Chapter 3 of the GARPS
The tables in Chapter 3 of the GARPs are used to assess the motor function of the spine and limbs. Sensory loss is assessed under Chapter 5. Assessments of service-related spine conditions under Chapter 3 involve more than just an assessment of the spine function and in many cases, will involve an assessment of lower limb function.
Thoraco-lumbar spine conditions
The thoraco-lumbar spine and associated musculature are fundamental structures for mobility, stabilising and allowing for upright posture, which are all requirements for efficient lower limb function.
GARP acknowledges this and provides that lower limb functional loss such as difficulty with stair climbing, slowed walking speed, and the need for walking aids, can all be direct outcomes of thoraco-lumbar spine disease.
Where a veteran has a service-related lumbar spine condition causing an effect on lower limb function, an assessment should be conducted under the spine tables as well as the lower limb function Table 3.2.2.
Sacroiliac conditions
As the sacroiliac joints link the pelvis to the spine, service-related sacroiliac joint disease and other sacroiliac joint conditions may affect the function of the lower limbs. Similar to an assessment of thoraco-lumbar spine conditions, it may be appropriate to assess the effect of service-related sacroiliac conditions on lower limb function under Table 3.2.2. The delegate should have regard to the available medical evidence in each case in order to determine an appropriate rating under Table 3.2.2.
Cervical spine conditions
Similar to an assessment of thoraco-lumbar spine conditions, where a veteran has a service-related cervical spine condition causing an effect on upper limb function, an assessment should be conducted under the spine tables as well as the upper limb function Table 3.1.2. A separate rating for both the right and left upper limb may be provided under Table 3.1.2, as long as the medical evidence confirms both upper limbs are affected by the service-caused cervical spine condition.
Coccyx conditions
Whilst part of the spine, the coccyx is not involved in the stabilisation of the lower limbs during ambulation, nor are there nearby nerve roots that affect lower limb function. On that basis, it would be unusual for conditions like coccydynia to be assessed under Table 3.2.2. If medical evidence suggests the function of the lower limbs is affected by a coccyx condition, delegates may decide to seek further clarification in order to rule out another condition causing the loss of lower limb function. However, ultimately if the delegate is satisfied the medical evidence confirms a veteran’s coccyx condition affects the function of their lower limbs, then a rating under Table 3.2.2 is possible.
Coccyx conditions and resting joint pain
GARP provides Table 3.4.1 resting joint pain ‘may’ be used to assess pain in the intervertebral joints. Whilst it is acknowledged that the coccyx does not involve the intervertebral joints, discretion is provided to delegates to use Table 3.4.1 to assess a veteran’s coccyx pain at rest. As with all cases, the delegate will need to have regard to the available medical evidence in the individual case in order to determine an appropriate rating under Table 3.4.1.
Sprains and strains
When assessing sprains and strains, whether of the lower limbs, upper limbs, or spine, delegates must consider the medical evidence in order to establish whether there is an impairment under the relevant tables of chapter 3 of GARP. Delegates should not apply any generalisations that sprains and strains are temporary and will resolve, rather, they should assess each case and the specific medical evidence relating to that case on an individual basis.
Under the MRCA, delegates must consider whether the service-related sprain or strains is permanent and stable. For more information about permanency and stability requirements under the MRCA, please see Chapter 5 of the MRCA PI Policy Manual. Where the medical evidence confirms a sprain or strain is permanent and stable and delegates are satisfied the legislative criteria relating to permanent impairment under the MRCA is met, an impairment rating may be applied under the relevant tables of chapter 3 and compensation paid accordingly.
Medical evidence requirements
Delegates should assess each case under chapter 3 on an individual basis by considering the relevant facts and evidence unique to the case. For more information relating to evidentiary requirements and medical investigation procedures please visit the compensation claims procedures manual.
Getting help
Where complex cases arise, delegates are encouraged to contact Benefits and Payment Policy for tailored guidance via the Delegate Support Framework.