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![]() New Table of DisabilitiesApril 2006 EditionChapter 19
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Table 19.1 | Loss of Function – Activities of Daily Living – Personal Hygiene | This table is used to rate impairment of an activity of daily living, specifically personal hygiene. |
Table 19.2 | Loss of Function – Activities of Daily Living – Dressing | This table is used to rate impairment of an activity of daily living, specifically dressing. |
Table 19.3 | Loss of Function – Activities of Daily Living – Eating | This table is used to rate impairment of an activity of daily living, specifically eating. |
Table 19.4 | Loss of Function – Activities of Daily Living – Transfers/Bed Mobility | This table is used to rate impairment of an activity of daily living, specifically transfers/bed mobility. |
Table 19.5 | Loss of Function – Activities of Daily Living – Locomotion | This table is used to rate impairment of an activity of daily living, specifically locomotion. |
Table 19.6 | Loss of Function – Activities of Daily Living – Bowel and Bladder Control | This table is used to rate impairment of an activity of daily living, specifically bowel and bladder control. |
Table 19.7 | Other Impairment – Chronic Pain | This table is used to rate chronic pain. |
Table 19.1 to Table 19.6 are used to rate entitled conditions that have multi-system or global body effects.
A rating may be applicable from each Table 19.1 to Table 19.6. If non-entitled conditions, or conditions rated within another chapter of the Table of Disabilities, are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this chapter. If applicable, the Partially Contributing Table is applied at each table level.
Only one rating may be selected from Table 19.7. If more than one rating is applicable, the ratings are compared and the highest selected.
A rating from this table is not added to a rating from any other chapter for the same entitled disability.
Pain and chronic pain are defined in many ways.
The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage". The US Commission on the Evaluation of Pain defines it as a "complex experience, embracing physical, mental, social, and behavioural processes, which compromises the quality of life of many individuals."
The American Medical Association defines chronic pain as "an evolving process in which injury may produce one pathogenic mechanism, which in turn produces others, so that the causes(s) of pain change over time".
The perception of pain and its severity is complex and individually based. Pain is highly influenced by emotion, the individual's personality and values, cognitive awareness, experiences, education and ethnic and cultural background. Chronic pain may affect the social and emotional well-being of the individual, and effects are proportional to the duration the pain has been present and to its intensity.
As the perception of pain is highly subjective, and as the study of the evaluation of pain continues to evolve, the objective evaluation of chronic pain is extremely difficult. Therefore, the evaluation of pain behaviour and emotional status and attitude is important in the assessment of chronic pain.
The manner in which emotional distress presents is very individual. It may present as withdrawal, anger or unreasonableness, depressive features or bodily complaints.
For VAC purposes, "chronic pain" is pain that persists beyond the period of time normally required for complete physical healing or pain due to chronic physical disorders such as rheumatoid arthritis. Further, this pain must be in existence for at least 6 months before it is considered to be chronic. This pain is generally expected to persist despite medical attention, although it may wax and wane over the 6-month period and thereafter. Key elements considered in the assessment of emotional distress in relation to pain include overall mood, anxiety, depressive features, and irritability. Symptoms of headache, musculoskeletal pain, fatigue, gastrointestinal distress, memory difficulties and insomnia are common, and will be included in the rating of the condition within this table.
Impairment from pain disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and chronic pain syndrome are rated within Chapter 21, Psychiatric Impairment and this chapter. The ratings are compared and the highest selected.
If non-entitled conditions or conditions rated within another chapter of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.
Each bullet () represents one criterion. In order for a rating to be established for Table 19.1, all criteria designated at that rating level must be met.
Table 19.1 – Loss of Function – Personal Hygiene
Rating | Criteria | Examples |
Nil |
|
– Preparing for and completing the following activities: cleaning teeth or dentures; clipping nails; combing or brushing hair; shaving or applying make-up; and washing, rinsing and drying the face and body either in the tub, shower or via sponge bath. |
One |
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– Pain with reaching to clip toe nails.
– Difficulty getting the arm overhead and reaching to brush hair. – Takes more than a reasonable amount of time to bathe/groom self. |
Four |
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– Requires use of a long-handled wash sponge/brush.
– Needs to use an electric razor for safety. |
Nine |
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– Requires the personal assistance of another person to prepare shower equipment or set Member/Veteran/Client up for a sponge bath.
– Requires the personal assistance of another person to supervise shower for safety reasons. – Member/Veteran/Client needs help with nail care only. – Member/Veteran/Client able to bathe self except for his/her feet. – Member/Veteran/Client not able to reach overhead to brush/comb hair. |
Thirteen |
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– Member/Veteran/Client needs help to bathe self below the knees and perineum/buttock areas and to perform nail care.
– Member/Veteran/Client able to only minimally assist by helping to position limbs for bathing, etc. |
Each bullet () represents one criterion. In order for a rating to be established for Table 19.2, all criteria designated at that rating level must be met.
Table 19.2 – Loss of Function – Dressing
Rating | Criteria | Examples |
Nil |
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– Obtaining clothes from their customary places such as drawers and closets; manages bra, pullover garment or front-opening garment; managing underpants, slacks, skirt, belt, stockings and shoes; manages zippers, buttons or snaps; and applies and removes prosthesis or orthosis when applicable. |
One |
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– Multiple attempts to reach feet before socks are removed.
– Pain with pulling on garments overhead, etc. – Takes more than a reasonable amount of time to dress/undress. |
Four |
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– Wears modified clothing, such as clothing with velcro.
– Uses one or more assistive devices such as prosthesis or orthosis, a button hook, sock aid, elastic shoe laces, etc. to dress. |
Nine |
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– Requires the personal assistance of another person to prepare/collect clothing for wear.
– Member/Veteran/Client needs help with shoes and socks only. – Member/Veteran/Client unable to put bra on independently. – Member/Veteran/Client able to dress the upper limbs, but requires assistance getting clothing over his/her feet to dress the lower limbs. |
Thirteen |
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– Member/Veteran/Client able to help dress one side, but requires assistance with closures, and getting clothing over head and over his/her feet to dress the lower limbs.
– Member/Veteran/Client able to only minimally assist by helping to position limbs for dressing, etc. |
Each bullet () represents one criterion. In order for a rating to be established for Table 19.3, all criteria designated at that rating level must be met.
Table 19.3 – Loss of Function – Eating
Rating | Criteria | Examples |
Nil |
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– Eating from a dish; using a spoon or fork to bring food to the mouth; food is chewed and swallowed, managing all consistencies of food; and drinking from a cup or glass. |
Three |
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– Difficulty cutting meat or buttering bread.
– Pain with moving the upper limb through range of motion required to bring fork or glass to the mouth. – Difficulty keeping food on fork or spoon due to unsteadiness. – Takes more than a reasonable amount of time to eat. |
Nine |
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– Requires modified table wear, such as a rocker knife, high-sided bowl, flatware with specialty handles, a drinking straw, etc.
– Requires modified food consistency or blenderized food. |
Thirteen |
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– Requires the personal assistance of another person to cut meats, butter breads, open cartons.
– Requires the personal assistance of another person to apply an orthosis. – Member/Veteran/Client is able to eat most of his/her meal independently. Requires assistance with heavy cups and foods, such as peas, which require a steadier hand. – Member/Veteran/Client requires supervision and help as the Member/Veteran/Client tends to choke, has swallowing problems, or is quite confused and forgets to eat. |
Eighteen |
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– Member/Veteran/Client is unable to use utensils. Member/Veteran/Client is able to raise foods such as breads, biscuits, sandwiches, etc. to his/her mouth independently, but requires the physical assistance of another person for all foods for which utensils are to be used. |
Twenty-one |
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– Member/Veteran/Client is fed.
– Member/Veteran/Client takes no food by mouth. |
Each bullet () represents one criterion. In order for a rating to be established for Table 19.4, all criteria designated at that rating level must be met.
Table 19.4 – Loss of Function – Transfers/Bed Mobility
Rating | Criteria | Examples |
Nil |
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– Able to sit up and move around in bed unaided, and able to move from sitting to standing and standing to sitting unaided. |
One |
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– A wide stance, shakiness, etc., when moving from sitting to standing, or from standing to sitting.
– Multiple attempts before successfully carrying out a transfer or movement in bed. – Pain with transfers and bed mobility. – May take more than reasonable time to carry out activity. |
Four |
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– Needs the use of the upper extremities when moving from sitting to standing, or from standing to sitting.
– Requires a raised seating/surface. – Needs assistive devices such as a bed ladder or similar device, transfer rails or a chair with arm rests, etc. |
Nine |
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– Requires that a person be available to prepare the surfaces for transfer (i.e. raise or lower the surface).
– Uncomfortable moving from sitting to standing or standing to sitting without the presence of another person "in case". |
Thirteen |
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– Requires some help positioning the lower extremities in bed.
– Requires the physical assistance of another person to help position the legs to prepare for transfers, etc. |
Eighteen |
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– Requires partial lift or support when moving from standing to sitting or sitting to standing.
– Requires partial lift, or boost, to move from lying to sitting, or to move around in bed. |
Twenty-one |
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– Requires the use of manual or electric lifts.
– Requires a two-person lift. |
Each bullet () represents one criterion. In order for a rating to be established for Table 19.5, all criteria designated at that rating level must be met.
Table 19.5 – Loss of Function – Locomotion
Rating | Criteria | Examples |
Nil |
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– Walks in a manner normal for age on a variety of different terrains and at varying speeds. |
Four |
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– Walks at a normal pace on flat ground but with intermittent difficulty.
– Caution needed on steps and uneven ground. – Intermittent pain with weight bearing. |
Nine |
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– Walks at a reduced pace in comparison with peers on flat ground.
– Unable to manage stairs or ramps without rails. – Pain restricts walking to 250 m or less at a time. Can walk further after resting. |
Eighteen |
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– Requires the physical assistance of another person to hold their arm for stability.
– Unable to negotiate stairs without personal assistance. – Requires routine use of a cane or crutch. – Pain restricts walking to 100 m or less at a time. Can walk further after resting. |
Twenty-six |
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– Client requires the routine use of a walker.
– Pain restricts walking to 50 m or less at a time. Can walk further after resting. |
Thirty-four |
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– Is bed/chair bound. |
Each bullet () represents one criterion. In order for a rating to be established for Table 19.6, only one criterion must be met at a level of impairment for that rating to be selected.
Table 19.6 – Loss of Function – Bowel and Bladder Control
Rating | Criteria |
Nil |
|
One |
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Four |
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Nine |
|
Thirteen |
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Eighteen |
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Twenty-six |
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Thirty-four |
|
Forty-three |
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Each bullet () represents one criterion. In order for a rating to be established for Table 19.7 , the majority of bullets at a certain rating level must be met.
Table 19.7 – Other Impairment – Chronic Pain
Rating | Criteria |
Nil |
|
Two |
|
Four |
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Nine |
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Thirteen |
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* Intractable pain is severe, persistent, ongoing pain that is unresponsive to the usual treatment modalities.
Step 1: | Determine the rating from Table 19.1 (Loss of Function – Activities of Daily Living – Personal Hygiene). |
Step 2: | Does the Partially Contributing Table apply? If yes, apply to the Step 1 rating. |
Step 3: | Determine the rating from Table 19.2 (Loss of Function – Activities of Daily Living – Dressing). |
Step 4: | Does the Partially Contributing Table apply? If yes, apply to the Step 2 rating. |
Step 5: | Determine the rating from Table 19.3 (Loss of Function – Activities of Daily Living – Eating). |
Step 6: | Does the Partially Contributing Table apply? If yes, apply to the Step 5 rating. |
Step 7: | Determine the rating from Table 19.4 (Loss of Function – Activities of Daily Living – Transfers/Bed Mobility). |
Step 8: | Does the Partially Contributing Table apply? If yes, apply to the Step 7 rating. |
Step 9: | Determine rating from Table 19.5 (Loss of Function – Activities of Daily Living – Locomotion). |
Step 10: | Does the Partially Contributing Table apply? If yes, apply to the Step 9 rating. |
Step 11: | Determine rating from Table 19.6 (Loss of Function – Activities of Daily Living – Bowel and Bladder Control). |
Step 12: | Does the Partially Contributing Table apply? If yes, apply to the Step 11 rating. |
Step 13: | Determine rating from Table 19.7 (Other Impairment – Activities of Daily Living – Chronic Pain). |
Step 14: | Does the Partially Contributing Table apply? If yes, apply to the Step 13 rating. |
Step 15: | Add the ratings at Step 2, 4, 6, 8, 10,12 and 14. |
Step 16: | Determine the Quality of Life rating. |
Step 17: | Add the ratings at Step 15 and 16. |
Step 18: | If partial entitlement exists, apply to rating at Step 17. |
Note: | If a client is entitled for a psychiatric condition and a condition having global or multi-system effects (e.g. major depression and fibromyalgia) the conditions are bracketed and the rating is determined using both this chapter and Chapter 21, Psychiatric Impairment. The ratings are compared and the highest selected. |
Step 19: | Compare ratings at Step 18 with rating from Chapter 21 Psychiatric Impairment (if applicable) and select the highest. |
This is the Disability Assessment. |