Cardiovascular system
AMA5 chapters 3 and 4 (pp 23 and 65) apply to the assessment of permanent impairment of the cardiovascular system, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:
- the Introduction in the Guidelines
- chapters 1 and 2 of AMA5
- the appropriate chapter(s) of the Guidelines for the body system they are assessing
- the appropriate chapter(s) of AMA5 for the body system they are assessing.
The Guidelines take precedence over AMA5.
Introduction
15.1 The cardiovascular system is discussed in AMA5 chapters 3 (Heart and Aorta) and 4 (Systemic and Pulmonary Arteries) (pp 25–85). These chapters can be used to assess permanent impairment of the cardiovascular system with the following minor modifications.
15.2 It is noted that in these chapters there are wide ranges for the impairment values in each category. When conducting an assessment, assessors should use their clinical judgement to express a specific percentage within the range suggested.
Exercise stress testing
15.3 As with other investigations, it is not the role of an assessor to order exercise stress tests purely for the purpose of evaluating the extent of permanent impairment.
15.4 If exercise stress testing is available, then it is a useful piece of information in arriving at the overall percentage impairment.
15.5 If previous investigations are inadequate for a proper assessment to be made, the assessor should consider the value of proceeding with the evaluation of permanent impairment without adequate investigations and data (see Chapter 1 of the Guideline – ordering of additional investigations).
Permanent impairment – maximum medical improvement
15.6 As for all assessments, maximal medical improvement is considered to have occurred when the worker’s condition is well stabilised and unlikely to change substantially in the next year, with or without medical treatment.
Vascular diseases affecting the extremities
15.7 Note that in this section, AMA5 tables 4-4 and 4-5 (p 76) refer to percentage impairment of the upper or lower extremity. Therefore, an assessment of impairment concerning vascular impairment of the arm or leg requires that the percentages identified in these tables be converted to whole person impairment (WPI). The table for conversion of the upper extremity is AMA5 Table 16-3 (p 439), and the table for conversion of the lower extremity is AMA5 Table 17-3 (p 527).
Thoracic outlet syndrome
15.8 Impairment due to thoracic outlet syndrome is assessed according to AMA5 Chapter 16, relating to the upper extremities, and Chapter 2 of the Guidelines.