Contents
- Introduction
- Rating Tables
- Section 1 - Determining Impairment Assessment of Urinary Tract Function
- Selection of Tables
- Loss of Function - Upper Urinary Tract
- Loss of Function - Lower Urinary Tract
- Tables and Steps
- Table 16.1 - Loss of Function - Upper Urinary Tract
- Steps to Determine Urinary Tract Assessment (Upper Tract)
- Table 16.2 - Loss of Function - Lower Urinary Tract
- Steps to Determine Urinary Tract Assessment (Lower Tract)
- Section 2 - Determining Impairment Assessment of Sexual, Reproductive and Breast Function
- Selection of Tables
- Loss of Function - Sexual and Reproductive - Male Anatomy
- Loss of Function - Sexual and Reproductive - Female Anatomy
- Other Impairment - Breasts - Male Anatomy
- Other Impairment - Breasts - Female Anatomy
- Tables and Steps
- Table 16.3 - Loss of Function - Sexual and Reproductive - Male Anatomy
- Steps to Determine Sexual and Reproductive Assessment (Male Anatomy)
- Table 16.4 - Loss of Function - Sexual and Reproductive - Female Anatomy
- Steps to Determine Sexual and Reproductive Assessment (Female Anatomy)
- Table 16.5 - Other Impairment - Breasts - Male Anatomy
- Steps to Determine Assessment (Breasts - Male Anatomy)
- Table 16.6 - Other Impairment - Breasts - Female Anatomy
- Steps to Determine Assessment (Breasts - Female)
Introduction
This chapter provides criteria for assessing permanent impairment from entitled urinary, sexual, reproductive and breast conditions.
The chapter is divided into two sections. The first section provides criteria to rate impairment of upper and lower urinary tract conditions. The second section provides criteria to rate impairment of sexual, reproductive and breast conditions.
Impairment from rectovaginal fistula(e) is rated within Chapter 14, Gastrointestinal Impairment.
Impairment from loss of a kidney due to tuberculosis is rated within Chapter 24, Tuberculosis Impairment.
Impairment from malignant urinary, sexual, reproductive and breast conditions is rated within Chapter 18, Malignant Impairment. Follow the steps contained within the Malignant Impairment chapter.
For the purposes of this chapter:
Female: means cis female, a person assigned female sex at birth and identifies as a woman.
Male: means cis male, a person assigned male sex at birth and identifies as a man.
Sex/gender diverse: means a person with differences in sexual development, people who do not identify within the binary terms of sex and/or gender as a man or a woman, and people who identify as transgender.
An individual’s present anatomy is used to select the applicable impairment table(s). This includes sex/gender diverse individuals who have not yet undertaken gender affirming treatment (hormone and/or surgery).
For sex/gender diverse individuals who have undertaken gender affirming treatment (hormone and/or surgery), the medical impairment rating is determined based on individual merit.
Penetrative sexual activity is defined as the insertion of a body part or other object into the mouth, vagina or anus, as part of human sexual activity.
Sexual activity is defined as the manner in which humans experience and express their sexuality.
Rating Tables
This chapter contains four “Loss of Function” tables and two “Other Impairment” tables which may be used to rate entitled urinary, sexual, reproductive and breast conditions.
The tables within this chapter are:
Table 16.1 | Loss of Function - Upper Urinary Tract | This table is used to rate impairment in the upper urinary tract. |
Table 16.2 | Loss of Function - Lower Urinary Tract | This table is used to rate impairment in the lower urinary tract. |
Table 16.3 | Loss of Function - Sexual and Reproductive - Male Anatomy | This table is used to rate impairment in sexual and reproductive function in male anatomy. |
Table 16.4 | Loss of Function - Sexual and Reproductive - Female Anatomy | This table is used to rate impairment in sexual and reproductive function in female anatomy. |
Table 16.5 | Other Impairment - Breasts - Male Anatomy | This table is used to rate impairment of the male breast. |
Table 16.6 | Other Impairment - Breasts - Female Anatomy | This table is used to rate impairment of the female breast. |
Section 1
Determining Impairment Assessment of Urinary Tract Function
The tables that may be used to rate impairment from urinary tract conditions are:
Table 16.1 | Loss of Function - Upper Urinary Tract | This table is used to rate impairment in the upper urinary tract. |
Table 16.2 | Loss of Function - Lower Urinary Tract | This table is used to rate impairment in the lower urinary tract. |
Loss of Function - Upper Urinary Tract
Table 16.1 is used to rate impairment from conditions of the upper urinary tract (kidney and ureter). 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.
Ratings in the upper urinary tract table take into account the presence of signs and symptoms and laboratory findings which may accompany the urinary tract impairment. Signs and symptoms may include hypertension, chronic anemia, edema, headache, dyspnea, fatigue, fever, chills, back pain, dizziness, hematuria, anuria and recurrent upper urinary tract infections.
Glomerular Filtration Rate(GFR) is the best indicator of overall kidney function. Estimation of GFR (eGFR) using an equation remains the accepted and most practical means of assessing kidney function. The current “gold standard” equation for eGFR is the CKD-EPI EquationFootnote1 (Chronic Kidney Disease Epidemiology Collaboration Equation).
When entitled upper urinary tract 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).
Loss of or impairment of function of a second kidney may result in a paired organ award. In such cases, refer to chapter 4 - Paired Organs and Paired Limbs for assessment purposes.
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.
Loss of Function - Lower Urinary Tract
Table 16.2 is used to rate impairment from conditions of the lower urinary tract (bladder and urethra), prostate and epididymis. 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 lower urinary tract 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 16.1 - Loss of Function - Upper Urinary Tract
Only one rating may be given for each entitled condition from Table 16.1. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest rating is selected.
Each bullet (•) represents one criterion. In order for a rating to be established for Table 16.1, follow the “ands” and “ors”.
Rating | Criteria |
---|---|
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Twenty-one |
|
Twenty-six |
|
Forty-three |
|
Fifty-seven |
|
Eighty-one |
|
*GFR units of measurement are mL/min/1.73 m2. A GFR>60mL/min/1.73 m2 in isolation is not CKD, unless other evidence of kidney damage is present. CKD, chronic kidney disease; GFR, glomerular filtration rate.
Steps to Determine Urinary Tract Assessment (Upper Tract)
- Step 1: Determine the rating from Table 16.1 (Loss of Function - Upper Urinary Tract).
- 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 above.
This is the Disability Assessment.
Table 16.2 - Loss of Function - Lower Urinary Tract
Only one rating may be given for each entitled condition from Table 16.2. 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 16.2, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
One |
|
Four |
|
Nine |
|
Thirteen |
|
Eighteen |
|
Twenty-six |
|
Thirty-four |
|
Forty-three |
|
Steps to Determine Urinary Tract Assessment (Lower Tract)
- Step 1: Determine the rating from Table 16.2 (Loss of Function - Lower Urinary Tract).
- 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 Step 4 rating.
This is the Disability Assessment
Section 2
Determining Impairment Assessment of Sexual, Reproductive and Breast Function
Selection of Tables
The tables that may be used to rate impairment from sexual and reproductive conditions are:
Table 16.3 | Loss of Function - Sexual and Reproductive - Male Anatomy | This table is used to rate impairment in sexual and reproductive function in male anatomy. |
Table 16.4 | Loss of Function - Sexual and Reproductive - Female Anatomy | This table is used to rate impairment in sexual and reproductive function in female anatomy. |
Table 16.5 | Other Impairment - Breasts - Male Anatomy | This table is used to rate impairment of the male breast. |
Table 16.6 | Other Impairment - Breasts - Female Anatomy | This table is used to rate impairment of the female breast. |
Loss of Function - Sexual and Reproductive - Male Anatomy
Table 16.3 is used to rate impairment from sexual and reproductive conditions impacting male anatomy.
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 Veterans Affairs Canada (VAC) purposes ‘Sterility’ is defined as the complete inability to produce offspring despite medical intervention.
‘Infertility’ is defined as inability to conceive after one year or longer of unprotected sex. For VAC purposes where an entitled condition results in infertility, it will be assessed on individual merits.
When entitled sexual and reproductive conditions impacting male anatomy 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.
Loss of Function - Sexual and Reproductive - Female Anatomy
Table 16.4 is used to rate impairment from impairment from sexual and reproductive conditions impacting female anatomy.
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 ‘Sterility’ is defined as the complete inability to produce offspring despite medical intervention.
‘Infertility’ is defined as inability to conceive after one year or longer of unprotected sex. For VAC purposes where an entitled condition results in infertility, it will be assessed on individual merits.
When entitled sexual and reproductive conditions impacting female anatomy 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 - Breasts - Male Anatomy
Table 16.5 is used to rate impairment from male breast 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.
When entitled male breast 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 - Breasts - Female Anatomy
Table 16.6 is used to rate impairment from female breast 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.
When entitled female breast 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 16.3 - Loss of Function - Sexual and Reproductive - Male Anatomy
Only one rating may be given for each entitled condition from Table 16.3. 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 16.3, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
One |
|
Four |
|
Nine |
|
Eighteen |
|
Twenty-six |
|
* A separate rating for permanent sterility is not given for these conditions.
Steps to Determine Sexual and Reproductive Assessment (Male Anatomy)
- Step 1: Determine the rating from Table 16.3 (Loss of Function - Sexual and Reproductive - Male Anatomy).
- 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 16.4 Loss of Function - Sexual and Reproductive - Female Anatomy
Only one rating may be given for each entitled condition from Table 16.4. 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 16.4, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
One |
|
Four |
|
Nine |
|
Eighteen |
|
Twenty-six |
|
* A separate rating for permanent sterility is not given for these conditions.
Steps to Determine Sexual and Reproductive Assessment (Female Anatomy)
- Step 1: Determine the rating from Table 16.4 (Loss of Function - Sexual and Reproductive - Female Anatomy)
- 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 16.5 - Other Impairment - Breasts - Male Anatomy
Only one rating may be given for each entitled condition from Table 16.5. 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 16.5, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
One |
|
Four |
|
Steps to Determine Assessment (Breasts - Male Anatomy)
- Step 1: Determine the rating from Table 16.5 (Other Impairment - Breasts - Male Anatomy).
- 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 16.6 - Other Impairment - Breasts - Female Anatomy
Only one rating may be given for each entitled condition from Table 16.6. 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 16.6, only one criterion must be met at a level of impairment for that rating to be selected.
Rating | Criteria |
---|---|
Nil |
|
Four |
|
Nine |
|
Thirteen |
|
Twenty-six |
|
Steps to Determine Assessment (Breasts - Female Anatomy)
- Step 1: Determine the rating from Table 16.6 (Other Impairment - Breasts - Female Anatomy).
- 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 Step 4 rating.
This is the Disability Assessment.