| Step 2 | Assess the information that is available and decide whether it is reliable and sufficient. | Page 8 |
| Step 3 | Determine the impairment rating based on effort tolerance. | Page 9 |
| Step 4 | (Omit this step if no respiratory disease is present.)Determine the impairment rating based on measurements of lung function. | Page 13 |
| Step 5 | Determine the total accepted cardiorespiratory functional impairment rating. | Page 21 |
| Step 6 | Consider the effects of cardiac failure (if any). | Page 24 |
| Step 7 | Moderate the total cardiorespiratory functional impairment rating to allow for effects of any non-accepted conditions. | Page 24 |
| Step 8 | Determine whether any ratings from the relevant Other Impairment tables apply (Tables 1.7, 1.8, 1.9, 1.10). | Page 25 |
Step 1: Establish what cardiorespiratory conditions are present.
For the purpose of assessing cardiorespiratory impairment, both the accepted and the non-accepted conditions are be taken into account. Both will affect the way in which cardiorespiratory functional impairment is calculated. (Their combined effect is taken into account in the application of Table 1.5 in Step 5.)
Any non-accepted conditions are to be subsequently allowed for by applying Chapter 19 (Partially Contributing Impairment) — see Step 7.
When considering the question: ‘What cardiorespiratory conditions are present in this veteran?’, it is not appropriate to rely simply on a list of accepted conditions. Both previously claimed but rejected cardiorespiratory conditions and unclaimed cardiorespiratory conditions may also be present.
Step 2: Assess the information that is available and decide whether it is reliable and sufficient.
To make a reliable cardiorespiratory assessment, there should be an adequate medical history of the veteran’s cardiorespiratory conditions. In addition, there should be information relating to the veteran’s effort tolerance and, if any respiratory disease is present, there should also be one or more sets of spirometry or other physiological measurements of respiratory function. The criteria by which the evaluation of the information is to be made are set out below.
An adequate history of the veteran’s illness and a description of the current symptoms and details of the current treatment should be available.
The history should be reviewed at the start of the cardiorespiratory assessment procedure to establish whether any major cardiorespiratory event (for example a myocardial infarction or bypass surgery) has occurred within the period of assessment.
An examination of the history will indicate whether any Other Impairment ratings (from Tables 1.7, 1.8, 1.9, 1.10) are applicable. For example, in the case of ischaemic heart disease, the history will reveal whether the veteran has had any myocardial infarctions, whether coronary bypass surgery has been performed and the outcome of any such surgery. In other cases, for example when respiratory disease is present, the current treatment will reveal whether any Other Impairment rating for cardiorespiratory conditions is applicable.
In long-standing respiratory conditions, there will often be a disease complex present that is more extensive than that implied by the original diagnostic label. For example, asthma may lead to chronic obstructive respiratory disease and chronic bronchitis may lead to small airways disease. Such extensions of the disease process are to be assessed as part and parcel of the original condition unless there is clear reason why they should not be — for example, they have been determined to be non-accepted conditions.
Effort tolerance information should always be obtained except if the veteran has a condition that renders the collection of reliable effort tolerance information impracticable.
Examples of conditions that may render the collection of reliable effort tolerance information impracticable include:
The date of the effort tolerance information used must be appropriate to the period of assessment: the effort tolerance information should be not more than six months older than the relevant time in the assessment period to which the information is to be applied.
Spirometry should always be obtained if any condition affecting the function of the lungs is present unless it is not practicable or appropriate to perform spirometry because:
The date of the spirometry used must be appropriate to the period of assessment: the spirometry should be not more than six months older than the relevant time in the assessment period to which the information is to be applied.
The nature of the spirometry should be appropriate: the nature of the spirometric readings should be consistent with the known conditions affecting the veteran and should also be consistent with such other information (eg, old spirometry) as is available or can reasonably be obtained. There should be no unexplained inconsistencies between the various reports.
If the nature of the spirometry cannot be reconciled with other relevant information, the spirometry may need to be repeated or the veteran referred to a respiratory physician for clarification of the situation.
If a veteran has emphysema, as evidenced by diminished carbon monoxide diffusing capacity, and diagnosed by a specialist respiratory physician, assessment can be made on the basis of effort tolerance alone.
Step 3: Determine the impairment rating based on effort tolerance.
To determine the impairment rating based on effort tolerance follow the substeps below.
(Each step is elaborated in the following pages.)
| Substep 3A | Determine the symptomatic activity level by applying Table1.1 — Activity Levels (with energy expenditure in METs). | Page 10 |
|---|---|---|
| Substep 3B | Convert that symptomatic activity level into an impairment rating. This step involves consulting either Table 1.2 — Loss of Cardiorespiratory Function: Exercise Tolerance (Males); or Table 1.3 — Loss of Cardiorespiratory Function: Exercise Tolerance (Females). | Page 13 |
After both substeps have been completed, a single rating will have been obtained. This rating is known as the impairment rating for effort tolerance.
If symptoms do not occur, a rating for the condition may be found in Table 1.6 (Cardiac Failure) if applicable, or in the relevant Other Impairment table.
Substep 3A: Determine the symptomatic activity level.
The symptomatic activity level is the exercise level (measured in METs) at which symptoms occur. One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen per kilogram of body weight per minute. Table 1.1 lists various activities grouped according to their energy expenditure in METs.
The symptomatic activity level is the level at which the activities from within any one METs category consistently give rise to symptoms of the accepted cardiorespiratory condition, such as angina, dyspnoea, palpitations, or fatigue. The symptomatic activity level may be determined by reference to a report specifically provided for the purpose as well as by reference to clinical notes and by comparison of the information with the activities listed in Table 1.1. (The symptomatic activity level may be determined by reference to activities other than those contained in Table 1.1 if the energy expenditure (in METs) of those activities is available in the medical or scientific literature.)
In determining the symptomatic activity level, greater reliance is to be placed on activities that involve steady, as opposed to sporadic, expenditure of energy. Such activities are more reliable as indicators of exercise tolerance. Less reliance is to be placed on activities that can be completed in less than a few minutes, as symptoms may take longer than this to occur.
Responses of the type ‘I cannot do such and such’ or ‘I do not do so and so’ are not useful in assessing the symptomatic activity level. What must be established is that level of exercise that the veteran is able to do but which results in angina, breathlessness, or some other cardiorespiratory symptom.
Symptoms that occur while an activity is performed are not necessarily a result of the energy expenditure occasioned by the activity. Many specific activities can be performed in a way that would mean that they were no longer examples of the METs level in which they are placed in Table 1.1. For example, while driving a car sedately is an example of 2–3 METs, driving a car in a Grand Prix is not.
Estimations of exercise tolerance above the 6-7 METs level should only be made using exercise tests. The activities above the 6-7 METs level are listed for information only.
TABLE 1.1
CARDIORESPIRATORY IMPAIRMENT: ACTIVITY LEVELS
(with energy expenditure in METs)
| 1-2 METs | Energy expended at rest or minimal activityLying down.Sitting and drinking tea.Using sewing machine (electric).Sitting down.Sitting and talking on telephone.Travelling in car as passenger.Standing.Sitting and knitting.Playing cards.Strolling (slowly).Light sweeping.Clerical work (desk work only). |
|---|---|
| 2–3 METs | Energy expanded in dressing, washing and performing light household dutiesLight household duties.Walking slowly (3.5 km/h).Playing piano, violin, or organ.Typing.Cooking or preparing meals.Playing billiards.Clerical work which involves moving around.Setting table.Driving power boat.Washing dishes.Playing golf (with power buggy).Bench assembly work (seated).Dressing, showering.Horseback riding at walk.Using self-propelled mower.Light tidying, dusting.Lawn bowls.Polishing silver.Driving car. |
| 3–4 METs | Energy expended in walking at an average paceWalking at average walking pace (5 km/h).Golf (pulling buggy).Machine assembly.Cleaning car (excludes vigorous polishing).Minor car repairs.Tidying house.Welding.Cleaning windows.Table tennis.Pushing light power mower over flat suburban lawn at slow steady paceVacuuming.Sedate cycling (10 km/h)Shifting chairs.Light gardening (weeding and water).Hanging out washing.Making bed. |
| 4–5 METs | Moderate activity: encompasses more strenuous daily activities with the exclusion of manual labour and vigorous exerciseMopping floors.Golf (carrying bag).Light carpentry (eg, chiselling, hammering).Scrubbing floors.Ballroom dancing.Beating carpets.Tennis doubles (social, non-competitive).Stocking shelves with light objects.Polishing furniture.Wallpapering.Shopping and carrying groceries (10 kg) |
This is an opening excerpt, not the complete document.