Chapter 13 - Hypertension and Vascular 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 hypertension and non-cardiac vascular conditions.

Non-cardiac vascular conditions include peripheral vascular arterial disease, varicose veins, deep vein thrombosis, aneurysm and intra-vascular conditions, Raynaud's disease/phenomenon, and conditions associated with cold exposure such as frostbite.

Thoracic outlet syndrome causing vascular impairment only is rated on individual merits.

No additional rating will be given from Chapter 22, Skin impairment as a result of skin manifestations due to conditions rated within this chapter.

Rating Tables

This chapter contains six "Other Impairment" tables which may be used to rate entitled hypertension and/or non-cardiac vascular conditions.

The tables within this chapter are:

Rating Tables

Table	Loss of Function	Other Impairment
Table 13.1	Other Impairment - Hypertension	This table is used to rate impairment from hypertension.
Table 13.2	Other Impairment - Peripheral Vascular Arterial Disease	This table is used to rate impairment from peripheral vascular arterial disease.
Table 13.3	Other Impairment - Varicose Veins	This table is used to rate impairment from varicose veins.
Table 13.4	Other Impairment - Deep Vein Thrombosis	This table is used to rate impairment from deep vein thrombosis.
Table 13.5	Other Impairment - Aneurysm and Intra-Vascular Conditions	This table is used to rate impairment from aneurysms and intra-vascular conditions of the larger arteries.
Table 13.6	Other Impairment - Raynaud's Disease/Phenomenon	This table is used to rate impairment from Raynaud's disease/phenomenon.
Table 13.7	Other Impairment - Frostbite, Immersion Foot, and Other Cold Injuries	This table is used to rate impairment from conditions associated with cold exposure.

Other Impairment - Hypertension

Table 13.1 is used to rate impairment from hypertension. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

Sustained, uncontrolled elevation of blood pressure over a period of time may result in impairment of other organ systems. The rating for hypertension does not include impairment due to end/target organ damage with the exception of hypertrophy of the left ventricle.

When entitled hypertension 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 - Peripheral Vascular Arterial Disease

Table 13.2 is used to rate impairment from entitled peripheral vascular arterial disease. Only one rating may be selected for the lower limbs as one functional unit.

When entitled peripheral vascular arterial disease 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).

Impairment resulting from amputation is rated using the Amputation Table in Chapter 17, Musculoskeletal Impairment. This rating is given in addition to the Table 13.2 rating.

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 - Varicose Veins

Table 13.3 is used to rate impairment from entitled varicose vein conditions of the lower limbs. Only one rating may be selected for each entitled lower limb.

When entitled varicose vein 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).

Impairment resulting from amputation is rated using the Amputation Table in Chapter 17, Musculoskeletal Impairment. The ratings are compared and the highest selected.

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 - Deep Vein Thrombosis

Table 13.4 is used to rate impairment from entitled deep vein thrombosis. Only one rating may be selected for each entitled limb. If more than one rating is applicable, the ratings are compared and the highest selected.

When entitled deep vein thrombosis 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 - Aneurysms and Intra-vascular Conditions

Table 13.5 is used to rate impairment from specific conditions that affect larger blood vessels. 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 aneurysms and intra-vascular 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 - Raynaud's Disease/phenomenon

Table 13.6 is used to rate impairment from Raynaud's disease/phenomenon. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

For the purposes of Table 13.6, characteristic attacks of Raynaud's disease/phenomenon consist of sequential colour changes of the digits. One or more of the extremities may be involved. The attacks may be precipitated by exposure to cold or emotional upset and may last minutes to hours, sometimes with pain and parasthesias.

When entitled Raynaud's Disease/phenomenon 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 - Frostbite, Immersion Foot, and Other Cold Injuries

Table 13.7 is used to rate impairment from frostbite, immersion foot, and other cold injuries. Only one rating may be selected for each affected area. If more than one rating is applicable for an affected area, the ratings are compared and the highest selected.

When entitled frostbite, immersion foot and other cold injuries 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).

Impairment resulting from amputation is rated using the Amputation Table in Chapter 17, Musculoskeletal Impairment. The ratings are compared and the highest selected.

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 13.1 - Other Impairment - Hypertension

Only one rating may be given from Table 13.1. 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 13.1, only one criterion must be met at a level of impairment for that rating to be selected.

Table 13.1 - Other Impairment - Hypertension

Rating	Criteria
Four	Hypertension requiring regular medication with diastolic pressure 99 mmHg or less; or Hypertension requiring regular medication with systolic pressure 159 mmHg or less.
Nine	Hypertension with a diastolic pressure consistently at 100 mmHg or higher, but less than 110 mmHg, despite regular medication; or Hypertension with a systolic pressure consistently at 160 mmHg or higher, but less than 180 mmHg, despite regular medication.
Thirteen	Hypertension with a diastolic pressure consistently at 110 mmHg or higher despite regular medication; or Hypertension with a systolic pressure consistently at 180 mmHg or higher despite regular medication.

Steps to Determine the Hypertension Impairment Assessment

• Step 1: Determine the rating from Table 13.1 (Other Impairment - Hypertension).
• Step 2: Does the Partially Contributing Table apply? If yes, apply to Step 1 rating.
• 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 Step 4 rating.

This is the Disability Assessment.

Table 13.2 - Other Impairment - Peripheral Vascular Arterial Disease

Only one rating may be given from Table 13.2. If more than one rating is applicable, the ratings are compared and the highest selected. The lower limbs are considered as one functional unit for the purposes of this table.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 13.2, all criteria designated at that rating level must be met.

Table 13.2 - Other Impairment - Peripheral Vascular Arterial Disease

Rating	Criteria
Nil	No intermittent claudication or rest pain or nocturnal pain.
Ten	Intermittent claudication after walking more than 200 meters at normal pace.
Twenty	Intermittent claudication after walking less than 200 meters but greater than 25 meters at normal pace.
Thirty	Intermittent claudication after walking less than 25 meters at normal pace or pain at rest or nocturnal pain.
Thirty-five	Ulceration secondary to peripheral vascular arterial disease involving one lower limb.
Forty-five	Ulceration secondary to peripheral vascular arterial disease involving both lower limbs.

Peripheral vascular arterial disease of the upper extremities is rare and will be rated on individual merits.

Table 13.3 - Other Impairment - Varicose Veins

Only one rating may be given from Table 13.3 for each entitled lower limb. If more than one rating is applicable for an entitled lower limb, the ratings are compared and the highest selected.

If ratings are possible from Table 13.3 and Table 13.4, the ratings are compared and the highest rating is selected for each entitled lower limb.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 13.3, only one criterion must be met at a level of impairment for that rating to be selected.

Table 13.3 - Other Impairment - Varicose Veins

Rating	Criteria
Two	Varicose veins that are disfiguring but without edema or skin changes*; or Daily discomfort.
Six	Varicose veins with edema or skin changes* without ulceration.
Nine	Varicose veins with edema and skin changes* with healed ulceration or ulcer of less than 6 months duration.
Thirteen	Varicose veins with edema and skin changes* with active ulceration of greater than 6 months duration.

* Skin changes may include dryness, scaling, bronzing or atrophy.

Table 13.4 - Other Impairment - Deep Venous Thrombosis (D.V.T.)

Only one rating may be given from Table 13.4 for each entitled lower limb. If more than one rating is applicable for an entitled lower limb, the ratings are compared and the highest selected.

If ratings are possible from Table 13.3 and Table 13.4, the ratings are compared and the highest selected for each entitled lower limb.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 13.4, only one criterion must be met at a level of impairment for that rating to be selected.

Table 13.4 - Other Impairment - Deep Venous Thrombosis (D.V.T.)

Rating	Criteria
Nil	One episode of D.V.T. with no sequelae.
Nine	D.V.T. requiring greater than 1 year thromboprophylaxis; or Post-thrombotic leg syndrome with edema and pain.
Thirteen	Post-thrombotic leg syndrome with edema, pain and ulceration; or Recurrent D.V.T. or pulmonary embolus secondary to D.V.T. while on thromboprophylaxis.

Deep vein thrombosis of the upper extremities is rare and will be assessed on individual merits.

Table 13.5 - Other Impairment - Aneurysms and Intra-Vascular Conditions

Only one rating may be given for each entitled condition from Table 13.5. 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 13.5, only one criterion must be met at a level of impairment for that rating to be selected.

Table 13.5 - Other Impairment - Aneurysms and Intra-Vascular Conditions

Rating	Criteria
Nil	Embolus successfully treated with no sequelae.
Two	Cerebral aneurysm, asymptomatic; or Aortic aneurysm of diameter less than 6 cm; or Aortic aneurysm surgically corrected; or Iliac or femoral or carotid aneurysms.
Nine	Embolus requiring continuous thromboprophylaxis medication; or Iliac or femoral or carotid conditions requiring continuous thromboprophylaxis medication.
Thirteen	Aortic aneurysm of 6 cm or more which is inoperable*.

* Inoperable refers to the situation where surgery cannot be performed due to general poor health.

Table 13.6 - Other Impairment - Raynaud's Disease/Phenomenon

Only one rating may be given from Table 13.6. 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 13.6, all criteria designated at that rating level must be met.

Table 13.6 - Other Impairment - Raynaud's Disease/Phenomenon

Rating	Criteria
One	Characteristic* attacks occurring less than once per week.
Four	Characteristic* attacks occurring one to three times per week.
Nine	Characteristic* attacks occurring four to six times per week.
Thirteen	Characteristic* attacks occurring at least daily.
Twenty-one	Characteristic* attacks and the presence of digital ulcers with or without fat pad necrosis and erosions.

* Characteristic attacks, for the purpose of this table, consist of sequential colour changes of the digits of one or more extremities lasting minutes to hours, sometimes with pain and parasthesias, and precipitated by exposure to cold or by emotional upset.

Table 13.7 - Other Impairment - Frostbite, Immersion Foot, and Other Cold Injuries

Only one rating may be given from Table 13.7 for an affected area. A separate rating may be given for the head and each limb. If more than one rating is applicable for an affected area, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 13.7, only one criterion must be met at a level of impairment for that rating to be selected.

Table 13.7 - Other Impairment - Frostbite, Immersion Foot, and Other Cold Injuries

Rating	Criteria
Two	Mild hypersensitivity to cold exposure manifested by pain/discomfort, colour change and/or changes in sensation.
Four	Moderate hypersensitivity to cold exposure manifested by pain/discomfort, colour change and/or changes in sensation.
Nine	Moderate hypersensitivity to cold exposure manifested by pain/discomfort, colour change and/or changes in sensation with permanent skin or nail changes; or Severe hypersensitivity to cold exposure manifested by pain/discomfort, colour change and/or changes in sensation.

Frostbite of areas, other than the head and extremities, is rare and will be assessed on individual merits.

Steps to Determine the Vascular Impairment Assessment

• Step 1: Determine the rating from Table 13.2 (Other Impairment - Peripheral Vascular Arterial Disease).

  Note: The lower limbs are considered as one functional unit for rating purposes within Table 13.2.

• Step 2: If an amputation results from peripheral vascular arterial disease an additional rating is taken from the amputation table within the Musculoskeletal Impairment chapter. Ratings from Table 13.2 and the amputation rating are added.
• Step 3: Does the Partially Contributing Table apply? If yes, then apply to the rating at Step 2.
• Step 4: Determine the Quality of Life rating.
• Step 5: Add the ratings at Step 3 and Step 4.
• Step 6: If partial entitlement exists, apply to the Step 5 rating.

This is the Disability Assessment for peripheral vascular arterial disease.

• Step 7: Determine the rating(s) from Table 13.3 (Other Impairment - Varicose Veins).
• Step 8: Does the Partially Contributing Table apply, If yes, then apply to the rating(s) at Step 7.
• Step 9: Determine the Quality of Life rating for each lower limb (if applicable).
• Step 10: Add rating(s) at Step 8 and Step 9 for each leg.
• Step 11: If partial entitlement exists, apply to Step 10 rating(s).

  Note: If amputation as a result of varicose veins right leg and varicose veins left leg is to be assessed, a rating is taken from the amputation table within Chapter 17, Musculoskeletal Impairment. Ratings from the amputation table and the Step 11 rating are compared and the highest selected.

This is the Disability Assessment for varicose veins.

• Step 12: Determine rating(s) from Table 13.4 (Other Impairment - Deep Vein Thrombosis).
• Step 13: Does the Partially Contributing Table apply? If yes, then apply to the rating(s) at Step 12.
• Step 14: Determine the Quality of Life rating for each lower limb (if applicable).
• Step 15: Add ratings at Step 13 and Step 14.
• Step 16: If partial entitlement exists, apply to the Step 15 rating(s).

This is the Disability Assessment for deep vein thrombosis right leg and deep vein thrombosis left leg.

• Step 17: If ratings are applicable from both Table 13.3 and 13.4, ratings from Step 11 and Step 16 are compared and the highest rating selected with one rating for each entitled lower limb.

This is the Disability Assessment varicose veins and deep vein thrombosis

• Step 18: Determine the rating from Table 13.5 (Other Impairment - Aneurysms and Intra - Vascular Conditions).
• Step 19: Does the Partially Contributing Table apply? If yes, then apply to the rating(s) at Step 18.
• Step 20: Determine the Quality of Life rating.
• Step 21: Add ratings at Step 19 and Step 20.
• Step 22: If partial entitlement exists, apply to the Step 21 rating.

This is the Disability Assessment for Aneurysms and intra- vascular conditions.

• Step 23: Determine the rating from Table 13.6 (Other Impairment - Raynaud's Disease/Phenomenon).
• Step 24: Does the Partially Contributing Table (PCT) apply? If yes, apply to Step 23 rating(s).
• Step 25: Determine the Quality of Life rating.
• Step 26: Add the ratings at Step 24 and Step 25.
• Step 27: If partial entitlement exists, apply to the Step 26 rating.

This is the Disability Assessment for Raynaud's Disease/Phenomenon conditions.

• Step 28: Determine rating(s) from Table 13.7 (Other Impairment - Frostbite, Immersion Foot, and Other Cold Injuries).

  Note: One rating may be given for each entitled, affected area.

  Note: If amputation results from frostbite, immersion foot or other cold injuries, a rating is also selected from the applicable amputation table within Chapter 17, Musculoskeletal Impairment. The applicable rating from the amputation table and the rating at Step 28 are compared and the highest selected.

• Step 29: Does the Partially Contributing Table apply? If yes, apply to each applicable rating in Step 28 above.
• Step 30: Determine the Quality of Life rating for each applicable entitled area.
• Step 31: Add applicable ratings at Step 29 and Step 30.
• Step 32: If partial entitlement exists, apply to each applicable rating at Step 31 above.

This is the Disability Assessment for frostbite, immersion foot or other cold injuries.