9.8.6 Chapter 3 – Impairment of Spine and Limbs
This chapter is used to assess the motor function of the spine and limbs.
In the assessment of spinal conditions using this chapter, GARP states;
‘If a spinal condition causes an effect on limb function, then that effect on limb function is also to be assessed under Parts 3.1 or 3.2 ……. For example, if a spinal condition which causes a reduced range of spinal movement also interferes with the proper function of the limbs, then a rating from Table 3.3.1 may be combined with a rating from Table 3.1.2 or 3.2.2”
GARP provides that spinal conditions that ‘cause an effect’ on limb function are assessed not only under the tables relating to spinal conditions (3.3), but that the effect of the spinal condition on limb function is also to be assessed under a table from Parts 3.1 (upper limb) or 3.2 (lower limb), whichever is relevant.
The lumbar spine and associated musculature are fundamental structures for mobility, stabilising the walking apparatus and allowing for upright posture; both requirements for efficient lower limb function. Medical evidence supports the understanding that lumbar spine disease, including degenerative joint diseases such as Lumbar Spondylosis, impacts lower limb function.
It is important to recognise some conditions will affect more than one body part/systems and may require consideration/assessment under more than one table and/or chapter. Functional outcomes such as difficulty with stair climbing, slowed walking speed, and the need for walking aids, can all be direct outcomes of lumbar spine disease, and are only adequately addressed by Table 3.2.2 in the GARP. For example, where there is loss of the ability to climb stairs due to a diagnosis of Lumbar Spondylosis, it is appropriate to assess this under table 3.2.2.
Delegates should be particularly mindful of applying this when the effect of a spinal condition on limb function is supported with appropriate medical evidence from the clients treating or assessing medical practitioner.
Medical opinion on the functional loss may be based on an examination of the client, medical history, and/or diagnostic imaging. The delegate would need to be satisfied that the medical report provided supports the rating allocated under any of the GARP tables. Further evidence can be sought from the assessing medical practitioner if this is unclear.
Therefore, if there is medical evidence to support that there is a loss covered by one of the limb tables as a result of a spine condition, then an impairment rating should be assigned and the veteran compensated accordingly.