Chapter 14 - Gastrointestinal Impairment

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Table of Contents PDF Version

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Introduction

This chapter provides criteria for assessing permanent impairment from entitled conditions of the gastrointestinal tract and the accessory organs of digestion (liver, gallbladder and pancreas). This chapter is also used to rate abdominal wall hernias, inguinal hernias, pilonidal sinus disease and obesity.

A rating is not given from this chapter for the conditions listed below. Each bullet indicates the appropriate chapter to be used.

• Impairment from dysphagia due to a neurological condition is rated within Chapter 20, Neurological Impairment.
• Impairment from diabetes mellitus is rated within Chapter 15, Endocrine and Metabolic Impairment.

No additional rating will be given from Chapter 22, Skin Impairment as a result of skin manifestations due to ostomies.

Impairment from malignant gastrointestinal conditions is rated within Chapter 18, Malignant Impairment. Follow the steps contained within the Malignant Impairment chapter.

Rating Tables and Charts

This chapter contains eight "Other Impairment" tables which may be used to rate entitled gastrointestinal conditions. Two reference charts are also included within this chapter. The first notes ideal weights by sex, height, and body build. The second is a body mass index chart.

The tables within this chapter give specific impairment ratings based largely on the presence of symptoms; however, most tables also contain applicable functional loss criteria (e.g. weight loss).

The tables within this chapter are:

Rating Tables and Charts

Table	Loss of Function	Other Impairment
Table 14.1	Other Impairment - Oral Cavity and Salivary Glands	This table is used to rate impairment of the oral cavity and salivary glands.
Table 14.2	Other Impairment - Esophagus	This table is used to rate impairment of the esophagus.
Table 14.3	Other Impairment - Stomach and Duodenum	This table is used to rate impairment of the stomach and duodenum.
Table 14.4	Other Impairment - Gastric Surgery	This table is used to rate impairment from past gastric surgery.
Table 14.5	Other Impairment - Small Bowel, Large Bowel, Rectum and Anus	This table is used to rate impairment of the small bowel, large bowel, rectum and anus.
Table 14.6	Other Impairment - Liver and Gallbladder	This table is used to rate impairment of the liver and gallbladder.
Table 14.7	Other Impairment - Pancreas	This table is used to rate impairment of the pancreas.
Table 14.8	Other Impairment - Miscellaneous Gastrointestinal	This table is used to rate impairment from miscellaneous gastrointestinal conditions.
Chart 1	Chart 1 - Weights by Sex, Height, and Body Build	This chart provides ideal weights by sex, height and body build.
Chart 2	Chart 2 - Body Mass Index (BMI) Chart	This is a body mass index chart.

Weight Loss

Weight loss is an important indicator of gastrointestinal disease severity. Weight loss criteria is contained within each applicable table.

Any weight loss must be caused by the entitled condition. For VAC purposes "a loss of weight" is defined as a significant involuntary weight reduction with the inability to regain weight, despite optimal therapy.

To determine impairment resulting from gastrointestinal conditions, the pre-morbid weight (weight before the beginning or worsening of the entitled gastrointestinal condition) is measured against any deviation or weight loss.

Steps to Determine Weight Loss:

• Step 1: Determine pre-morbid weight

  Pre-morbid weight may be determined from medical history or previous health records.

  Where pre-morbid weight is absent, to approximate pre-morbid weight, refer to either:

  Chart 1 - Weights by Sex, Height, and Body Build, or Chart 2 - the Body Mass Index (BMI) Chart and related Instructions.

• Step 2: Determine the weight at the time of the assessment.
• Step 3: Determine the weight loss by subtracting the assessment weight (Step 2) from the pre-morbid weight (Step 1) and express in terms of a percentage.

  Where the weight in Step Two is equal to or greater than the pre-morbid weight, no rating based on involuntary weight loss can be given.

  Where the weight in Step Two is less than the pre-morbid weight, express the difference as a percentage of the pre-morbid weight.

  weight loss (pre-morbid weight - assessment weight) / pre-morbid weight X 100% = %

• Step 4: Apply the weight loss percentages to the applicable table.

Other Impairment - Oral Cavity and Salivary Glands

Table 14.1 is used to rate impairment of the oral cavity and salivary glands. Only one rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

When entitled oral cavity and salivary gland conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Esophagus

Table 14.2 is used to rate impairment of the esophagus. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

If more than one condition of the esophagus is to be rated from Table 14.2, the conditions are bracketed for assessment purposes.

When entitled conditions of the esophagus result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Stomach and Duodenum

Table 14.3 is used to rate impairment of the stomach and duodenum. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

If more than one condition of the stomach and duodenum is to be rated from Table 14.3, the conditions are bracketed for assessment purposes.

If a Member/Veteran/Client has had gastric surgery, a rating(s) may be applicable from Table 14.4 and/or Table 14.5. Any applicable rating(s) from Table 14.4 and/or Table 14.5 must be added to the rating from this table.

When entitled stomach and duodenum conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Gastric Surgery

Table 14.4 is used to rate impairment from past gastric surgery. Only one rating may be selected for each condition. If more than one rating is applicable for a condition, the ratings are compared and the highest selected.

Note: Postvagotomy syndrome is rated within Table 14.5 - Other Impairment - Small Bowel, Large Bowel, Rectum and Anus.

Any applicable rating(s) from this table or Table 14.5 must be added to the impairment rating(s) from Table 14.3.

When entitled gastric conditions which require surgery result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Small Bowel, Large Bowel, Rectum and Anus

Table 14.5 is used to rate impairment for each entitled condition of the small bowel, large bowel, rectum and anus. Only one rating may be selected for an entitled condition. If more than one rating is applicable, the ratings are compared and the highest selected.

For VAC purposes, bowel disorders include irritable bowel syndrome, diverticulosis, diverticulitis, chronic constipation, chronic diarrhea and postvagotomy syndrome.

Inflammatory bowel disease (IBD) ratings obtained from Table 14.5 include all intestinal manifestations of IBD as well as aphthous stomatitis, anemia and constitutional signs and symptoms such as nausea, fever and fatigue.

When entitled small bowel, large bowel, rectum and anus conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Liver and Gallbladder

Table 14.6 is used to rate impairment of the liver and gallbladder. Two ratings may be selected from Table 14.6, one rating for liver disease and one rating for gallbladder disease. If more than one rating is applicable for the liver, the ratings are compared and the highest selected. If more than one rating is applicable for the gallbladder, the ratings are compared and the highest selected.

If more than one condition of the liver is to be rated, the conditions are bracketed for assessment purposes.

If more than one condition of the gallbladder is to be rated, the conditions are bracketed for assessment purposes.

When entitled liver or gallbladder disease results in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Pancreas

Table 14.7 is used to rate impairment of the pancreas. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

If more than one condition of the pancreas is to be rated from Table 14.7, the conditions are bracketed for assessment purposes.

When entitled conditions of the pancreas result in diabetes mellitus, a consequential entitlement decision is required. If awarded, the resulting impairment is rated within Chapter 15, Endocrine and Metabolic Impairment.

If non-entitled conditions or conditions rated within another chapter/table 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.

Other Impairment - Miscellaneous Gastrointestinal

Table 14.8 is used to rate impairment of miscellaneous gastrointestinal conditions. Only one rating may be selected for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

For VAC purposes morbid obesity is defined as a Body Mass Index (BMI) greater than or equal to 40. Morbid obesity is rated within this table only when it is an entitled condition.

When entitled miscellaneous gastrointestinal conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table 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.

Table 14.1 - Other Impairment - Oral Cavity and Salivary Glands

Only one rating may be given for each entitled condition from Table 14.1. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.1, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.1 - Other Impairment - Oral Cavity and Salivary Glands

Rating	Criteria
Nil	Conditions of the oral cavity and salivary glands: Salivary gland swelling; or Xerostomia not requiring treatment; or Single episode of acute sialodenitis; or Single episode of salivary calculi; or Halitosis; or Ingestion: Oral conditions that do not interfere with chewing or swallowing; or Maintenance of Nutrition: No involuntary weight loss.
Two	Conditions of the oral cavity and salivary glands: Xerostomia requiring regular treatment; or Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Conditions of the oral cavity and salivary glands: Recurrent salivary calculi; or Recurrent episodes of sialadenitis; or Ingestion: Mild to moderate difficulty in chewing or swallowing.
Nine	Maintenance of Nutrition: Permanent soft or semi-solid diet required.
Thirteen	Ingestion: Significant difficulty in chewing; or Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Permanent pureed or liquid diet required; or Esophagostomy or gastrostomy.
Eighteen	Maintenance of Nutrition: Jejunostomy.
Twenty-six	Maintenance of Nutrition: Involuntary weight loss of 15 - 19%.
Thirty-four	Maintenance of Nutrition: Involuntary weight loss of 20 - 25%.
Forty-three	Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Maintenance of Nutrition: Involuntary weight loss greater than 30%.

Steps to Determine Gastrointestinal Oral Cavity and Salivary Glands Assessment

• Step 1: Determine the rating from Table 14.1 (Other Impairment - Oral Cavity and Salivary Glands).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Note: If a condition of the oral cavity and the salivary glands both require a rating, the steps are repeated.

Table 14.2 - Other Impairment - Esophagus

Only one rating may be given from Table 14.2. If more than one rating is applicable, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.2, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.2 - Other Impairment - Esophagus

Rating	Criteria
Nil	Conditions of the esophagus: Hiatus hernia; or Ingestion: Esophageal conditions that do not interfere with swallowing; or Maintenance of Nutrition: No involuntary weight loss.
Two	Conditions of the esophagus: Gastroesophageal reflux disease with mild symptoms requiring intermittent treatment; or Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Conditions of the esophagus: Gastroesophageal reflux disease requiring regular treatment; or Ingestion: Mild to moderate dysphagia; or Dysphagia requiring dilatation once per year.
Nine	Maintenance of Nutrition: Permanent soft diet required.
Thirteen	Conditions of the esophagus: Gastroesophageal reflux disease with erosions/ulcerations of the distal esophagus; or Ingestion: Significant dysphagia; or Dysphagia requiring dilatation two or three times per year; or Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Permanent pureed or liquid diet required; or Esophagostomy or gastrostomy.
Eighteen	Conditions of the esophagus: Gastroesophageal reflux disease complicated by Barrett's esophagus; or Esophagectomy; or Maintenance of Nutrition: Jejunostomy.
Twenty-six	Ingestion: Dysphagia requiring dilatation four or five times per year; or Maintenance of Nutrition: Involuntary weight loss of 15 - 19%.
Thirty-four	Ingestion: Dysphagia requiring dilatation six or more times per year; or Maintenance of Nutrition: Involuntary weight loss of 20 - 25%.
Forty-three	Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Maintenance of Nutrition: Involuntary weight loss of greater than 30%.

Steps to Determine Gastrointestinal Esophagus Assessment

• Step 1: Determine the rating from Table 14.2 (Other Impairment - Esophagus).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Table 14.3 - Other Impairment - Stomach and Duodenum

Only one rating may be given from Table 14.3. If more than one rating is applicable, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.3, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.3 - Other Impairment - Stomach and Duodenum

Rating	Criteria
Nil	Conditions of the stomach and duodenum: Single episode of peptic ulcer disease, gastritis or duodenitis successfully treated; or Maintenance of Nutrition: No involuntary weight loss.
Two	Conditions of the stomach and duodenum: Functional dyspepsia, gastritis or duodenitis requiring intermittent treatment; or Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Conditions of the stomach and duodenum: Functional dyspepsia, gastritis or duodenitis requiring regular treatment; or Recurrent peptic ulcer disease requiring intermittent treatment.
Nine	Conditions of the stomach and duodenum: Peptic ulcer disease with ongoing symptoms requiring regular treatment.
Thirteen	Conditions of the stomach and duodenum: Peptic ulcer disease complicated by recurrent bleeding or outlet obstruction despite optimal treatment; or Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Gastrostomy.
Eighteen	Maintenance of Nutrition: Jejunostomy.
Twenty-one	Conditions of the stomach and duodenum: Peptic ulcer disease complicated by recurrent bleeding and outlet obstruction despite optimal treatment.
Twenty-six	Maintenance of Nutrition: Involuntary weight loss of 15 - 19%.
Thirty-four	Maintenance of Nutrition: Involuntary weight loss of 20 - 25%.
Forty-three	Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Maintenance of Nutrition: Involuntary weight loss of greater than 30%.

Table 14.4 - Other Impairment - Gastric Surgery

Only one rating may be given for each entitled condition from Table 14.4. If more than one rating is applicable for a condition, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.4, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.4 - Other Impairment - Gastric Surgery

Rating	Criteria
Nil	Past gastric surgery; asymptomatic.
Four	Intermittent dumping syndrome.
Nine	Frequent dumping syndrome; or Bile reflux gastritis.
Thirteen	Dumping syndrome on most days.

Note: Postvagotomy syndrome is rated within Table 14.5.

Steps to Determine Gastrointestinal Stomach and Duodenum Assessment

• Step 1: Determine the rating from Table 14.3 (Other Impairment - Stomach and Duodenum).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the rating(s) from Table 14.4 (Other Impairment - Gastric Surgery) (if applicable).

Note: A rating may also be applicable for signs and symptoms of postvagotomy syndrome from the bowel disorder section of Table 14.5 (Other Impairment - Small bowel, Large bowel, Rectum and Anus). If so, applicable ratings from Table 14.4and Table 14.5 are added.

• Step 4: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 3.
• Step 5: Add the ratings at Step 2 and Step 4.
• Step 6: Determine the Quality of Life rating.
• Step 7: Add the ratings at Step 5 and Step 6.
• Step 8: If partial entitlement exists, apply to the rating at Step 7.

This is the Disability Assessment

Table 14.5 - Other Impairment - Small Bowel, Large Bowel, Rectum and Anus

Only one rating may be given for each entitled condition from Table 14.5. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.5, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.5 - Other Impairment - Small Bowel, Large Bowel, Rectum and Anus

Rating	Criteria
Nil	Conditions of the rectum and anus: Hemorrhoidal tags; or Previous hemorrhoidectomy; or Healed anal fissure; or Healed anal fistula; or Healed perineal fistula; or Rectal abscess operated, no recurrence; or Healed rectovaginal fistula; or Bowel Disorder: Occasional diarrhea/constipation not requiring dietary measures or medication(s); or Maintenance of Nutrition: No involuntary weight loss; or Excretion: Hemicolectomy.
Two	Conditions of the rectum and anus: Recurrent rectal abscesses requiring surgical treatment 1-2 times per year; or Bowel disorder: Requiring intermittent medication(s); or Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Conditions of the small bowel, large bowel, rectum and anus: Hemorrhoids present; occasional pain and/or bleeding; or Anal fissure; recurrent symptoms requiring medications; or Recurrent rectal abscesses requiring surgical treatment 3-4 times per year; or Intermittent rectal prolapse; or Bowel disorder: Responsive to continuous dietary measures and continuous medication(s); or Inflammatory bowel disease: Crohn's disease or ulcerative colitis with minimal symptoms; or Maintenance of Nutrition: Malabsorption with symptoms well controlled with dietary measures and continuous medication(s); or Excretion: Fecal incontinence associated with occasional staining; no incontinent pad required.
Nine	Conditions of the small bowel, large bowel, rectum and anus: Hemorrhoids present requiring ongoing medication(s); persistent pain and/or bleeding; or Bowel disorder: Only partially controlled by continuous dietary measures and continuous medications; or Inflammatory bowel disease: Infrequent, mild exacerbations. Symptoms well controlled with intermittent medical therapy; or Excretion: Fecal incontinence associated with soiling but less than daily; may need incontinent pad on occasion.
Thirteen	Conditions of the rectum and anus: Persistent rectal prolapse; or Rectal abscesses requiring surgical treatment more than four times per year; or Bowel disorder: Poor response to continuous dietary measures and continuous medication(s); abdominal pain on most days; considerable interference with daily activities; or Inflammatory bowel disease: One exacerbation per year; or Continuous medication required; or Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Prescribed exclusion diet with permanent severe restriction (e.g. gluten-free diet); or Malabsorption and nutritional deficiencies: with some signs and symptoms (e.g. steatorrhea) despite continuous dietary measures and continuous medication(s); or Esophagostomy or gastrostomy; or Excretion: Fecal incontinence necessitating frequent changes of underwear or 1-4 incontinent pads per day; or Total colectomy.
Eighteen	Maintenance of Nutrition: Jejunostomy.
Twenty-six	Inflammatory bowel disease: Moderate symptoms requiring continuous medical therapy; two to four exacerbations per year; some constitutional symptoms such as weight loss and fever present; hospitalization(s) may be required, but no surgical intervention required; or Maintenance of Nutrition: Involuntary weight loss of 15 - 19%; or Excretion: Fecal incontinence necessitating use of greater than 4 incontinent pads per day; or Permanent colostomy.
Thirty-four	Maintenance of Nutrition: Involuntary weight loss of 20 - 25%; or Excretion: Ileostomy; or Fecal incontinence with complete loss of sphincter control.
Forty-three	Inflammatory bowel disease: Severe symptoms requiring continuous medical therapy and surgical intervention(s) required; or Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Maintenance of Nutrition: Involuntary weight loss greater than 30%.
Eighty-one	Inflammatory bowel disease: Severe illness not responding to medical or surgical treatment; requiring prolonged and repeated hospitalization(s) with severe nutritional impairment.

Inflammatory bowel disease associated with enterocutaneous fistula(e) are rated on individual merits.

Steps to Determine Gastrointestinal Small Bowel, Large Bowel, Rectum and Anus Assessment

• Step 1: Determine the rating from Table 14.5 (Other Impairment - Small Bowel and Large Bowel, Rectum and Anus).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Note: If more than one entitled condition requires a rating, the steps must be repeated.

Table 14.6 - Other Impairment - Liver and Gallbladder

Two ratings may be selected from Table 14.6, one rating for liver disease and one rating for gallbladder disease. If more than one rating is applicable for the liver, the ratings are compared and the highest selected. If more than one rating is applicable for the gallbladder, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.6, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.6 - Other Impairment - Liver and Gallbladder

Rating	Criteria
Nil	Conditions of the liver and gallbladder: Gallbladder disease: asymptomatic; or Cholecystectomy; or Liver disease: asymptomatic; normal or mildly abnormal liver tests; or Maintenance of Nutrition: No involuntary weight loss.
Two	Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Conditions of the liver and gallbladder: Gallbladder disease: recurrent attacks of biliary colic, with or without jaundice; or Maintenance of Nutrition: Malabsorption: symptoms well controlled with continuous dietary measures and continuous medication(s).
Nine	Conditions of the liver and gallbladder: Liver disease: mildly abnormal liver function tests; clinical signs/symptoms of liver disease such as fatigue, but no history of jaundice, ascites, or bleeding episode (esophageal varices) within the last 5 years.
Thirteen	Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Malabsorption and nutritional deficiencies with some signs and symptoms (e.g. steatorrhea) despite continuous dietary measures and continuous medication(s).
Eighteen	Conditions of the liver and gallbladder: Liver disease: persistent elevation of liver function tests and ONE of the following objective signs within the past 5 years: jaundice ascites 1 bleeding episode (esophageal varices).
Twenty-six	Conditions of the liver and gallbladder: Liver transplant (minimum rating); or Maintenance of Nutrition: Involuntary weight loss of 15 - 19%.
Thirty-four	Conditions of the liver and gallbladder: Liver disease: abnormal liver function tests and ONE of the following objective signs within the past 1 year: jaundice ascites 1 bleeding episode (esophageal varices); or Maintenance of Nutrition: Involuntary weight loss of 20 - 25%.
Forty-three	Conditions of the liver and gallbladder: Progressive liver disease with hepatic encephalopathy or TWO of the following objective signs within the past 1 year: persistent jaundice ascites 1 bleeding episode (esophageal varices); or Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Conditions of the liver and gallbladder: Progressive liver disease with hepatic encephalopathy and TWO of the following objective signs within the past 1 year: persistent jaundice ascites 1 bleeding episode (esophageal varices); or Maintenance of Nutrition: Involuntary weight loss greater than 30%.
Eighty-one	Conditions of the liver and gallbladder: Progressive liver disease with ALL of the following objective signs within the past 1 year: persistent jaundice ascites 1 bleeding episode (esophageal varices) hepatic encephalopathy.

Steps to Determine Gastrointestinal Liver and Gallbladder Assessment

• Step 1: Determine the rating from Table 14.6 (Other Impairment - Liver and Gallbladder).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Note: If both a liver and gallbladder condition require a rating, the steps must be repeated.

Table 14.7 - Other Impairment - Pancreas

Only one rating may be given from Table 14.7. If more than one rating is applicable, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.7, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.7 - Other Impairment - Pancreas

Rating	Criteria
Nil	Conditions of the pancreas: Pancreatic disease: asymptomatic; or Maintenance of Nutrition: No involuntary weight loss.
One	Conditions of the pancreas: Pancreatic disease with mild infrequent symptoms.
Two	Maintenance of Nutrition: Minor diet alterations, e.g. permanent avoidance of certain foods.
Four	Maintenance of Nutrition: Malabsorption with symptoms well controlled with continuous dietary measures and continuous medication(s).
Nine	Conditions of the pancreas: Pancreatic pseudocyst*: managed conservatively.
Thirteen	Conditions of the pancreas: Chronic pancreatitis with ongoing intermittent attacks of abdominal pain; or Maintenance of Nutrition: Involuntary weight loss of 10 - 14%; or Malabsorption and nutritional deficiencies with some signs and symptoms (e.g. steatorrhea) despite continuous dietary measures and continuous medication(s).
Eighteen	Conditions of the pancreas: Chronic pancreatitis with frequent attacks of abdominal pain or two or more admissions to hospital within the past year.
Twenty-six	Maintenance of Nutrition: Involuntary weight loss of 15 - 19%.
Thirty-four	Maintenance of Nutrition: Involuntary weight loss of 20 - 25%.
Forty-three	Maintenance of Nutrition: Involuntary weight loss of 26 - 30%.
Sixty-one	Maintenance of Nutrition: Involuntary weight loss of greater than 30%.

* Pancreatic pseudocyst requiring surgical decompression will be rated on individual merits.

Steps to Determine Gastrointestinal Pancreas Assessment

• Step 1: Determine the rating from Table 14.7 (Other Impairment - Pancreas).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Table 14.8 - Other Impairment - Gastrointestinal Miscellaneous

Only one rating may be given for each entitled condition from Table 14.8. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 14.8, only one criterion must be met at a level of impairment for that rating to be selected.

Table 14.8 - Other Impairment - Gastrointestinal Miscellaneous

Rating	Criteria
Nil	• Abdominal wall hernia: asymptomatic, no pain or discomfort; or • Abdominal wall hernia: operated with no symptoms, well healed; or • Inguinal hernia: operated with no symptoms, well healed; or • Pilonidal sinus disease: asymptomatic; or • Pilonidal sinus disease: operated with no symptoms, well healed.
Two	• Abdominal wall hernia: resulting in slight visible protrusion only with increased abdominal pressure, occasional mild discomfort; or • Inguinal hernia: with slight visible protrusion only with increased abdominal pressure, occasional mild discomfort; or • Abdominal wall hernia: operated with ongoing discomfort, well healed scar but scar may be tender; or • Inguinal hernia: operated with ongoing discomfort, well healed scar but scar may be tender.
Three	• Abdominal wall hernia: resulting in visible protrusion, manually reducible, frequent discomfort which precludes heavy lifting but is able to carry out normal daily activities; or • Inguinal hernia: resulting in visible protrusion, manually reducible, frequent discomfort which precludes heavy lifting but is able to carry out normal daily activities.
Four	• Pilonidal sinus disease: recurrent disease with intermittent symptoms despite surgery; or • Morbid obesity: Body Mass Index (BMI) greater than or equal to 40.
Nine	• Abdominal wall hernia: resulting in large visible protrusion, irreducible and irreparable, persistent discomfort, limits normal activities; or • Inguinal hernia: large in size, not readily reducible and irreparable, persistent discomfort, limits normal activities; or • Pilonidal sinus disease: with chronic drainage despite surgery.

Steps to Determine Miscellaneous Gastrointestinal Assessment

• Step 1: Determine the rating from Table 14.8 (Other Impairment - Miscellaneous - Gastrointestinal).
• Step 2: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 1.
• Step 3: Determine the Quality of Life rating.
• Step 4: Add the ratings at Step 2 and Step 3.
• Step 5: If partial entitlement exists, apply to the rating at Step 4.

This is the Disability Assessment

Note: If more than one entitled condition requires a rating, the steps must be repeated.

Reference Chart 1 - Weights by Sex, Height, and Body Build

Indoor clothing weighing 2.3 kg [5 lb] for men and 1.4 kg [3 lb] for women; and shoes with 2.5 cm [1 in] heels.

Men

Reference Chart 1 - Weights by Sex, Height, and Body Build

Height in (cm)	Weight lb (kg)
	Small Frame	Medium Frame	Large Frame
62 (157)	128-134 (58.0-60.7)	131-141 (59.2-63.9)	138-150 (62.5-67.8)
63 (160)	130-136 (59.0-61.7)	133-143 (60.3-64.9)	140-153 (63.5-69.4)
64 (163)	132-138 (60.0-62.7)	135-145 (61.3-66.0)	142-156 (64.5-71.1)
65 (165)	134-140 (60.8-63.5)	137-148 (62.1-67.0)	144-160 (65.3-72.5)
66 (168)	136-142 (61.8-64.6)	139-151 (63.2-68.7)	146-164 (66.4-74.7)
67 (170)	138-145 (62.5-65.7)	142-154 (64.3-69.8)	149-168 (67.5-76.1)
68 (173)	140-148 (63.6-67.3)	145-157 (65.9-71.4)	152-172 (69.1-78.2)
69 (175)	142-151 (64.3-68.3)	148-160 (66.9-72.4)	155-176 (70.1-79.6)
70 (178)	144-154 (65.4-70.0)	151-163 (68.6-74.0)	158-180 (71.8-81.8)
71 (180)	146-157 (66.1-71.0)	154-166 (69.7-75.1)	161-184 (72.8-83.3)
72 (183)	149-160 (67.7-72.7)	157-170 (71.3-77.2)	164-188 (74.5-85.4)
73 (185)	152-164 (68.7-74.1)	160-174 (72.4-78.6)	168-192 (75.9-86.8)
74 (188)	155-168 (70.3-76.2)	164-178 (74.4-80.7)	172-197 (78.0-89.4)
75 (190)	158-172 (71.4-77.6)	167-182 (75.4-82.2)	176-202 (79.4-91.2)
76 (193)	162-176 (73.5-79.8)	171-187 (77.6-84.8)	181-207 (82.1-93.9)

Women

Reference Chart 1 - Weights by Sex, Height, and Body Build

Height in (cm)	Weight lb (kg)
	Small Frame	Medium Frame	Large Frame
58 (147)	102-111 (46.2-50.2)	109-121 (49.3-54.7)	118-131 (53.3-59.3)
59 (150)	103-113 (46.7-51.3)	111-123 (50.3-55.9)	120-134 (54.4-60.9)
60 (152)	104-115 (47.1-52.1)	113-126 (51.1-57.0)	122-137 (55.2-61.9)
61 (155)	106-118 (48.1-53.6)	115-129 (52.2-58.6)	125-140 (56.8-63.6)
62 (157)	108-121 (48.8-54.6)	118-132 (53.2-59.6)	128-143 (57.8-64.6)
63 (160)	111-124 (50.3-56.2)	121-135 (54.9-61.2)	131-147 (59.4-66.7)
64 (163)	114-127 (51.9-57.8)	124-138 (56.4-62.8)	134-151 (61.0-68.8)
65 (165)	117-130 (53.0-58.9)	127-141 (57.5-63.9)	137-155 (62.0-70.2)
66 (168)	120-133 (54.6-60.5)	130-144 (59.2-65.5)	140-159 (63.7-72.4)
67 (170)	123-136 (55.7-61.6)	133-147 (60.2-66.6)	143-163 (64.8-73.8)
68 (173)	126-139 (57.3-63.2)	136-150 (61.8-68.2)	146-167 (66.4-75.9)
69 (175)	129-142 (58.3-64.2)	139-153 (62.8-69.2)	149-170 (67.4-76.9)
70 (178)	132-145 (60.0-65.9)	142-156 (64.5-70.9)	152-173 (69.0-78.6)
71 (180)	135-148 (61.0-66.9)	145-159 (65.6-71.9)	155-176 (70.1-79.6)
72 (183)	138-151 (62.6-68.4)	148-162 (67.0-73.4)	158-179 (71.6-81.2)

Chart 2 - BMI Chart

Instructions for Use of BMI Chart

To estimate pre-morbid weight, locate the point on the chart where height and the midpoint of Zone B intersect and follow the horizontal line to determine the estimated weight. Read the number on the dashed line closest to this point.

For example, if you are 173 cm tall and you have a BMI of approximately 22 at the midpoint of Zone B, your estimated weight would be 66 kg.

You can calculate your BMI using this formula: BMI = weight(kg)/height(m2).

• Zone A = Underweight
• Zone B = Normal
• Zone C = Overweight
• Zone D = Obesity