GARP Chapter 1: Heart and Lung Conditions, Explained Simply

Chapter 1 covers your heart and your lungs.

The surprise is what it measures. It is not your scan. It is not how many stents you have. It is how far you can go before you get symptoms.

What goes in this chapter?

Heart disease, angina, heart attacks, valve problems
Asthma, emphysema, chronic bronchitis, COPD
Problems with the chest wall or the diaphragm
Nerve damage affecting the breathing muscles
Anaemia

Two things go somewhere else. High blood pressure and blood vessel problems go to Chapter 2. Anything that comes in attacks, like badly controlled asthma, may be better rated under Chapter 15.

The measurement: METs

Everyday activities are given an effort score called a MET.

1 to 2 METs — lying down, sitting, making a cup of tea, light sweeping
2 to 3 METs — getting dressed, washing, light housework
Higher — walking briskly, stairs, carrying, digging

The assessor works out the level at which you reliably get symptoms. Chest pain, breathlessness, palpitations or unusual tiredness. That level goes into a table and becomes your points. The table is age adjusted.

The answer that costs veterans money

The Guide says this outright. Answers like "I can't do that" or "I don't do that any more" are no use to the assessment.

They need to know what you can do, and what happens when you do it.

So do not say: "I don't do stairs."

Say: "I can do one flight. At the top I'm puffing and have to stop for a minute."

That one change in wording can be worth real points.

Two more things about the effort question

Steady activities count more than short bursts. Mowing, walking the dog, carrying the shopping in. Symptoms often take a few minutes to show up.
Anything above about 6 to 7 METs has to be proven by an exercise test. You cannot just say you are fit enough.

Lung function tests

If you have any lung condition, you normally need spirometry.

Three numbers are read off it: FEV1, FVC and MEF 25–75. Each is compared with what a person of your age, height and sex should get. The worst of the three sets your points. Anything at 85% of predicted or better scores zero.

Two rules to know:

The test is done without a puffer first, and the pre-puffer numbers are used if both exist.
The best set of blows is chosen, not the worst. The protocol is fixed. It is not something to be managed.

The six month rule

This is the most common reason a heart or lung assessment comes out low.

Your spirometry and your effort tolerance information must be no more than six months old. Two-year-old lung function tests cannot be used. Book them before the assessment, not after.

How the two scores are put together

It depends what you have.

Heart problem only → your points come from the effort test alone.
Lung problem only → the average of the effort score and the spirometry score.
Both → the higher of the two.

You only ever get one effort score and one lung score, no matter how many conditions you have.

Heart failure

There is a separate small table for heart failure. It runs from 10 points for early signs on X-ray, up to 20 points for an ejection fraction of 40% or less that has not improved with treatment.

You get the higher of that and your effort score. For most people the effort score is bigger. The heart failure table matters most for someone who cannot be exercise tested at all.

Taking out what service did not cause

The assessment counts everything at the start, accepted or not. Then it takes the non-accepted share back out using Chapter 19.

This is where a smoking history gets weighed against accepted chronic bronchitis. If the medical evidence does not separate the two clearly, somebody will estimate the split. Get it addressed properly in the report.

The last check

Finally your score is compared against four "Other Impairment" tables — ischaemic heart disease, valve disease, other heart disease, and lower airway disease. You get the higher of that and your functional score.

That is why your history matters. A past heart attack or bypass can score more here than your current walking test would give you.

What this means for you

Book your lung function test. Within six months of the assessment.
Describe what you can do, and what it does to you. Not what you avoid.
Use steady activities as your examples. Mowing, shopping, walking.
Mention the past events. Heart attacks, surgery, hospital admissions. They can score on their own.
If something else stops you exercising, like your knees, make sure the doctor writes down why. The Guide expects that to be handled, not used against you.

Common questions

Is sleep apnoea in this chapter?

Usually not by this route. Sleep apnoea does not normally reduce your exercise tolerance, and this method needs a loss of exercise tolerance to measure. If it has caused heart problems that are separately accepted, those are rated here.

My puffer makes my numbers look better. Which are used?

The pre-puffer results, where both are available. That is the rule.

What if I cannot walk because of my back or knees?

The Guide expects that. "Exercise tolerance" means heart and lung tolerance, not total fitness. The doctor must record what is limiting you and why.

Does my age change the number?

Yes, for the MET tables and the lung function table. The combining table and the heart failure table are not age adjusted.

Next in this series

Chapter 2: blood pressure and blood vessels.

Want a hand with yours?

If you have a permanent impairment assessment coming up, we do these every week. Call 0429 146 039 or email reception@vhc.org.au.