Contents
Introduction
This chapter is used to assess the effects of an entitled condition on a Member/Veteran/Client's Quality of Life (QOL). Activities of Independent Living, Recreational and Community Activities, and Personal Relationships are all components considered in a QOL rating. One QOL rating is arrived at for each entitled condition or bracketed entitled conditions. The term "bracketed conditions" is defined as entitled conditions which affect the same body areas or result in a similar loss of function and cannot be separated for medical assessment purposes, that are grouped or "bracketed" together to arrive at one Medical Impairment rating.
The effects of an entitled condition may limit or prevent the fulfilment of a role in the above-noted QOL components that would be normal for a Member/Veteran/Client of the same age without a disability.
It must be emphasized that, when and where possible, the usual or accustomed activities that the Member/Veteran/Client was engaged in prior to the disability or worsening of the disability should be the major consideration in determining the QOL effects from the entitled condition or the bracketed entitled conditions. In addition, the inability to perform or to modify usual QOL activities must be directly due to the entitled condition and not other variables or characteristics such as non-entitled condition(s), lack of skill, motivation, choice, availability or access to recreational activities, employment, etc. The appropriate QOL level will be determined based on the provided information. In the absence of the QOL information, a Member/Veteran/Client will be awarded the minimum QOL level 1 rating in relation to the Medical Impairment rating.
Judgement is to be used by the decision maker as to the extent that the entitled condition contributed to the QOL effects versus other factors such as non-entitled condition(s), etc. The Partially Contributing Table should not be applied to the QOL rating as that table is specific to the calculation of Medical Impairment ratings only.
Each time there is a new entitlement award or a review of an assessment, at either the departmental or VRAB level, a QOL rating for each entitled condition or bracketed entitled conditions is added to the Medical Impairment rating to arrive at the Disability Assessment. It is the final Disability Assessment which would be the subject of a review or appeal.
Assessment Example:
Member/Veteran/Client is entitled for chronic sinusitis and hearing loss:
Medical Impairment rating for chronic sinusitis
Table 10.2
(Nose, Throat, Sinus Impairment Assessment chapter) is 5.
QOL rating for chronic sinusitis
Table 2.2 (QOL chapter) at level 1 is 1.
Disability Assessment for chronic sinusitis is 6%
Medical Impairment rating for hearing loss
Table 9.1 (Hearing Loss and Ear Impairment) is 20
QOL rating for hearing loss
Table 2.2 (QOL chapter) at level 1 is 2.
Disability Assessment for hearing loss is 22%.
The Member/Veteran/Client would have a Total Disability of 28% (6% + 22% ).
Partial Entitlements
In cases of partial entitlement, the Medical Impairment rating and the QOL rating are added and the level of entitlement is applied to determine the Disability Assessment.
In cases of bracketed assessments, the bracketed Medical Impairment rating and QOL rating are added and the highest degree of entitlement is applied to determine the Disability Assessment.
Definitions:
"Activities of Independent Living" refer to the Member/Veteran/Client's ability to sustain effective routines in a domestic and/or work environment and to perform important activities such as using forms of transport which enable the Member/Veteran/Client to maintain self-sufficiency. The ability to work takes into account any necessary changes or modifications to employment or the workplace. Only the impact of the entitled condition or bracketed entitled conditions on the Member/Veteran/Client's ability to engage in these activities is to be taken into account; the Member/Veteran/Client's inability to do domestic, travel or employment activities for some other reason (e.g. choice, habit, inexperience, lack of skill) is not to be taken into account.
"Recreational and Community Activities" refers to the ability to take part in any activities of the Member/Veteran/Client's choosing. A recreational rating is based on the Member/Veteran/Client's normal recreational and community activities and measures the limitation placed by the entitled condition or bracketed entitled conditions on the ability to continue those activities. It also takes into account the Member/Veteran/Client's need to modify recreational pursuits or to seek alternatives. Community activities include work in a voluntary capacity.
"Personal relationships" refers to the Member/Veteran/Client's ability to initiate, take part in and maintain appropriate and customary social, sexual and interpersonal relationships. To determine the effect on personal relationships, it is necessary to establish how the physical and psychological effects of the entitled condition or bracketed entitled conditions affect the Member/Veteran/Client's usual ability to interact socially with others.
Method of Assessment
To determine the appropriate QOL level, three (3) levels of ratings are used within Table 2.1 (Level 1, Level 2, and Level 3).
Once the appropriate QOL level is determined, and the Medical Impairment rating of the entitled condition or bracketed entitled conditions is identified, the final calculation of the QOL rating is determined using Table 2.2.
Level 1
At this level the Member/Veteran/Client's QOL is considered mildly affected by the entitled condition or bracketed entitled conditions. "Mildly Affected" is defined as a slight degree of change in usual and accustomed QOL functioning which is due to the entitled condition or bracketed entitled conditions.
Level 2
At this level, the Member/Veteran/Client's QOL is considered to be moderately affected by the entitled condition or bracketed entitled conditions. "Moderately Affected" is defined as a medium degree of change in usual and accustomed QOL functioning which is due to the entitled condition or bracketed entitled condition.
Level 3
At this level, the Member/Veteran/Client's quality of life is considered to be extremely affected by the entitled conditions."Extremely Affected" is defined as a significant degree of change in usual and accustomed QOL functioning which is due to the entitled condition and or bracketed entitled conditions.
Calculation of Quality of Life Rating and Disability Assessment
Follow the steps below to calculate the QOL rating.
Step 1:
Determine the QOL level due to each entitled condition or bracketed entitled conditions using Table 2.1.
Step 2:
Determine the QOL rating using Table 2.2. Identify the Medical Impairment rating for the entitled condition or bracketed entitled conditions as calculated using the Medical Impairment chapters and apply the QOL level to determine the final QOL rating for each entitled condition or bracketed entitled conditions.
Step 3:
If there is full entitlement for an entitled condition, add the Medical Impairment rating and QOL rating to form the Disability Assessment.
[If there is partial entitlement for an entitled condition]:
the Medical Impairment rating and the QOL rating are added and the level of entitlement is applied to determine the Disability Assessment.
In cases of bracketed assessments, the Medical Impairment rating and QOL rating are added and the highest degree of entitlement is applied to determine the Disability Assessment.
Every Member/Veteran/Client will be assigned a rating from the Level 1 column based on the Medical Impairment rating from the entitled condition or bracketed entitled conditions (calculated using the Medical Impairment chapters), unless it is determined that the criteria to establish a higher rating of Level 2 or Level 3 are met. To establish a level 2 or 3 rating, the majority of criteria for that level must be met.
Table 2.1 - QOL Level Determination Table
| QOL Level | Criteria |
|---|---|
| Level 1 | Mild interference with the ability to carry out the usual and accustomed activities of independent living, recreational and community activities, and/or personal relationships due to the entitled condition or bracketed entitled conditions:
|
| Level 2 | Moderate interference with the ability to carry out the usual and accustomed activities of independent living, recreational and community activities, and/or personal relationships due to the entitled condition or bracketed entitled conditions:
Majority of the following criteria must be met for a level 2 rating.
|
| Level 3 | Extreme interference with the ability to carry out usual and accustomed activities of independent living, recreational and community activities, and/or personal relationships due to the entitled condition or bracketed entitled conditions. Majority of the following criteria must be met for a level 3 rating.
|
* Scope is defined as family, friends, colleagues and neighbours.
Table 2.2 - Quality of Life Conversion Table
(Medical Impairment rating + QOL Rating = Disability Assessment)
| Medical Impairment Rating (Calculated Using Impairment Chapters) |
Level 1 QOL Rating |
Level 2 QOL Rating |
Level 3 QOL Rating |
|---|---|---|---|
| 1-10 | 1 | 2 | N/A |
| 11 - 20 | 2 | 3 | 5 |
| 21 - 30 | 3 | 5 | 7 |
| 31 - 40 | 4 | 6 | 9 |
| 41 - 50 | 5 | 7 | 11 |
| 51 - 60 | 6 | 9 | 13 |
| 61 - 70 | 7 | 11 | 15 |
| 71 - 80 | 8 | 13 | 17 |
| 81 - 100 | 10 | 15 | 20 |
Note: As per the Pension Act, payment of disability pensions/awards/compensations cannot exceed the maximum of 100% as set out in Schedule I or Schedule 3 of the Veterans Well-being Act.