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12.7.6 Resting Joint Pain and Disfigurement & Social Impairment in transitional claims
The transitional arrangements under section 13 of the Military, Rehabilitation and Compensation (Consequential and Transitional Provisions) Act 2004 (CTPA) requires that impairment points from VEA and/or DRCA conditions are included as part of the MRCA assessment.
Chapter 25 of the GARP M contains the method for calculating the amount of PI compensation payable in transitional scenarios and requires an assessment of all MRCA accepted conditions and a separate assessment of all VEA/DRCA accepted conditions.
Resting Joint Pain
Where the medical evidence shows resting joint pain arising from conditions accepted under both MRCA and VEA/DRCA, the delegate may assign a rating under the MRCA and then a separate rating under the VEA/DRCA. This may result in two resting joint pain ratings.
The total ratings under MRCA are then combined with the total ratings under the VEA/DRCA to calculate the client's overall impairment rating.
As with any impairment rating, the allocation of resting joint pain should be based on the available medical evidence. Where it is clear that resting joint pain is attributable to only MRCA conditions, or only the VEA/DRCA conditions, then it would not be appropriate to assign two ratings. There is also nothing preventing the highest resting joint pain rating from being applied to the MRCA conditions and to the VEA/DRCA conditions, as long as the delegate is satisfied the medical evidence supports the ratings.
Examples – Resting Joint Pain
A veteran has accepted conditions of the spine and ankles under the VEA/DRCA as well as accepted conditions of the knees and shoulders under the MRCA. The medical evidence shows the spine condition causes pain which limits the veterans comfortable sitting time and the delegate is satisfied a rating of 5 is assigned for resting joint pain to the accepted VEA/DRCA conditions. The medical evidence also shows the knee conditions cause severe pain which is not ameliorated by treatment. The delegate is satisfied a rating of 10 is assigned to the accepted MRCA conditions. In this scenario, a rating of 10 for resting joint pain may be included in Step 1(a) of Chapter 25, and, another rating of 5 for resting joint pain in Step 2(b).
Disfigurement and Social Impairment
As with resting joint pain, where the medical evidence shows disfigurement and social impairment arising from both MRCA accepted conditions and VEA/DRCA accepted conditions, the delegate may decide to allocate two ratings.
Where it is clear that disfigurement and social impairment is attributable to only MRCA conditions, or the VEA/DRCA conditions only, then it would not be appropriate to assign two ratings. Additionally, there may be times where the delegate may need to apportion the impairment by using Chapter 19. Chapter 17 directs that Chapter 19 may be used where there is a non-accepted condition contributing to disfigurement and social impairment. It is acknowledged that this scenario may be rare, because non-accepted conditions are not always known, however the option to use Chapter 19 to adjust for non-accepted conditions is available for the delegate if appropriate.
Examples – Disfigurement and Social Impairment
A veteran has accepted skin conditions under the VEA/DRCA including deep scarring on the cheek and eyebrow from the removal of BCCs and SCCs. The veteran also has PTSD and anxiety disorder accepted under the MRCA. The medical evidence shows the scarring on the veteran’s face is noticeable to others, and the delegate is satisfied a rating of 2 may be assigned to the accepted VEA/DRCA conditions. The medical evidence shows the mental health conditions causes the veteran to become agitated in public causing frequent outbursts, which are obvious to others, and cause the veteran to avoid some normal activities. The delegate is satisfied a rating of 2 may also be assigned to the accepted MRCA conditions. In this scenario, a rating of 2 for disfigurement may be included in Step 1(a) of Chapter 25, and, another rating of 2 in Step 2(b).
A veteran has an accepted right knee condition under the DRCA and suffered a worsening of the condition which is now accepted under the MRCA. The veteran has undergone extensive surgeries and as a result suffers noticeable scarring on the knee, thigh and shin, as well as a limp which requires the use of a cane. The medical practitioner provided an opinion apportioning the total lower limb impairment as 50% to the original condition accepted under DRCA and 50% to the worsening of the condition under MRCA. The delegate decides a total rating of 10 is applicable for disfigurement as a result of the knee condition. It would be open to the delegate in this scenario to take into consideration the medical practitioner’s opinion and provide a rating of 5 for disfigurement for inclusion in Step 1(a) and a rating of 5 for inclusion at Step 1(b) of Chapter 25.
A veteran has accepted conditions under the VEA/DRCA which are not causing any significant disfigurement and only slight embarrassment. The delegate is satisfied a rating of 0 for disfigurement may be allocated to the accepted VEA/DRCA conditions. The veteran also has lumbar spondylosis accepted under the MRCA. The report provided by the treating orthopaedic surgeon shows the veteran also suffers scoliosis, which is not accepted under MRCA. The orthopod advises that as a result of the total spine conditions the veteran suffers a significant leg shortening on one side effecting his gait, but that lumbar spondylosis contributes about 50% to the impairment. The delegate decides a total rating of 10 is applicable for disfigurement, but notes the contribution by the non-accepted condition. It would be open to the delegate in this scenario to use Chapter 19 to calculate the appropriate rating to be included at Step 1(a) of Chapter 25 for accepted MRCA conditions and a rating of 0 for inclusion at Step 1(b).
It is acknowledged that the examples provided on this page may not cover every scenario. If the decision maker requires any further guidance with respect to either resting joint pain or disfigurement and social impairment in transitional cases, they are encouraged to contact Benefits & Payments Policy through the Delegate Support Framework.