Part Part 16 - Guide to Determining Impairment and Compensation

CHAPTER 16

ACTIVITIES OF DAILY LIVING

The Activities of Daily Living (ADLs) are a defined set of activities necessary for normal self-care. The activities are movement in bed, transfers, locomotion, dressing, personal hygiene, and feeding.

These six activities are defined as follows:

“movement in bed” means sitting in, rising from, and moving around in, bed;
“transfers” means moving from one seat to another, changing position from sitting to standing, and transferring to and from the toilet and bed;
“locomotion” means walking on the level, on gentle slopes and down stairs;
“dressing” means putting on socks, stockings, and shoes, as well as clothing the upper and lower trunk;
“personal hygiene” means grooming, and washing of face, trunk, extremities and perineum;
“feeding” means eating and drinking, but not the preparation of food.

“Effects on ADLs” is to be used to assess conditions for which criteria do not exist in the system specific tables of Chapters 1 to 12, or are inadequate, or for which the application of the tables in Chapter 14 (Malignant Conditions) or Chapter 15 (Intermittent Impairment) is inappropriate.

Table 16.3 (Other Impairment) covers such non-specific indicators of disease as pain, lethargy and prognosis.

This chapter is to be applied in the assessment of conditions that result in the veteran being bedfast, chairfast, housebound or nearly housebound. Such conditions include the effects of severe strokes, severe Parkinson’s disease, severe heart failure, severe respiratory disease, severe liver failure, severe kidney failure and some dementias.

ADLs may be used to rate a single condition if its effects are well-differentiated, or may be used to rate all conditions together if their effects are difficult to differentiate.

When ADLs are used to rate a single condition, an impairment rating or ratings from other chapters may be combined with a rating derived from Chapter 16 provided that the ratings relate to different conditions.

When ADLs are used to rate all conditions together, no ratings from other chapters are to be combined with the rating from Chapter 16.

Calculation of the impairment rating for an accepted condition using ADLs

Follow the steps below to calculate the impairment rating due to an accepted condition using the ADLs.

STEP 1	For each of the six ADLs obtain a grading code for that activity.	Page 181

<table cellspacing="0" cellpadding="0" style="border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td style="width:74.25pt; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top">Table 16.1</td><td style="width:346.95pt; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><img src="image.005.png" width="35" height="45" alt=""></td></tr><tr><td colspan="2" style="width:432pt; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">ACTIVITIES OF DAILY LIVING GRADING CODES</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Code</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Description</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">NIL</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Independent, and can perform the task as well as peers do, or with minor difficulty only.</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">ONE</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Can complete the task independently, but with considerably more difficulty than peers have.</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">FOUR</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Requires some degree of personal assistance in order to perform the task.</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">SIX</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Requires extensive assistance in order to perform the task.</td></tr><tr><td style="width:74.25pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">EIGHT</td><td style="width:346.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Unable to contribute towards performance of the task. Completely dependent.</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><tbody><tr><td style="width:102.6pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top">Functional Loss Table 16.2</td><td colspan="2" style="width:221.4pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><img src="image.005.png" width="35" height="45" alt=""></td></tr><tr><td colspan="3" style="width:334.8pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">LOSS OF FUNCTION: ACTIVITIES OF DAILY LIVING</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Impairment Ratings</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Sum of Grading Codes</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">NIL</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">0</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">FIVE</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">1–2</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">TEN</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">3–4</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">TWENTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">5–6</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">THIRTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">7–8</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">FORTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">9–11</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">FIFTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">12–14</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">SIXTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">15–17</td></tr><tr><td colspan="2" style="width:109.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">SEVENTY</td><td style="width:214.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">18+</td></tr><tr style="height:0pt"><td style="width:113.4pt"></td><td style="width:7.1pt"></td><td style="width:225.1pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><tbody><tr><td colspan="2" style="width:79.65pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top">Other Impairment Table 16.3</td><td style="width:341.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><img src="image.005.png" width="35" height="45" alt=""></td></tr><tr><td colspan="3" style="width:432pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">ACTIVITIES OF DAILY LIVING: OTHER IMPAIRMENT</td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Impairment Ratings</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Criteria</td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">NIL</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><ul style="margin:0pt; padding-left:0pt"><li class="Bullet" style="margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">No, or negligible, i.e. easily tolerated symptoms.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Evidence of disease, but minimal interference with daily tasks.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Feeling of good health most of the time.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.65pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Normal or almost normal life expectancy in spite of disorders.</li></ul></td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">FIVE</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><ul style="margin:0pt; padding-left:0pt"><li class="Bullet" style="margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Daily (or almost-daily) symptoms that are irritating and not easily tolerated, but which improve with medication.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.65pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Some daily tasks performed inefficiently because of generalised lethargy.</li></ul></td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">TEN</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><ul style="margin:0pt; padding-left:0pt"><li class="Bullet" style="margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Daily (or almost-daily) symptoms that are irritating and not easily tolerated. Treatment is not available, or is of little value, or gives only short remission.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Noticeable loss of energy, leading to loss of efficiency and avoidance of some tasks previously easily performed.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.65pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Decreased life expectancy. Five year survival less than 75% of normal.</li></ul></td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">TWENTY</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top"><ul style="margin:0pt; padding-left:0pt"><li class="Bullet" style="margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Intense daily (or almost daily) symptoms which are impossible to ignore, but that prevent few daily tasks. Decreased efficiency in most activities.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.6pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Marked loss of energy leads to avoidance of many daily tasks, most of which can be completed but rapidly cause fatigue.</li><li class="Bullet" style="margin-top:3pt; margin-left:9.65pt; margin-bottom:3pt; text-indent:0pt; page-break-after:avoid; padding-left:4.55pt; font-family:serif; font-size:10pt">Five year survival less than 50% of normal.</li></ul></td></tr><tr><td style="width:65.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">THIRTY- FIVE</td><td colspan="2" style="width:355.7pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top">Five year survival less than 25% of normal.</td></tr><tr style="height:0pt"><td style="width:76.3pt"></td><td style="width:14.15pt"></td><td style="width:352.35pt"></td></tr></tbody></table> ```

Part 16

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