Guide to Determining Impairment and Compensation (Cth)
Australian Government
Military Rehabilitation and Compensation Act 2004
GUIDE TO DETERMINING IMPAIRMENT AND COMPENSATION
Instrument 2015 No. MRCC 4
The Military Rehabilitation and Compensation Commission, pursuant to section 67 of the Military Rehabilitation and Compensation Act 2004 (the Act):
(a) repeals the Guide to Determining Impairment and Compensation (Instrument 2005 No. M9 of 2005); and
(b) determines this Guide to Determining Impairment and Compensation.
Dated this 2nd day of July 2015
The Seal of the )
Military Rehabilitation and Compensation Commission) SEAL
was affixed hereto in the )
presence of: )
Simon Lewis Major General Craig Orme……………… …Major General Mark Kelly
……………………………………………………………………………………….……………………………….
SIMON LEWIS MAJOR GENERAL CRAIG ORME MAJOR GENERAL MARK KELLY
AM, CSC AO DSC
CHAIR MEMBER MEMBERRear Admiral Robyn Walker Air Vice-Marshal Tony Needham
…………………………………...................................................................................................................................…REAR ADMIRAL ROBYN WALKER MS J TAYLOR AIR VICE-MARSHAL TONY NEEDHAM
AM RN AM
MEMBER MEMBER MEMBER
1 Name
This is the Guide to Determining Impairment and Compensation.
2 Short Title
The short title for the Guide to Determining Impairment and Compensation is GARP M.
3 Commencement
This instrument commences on the day after it is registered.
4 Authority
This instrument is made under the Military Rehabilitation and Compensation Act 2004.
Definitions
(1)In this instrument:
C&T Act means the Military Rehabilitation and Compensation (Consequential and Transitional Provisions) Act 2004.
GARP V means the Guide to the Assessment of Rates of Veterans’ Pensions in force from time to time under section 29 of the VEA.
MRCA means the Military Rehabilitation and Compensation Act 2004.
MRCC means the Military Rehabilitation and Compensation Commission.
SRCA means the Safety, Rehabilitation and Compensation Act 1988.
VEA means the Veterans’ Entitlements Act 1986.
Guide determination
(2)For the purposes of section 67 of the MRCA, it is determined by the Military Rehabilitation and Compensation Commission that the following Guide to Impairment and Compensation (the Guide) (comprising pages i to iv for the Introduction and pages 1 to 232 for the remainder of the Guide) applies as the guide for the determination of the degree of impairment and lifestyle ratings when determining the compensation payable to a person under the MRCA.
Power under C&T Act
(3)Subsection 13(4) of the C&T Act provides that the MRCC may include in the guide under section 67 of the MRCA one or more methods of working out the amount of compensation a person is entitled to under Part 2 of Chapter 4 of the MRCA for a service injury or disease where a person also has:
(a)a separate war-caused injury or war-caused disease or defence-caused injury or defence-caused disease (within the meaning of the VEA); or
(b)a separate injury or disease (within the meaning of the SRCA).
A method may (but does not have to) include a method of offsetting payments made to the person under the VEA or SRCA in respect of the old injury or disease.
GUIDE TO DETERMINING IMPAIRMENT AND COMPENSATION (GARP M)
INTRODUCTION
Purpose
This Guide is to be applied to assess the degree of impairment from service injury or disease. Its provisions are binding on the Military Rehabilitation and Compensation Commission, the Veterans’ Review Board, and the Administrative Appeals Tribunal.
Legal background
The Military Rehabilitation and Compensation Act 2004 provides for periodic payments to be made to members for impairment resulting from service injuries or diseases as defined in section 5 of the Act.
Part 2 of Chapter 4 of the Act provides that periodic payments are payable only if certain thresholds are reached as determined by reference to the extent of the veteran’s incapacity as assessed in accordance with this Guide. Subsection 67(1) of the Act provides that the Guide prepared by the Military Rehabilitation and Compensation Commission sets out:
(a) criteria to be used in deciding the degree of impairment of a person resulting from a service injury or disease; and
(b) methods by which the degree of that impairment can be expressed in impairment points on a scale from 0 to 100; and
(c) criteria to be used in assessing the effect of a service injury or disease on a person’s lifestyle; and
(d) methods by which the effect of a service injury or disease on a person’s lifestyle can be expressed as a numerical rating; and
(e) methods by which the impairment points of a person, and the effect on a person’s lifestyle, from a service injury or disease can be used to determine the compensation payable to the person under this Part by reference to the maximum compensation that can be payable to a person under this Part.
In addition the Guide, in accordance with subsection 67(2) of the Act
(a) specifies different methods under paragraph (1)(e) for:
(i) service injuries or diseases that relate to warlike service or non‑warlike service; and
(ii) other service injuries or diseases; and
(b) specifies a method for determining the compensation payable to a person who has both:
(i) a service injury or disease that relates to warlike service or non‑warlike service; and
(ii) another service injury or disease.
Definitions
In this Guide, unless a contrary intention appears:
accepted condition means an injury or disease that has been determined to be caused by service.
Act means the Military Rehabilitation and Compensation Act 2004 as amended from time to time.
add means find the arithmetic sum of two or more numbers.
clinical features includes signs and symptoms.
combine means produce a result by combining two or more numbers by applying Chart 18.1 (Combined Values Chart) in Chapter 18 in accordance with that Chapter.
Commission means the Military Rehabilitation and Compensation Commission.
condition means an injury or a disease.
defence-caused injury and defence-caused disease have the meaning given in section 70 of the VEA.
disease means:
(a) any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development); or
(b) the recurrence of such an ailment, disorder, defect or morbid condition;
but does not include:
(c) the aggravation of such an ailment, disorder, defect or morbid condition; or
(d) a temporary departure from:
(i)the normal physiological state; or
(ii)the accepted ranges of physiological or biochemical measures;
that results from normal physiological stress (for example, the effect of exercise on blood pressure) or the temporary effect of extraneous agents (for example, the effect of alcohol on blood cholesterol levels).
GARP V means the Guide to the Assessment of Rates of Veterans’ Pensions in force from time to time under section 29 of the VEA.
Guide means this Guide to Determining Impairment and Compensation.
impairment, in relation to a person, means the loss, the loss of the use, or the damage or malfunction, of any part of the person’s body, of any bodily system or function, or of any part of such a system or function.
impairment rating means a measure of the degree of medical impairment on a scale of 0 to 100.
injury means any physical or mental injury (including the recurrence of a physical or mental injury) but does not include:
(a) a disease; or
(b) the aggravation of a physical or mental injury.
lifestyle points means the number of points determined using the tables in Chapter 22 of this Guide.
lifestyle averaged points means the total of lifestyle points added together and averaged for each of the tables used.
lump sum means the amount payable after determining the periodic payment for a service injury or disease and converted to a single dollar amount in accordance with the tables provided by the Australian Government Actuary for that purpose.
member or former member means a member or former member of the Defence Force who serves or served on or after 1 July 2004.
non-accepted condition means any injury or disease that has not been determined under the Act to be service related or has been determined under the Act not to be service related.
periodic payment means the amount determined by reference to the tables in this guide for warlike and non-warlike service or for peacetime service and the maximum amount payable under the relevant provision of the Act.
service means service in the Defence Force which is warlike service, non‑warlike service or peacetime service as determined by the Minister for Defence from time to time.
service disease has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.
Note: A reference to a service disease being contracted includes a reference to a disease being aggravated by defence service (see section 7 of the Act).
service injury has the meaning given by section 27, subsections 29(1) and (2), and section 30 of the Act.
Note: A reference to a service injury being sustained includes a reference to an injury being aggravated by defence service (see section 7 of the Act).
SRCA means the Safety, Rehabilitation and Compensation Act 1988.
Statement of Principles means:
(a)a Statement of Principles determined by the Repatriation Medical Authority under section 196B of the VEA and to which section 19 of the C&T Act applies; or
(b)a determination made by the Commission under subsection 340(2) or (3) of the Act.
VEA means the Veterans’ Entitlements Act 1986.
veteran means a member or former member of the Defence Force (including a deceased person) under section 5 of the MRCA in respect of whom an injury or disease has been determined to be caused by that service.
war-caused injury and war-caused disease have the meaning given in section 9 of the VEA.
worksheet means a page or pages of this Guide, identified as such, that gives a structure by which certain calculations may be set out to assist in determining an impairment rating.
Definitions of words and phrases that are used in only one chapter are to be found in that chapter.
Acknowledgment of sources
The Guide to the Assessment of Rates of Veterans’ Pensions Fifth Edition, Part A Chapters 1–12 and Part B Chapters 13-17 and Part C Chapters 18-21 are the basic tables for this Guide.
That publication acknowledges that the following published works were found to be useful in the preparation of the VEA Guide (GARP V) and therefore were basic to this Guide as well:
Guides to the Evaluation of Permanent Impairment, 4th edition, American Medical Association, 1993;
International Classification of Impairments, Conditions, and Handicaps, World Health Organisation, Geneva, 1980; and
Publication No 118 of the National Acoustic Laboratories, Improved Procedure for Determining Percentage Loss of Hearing, by J. Macrae, Australian Government Publishing Service, Canberra, 1988.
HOW TO USE THIS GUIDE
The subject of assessment
This Guide is to be applied to assess the impairment points due to injuries or diseases, or both, that are determined to be service related.
In making any determination on the impairment the clinical features of injuries or diseases are to be taken into account. Sequelae of conditions can only be assessed after the sequelae have been determined to be service related.
The elements of whole person impairment and compensation
The two elements required to determine a periodic payment are medical impairment and lifestyle. Impairment is dealt with in Chapters 1 – 21 of this Guide. Lifestyle effects are dealt with separately and are described in Chapter 22 of this Guide.
Chapters 1 to 16 of this Guide contain two principal types of tables. Physical loss is to be rated against criteria in “Other Impairment” tables. Functional loss is to be rated against criteria in “Functional Loss” tables.
Greater emphasis has been given throughout this Guide to functional loss as a basis for assessment. It is measured by reference to an individual’s performance efficiency compared with an average, healthy person of the same age and sex, in a set of defined vital functions. This is a means of compensating for the loss of ability to perform everyday functions.
Each table contains benchmark values, generally at intervals of five points. In some cases the range between nil and five includes a rating of two points. In some other cases intervals are greater than five points because lesser increments of impairment cannot be distinguished.
Each benchmark is a threshold value, that is, the rating applies only if the threshold is achieved or exceeded. Ratings are not to be rounded up to the next benchmark. Similarly, ratings between benchmark values contained in the tables are not to be interpolated.
In some tables more than one criterion is stated opposite a benchmark value. The different criteria are marked by dot points. Where more than one criterion is stated for a particular value, the condition being assessed has to satisfy one of the criteria in order to attract the impairment rating of that value.
Each chapter contains step-by-step instructions to be followed in the use and application of the tables.
Determining compensation payable
This Guide specifies the only way of determining the amount of compensation payable is by reference to the maximum compensation that can be paid. The maximum is specified in the Act as a weekly amount. It becomes payable only when a person’s impairment rating reaches 80 points.
The Guide includes tables that will give a compensation factor for different impairment and lifestyle ratings. Different tables are used for warlike and non-warlike service and for peacetime service. The maximum compensation is multiplied by the compensation factor to give the weekly amount of compensation payable.
Medical impairment
Under this Guide medical impairment has two components:
(a)physical loss of, or disturbance to, any body part or system; and
(b)the resultant functional loss.
Whole person impairment
Medical impairment is expressed in impairment points, out of a maximum rating of 100. On this scale, zero corresponds to no impairment or negligible impairment from accepted conditions, and 100 points corresponds to death. Effectively, impairment points are percentages of the impairment of the whole person.
Loss of hearing, loss of taste, loss of smell, loss of a finger or of a toe as impairment for a single condition can be compensated for under this Guide only if a threshold value of 5 impairment points is reached. Any combination of loss from conditions that delivers a combined impairment of 10 or more will attract compensation.
Example
Loss of taste rated at 5 impairment points and mild reflux rated at 2 impairment points.
¨ A payment for loss of taste is permitted but, since 5 plus 2 is 7 and does not reach the threshold of 10 impairment points, no other payment is made.
Loss of taste rated at 5 impairment points and reflux rated at 5 impairment points.
¨ The reflux 5 points when combined with the loss of taste reaches the threshold of 10 impairment points and so payment is made on the basis of 10 impairment points.
Functional loss
Medical impairment is measured chiefly by loss of vital functions and is addressed in the twelve system specific chapters of this Guide, as follows:
Cardio-Respiratory Impairment
Hypertension and Non-Cardio Vascular Conditions
Impairment of Spine and Limbs
Emotional and Behavioural
Neurological Impairment
Gastro-intestinal Impairment
Ear, Nose, and Throat Impairment
Visual Impairment
Renal and Urinary Tract Function
Sexual Function, Reproduction, and Breasts
Skin Impairment
Endocrine and Haemopoietic Impairment
Other Impairment
Other Impairment is the physical loss of, or disturbance to, any body part or system. This concept is extended in some chapters in this Guide to include discomfort, pain, poor prognosis and other, less tangible, effects of accepted conditions.
Lifestyle effects
Lifestyle effects are to be assessed by applying Chapter 22 of this Guide in accordance with that Chapter.
The Tables
Types of Tables
There are several different sorts of tables used in GARP V that remain common to both GARP V and this Guide. Basically these are various impairment tables, the lifestyle tables and the tables to deal with more complex matters.
However the MRCA requires the Commission to specify two particular tables that are not used in GARP V or the VEA. These are tables that arise from the method specified by the Commission to determine compensation payable for warlike and non-warlike as distinct from peacetime service (see Tables 1 and 2 of Chapter 23). In addition the Commission must specify a method for determining compensation payable when a mixture of warlike (or non-warlike) and peacetime service causes the whole person impairment
Gender Use
Some tables are for men only, some for women only, and others (the majority) are not gender specific. Each table is clearly marked in the top right hand corner:
¨ the symbol
means that the table is only to be used for the assessment of female veterans;
¨ the symbol
means that the table is only to be used for the assessment of male veterans;
¨ the symbol
means that the table is used for either male or female veterans.
Age Adjustment
Some tables incorporate age dependent criteria. Some other tables have no such criteria and require subsequent age adjustment by applying tables provided for that purpose.
Each table is clearly marked in the bottom left hand corner with instructions on age adjustment for ratings derived from that table.
Conversion Factor Tables
The Commission is required by paragraph 67(1)(e) to provide methods that enable Lifestyle to be combined with Impairment to give compensation for each type of service by reference to the maximum compensation payable. These are set out as compensation factors in tables in Chapter 23 and include a different set of factors to be used for warlike and non-warlike service and for other service as provided for in the Act (see subsection 67(2)).
Non-system specific assessments
This Guide has chapters describing alternate methods of assessing certain conditions:
Chapter 13 — Negligible Impairment
Chapter 14 — Malignant Conditions
Chapter 15 — Intermittent Impairment
Chapter 16 — Activities of Daily Living
Chapter 17 — Disfigurement
Conditions and their sequelae
Only the clinical features of an accepted condition may be taken into account in making an assessment. If the accepted condition causes some other distinct and diagnosable condition (sequela), the symptoms of the sequela cannot be taken into account when assessing the original accepted condition.
Sequelae can only be assessed when they have been separately determined to be service related.
Applying the instructions
To the extent of any inconsistency between an instruction in this “How to use the Guide” and a specific instruction concerning a particular matter in this Guide, the specific instruction in this “How to use the Guide” is to apply to that particular matter.
Duration of assessment period or date of determination and commencement of periodic payment and permanent impairment and interim payments
Assessment can only be made by reference to the available medical and other material that, of necessity, relates to a particular point or period in time.
The assessment of the impairment and lifestyle ratings must be based on the Commission’s reasonable satisfaction on the available material. If there is a significant change in impairment during the course of an investigation a payment may still be made as an interim payment. Interim payments are made until the Commission is satisfied that the condition has stabilised at an impairment level.
If the condition worsens after the last payment is made the person may claim additional compensation for the worsening and further periodic payments or lump sums can be made.
Apportionment of impairment ratings
It is sometimes necessary, for an accepted condition, to compare an impairment rating derived from one table with an impairment rating derived from another table. When two or more conditions contribute to the impairment ratings from either or both tables, and comparison is necessary, the method called “apportionment” is to be applied before making the comparison.
Details of the application of apportionment are given in Chapter 20.
Apportionment between tables
If a condition can be rated using both a functional loss table and an “Other Impairment” table, only the higher of the two ratings is to be given to the veteran.
Paired organ policy
The paired organ policy applies to eyes, kidneys etc and is described in detail in Chapter 21 of this Guide.
Impairment for specific disabilities
The Act provides only for impairment and does not convert that rating into a degree of incapacity like the VEA requires. Instead the impairment and lifestyle ratings determine a factor, not a degree of incapacity. Incapacity applies to ability to perform military service or a civilian occupation. Therefore, Chapter 24, “Degree of incapacity for specific disabilities” of GARP V, has been omitted. Instead impairment ratings are based only on the Tables from Chapter 1 to 21 of this Guide.
MEDICAL IMPAIRMENT
PART A: SYSTEM SPECIFIC ASSESSMENT
CHAPTER 1
CARDIORESPIRATORY IMPAIRMENT
INTRODUCTION
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:
·conditions that do not decrease exercise tolerance;
·conditions that do not produce symptoms; and
·intermittent conditions.
“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.
Medical history
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
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:
·hemiparesis following a stroke;
·quadriplegia or hemiplegia;
·severe arthritis of the lower limbs; and
·certain mental conditions such as dementia (in which the veteran’s ability to co-operate or provide useful information may be restricted).
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.
Measurements of lung function
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 veteran is very old or frail and cannot reasonably attend a clinic where spirometry can be performed; or
·the veteran lives in a remote locality and cannot reasonably attend a clinic where spirometry can be performed; or
·the veteran’s impairment from other accepted conditions is of such a degree that it would result in a combined impairment rating of at least 68 points.
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 activity
· Lying 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 duties
· Light 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 pace
· Walking 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 pace
· Vacuuming.
· 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 exercise
· Mopping 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).
· Gentle swimming.
· Painting outside of house.
· Hoeing (soft soil).
· Stacking firewood.
5–6 METs
Heavy exercise: manual labour or vigorous sports
· Walking 6.5 km/h (sustained brisk walk, discomfort in talking at the same time).
· Walking slowly but steadily up stairs.
· Carpentry (eg. Sawing and planing with hand tools).
· Swimming laps (non-competitive).
· Pushing a full wheelbarrow (20 kg).
· Shovelling dirt (12 throws a minute).
· Digging in garden.
6–7 METs
· Badminton (competitive)
· Tennis (singles, non-competitive).
· Water skiing.
· Loading truck with bricks.
· Using a pick and shovel to dig trenches.
7–8 METs
Very heavy exercise
· Jogging (8 km/h).
· Horseback riding (galloping).
· Carrying heavy objects (30 kg) on level ground.
· Sawing hardwood with hand tools.
8–9 METs
· Running (9 km/h).
· Skiing (cross-country.
· Chopping hardwood.
· Callisthenics.
· Squash (non competitive).
10+ METs
· Running quickly (10 km/h).
· Cycling quickly (25 km/h).
· Carrying loads (10 kg) up a gradient.
· Football (any code).
The activities listed under each heading are examples. There will be other activities that have the same METs expenditure and hence can be used for reference if their METs level is known.
Ratings derived from METs are age adjusted
Alternate procedures for establishing the symptomatic activity level
1. The symptomatic activity level may be determined by exercise tests. These tests include:
- use of treadmills; or
- cycles; or
- rowing machines.
Because of their greater objectivity, the results of exercise tests (when available) are to be used in preference to the method of calculating exercise tolerance as described above. Moreover, exercise tests must always be used to make an estimate of exercise tolerance above 6–7 METs.
2. If certain levels of activity have been prohibited by the treating doctor, because of the adverse effect the prohibited activity is likely to have on the veteran’s health as a result of the accepted condition, then the level of exercise that has been prohibited may be regarded as the symptomatic activity level.
Substep 3B: Convert the symptomatic activity level into an impairment rating.
The symptomatic activity level is used, in conjunction with the veteran’s age, height, and sex, to obtain an impairment rating.
In the case of a male, Table 1.2 is to be applied.
In the case of a female, Table 1.3 is to be applied.
For the purposes of Tables 1.2 and 1.3, a veteran’s age is taken to be his or her age in whole years at the date of the report relating to the exercise tolerance (unless the report is of a retrospective type and clearly refers to some earlier period, in which case the veteran’s age is taken to be his or her age in whole years at the relevant time).
Step 4: (Omit this step if no respiratory disease is present.) Determine the impairment rating based on measurements of lung function.
FEVl, FVC, and MEF 25–75 are the usual physiological measurements of lung function. Determinations of FEVl, FVC, and MEF 25–75 should be conducted by an experienced operator without specific administration of a bronchodilator. The best set of results should be selected, that is, the set of results which indicates the greatest degree of health and, consequently, the lowest degree of impairment.
If both pre-bronchodilator and post-bronchodilator results are available the pre-bronchodilator results are to be applied in determining the impairment rating based on measurements of lung function.
To determine the impairment rating based on measurements of lung function, follow the substeps below.
Substep 4A Obtain the measured FEVl, FVC, and MEF 25–75 from the data. Substep 4B Work out the predicted FEVl, FVC, and MEF 25–75 for a person of the same age, height, and gender. This can be done either by applying the nomograms Figure 1a (for males) or Figure 1b (for females) or by applying the formula relating to each nomogram. Substep 4C Express the measured FEV1 as a percentage of the predicted FEV1, and Express the measured FVC as a percentage of the predicted FVC, and Express the measured MEF 25–75 (if appropriate) as a percentage of the predicted MEF 25–75.
These conversions are performed by applying the formula:
Measured value as % of predicted value = Actual value x 100
Predicted Value
Substep 4D Determine an impairment rating from a physiological measurement by using the percentage obtained in substep 4C in conjunction with Table 1.4. Separate impairment ratings can be obtained from each physiological measurement (that is, from the FEV1, FVC, and MEF 25–75). Substep 4E The final impairment rating is the highest (or equal highest) of the ratings obtained in substep 4D.
Function Loss Table 1.2
LOSS OF CARDIORESPIRATORY FUNCTION: EXERCISE TOLERANCE
(Males) Age Symptomatic Activity Level Age Symptomatic Activity Level (METs*) (METs*) less than
25
1–2 2–3 3–4 4–5 5–6 6–7 7–8 8–9 10+ 1–2 2–3 3–4 4–5 5–6 6–7 7–8 8–9 10+ 90
80
70
60
50
40
30
20
10
55
80
70
55
40
25
15
10
25 90 80 70 60 50 40 30 20 10 56 80 70 54 39 24 15 9 26 90 80 70 60 50 40 30 20 10 57 80 69 53 38 23 14 8 27 89 80 70 59 48 38 28 19 10 58 80 69 52 37 22 14 7 28 89 80 70 59 47 37 27 19 10 59 80 68 51 36 21 13 6 29 88 80 70 58 46 36 26 18 10 60 80 68 50 35 20 13 5 30 88 80 70 58 45 35 25 18 10 61 80 67 49 34 19 12 4 31 87 80 70 57 44 34 24 17 10 62 80 67 48 33 18 12 3 32 87 80 70 57 43 33 23 17 10 63 80 66 47 32 17 11 2 33 86 80 70 56 42 32 22 16 10 64 80 66 46 31 16 11 34 86 80 70 56 41 31 21 16 10 65 80 65 45 30 15 10 35 85 80 70 55 40 30 20 15 10 66 80 64 44 29 15 9 36 85 80 70 55 39 29 20 15 9 67 79 63 43 28 14 8 37 85 79 69 54 38 28 19 14 8 68 79 62 42 27 14 7 38 85 79 69 54 37 27 19 14 7 69 78 61 41 26 13 6 39 85 78 68 53 36 26 18 13 6 70 78 60 40 25 13 5 40 85 78 68 53 35 25 18 13 5 71 77 59 39 24 12 4 41 85 77 67 52 34 24 17 12 4 72 77 58 38 23 12 3 42 85 77 67 52 33 23 17 12 3 73 76 57 37 22 11 2 43 85 76 66 51 32 22 16 11 2 74 76 56 36 21 11 1 44 85 76 66 51 31 21 16 11 75 75 55 35 20 10 45 85 75 65 50 30 20 15 10 76 75 55 35 19 9 46 85 75 64 49 30 20 15 9 77 75 54 34 18 8 47 84 74 63 48 29 19 14 8 78 75 54 34 17 7 48 84 74 62 47 29 19 14 7 79 75 53 33 16 6 49 83 73 61 46 28 18 13 6 80 75 53 33 15 5 50 83 73 60 45 28 18 13 5 81 75 52 32 14 4 51 82 72 59 44 27 17 12 4 82 75 52 32 13 3 52 82 72 58 43 27 17 12 3 83 75 51 31 12 2 53 81 71 57 42 26 16 11 2 84 75 51 31 11 1 54 81 71 56 41 26 16 11 85 75 50 30 10 above 85 75 50 30 10 *One MET represents the energy expenditure associated with the consumption of 3.5 mL oxygen/kg body Weight/min. Ratings derived from METs are age adjusted
Functional Loss Table 1.3
LOSS OF CARDIORESPIRATORY FUNCTION: EXERCISE TOLERANCE
(Females) Age Symptomatic Activity Level Age Symptomatic Activity Level (METs*) (METs*) less than
25
1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+ 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+ 90
80
70
55
40
30
20
15
10
55
80
65
50
30
20
15
10
25 90 80 70 55 40 30 20 15 10 56 80 65 49 29 20 15 9 26 90 80 69 54 40 30 20 15 10 57 80 64 48 28 19 14 8 27 89 79 68 53 39 29 20 15 10 58 80 64 47 27 19 14 7 28 89 79 67 52 39 29 20 15 10 59 80 63 46 26 18 13 6 29 88 78 66 51 38 28 20 15 10 60 80 63 45 25 18 13 5 30 88 78 65 50 38 28 20 15 10 61 80 62 44 24 17 12 4 31 87 77 64 49 37 27 20 15 10 62 80 62 43 23 17 12 3 32 87 77 63 48 37 27 20 15 10 63 80 61 42 22 16 11 2 33 86 76 62 47 36 26 20 15 10 64 80 61 41 21 16 11 34 86 76 61 46 36 26 20 15 10 65 80 60 40 20 15 10 35 85 75 60 45 35 25 20 15 10 66 80 59 39 20 15 9 36 85 75 60 45 34 25 20 15 9 67 79 58 38 19 14 8 37 85 75 60 44 33 24 19 14 8 68 79 57 37 19 14 7 38 85 75 60 44 32 24 19 14 7 69 78 56 36 18 13 6 39 85 75 60 43 31 23 18 13 6 70 78 55 35 18 13 5 40 85 75 60 43 30 23 18 13 5 71 77 54 34 17 12 4 41 85 75 60 42 29 22 17 12 4 72 77 53 33 17 12 3 42 85 75 60 42 28 22 17 12 3 73 76 52 32 16 11 2 43 85 75 60 41 27 21 16 11 2 74 76 51 31 16 11 1 44 85 75 60 41 26 21 16 11 75 75 50 30 15 10 45 85 75 60 40 25 20 15 10 76 75 49 29 15 9 46 85 74 59 39 25 20 15 9 77 75 48 28 14 8 47 84 73 58 38 24 19 14 8 78 75 47 27 14 7 48 84 72 57 37 24 19 14 7 79 75 46 26 13 6 49 83 71 56 36 23 18 13 6 80 75 45 25 13 5 50 83 70 55 35 23 18 13 5 81 75 44 24 12 4 51 82 69 54 34 22 17 12 4 82 75 43 23 12 3 52 82 68 53 33 22 17 12 3 83 75 42 22 11 2 53 81 67 52 32 21 16 11 2 84 75 41 21 11 1 54 81 66 51 31 21 16 11 85 75 40 20 10 above 85 75 40 20 10 *One MET represents the energy expenditure associated with the consumption of 3.5mL oxygen/kg body weight/min. Ratings derived from METs are age adjusted
FIGURE 1a ‑ PREDICTION NOMOGRAM: MALE (BTPS)
FIGURE 1b ‑ PREDICTION NOMOGRAM: FEMALE (BTPS)
Functional Loss Table 1.4
LOSS OF CARDIORESPIRATORY FUNCTION: PHYSIOLOGICAL MEASUREMENTS
Impairment
RatingFEV1 as a
percentage
of predictedFVC as a
percentage
of predictedMEF 25–75 as a
percentage
of predictedNIL 85 85 85 TWO 84 SIX 84 84 SEVEN 83 EIGHT 83 83 TEN 82 82 ELEVEN 81 82 81 TWELVE THIRTEEN 80 80 FOURTEEN 79 81 79 FIFTEEN SIXTEEN 78 80 78 SEVENTEEN 77 77 EIGHTEEN 76 79 76 NINETEEN TWENTY 75 78 75 TWENTY-ONE 74 74 TWENTY-TWO 73 77 73 TWENTY-THREE 72 72 TWENTY-FOUR 71 76 71 TWENTY-FIVE TWENTY-SIX 70 75 70 TWENTY-SEVEN 69 74 69 TWENTY-EIGHT 68 68 TWENTY-NINE 67 73 67 THIRTY 66 72 66 THIRTY-ONE 65 71 65 THIRTY-TWO 64 64 THIRTY-THREE 63 70 63 THIRTY-FOUR 62 69 62 THIRTY-FIVE 61 68 61 THIRTY-SIX 60 67 60 THIRTY-SEVEN 59 59
Functional Loss Table 1.4 (continued)
LOSS OF CARDIORESPIRATORY FUNCTION: PHYSIOLOGICAL MEASUREMENTS
Impairment
RatingFEV1 as a
percentage
of predictedFVC as a
percentage
of predictedMEF 25–75 as a
percentage
of predictedTHIRTY-EIGHT 58 66 58 THIRTY-NINE 57 65 57 FORTY 64 FORTY-ONE 56 63 56 FORTY-TWO 55 62 55 FORTY-THREE 54 61 54 FORTY-FOUR 53 60 53 FORTY-FIVE 52 52 FORTY-SIX 51 59 51 FORTY-SEVEN 50 58 50 FORTY-EIGHT 49 57 49 FORTY-NINE 48 56 48 FIFTY 47 55 47 FIFTY-ONE 46 54 46 FIFTY-TWO 45 53 45 FIFTY-THREE 44 52 44 FIFTY-FOUR 43 51 43 FIFTY-FIVE 42 50 42 FIFTY-SIX 41 49 41 FIFTY-SEVEN 40 40 FIFTY-EIGHT 39 48 39 FIFTY-NINE 38 47 38 SIXTY 37 46 37 SIXTY-ONE 36 45 36 SIXTY-TWO 35 44 35 SIXTY-THREE 34 43 34 SIXTY-FOUR 33 42 33 SIXTY-FIVE 32 41 32 SIXTY-SIX 31 40 31 SIXTY-SEVEN 30 39 30 SIXTY-EIGHT 29 38 29 SIXTY-NINE 28 37 28 SEVENTY 27 36 27 Ratings derived from this table are age adjusted
Whenever the measured parameter is less than 85% of the predicted, Table 1.4 corresponds to the following formulas:
Impairment rating based on FEV1
=
98 - % FEV1 +
50
(% FEV1-90)
Impairment rating based on FVC
=
108 - % FVC +
100
(%FVC-88.5)
Impairment rating based on MEF 25–75
=
98 - % MEF +
50
(% MEF-90)
When the measured parameter is 85% or more of the predicted, then the impairment rating is defined as NIL
“%FEV1” means measured FEV1 expressed as a percentage of predicted FEV1.
“%FVC” means measured FVC expressed as a percentage of predicted FVC. “%MEF” means measured MEF 25‑75 expressed as a percentage of predicted MEF 25–75.In each case the percentage is to be rounded to the nearest integer before the formula is applied.
If these formulas are applied the resulting impairment rating is always to be rounded to the nearest integer.
Step 5: Calculate the total accepted cardiorespiratory functional impairment rating.
At this stage there will usually be an impairment rating derived from effort tolerance information and there may also be an impairment rating derived from measurements of lung function. These must be combined into a single cardiorespiratory functional impairment rating. The method by which that is to be done is set out in Table 1.5.
For the purposes of Table 1.5, the following abbreviations have been used:
Abbreviation Meaning “FI” means cardiorespiratory functional impairment rating. “No FI” means a cardiorespiratory functional impairment rating cannot be calculated from either effort tolerance information or measurements of lung function. “METs” means the cardiorespiratory functional impairment rating is to be taken as the impairment rating derived from METs alone. “Spirometry” means the cardiorespiratory functional impairment rating is to be taken as the impairment rating derived from measurements of respiratory function. “average of METs and Spirometry” means the average of the cardiorespiratory functional impairment rating derived from METs alone and the cardiorespiratory functional impairment rating derived from measurements of respiratory function alone — using the ordinary formula for averaging two quantities or by use of the nomogram in Figure 1c. In either case, the result is to be rounded to the nearest integer.
Procedural Table 1.5
CARDIORESPIRATORY FUNCTIONAL IMPAIRMENT
Respiratory disease present No respiratory disease Spirometry obtainable Spirometry not obtainable Cardiac disease present METs data obtainable FI = higher of METs and Spirometry FI = METs FI = METs METs data not obtainable FI = Spirometry No FI No FI No cardiac disease METs data obtainable FI = average of METs and Spirometry FI = METs METs data not obtainable FI = Spirometry No FI In applying this table, both accepted and non-accepted conditions are to be taken into account. No age adjustment permitted for this table
From Table 1.5 it will be seen that:
·if cardiac conditions exist in the absence of respiratory disease, cardiorespiratory functional impairment should be measured by effort tolerance alone;
·if respiratory conditions exist in the absence of cardiac disease, the cardiorespiratory functional impairment rating is the rounded average of (i) impairment as measured by effort tolerance, and (ii) impairment as measured by spirometry;
·if both cardiac and respiratory conditions co-exist, the cardiorespiratory functional impairment rating is the greater of (i) the impairment rating as measured by effort tolerance, and (ii) the impairment rating as measured by spirometry.
In applying these rules, both accepted and non-accepted cardiac and respiratory conditions are to be taken into account.
Only one rating for effort tolerance is to be given irrespective of the number of conditions that contribute to the relevant impairment.
Only one rating is to be given for physiological measurements of lung function irrespective of the number of conditions that contribute to the relevant impairment.
This single “total cardiorespiratory functional impairment” is due to the combined effect of all cardiorespiratory conditions whether accepted or not.
FIGURE 1c ‑ LOSS OF REPIRATORY FUNCTION RESPIRATORY NOMOGRAM
This nomogram is to be used in accordance with the instructions in Step 5 and the procedural Table 1.5.
Results from this nomogram are to be rounded to the nearest five points. 2.5 is to be rounded up to 5 and 7.5 is to be rounded up to 10.
This nomogram corresponds to the formula:
Impairment Rating =
METs Impairment Rating + Impairment Rating of Physiological Measurement
2Step 6: Consider the effects of cardiac failure (if any).
For the purposes of assessment under this Guide, cardiac failure is considered to be a surrogate measure of cardiorespiratory impairment. When cardiac failure is present, the impairment rating calculated using effort tolerance will usually exceed any possible impairment rating from Table 1.6. Table 1.6 is of particular importance in assessing a veteran who is unable to be rated using effort tolerance because of significant conditions such as hemiplegia.
Functional Loss Table 1.6
CARDIAC FAILURE
Impairment Ratings
Criteria
NIL No cardiac failure; that is, neither symptoms nor X-ray evidence of cardiac failure. TEN · No symptoms, but X-ray evidence of early cardiac failure.
· Evidence of right ventricular failure.
FIFTEEN Left or biventricular cardiac failure demonstrated by ejection fraction of between 40% and 60% and persisting despite therapy. TWENTY Left or biventricular cardiac failure demonstrated on X-ray or by ejection fraction of less than or equal to 40% and persisting despite therapy. Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen. No age adjustment allowed for this table
A rating from Table 1.6 is to be compared with the total cardiorespiratory functional impairment rating (obtained in Step 5) and the higher of the two is to be chosen.
Step 7: Moderate the total cardiorespiratory functional impairment rating to allow for effects of any non-accepted conditions.
Partially contributing impairment
If non-accepted conditions contribute to the impairment, Chapter 19 (Partially Contributing Impairment) is to be applied to determine impairment from the accepted conditions.
If cardiac conditions exist in the absence of respiratory disease: if there is more than one cardiac condition present (for example ischaemic heart disease and a valvular heart disease) and some are accepted and some are not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition.
If a respiratory condition exists in the absence of cardiac disease, the symptomatic activity level will generally be the exercise level (in METs) at which dyspnoea occurs. If there is more than one respiratory condition present and at least one is accepted and at least one is not accepted, then the total cardiorespiratory functional impairment rating must be moderated by applying Chapter 19 to determine the impairment due to the accepted condition or conditions.
If cardiac and respiratory conditions co-exist, and at least one is accepted and at least one is not accepted, it is necessary to determine the total cardiorespiratory functional impairment rating (as set out in the previous steps), and then to moderate that rating by applying Chapter 19 to determine the impairment due to the accepted condition.
The result that is then derived is the “total accepted cardiorespiratory functional impairment rating”.
Step 8: Determine whether any ratings from the cardiorespiratory Other Impairment tables apply.
Cardiorespiratory Other Impairment tables
Once the total accepted cardiorespiratory functional impairment rating has been determined, it must be compared with the relevant cardiorespiratory Other Impairment tables. For assessment purposes, four categories of cardiorespiratory condition are recognised. These categories are:
·ischaemic heart disease;
·valvular heart disease;
·miscellaneous heart disease; and
·lower respiratory tract conditions.
There are four cardiorespiratory Other Impairment tables — corresponding to each of the above categories. These tables are:
Table 1.7 — Cardiorespiratory Impairment: Ischaemic;
Table 1.8 — Cardiorespiratory Impairment: Valvular;
Table 1.9 — Cardiorespiratory Impairment: Miscellaneous; and
Table 1.10 — Cardiorespiratory Impairment: Respiratory.
Only one rating is to be selected from each of these cardiorespiratory Other Impairment tables (Tables 1.7, 1.8, 1.9, and 1.10) for any condition or combination of conditions.
If accepted conditions belonging to more than one of the four categories of cardiorespiratory disease above are present, then the relative contribution of their effect on the total accepted cardiorespiratory functional impairment must be estimated by applying Chapter 20 (Apportionment). The rating for each condition will be the higher of the cardiorespiratory functional impairment rating attributed to it and its cardiorespiratory Other Impairment rating.
The cardiorespiratory worksheet (at page 29) should also be consulted.
Other Impairment Table 1.7
CARDIORESPIRATORY IMPAIRMENT: ISCHAEMIC HEART DISEASE
Impairment Ratings
Criteria
NIL No history of symptoms but evidence of transient ischaemia on exercise ECG testing. TEN · Coronary artery disease, characterised by typical history of angina pectoris.
· Coronary artery disease, characterised by history of uncomplicated myocardial infarct, with no subsequent evidence of cardiac failure and infrequent or no angina.
· Coronary artery disease, with single vessel disease (other than left main coronary) demonstrated on angiogram.
· Coronary artery disease with successful coronary artery surgery, followed by no angina or only infrequent angina but no further infarcts or cardiac failure.
FIFTEEN Coronary artery disease with multi-vessel disease (not successfully corrected) demonstrated on angiogram. TWENTY · Coronary artery disease characterised by a history of myocardial infarct followed, immediately or after a lapse of time, by continuing angina or further infarcts.
· Coronary artery disease characterised by left main coronary artery disease (not successfully corrected) demonstrated on angiogram.
· Coronary artery disease with successful coronary artery surgery, followed, after a lapse of time, by frequent angina or further infarcts or cardiac failure.
Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen.
No age adjustment permitted for this table
Other Impairment Table 1.8
CARDIORESPIRATORY IMPAIRMENT: VALVULAR HEART DISEASE
Impairment Ratings Criteria
NIL · Mitral valve prolapse with no or minimal symptoms.
· Aortic sclerosis with no or minimal symptoms.
FIVE Diagnosed valvular heart disease (other than mitral valve prolapse or aortic sclerosis) with no symptoms and no X-ray evidence of cardiac failure. TEN Valvular heart disease with successful valve replacement, not requiring anticoagulant medication, with no subsequent symptoms or evidence of cardiac failure. FIFTEEN Valvular heart disease with successful valve replacement, requiring anticoagulant medication, with no subsequent symptoms or evidence of cardiac failure. Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen. No age adjustment permitted for this table
Other Impairment Table 1.9
CARDIORESPIRATORY IMPAIRMENT: MISCELLANEOUS
Impairment Ratings Criteria
NIL Flow murmurs. TWO Chronic asymptomatic arrhythmia, eg. atrial fibrillation, atrial or ventricular ectopic beats. FIVE Need for a permanent pacemaker. Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen. No age adjustment permitted for this table
Arrhythmias are usually to be rated by applying Chapter 15 (Intermittent Impairment) unless they cause a permanent restriction of exercise tolerance, in which case they are to be assessed by their effect on effort tolerance.
Other Impairment Table 1.10
CARDIORESPIRATORY IMPAIRMENT: LOWER RESPIRATORY TRACT Impairment Ratings Criteria
NIL Asymptomatic pleural plaques TWO · Recurrent lower respiratory infections (at least 6 per year)
· Intermittent use of bronchodilator medication.
FIVE · Daily use of inhaled steroids required.
· Regular, daily use of bronchodilator medication.
· Chronic cough, with production of at least 50mL sputum/day.
TEN · Regular, daily use of bronchodilator medication required in addition to daily inhaled steroids.
· Chronic cough, with production of at least 100 mL sputum/day.
TWENTY Repeated courses (at least several courses per year) or permanent use of oral steroids required. Only one rating is to be selected from this table for any condition or combination of conditions. If more than one criterion applies, that which gives the higher or highest rating is to be chosen. No age adjustment permitted for this table
Peripheral Vascular Conditions
Tables 1.2 and 1.3 are to be applied to assess those conditions that affect exercise tolerance from a cardiorespiratory point of view. Peripheral vascular conditions typically cause loss of function of the lower limbs only and therefore are to be assessed under lower limb impairment (using Chapter 3).
Atherosclerosis frequently causes both a cardiorespiratory condition and a peripheral vascular condition. In such cases, if both types of conditions are accepted conditions, then both conditions are to be rated using the appropriate assessment procedure.
The rating of asthma depends on the clinical circumstances. If asthma has caused chronic airways obstruction the method of assessment described in this chapter is to be applied. If there is little fixed obstruction and a large reversible component, the rating is to be based on the occurrence of attacks using the method of intermittent impairment (Chapter 15). Asthma can also be rated, if there is minimal loss of function, from Table 1.10.
CHAPTER 2
HYPERTENSION AND NON-CARDIAC VASCULAR CONDITIONS
This Chapter contains three parts:
Part 2.1 — Hypertension
Part 2.2 — Vascular Conditions of the Lower Limbs
Part 2.3 — Other Non-Cardiac Vascular Conditions
INTRODUCTION
This chapter is to be applied in determining impairment ratings for hypertension and non-cardiac vascular conditions. For conditions affecting the heart itself refer to Chapter 1 (Cardiorespiratory Impairment).
PART 2.1: HYPERTENSION
Hypertension, of itself, does not affect effort tolerance. Therefore, uncomplicated hypertension is not to be assessed under Chapter 1 (Cardiorespiratory Impairment) but in the manner set out below.
Calculation of the impairment rating for hypertension
Follow the steps below to calculate the impairment rating for hypertension.
STEP 1 Establish whether any target organ damage is present. Page 30 STEP 2 (Omit this step if there is no target organ damage.)
Calculate the total functional impairment for any accepted target organ damage
Page 31 STEP 3 Calculate the Other Impairment rating for the accepted hypertension by applying Table 2.1.1. Page 32 STEP 4 (Omit this step if there is no target organ damage.)
Compare the rating obtained in Step 2 with the rating obtained in Step 3. Take the higher of these two ratings
Page 32 Step 1: Establish whether any target organ damage is present.
For the purposes of this chapter, “target organ damage” means any of the following:
·hypertensive retinopathy, grade III or IV;
·hypertensive cardiac disease, with ECG or X-ray evidence of left ventricular hypertrophy;
·hypertensive nephropathy demonstrated at biopsy, or by presence of proteinuria or elevated serum creatinine level; or
·hypertensive cerebral haemorrhage.
Certain other conditions have hypertension as a contributing factor in their aetiology (for example: ischaemic heart disease and peripheral vascular disease). Such conditions are not to be regarded as being target organ damage when applying Part 2.1.
Step 2: Calculate the total functional impairment due to any accepted target organ damage.
Accepted hypertensive retinopathy is to be assessed by applying Chapter 8.
If other ophthalmic conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
Accepted hypertensive cardiac disease is to be assessed by applying Chapter 1.
If other cardiorespiratory conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
Accepted hypertensive nephropathy is to be assessed by applying Chapter 9.
If other renal conditions are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
Accepted hypertensive cerebral haemorrhage is to be assessed according to the specific effects of the haemorrhage.
The impairment ratings attributable to the accepted target organ damage are to be combined by applying Chapter 18 (Combined Values Chart) to obtain the total impairment rating for accepted target organ damage.
Target organ damage that is not an accepted condition cannot be assessed under this Guide. Target organ damage can be assessed under this Guide only after it has been claimed and has become an accepted condition.
The criterion in Table 2.1.1 which refers to “hypertension of such a degree that target organ damage is present” is not an assessment of the target organ damage itself but is a measure of the severity of the hypertension.
Step 3: Determine an impairment rating for hypertension from Table 2.1.1.
Other Impairment Table 2.1.1
HYPERTENSION
Impairment Ratings Criteria
NIL Hypertension adequately controlled by diet and weight loss without long-term medication. TWO Hypertension requiring long-term medication but without side-effects of the medication and with no evidence of target organ damage. FIVE · Hypertension with diastolic pressure consistently at or greater than 90 mm Hg despite treatment.
· Hypertension: controlled but frequent minor side effects of medication which cause no loss of function.
TEN · Hypertension: diastolic pressure consistently greater than 100 mm Hg.
· Hypertension of such a degree that target organ damage is present.
· Hypertension: controlled but with side effects of medication causing a significant and persistent loss of function.
Only one rating is to be selected from this table. No age adjustment permitted for this table
For the purpose of determining a rating of 10 impairment points from Table 2.1.1 (dot point 2) target organ damage has to be present either as an accepted condition or as a non-accepted condition.
Step 4: (Omit this step if is there is no target organ damage.) Compare the rating obtained in Step 2 with the rating obtained in Step 3. Take the higher rating.
The total impairment rating for accepted target organ damage is to be compared with any applicable rating from Table 2.1.1, and the higher of the two is to be taken as the impairment rating for the accepted hypertension.
Substep 4A If the impairment rating from Table 2.1.1 is higher than the total rating for accepted target organ damage, the latter rating is to be discarded and its components are not to be used in any further calculations. Substep 4B If the impairment rating for accepted target organ damage is higher than the rating from Table 2.1.1, the rating from Table 2.1.1 is to be discarded and each of the components of the rating for accepted target organ damage is to be included in the final combining of all impairment ratings. Impairment ratings from Table 2.1.1 are not routinely compared with ratings from the functional loss tables in Chapter 1 (Cardiorespiratory Impairment) except if hypertensive cardiomyopathy is present. Instead, they are to be compared with the impairment rating for the total loss of function due to target organ damage.
The total impairment rating for target organ damage is not to be combined with the impairment rating obtained from Table 2.1.1.
PART 2.2: VASCULAR CONDITIONS OF THE LOWER LIMBS
Each vascular condition of the lower limbs is characterised as belonging to one or more of three categories. These categories are:
·(arterial) peripheral vascular disease;
·varicose veins and vascular leg ulcers; and
·oedema.
Each category is to be assessed by applying a specific table from this part of the Guide. Depending on their effects, vascular conditions of the lower limbs may be rated under one or more of these tables.
Determination of the impairment rating for vascular conditions of the lower limbs
Follow the steps below to determine the impairment rating for each type of accepted vascular condition of the lower limbs.
(Each step is elaborated in the following pages.)
STEP 1 Establish whether any effect on lower limb function is present. Page 34 STEP 2 Establish whether any effect on the skin is present. Page 34 STEP 3 (Omit this step if there is no effect on lower limb function)
Determine the impairment rating for the effects on lower limb function.
Page 34 STEP 4 (Omit this step if there is no effect on skin)
Determine the impairment rating for the effects on the skin.
Page 34 STEP 5 Determine the Other Impairment rating for the vascular conditions of the lower limbs by applying Tables 2.2.1, 2.2.2, and 2.2.3. Page 34 STEP 6 Combine the impairment ratings obtained in Steps 3 and 4. Page 36 STEP 7 Combine the impairment ratings obtained in Step 5. Page 36 STEP 8 Compare the impairment ratings obtained in Steps 6 and 7. Page 36 STEP 9 If the comparison made in Step 8 shows that the impairment rating obtained in Step 6 is greater than the impairment rating obtained in Step 7, then the ratings obtained in Steps 3 and 4 are the final impairment ratings for the vascular condition. Page 36 STEP 10 If the comparison made in Step 8 shows that the impairment rating obtained in Step 7 is greater than the impairment rating obtained in Step 6, then the separate ratings that have been combined in Step 5 are the final impairment rating(s) for the vascular condition. Page 37 Step 1: Establish whether any effect on lower limb function is present.
Lower limb function may be affected by peripheral vascular disease. If peripheral vascular disease is present, the veteran’s walking distance is likely to be reduced as a result of intermittent claudication (cramplike pain in the calves of the legs).
Step 2: Establish whether any effect on the skin is present.
Varicose veins can affect the skin of the lower limbs. They may cause discolouration or pruritus (itching). Excoriations (scratch marks) may be present.
Step 3: (Omit this step if there is no effect on lower limb function.) Determine the impairment rating for the effects on lower limb function.
Lower Limb Function is to be assessed by applying Chapter 3 (Impairment of Spine And Limbs) — Part 3.2. If other conditions affecting lower limb function are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
The effects of vascular conditions of the lower limbs on lower limb function are taken to be symptoms or manifestations of the condition. Hence, they are to be assessed as part of the vascular condition of the lower limbs.
Step 4: (Omit this step if there is no effect on the skin.) Determine the impairment rating for the effects on the skin.
Skin conditions are to be assessed by applying Chapter 11 (Skin Impairment). If other conditions affecting the skin are present, they must be allowed for by applying Chapter 20 (Apportionment) or Chapter 19 (Partially Contributing Impairment) as appropriate.
The effects of vascular conditions of the lower limbs on the skin of the lower limbs are taken to be symptoms or manifestations of the condition. Hence, they are to be assessed as part of the vascular condition of the lower limb.
Step 5: Determine the Other Impairment rating for the vascular conditions of the lower limbs by applying Tables 2.2.1, 2.2.2, and 2.2.3.
There are three Other Impairment tables relating to the effects of vascular conditions of the lower limbs. A condition may be rated under more than one table if appropriate. However, only one rating may be taken from each table irrespective of how many conditions contribute to the type of impairment to which that table relates.
The three Other Impairment tables are:
Table 2.2.1 — (Arterial) Peripheral Vascular Disease
Table 2.2.2 — Varicose Veins
Table 2.2.3 — Oedema.Amputations arising from peripheral vascular disease cannot be assessed unless they have been separately accepted. They can then be assessed under Chapter 3 (Impairment of Spine and Limbs).
Other Impairment Table 2.2.1
(ARTERIAL) PERIPHERAL VASCULAR DISEASE
Impairment Ratings Criteria
NIL No peripheral vascular disease is present. TWO Minor peripheral vascular disease or peripheral vascular disease that has been successfully treated. FIVE Moderate peripheral vascular disease is present but causes little restriction of activities. TEN Severe peripheral vascular disease, the expected effects of which are masked by a non-accepted condition (eg, masked by restriction on walking due to a musculoskeletal disorder). Irrespective of whether one or two legs are affected, only one rating may be selected from this table. No age adjustment permitted for this table
Other Impairment Table 2.2.2
VARICOSE VEINS
Impairment Ratings Criteria
NIL · Varicose veins which are not greatly disfiguring, which cause only trivial symptoms, and which impose no significant restriction on activities.
· Superficial, small or transient ulceration.
TWO Varicose veins which are unsightly or even gross but which impose no significant restriction on activities. FIVE Varicose veins, varicose ulcers — causing constant or almost constant symptoms which are not easily tolerated and require medication or therapy. TEN Very severe varicose veins or ulceration — difficult to control and requiring periodic confinement or hospital admissions. Irrespective of whether one or two legs are affected, only one rating may be selected from this table. No age adjustment permitted for this table
Other Impairment Table 2.2.3
OEDEMA
Impairment Ratings Criteria
NIL Mild or transient oedema. FIVE Moderate and persistent oedema. TEN Marked oedema, that is only partly controlled by treatment or therapy. Irrespective of whether one or two legs are affected, only one rating may be selected from this table. No age adjustment permitted for this table
An impairment rating from this table may be given in addition to an impairment rating from Chapter 1 even when both arise from the same condition (eg, heart failure).
Step 6: Combine the impairment ratings obtained in Steps 3 and 4.
If ratings were obtained both in Step 3 and in Step 4, then the ratings are to be combined. This combining is for the purpose of the comparison to be made in Step 8. If only one rating has been given in Steps 3 and 4, then the result to be obtained in Step 6 is to be the same as the one rating given in either Step 3 or Step 4.
Step 7: Combine the impairment ratings obtained in Step 5.
If more than one rating has been given in Step 5 then the ratings are to be combined. This combining is for the purpose of the comparison to be made in Step 8. If only one rating has been given in Step 5, then the result to be obtained in Step 7 is to be the same as the result obtained in Step 5.
Step 8: Compare the impairment ratings obtained in Steps 6 and 7.
Step 9: If the comparison made in Step 8 shows that the impairment rating obtained in Step 6 is higher than the impairment rating obtained in Step 7, then the ratings obtained in Steps 3 and 4 are the final impairment ratings for the vascular condition.
If more than one rating was obtained in Steps 3 and 4 those ratings are not to be combined at this stage, but each is to be included in the final combining of all ratings.
Step 10: If the comparison made in Step 8 shows that the impairment rating obtained in Step 7 is higher than the impairment rating obtained in Step 6, then the rating(s) obtained in Step 5 are the final impairment rating(s) for the vascular condition.
If more than one rating was obtained in Step 5 those ratings are not to be combined at this stage, but each is to be included in the final combining of all ratings.
PART 2.3: OTHER NON-CARDIAC VASCULAR CONDITIONS
This Part is to be applied for a variety of vascular conditions not covered elsewhere in the Guide.
Other Impairment Table 2.3.1
ANEURYSMS AND INTRA-VASCULAR CONDITIONS
Impairment Ratings Criteria
NIL No aneurysms or intra-vascular conditions present. TWO · Aortic aneurysm of diameter less than 6 cm.
· Renal artery stenosis.
· Iliac or femoral or carotid aneurysms.
FIVE · Embolus requiring anticoagulant medication.
· Non-valvular vascular conditions requiring anti-coagulant medication.
· Aortic aneurysm of 6 cm diameter or more.
· Aortic aneurysm surgically corrected.
TEN Other vascular conditions (eg. severe deep venous thrombosis) that are difficult to control. The impairment from any single condition can only receive one rating from this table. If the impairment from a given condition (eg, an aortic aneurysm) satisfies more than one criterion, it is to be given only the highest applicable rating. No age adjustment permitted for this table
·recreational and community activities, and
·employment and domestic activities.
All are of equal weight.
Pain, suffering, impaired memory or concentration, or interference with sleep or sleeping arrangements, that result from the accepted conditions must be taken into account. The rating that best accommodates the veteran’s circumstances is to be selected from the descriptions in Tables 22.1 to 22.5.
The criteria in the Lifestyle Rating Self Assessment Form are the same as the criteria in Tables 22.1 to 22.5. Ratings are based on a progressive scale of 0–7 (with the exception of Table 22.5 in which the scale ranges from 0–5). A zero rating indicates that a veteran’s lifestyle is only negligibly affected by the accepted conditions. A rating of 7 indicates that the effect of the accepted conditions on a veteran’s lifestyle is of the utmost severity.
Calculation of lifestyle rating
Follow the steps below to calculate the lifestyle rating, except in those cases where the veteran has made a self-assessment that has been accepted.
STEP 1 Determine the lifestyle rating from each of Tables 22.1, 22.2, 22.3, 22.4 and 22.5. STEP 2 Compare the lifestyle ratings obtained from Tables 22.4 and 22.5. Take the higher rating. STEP 3 Add together the lifestyle ratings from Tables 22.1, 22.2, 22.3 and the lifestyle rating obtained in Step 2. STEP 4 Divide the number obtained in Step 3 by four. The result of the division is to be rounded to the nearest integer. The fraction of 0.5 is to be rounded up. This is the final lifestyle rating to be used in the assessment. PERSONAL RELATIONSHIPS
“Personal relationships” refers to the veteran’s ability to take part in and maintain customary social, sexual and interpersonal relationships.
To determine the effect on personal relationships, it is necessary to establish how the physical and psychological effects of accepted conditions affect the veteran’s ability to interact socially with others.
Lifestyle Effects Table 22.1
PERSONAL RELATIONSHIPS
Ratings
Criteria
NIL
No or negligible effect on personal and social relationships. Relationships are satisfying, with full participation in accustomed social and personal activities.
ONE
Personal and social relationships are fairly satisfying. Intermittent disadvantages may inhibit, but not prevent participation in accustomed range of social and personal activities.
TWO
Mildly affected personal and social relationships. Social contacts and activities are reduced, veteran’s participation in the accustomed range of activities is restricted.
THREE
Moderately affected personal and social relationships. Relationships usually confined to family, close friends, colleagues and neighbours. Unable to relate to casual acquaintances.
FOUR
Markedly affected relationships. Most relations are unsatisfying, maintenance of usual relations with relatives, friends, neighbours and colleagues is difficult. Much less time is spent socialising than was the case formerly.
FIVE
Severely affected relationships. Able to relate only to particular, or few people, eg spouse or children. These remaining relationships are strained and of low quality.
SIX
Extreme difficulty in relating to anyone, for example:
· difficulties in relating because of psychosis; or
· social interaction limited to carer(s) due to confinement; or
ability to communicate is restricted due to stroke or other effect of accepted conditions.
SEVEN
Unable to relate to anyone. All relationships are prevented.
One rating from this table is to be selected.
No age adjustment permitted for this table
MOBILITY
The mobility rating measures the effects of the accepted conditions on the veteran’s mobility. “Mobility” refers to the veteran’s ability to move about effectively in carrying out the ordinary activities of life. It allows for the veteran’s ability to use available forms of transport. Lack of public transport is not to be taken into account.
Both physical and psychological impediments to mobility are to be taken into account when applying Table 22.2. Restrictions on mobility due to mental health factors (e.g. agoraphobia, claustrophobia, dementia, anxiety, confusion, etc), or sensory deficit (e.g. hearing loss, or reduced vision) should be rated in the same way as the more obvious restrictions due to physical impairment.
Lifestyle Effects Table 22.2
MOBILITY Allowance for accepted mental conditions is possible in the rating of effects on mobility and hence on lifestyle. Ratings Criteria NIL No or minimal restrictions of mobility, ie full mobility. ONE
Intermittent or periodic effects on mobility:
· mobility affected only when impairment eg migraine, angina, sciatica, or panic attack, is present. Between attacks there are no restrictions;
· if there is permanent impairment, eg night blindness, the effect is only sporadically limiting.
TWO Mild effects on mobility, eg slowing of pace in some circumstances, or need for a walking stick. THREE Moderately reduced mobility:
· mobility curtained or diminished because of frailty, lack of confidence; or moderate agoraphobia;
· travel as a passenger, in private and public transport, possible in most circumstances without undue difficulty (‘undue difficulty’ not being the need for a break in travel or for special seating arrangements);
· dependent on a walking stick or similar device. Independent in leaving home and reaching destination, but has some difficulty.
FOUR Markedly reduced mobility:
· assistance is needed to cope with public or private transport;
· there is considerable difficulty in travelling from home to destination;
· restricted in the use of at least two forms of public transport..
FIVE Major impediments to mobility:
· dependent upon others, or mechanical devices such as wheelchairs;
· unable to use most forms of public transport;
· able to drive a car only in a situation of emergency and then only for a short distance.
SIX Severe impediments to mobility:
· restricted to home and immediate vicinity, unless door to door transport and assistance from others are provided;
· unable to drive a car in any circumstances whatever.
SEVEN Restricted to room or chair:
· severe agoraphobia permanently confines veteran to home;
· dependent upon others, or hoists or similar appliances, for getting in and out of bed.
One rating from this table is to be selected.
No age adjustment permitted for this table
RECREATIONAL AND COMMUNITY ACTIVITIES
This refers to the ability to take part in any activities of the veteran’s choosing.
A recreational rating is based on the veteran’s normal recreational and community activities and measures the limitation placed by the accepted conditions on the ability to continue those activities. The table takes into account the veteran’s need to modify recreational pursuits or to seek alternatives. Community activities include welfare work in a voluntary capacity.
Lifestyle Effects
Table 22.3
RECREATIONAL AND COMMUNITY ACTIVITIES
Ratings Criteria NIL Able to undertake the full range of usual recreational pursuits and community activities. ONE Intermittent interference with recreational pursuits and community activities. Between episodes is able to continue with the range of accustomed recreational pursuits and community activities. TWO Mild but constant interference with accustomed recreational pursuits and community activities, but is able to continue with them — even if less frequently — or to enjoy alternatives. THREE Unable to continue some accustomed recreational pursuits and community activities, for example:
· competition sporting activities (golf, tennis, bowls, etc) but is still able to enjoy most other activities (camping out, hobbies, going visiting, watching sport, etc);
· unable to perform some community or voluntary activities involving physical activity (eg working bees) but is still able to participate in most other activities including welfare work, fund raising work etc.
FOUR Unable to take part in formerly favoured recreational pursuits, leisure and community activities, but less physical activities are possible, for example:
· restricted to generally non-active interests (eg music, art, stamp or coin collecting, attending clubs, etc); and
· unable to participate in accustomed activities (eg camping, going for long walks, fishing, voluntary activities such as meals on wheels).
FIVE Greater reduction in the number and kind of recreational activities which can be undertaken; some assistance is needed to undertake those which are still possible, for example:
· can only visit or go out if taken to and from destination;
· finds doing a hobby or relaxing (for example, stamp collecting, art & crafts, playing or listening to music, playing cards, etc.) difficult to enjoy due to pain, suffering, or loss of dexterity.
SIX Able to engage in only a very few satisfying recreational activities. Restricted to a few passive activities such as watching TV, listening to radio, reading or receiving visitors. SEVEN Unable to take part in any recreational activities. One rating from this table is to be selected. No age adjustment permitted for this table
DOMESTIC AND EMPLOYMENT ACTIVITIES
There are two tables for this lifestyle component. A lifestyle rating is to be selected from each table, where applicable, and the higher of the two lifestyle ratings is to be chosen as the lifestyle rating for domestic and employment activities.
Domestic Activities
“Domestic activity” refers to the veteran’s ability to sustain effective routines in a domestic environment. Only the impact of accepted conditions on the ability to engage in domestic activity is to be taken into account: the veteran’s inability to do domestic work for some other reason (for example, choice, habit, inexperience, lack of skill) is not to be taken into account.
Lifestyle Effects
Table 22.4
DOMESTIC ACTIVITIES Ratings Criteria NIL Able to sustain any usual activities. ONE Intermittent effects of accepted disablement on usual activity. TWO Able to carry out accustomed tasks, but has difficulty with some heavier tasks, for example:
· has difficulty with heavy gardening activities such as digging, pruning trees etc.
THREE Unable to perform heavy activities, but able to carry out lighter household tasks, taking breaks during sustained activity, for example:
· mowing the lawn;
· washing the car;
· performing light maintenance or gardening activities if working at own pace, taking breaks as necessary.
FOUR Unable to carry out a full range of normal household activities, particularly some moderate tasks which require exertion. Needs assistance with some activities, for example:
· vacuuming carpets, cleaning floors, or mowing lawns;
· home repairs and maintenance, etc.
FIVE Limitation of household activity to a small range of light tasks, for example:
· watering the garden but has difficulty in weeding or pruning;
· able to do some light household activities but has difficulty bending to make beds, or in putting out the rubbish bin;
· requires assistance with grocery shopping.
SIX Able to carry out only very limited domestic activities, usually a restricted range of indoor activities. May require supervision in carrying out such activities, for example:
· able to do very light tidying, dusting but unable to cook or prepare meals;
· has difficulty standing to set table or wash dishes.
SEVEN Total dependency upon others for domestic tasks. One rating from this table is to be selected. No age adjustment permitted for this table
Employment Activities
“Employment activities” refers to the veteran’s ability to work. An employment rating is based on the effects of the accepted conditions on the ability to work for remuneration. It should take into account any necessary changes or modifications to employment or the workplace.
Ratings from Table 22.5 do not confer on the veteran an earnings related benefit, but are intended to compensate for the adverse effects (other than loss of income) of unemployment, reduced employment, or diminished quality of working life.
There are only six criteria on Table 22.5.
Lifestyle Effects
Table 22.5
EMPLOYMENT ACTIVITIES Ratings Criteria NIL Able to engage in usual employment. ONE Able to carry out usual employment that is affected intermittently. TWO Able to follow accustomed employment but difficulty is experienced in carrying out full range of occupational activities. THREE Unable to follow accustomed employment without modification to workplace, provision of aids or restructuring of tasks. FOUR Either unable to work full time in normal occupation, or has had to change occupation or number of hours worked, or both, because of the accepted conditions. FIVE Unable to work. One rating from this table is to be selected. No age adjustment permitted for this table
CALCULATING PERMANENT IMPAIRMENT COMPENSATION
Chapter 23
CALCULATING PERMANENT IMPAIRMENT COMPENSATION
Section 67 of the Military Rehabilitation and Compensation Act 2004 provides that this Guide can specify how the Military Rehabilitation and Compensation Commission is to determine the compensation payable to a person under Part 2 of that Act.
Different factors apply for any combination of impairment (no rounding up or down) and lifestyle effect (where rounding to nearest integer is allowed). Once a rating of 80 impairment points is achieved no lifestyle needs to be calculated as this rating pays the maximum weekly payment under the Act. The maximum payment is payable at 80 impairment points for all types of service.
Warlike, non-warlike and peacetime service
Table 1 is for warlike and non-warlike service. Table 2 is for peacetime service. The factors for warlike and non-warlike service reflect a premium where impairment has resulted from that service rather than peacetime service.
The differential lessens as impairment rates over 50 points are reached. Impairment of 80 or more points attracts the same level of compensation regardless of the nature of the service that gave rise to the injury or disease.
How to calculate a weekly compensation payment
Petty Officer Andrews is 28 when she applies for compensation. It is determined that she has incapacity caused by an injury suffered on non-warlike service. She is assessed as having an impairment rating of 15 and 1 lifestyle point.
From the table for non-warlike service the factor for her injury is .155.
The maximum payment is $245.82 per week. When this amount is factored she is entitled to $38.10 per week (note that the maximum payment amount is indexed annually on 1 July).
Combining impairment ratings
If all accepted conditions have been given impairment ratings, the ratings are to be combined by applying Table 18.1 (Combined Values Chart) in this Guide.
Details on how to apply Table 18.1 are given in Chapter 18.
However, the combined impairment rating obtained by applying Table 18.1 (Combined Values Chart) is not to be rounded. Rounding is unnecessary since impairment periodic payments are based on whatever impairment rating is determined and are not in multiples of 5 or 10 as in the VEA.
Determining the factor for compensation payment
The combined impairment rating which is obtained by applying Chapter 18 (Combined Values Chart) is to be combined with the lifestyle rating on either the Warlike and Non-warlike Factors Table (Table 23.1) or the Peacetime Factors Table (Table 23.2). This is to determine the factor to be multiplied by the maximum lump sum payment available under the Act.
A veteran’s lifestyle rating is expected to be broadly consistent with the degree of medical impairment from accepted conditions as measured by the Combined Impairment Rating. In most cases a lifestyle rating that falls within the shaded area of Tables 23.1 and 23.2 will satisfy the requirement of broad consistency. There may be exceptional cases and, in accordance with Chapter 22 of this Guide, a lifestyle rating outside the shaded area may be allocated.
Where a member or former member has two or more types of service and different conditions under each then the instructions on “Combined Ratings” apply.
Table 23.1: COMPENSATION FACTORS FOR CALCULATING PERMANENT IMPAIRMENT COMPENSATION - WARLIKE AND NON-WARLIKE SERVICE
Lifestyle Impairment 0 1 2 3 4 5 6 7 0 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 5 0.044 0.067 0.089 0.111 0.133 0.156 0.178 0.200 6 0.053 0.075 0.098 0.120 0.142 0.165 0.187 0.209 7 0.062 0.084 0.107 0.129 0.151 0.173 0.196 0.218 8 0.071 0.093 0.115 0.138 0.160 0.182 0.205 0.227 9 0.080 0.102 0.124 0.147 0.169 0.191 0.213 0.236 10 0.088 0.111 0.133 0.155 0.178 0.200 0.222 0.245 11 0.097 0.120 0.142 0.164 0.187 0.209 0.231 0.253 12 0.106 0.128 0.151 0.173 0.195 0.218 0.240 0.262 13 0.115 0.137 0.160 0.182 0.204 0.227 0.249 0.271 14 0.124 0.146 0.168 0.191 0.213 0.235 0.258 0.280 15 0.133 0.155 0.177 0.200 0.222 0.244 0.267 0.289 16 0.142 0.164 0.186 0.208 0.231 0.253 0.275 0.298 17 0.150 0.173 0.195 0.217 0.240 0.262 0.284 0.307 18 0.159 0.182 0.204 0.226 0.248 0.271 0.293 0.315 19 0.168 0.190 0.213 0.235 0.257 0.280 0.302 0.324 20 0.177 0.199 0.222 0.244 0.266 0.288 0.311 0.333 21 0.186 0.208 0.230 0.253 0.275 0.297 0.320 0.342 22 0.195 0.217 0.239 0.262 0.284 0.306 0.328 0.351 23 0.203 0.226 0.248 0.270 0.293 0.315 0.337 0.360 24 0.212 0.235 0.257 0.279 0.302 0.324 0.346 0.368 25 0.221 0.243 0.266 0.288 0.310 0.333 0.355 0.377 26 0.230 0.252 0.275 0.297 0.319 0.342 0.364 0.386 27 0.239 0.261 0.283 0.306 0.328 0.350 0.373 0.395 28 0.248 0.270 0.292 0.315 0.337 0.359 0.382 0.404 29 0.257 0.279 0.301 0.323 0.346 0.368 0.390 0.413 30 0.265 0.288 0.310 0.332 0.355 0.377 0.399 0.422 31 0.274 0.297 0.319 0.341 0.363 0.386 0.408 0.430 32 0.283 0.305 0.328 0.350 0.372 0.395 0.417 0.439 33 0.292 0.314 0.337 0.359 0.381 0.403 0.426 0.448 34 0.301 0.323 0.345 0.368 0.390 0.412 0.435 0.457 35 0.310 0.332 0.354 0.377 0.399 0.421 0.443 0.466 36 0.318 0.341 0.363 0.385 0.408 0.430 0.452 0.475 37 0.327 0.350 0.372 0.394 0.417 0.439 0.461 0.483 38 0.336 0.358 0.381 0.403 0.425 0.448 0.470 0.492 39 0.345 0.367 0.390 0.412 0.434 0.457 0.479 0.501 40 0.354 0.376 0.398 0.421 0.443 0.465 0.488 0.510 41 0.363 0.385 0.407 0.430 0.452 0.474 0.497 0.519 42 0.372 0.394 0.416 0.438 0.461 0.483 0.505 0.528 43 0.380 0.403 0.425 0.447 0.470 0.492 0.514 0.537 44 0.389 0.412 0.434 0.456 0.478 0.501 0.523 0.545 45 0.398 0.420 0.443 0.465 0.487 0.510 0.532 0.554 46 0.407 0.429 0.452 0.474 0.496 0.518 0.541 0.563 47 0.416 0.438 0.460 0.483 0.505 0.527 0.550 0.572 48 0.425 0.447 0.469 0.492 0.514 0.536 0.558 0.581 49 0.434 0.456 0.478 0.500 0.523 0.545 0.567 0.590 50 0.442 0.465 0.487 0.509 0.532 0.554 0.576 0.598 51 0.461 0.483 0.504 0.526 0.547 0.569 0.590 0.612 52 0.480 0.500 0.521 0.542 0.563 0.584 0.604 0.625 53 0.498 0.518 0.538 0.558 0.578 0.598 0.619 0.639 54 0.517 0.536 0.555 0.575 0.594 0.613 0.633 0.652 55 0.535 0.554 0.572 0.591 0.610 0.628 0.647 0.665 56 0.554 0.572 0.590 0.607 0.625 0.643 0.661 0.679 57 0.572 0.590 0.607 0.624 0.641 0.658 0.675 0.692 58 0.591 0.607 0.624 0.640 0.656 0.673 0.689 0.706 59 0.610 0.625 0.641 0.656 0.672 0.688 0.703 0.719 60 0.628 0.643 0.658 0.673 0.688 0.703 0.717 0.732 61 0.647 0.661 0.675 0.689 0.703 0.717 0.732 0.746 62 0.665 0.679 0.692 0.706 0.719 0.732 0.746 0.759 63 0.684 0.697 0.709 0.722 0.735 0.747 0.760 0.772 64 0.703 0.714 0.726 0.738 0.750 0.762 0.774 0.786 65 0.721 0.732 0.743 0.755 0.766 0.777 0.788 0.799 66 0.740 0.750 0.761 0.771 0.781 0.792 0.802 0.813 67 0.758 0.768 0.778 0.787 0.797 0.807 0.816 0.826 68 0.777 0.786 0.795 0.804 0.813 0.822 0.830 0.839 69 0.796 0.804 0.812 0.820 0.828 0.836 0.845 0.853 70 0.814 0.822 0.829 0.836 0.844 0.851 0.859 0.866 71 0.833 0.839 0.846 0.853 0.859 0.866 0.873 0.880 72 0.851 0.857 0.863 0.869 0.875 0.881 0.887 0.893 73 0.870 0.875 0.880 0.885 0.891 0.896 0.901 0.906 74 0.888 0.893 0.897 0.902 0.906 0.911 0.915 0.920 75 0.907 0.911 0.914 0.918 0.922 0.926 0.929 0.933 76 0.926 0.929 0.932 0.935 0.938 0.941 0.943 0.946 77 0.944 0.946 0.949 0.951 0.953 0.955 0.958 0.960 78 0.963 0.964 0.966 0.967 0.969 0.970 0.972 0.973 79 0.981 0.982 0.983 0.984 0.984 0.985 0.986 0.987 80 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000
For impairment greater than 80 points, the value is always 1.00.
Table 23.2: COMPENSATION FACTORS FOR CALCULATING PERMANENT IMPAIRMENT COMPENSATION - PEACETIME SERVICE
Lifestyle Impairment 0 1 2 3 4 5 6 7 0 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 5 0.025 0.037 0.050 0.062 0.075 0.087 0.100 0.112 6 0.030 0.042 0.055 0.067 0.080 0.092 0.105 0.117 7 0.035 0.047 0.060 0.072 0.085 0.097 0.110 0.122 8 0.040 0.052 0.065 0.077 0.090 0.102 0.114 0.127 9 0.045 0.057 0.070 0.082 0.094 0.107 0.119 0.132 10 0.050 0.062 0.074 0.087 0.099 0.112 0.124 0.137 11 0.054 0.067 0.079 0.092 0.104 0.117 0.129 0.142 12 0.059 0.072 0.084 0.097 0.109 0.122 0.134 0.147 13 0.064 0.077 0.089 0.102 0.114 0.127 0.139 0.152 14 0.069 0.082 0.094 0.107 0.119 0.132 0.144 0.157 15 0.074 0.087 0.099 0.112 0.124 0.137 0.149 0.162 16 0.079 0.092 0.104 0.117 0.129 0.142 0.154 0.167 17 0.084 0.097 0.109 0.122 0.134 0.147 0.159 0.172 18 0.089 0.102 0.114 0.127 0.139 0.152 0.164 0.176 19 0.094 0.107 0.119 0.131 0.144 0.156 0.169 0.181 20 0.099 0.111 0.124 0.136 0.149 0.161 0.174 0.186 21 0.104 0.116 0.129 0.141 0.154 0.166 0.179 0.191 22 0.109 0.121 0.134 0.146 0.159 0.171 0.184 0.196 23 0.114 0.126 0.139 0.151 0.164 0.176 0.189 0.201 24 0.119 0.131 0.144 0.156 0.169 0.181 0.194 0.206 25 0.124 0.136 0.149 0.161 0.174 0.186 0.199 0.211 26 0.129 0.141 0.154 0.166 0.179 0.191 0.204 0.216 27 0.134 0.146 0.159 0.171 0.184 0.196 0.209 0.221 28 0.139 0.151 0.164 0.176 0.189 0.201 0.213 0.226 29 0.144 0.156 0.169 0.181 0.193 0.206 0.218 0.231 30 0.149 0.161 0.173 0.186 0.198 0.211 0.223 0.236 31 0.153 0.166 0.178 0.191 0.203 0.216 0.228 0.241 32 0.158 0.171 0.183 0.196 0.208 0.221 0.233 0.246 33 0.163 0.176 0.188 0.201 0.213 0.226 0.238 0.251 34 0.168 0.181 0.193 0.206 0.218 0.231 0.243 0.256 35 0.173 0.186 0.198 0.211 0.223 0.236 0.248 0.261 36 0.178 0.191 0.203 0.216 0.228 0.241 0.253 0.266 37 0.183 0.196 0.208 0.221 0.233 0.246 0.258 0.271 38 0.188 0.201 0.213 0.226 0.238 0.251 0.263 0.275 39 0.193 0.206 0.218 0.230 0.243 0.255 0.268 0.280 40 0.198 0.210 0.223 0.235 0.248 0.260 0.273 0.285 41 0.203 0.215 0.228 0.240 0.253 0.265 0.278 0.290 42 0.208 0.220 0.233 0.245 0.258 0.270 0.283 0.295 43 0.213 0.225 0.238 0.250 0.263 0.275 0.288 0.300 44 0.218 0.230 0.243 0.255 0.268 0.280 0.293 0.305 45 0.223 0.235 0.248 0.260 0.273 0.285 0.298 0.310 46 0.228 0.240 0.253 0.265 0.278 0.290 0.303 0.315 47 0.233 0.245 0.258 0.270 0.283 0.295 0.308 0.320 48 0.238 0.250 0.263 0.275 0.288 0.300 0.312 0.325 49 0.243 0.255 0.268 0.280 0.292 0.305 0.317 0.330 50 0.248 0.260 0.272 0.285 0.297 0.310 0.322 0.335 51 0.273 0.285 0.297 0.309 0.321 0.333 0.345 0.357 52 0.298 0.309 0.321 0.333 0.344 0.356 0.368 0.379 53 0.323 0.334 0.345 0.356 0.368 0.379 0.390 0.401 54 0.348 0.359 0.369 0.380 0.391 0.402 0.413 0.424 55 0.373 0.383 0.394 0.404 0.415 0.425 0.435 0.446 56 0.398 0.408 0.418 0.428 0.438 0.448 0.458 0.468 57 0.423 0.433 0.442 0.452 0.461 0.471 0.480 0.490 58 0.448 0.457 0.466 0.476 0.485 0.494 0.503 0.512 59 0.473 0.482 0.491 0.499 0.508 0.517 0.526 0.534 60 0.498 0.507 0.515 0.523 0.532 0.540 0.548 0.557 61 0.523 0.531 0.539 0.547 0.555 0.563 0.571 0.579 62 0.549 0.556 0.563 0.571 0.578 0.586 0.593 0.601 63 0.574 0.581 0.588 0.595 0.602 0.609 0.616 0.623 64 0.599 0.605 0.612 0.619 0.625 0.632 0.639 0.645 65 0.624 0.630 0.636 0.642 0.649 0.655 0.661 0.667 66 0.649 0.655 0.660 0.666 0.672 0.678 0.684 0.690 67 0.674 0.679 0.685 0.690 0.696 0.701 0.706 0.712 68 0.699 0.704 0.709 0.714 0.719 0.724 0.729 0.734 69 0.724 0.729 0.733 0.738 0.742 0.747 0.752 0.756 70 0.749 0.753 0.757 0.762 0.766 0.770 0.774 0.778 71 0.774 0.778 0.782 0.785 0.789 0.793 0.797 0.800 72 0.799 0.803 0.806 0.809 0.813 0.816 0.819 0.823 73 0.824 0.827 0.830 0.833 0.836 0.839 0.842 0.845 74 0.850 0.852 0.854 0.857 0.859 0.862 0.864 0.867 75 0.875 0.877 0.879 0.881 0.883 0.885 0.887 0.889 76 0.900 0.901 0.903 0.905 0.906 0.908 0.910 0.911 77 0.925 0.926 0.927 0.928 0.930 0.931 0.932 0.933 78 0.950 0.951 0.951 0.952 0.953 0.954 0.955 0.956 79 0.975 0.975 0.976 0.976 0.977 0.977 0.977 0.978 80 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 For impairment greater than 80 points, the value is always 1.00.
Combined ratings
If the two service-caused conditions lead to impairment ratings of A for warlike (or non-warlike) service and B for peacetime service, then the compensation payable will be a weighted average. This is determined on the amount that would be paid if they both were caused by warlike (or non-warlike) and both by peacetime service. The weights used are the impairment ratings A and B. If the combined impairment is C (see Chapter 18) and the lifestyle effect is L, this can be expressed as:
CFfinal(C,L) =
A * CFwl(C,L) + B * CFpt(C,L)
(A + B)
where the CF values for warlike (or non-warlike) and peacetime service are taken from the relevant tables the final value of CF is applied to determine the final level of compensation.
Captain Brown has two conditions, a gastro-intestinal condition (A) resulting from warlike service assessed as 20 impairment points and a spinal injury (B) resulting from peacetime service assessed as 30 impairment points.
The lifestyle rating (L) from these conditions is 4.
The combined impairment rating (C) is 44.
The compensation factor that would be applied if both conditions resulted from warlike service would be 0.478.
If both conditions resulted from peacetime service it would be 0.268.
The weighted average, using the above formula, is (20 * 0.478 + 30 * 0.268)/(20 + 30) or 0.352.
The maximum compensation payable of $245.82 is multiplied by this factor to give a periodic payment of $86.53 per week.
Note: If the gastro-intestinal condition had arisen from peacetime service and the spinal condition from warlike service, with the same impairment and lifestyle ratings, the final compensation factor would be (30 * 0.478 + 20 * 0.268)/(30 + 20) or 0.394, with a periodic payment of $96.85 per week.
Chapter 24
CONVERTING WEEKLY SUMS INTO LUMP SUMS
Once the MRCC determines that compensation is payable under any of sections 68, 71 or 75(2) of the Act it must notify the claimant of the weekly amount of compensation and advise if it may be converted wholly or partly into a lump sum.
A member may accept the weekly payment for life or convert all or part of it to a lump sum using factors approved by the Australian Government Actuary.
The convertible amount
The convertible amount (see section 78) is the weekly amount of compensation that is payable.
If the convertible amount is less than 10% of the maximum weekly amount payable under the Military Rehabilitation and Compensation Act 2004, the person may convert the entire amount to a lump sum.
If the convertible amount is at least 10% but not more than 20% of the maximum weekly amount payable under the Act then the person may convert 50% or 100% to a lump sum.
If the convertible amount is more than 20% of the maximum weekly amount payable under the Act then the person may convert 25%, 50%, 75% or 100% to a lump sum.
Chapter 25
METHOD OF WORKING OUT THE AMOUNT OF COMPENSATION PAYABLE UNDER THE MRCA FOR A PERSON WITH A VEA OR SRCA INJURY OR DISEASE
This Chapter deals with situations where an injury or disease (the condition) has been accepted under the VEA or the SRCA before a claim is made under the MRCA. The claim under the MRCA may be for a new condition unrelated to the first or for an aggravation of the pre-existing condition. The method to deal with amounts of compensation already paid for the condition and the amount due under the MRCA now or later is described below.
Bringing across impairment points from an unrelated VEA injury or disease
A claim made under section 319 of the MRCA may result in liability for an injury or disease being accepted and compensation payable. Where a person entitled to a payment under MRCA in respect of permanent impairment is also entitled to a payment of disability pension under the VEA, or has an accepted condition under the VEA, the combined impairment must be determined under the MRCA using this Guide. An accepted condition under the VEA is referred to as the old injury or disease.
The MRCA claim may not result in a greater impairment rating, or result in a compensation periodic payment because it is too small to meet the threshold value. It may also be that it is only a temporary change. In the latter case liability is established for the purpose of paying incapacity payments.
In order to decide whether or not compensation is payable under the MRCA the impairment resulting from any old injury or disease must be determined using this Guide, as at the date of the MRCA determination. The points so derived for the old injury or disease must then be combined with those attributable to the injury or disease claimed under the MRCA using the combined impairment table to determine the overall impairment assessment for the purpose of the MRCA.
IR—Impairment Rating
V—Old VEA injury or disease
M—MRCA injury or diseaseTotal IR(V + M) = combined [IR(V) + IR(M)]
Determine the lifestyle effect of both V and M taken together.
Calculate the MRCA periodic payment for the resulting total impairment ratings and lifestyle effects in $/week.
Subtract VEA disability pension payment in $/week.
The remainder is the net MRCA periodic payment.
The net MRCA periodic payment is the periodic payment due to the claimant because of the effects of the MRCA injury or disease. The VEA disability pension continues in payment for life. The net periodic payment under the MRCA continues for life.
The net MRCA periodic payment, but not the VEA disability pension, can be converted to a lump sum in accordance with section 78 of the MRCA.
Bringing across impairment points from a VEA injury or disease that is aggravated
A claim can be made under section 319 is in respect of the cause, aggravation or material contribution to the old injury or disease. The combined impairment must be determined under the MRCA using this Guide.
A claim can be made for the aggravation or material contribution to the signs or symptoms of such an injury or disease because of section 30 of the MRCA.
The MRCA claim may not result in a greater impairment rating, or result in a compensation periodic payment because it is too small to meet the threshold value. It may also be that it is only a temporary change. In the latter case liability is established for the purpose of paying incapacity payments.
IR—Impairment Rating
V—Old VEA injury or disease
V*—MRCA injury or disease (aggravation of V)IR(V+V*) = impairment rating for the aggravated condition
Determine the lifestyle effect of both V and V* taken together.
Calculate the MRCA periodic payment for the resulting total impairment ratings and lifestyle effects in $/week.
Subtract VEA disability pension payment in $/week.
The remainder is the net MRCA periodic payment.
The net MRCA periodic payment is the periodic payment due to the claimant because of the effects of the MRCA injury or disease. The VEA disability pension continues in payment for life. The net periodic payment under the MRCA continues for life.
The net MRCA periodic payment, but not the VEA disability pension, can be converted to a lump sum in accordance with section 78 of the MRCA.
Bringing across impairment points from an unrelated SRCA injury or disease
A claim made under section 319 of the MRCA may result in liability for an injury or disease being accepted and compensation payable. Where a person entitled to a payment under MRCA in respect of permanent impairment was or is paid a lump sum for permanent impairment under the SRCA or liability for a condition accepted under the SRCA the combined impairment must be determined under the MRCA using this Guide. An accepted liability under the SRCA is referred to as the old injury or disease.
This may not result in a greater impairment rating, or result in a compensation periodic payment because it is too small to meet the threshold value. It may also be that it is only a temporary change. In the latter case liability is established for the purpose of paying incapacity payments.
The impairment resulting from any old injury or disease must be determined using this Guide as at the date of the MRCA determination. The points so derived for the old injury or disease must then be combined using the combined impairment table to determine the overall impairment assessment for the purpose of the MRCA.
IR—Impairment Rating
S—Old SRCA injury or disease
M—MRCA injury or diseaseTotal IR(S + M) = combined [IR(S) + IR(M)]
Determine the lifestyle effect of both M and S taken together.
The SRCA lump sum, converted to a periodic payment, is subtracted from the MRCA periodic payment to get the net MRCA periodic payment.
In order to calculate the net MRCA periodic payment the SRCA lump sum must be converted to a periodic payment. The SRCA amount is converted to a current lump sum value (by multiplying by the ratio of the current value for maximum SRCA section 24 payment to the value when the lump sum payment was made) and the amount converted to a periodic payment by dividing by an age-based number provided by the Australian Government Actuary for this purpose. The age to be used in applying this age-based number is the age the person was at the time the SRCA lump sum was paid. The amount is indexed annually (on 1 July) using the indexation factor calculated under section 404 of the MRCA.
The net MRCA periodic payments continue for life or can be converted to a lump sum in accordance with section 78 of the MRCA.
Bringing across impairment points from a SRCA injury or disease that is aggravated
A claim can be made under section 319 is in respect of the aggravation or material contribution to the old injury or disease, or the aggravation or material contribution to the signs or symptoms of such an injury or disease. The total impairment must be determined under the MRCA using this Guide.
This may not result in a greater impairment rating, or result in a compensation periodic payment because it is too small to meet the threshold value. It may also be that it is only a temporary change. In the latter case liability is established for the purpose of paying incapacity payments.
The impairment resulting from any old injury or disease must be determined using this Guide as at the date of the MRCA determination. The points so derived for the old injury or disease must then be combined using the combined impairment table to determine the overall impairment assessment for the purpose of the MRCA.
IR—Impairment Rating
S—Old SRCA injury or disease
S*—MRCA injury or disease (aggravation of S)
IR(S + S*) = impairment rating for the aggravated conditionDetermine the lifestyle effect of both S and S* taken together.
The SRCA lump sum, converted to a periodic payment, is subtracted from the MRCA periodic payment to get the net MRCA periodic payment.
In order to calculate the net MRCA periodic payment the SRCA lump sum must be converted to a periodic payment. The SRCA amount is converted to a current lump sum value (by multiplying by the ratio of the current value for maximum SRCA section 24 payment to the value when the lump sum payment was made) and the amount converted to a periodic payment by dividing by an age-based number provided by the Australian Government Actuary for this purpose. The age to be used in applying this age-based number is the age the person was at the time the SRCA lump sum was paid. The amount is indexed annually (on 1 July) using the indexation factor calculated under section 404 of the MRCA.
The net MRCA periodic payments continue for life or can be converted to a lump sum in accordance with section 78 of the MRCA.
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