Assessment overview
How this assessment usually works
Cardiovascular assessment uses the relevant AMA5 heart, aorta or arterial category as modified by NSW Chapter 15. Broad category ranges require a reasoned specific percentage, and regional vascular values may need conversion before they become WPI.
For cardiovascular, the assessor gives a medical opinion about permanent impairment under the NSW workers compensation guidelines; the assessor does not decide legal liability. Once the body-system method and percentage are understood, separate advice may be needed about Section 66 compensation, weekly payments, medical-expense time limits or work injury damages.
Injuries and diagnoses assessed in this body system
The referral and report should identify the accepted diagnosis precisely. Similar symptoms can use different assessment methods depending on the injured structure.
- accepted coronary artery, myocardial, pericardial, valvular or congenital heart impairment
- aortic disease, hypertension-related cardiac damage or cardiomyopathy where causally accepted
- systemic or pulmonary arterial disease and stable peripheral vascular impairment
- upper- or lower-extremity vascular loss and thoracic outlet syndrome using their specified regional methods
When a permanent impairment assessment can occur
For cardiovascular, assessment should occur only after maximum medical improvement (MMI). NSW Guidelines paragraph 1.15 describes a condition that is well stabilised and unlikely to change substantially during the next year, with or without treatment.
For cardiovascular, if adequate treatment or rehabilitation could materially change the impairment, paragraph 1.16 says the assessment should be deferred. The report should explain why the timing is appropriate.
For cardiovascular, maximum medical improvement requires an adequately investigated, stable cardiovascular condition. Recent intervention, medication change, unstable angina, decompensation or anticipated surgery may require deferral.
The NSW and AMA5 assessment method
The NSW Workers Compensation Guidelines prevail over AMA5 wherever the two differ. The method is a medical assessment framework, not a self-scoring exercise.
NSW Guidelines Chapter 15 applies AMA5 Chapters 3 and 4 with NSW modifications. The specific table depends on the accepted heart, aortic, pulmonary-arterial, systemic-arterial or peripheral-vascular condition.
The cardiovascular tables use objective disease criteria together with functional class, treatment and symptoms. Relevant measures can include imaging, angiography, valve measurements, blood pressure effects, ejection fraction and available exercise capacity in METs.
The AMA5 cardiovascular categories contain broad percentage ranges. NSW paragraph 15.2 requires clinical judgment and a stated specific percentage within the supported range; the diagnosis or one test value does not automatically justify the top of a class.
It is not the assessor's role to order exercise stress testing solely for impairment evaluation. Existing clinically obtained testing may be useful, but inadequate investigations may mean a reliable assessment cannot yet be made.
Thoracic outlet syndrome is assessed under AMA5 Chapter 16 and NSW Chapter 2 rather than as a generic cardiovascular percentage.
What the assessor actually measures
For cardiovascular, the percentage should be traceable to relevant, stable and reproducible findings.
- ECG, echocardiography, ejection fraction, valve or aortic imaging, angiography and other tests relevant to the accepted diagnosis
- NYHA-style functional limitation, including the level of exertion that produces symptoms and whether ordinary activity is limited
- clinically available exercise capacity in METs or VO2 where relevant, interpreted with the rest of the table criteria
- diet, medication, surgery or intervention and whether symptoms persist despite treatment
- peripheral pulses, vascular imaging, oedema, skin or tissue effects and the regional arm or leg method where applicable
How the measurements are converted to WPI
Place the condition in the applicable AMA5 cardiovascular class after applying NSW Chapter 15, then select a precise WPI within that range from all required clinical, treatment and functional criteria.
A single feature from a more severe class does not necessarily move the whole assessment into that class if the table requires additional criteria. The report should explain how apparently inconsistent factors were reconciled.
AMA5 Tables 4-4 and 4-5 give upper- or lower-extremity impairment, not WPI. Arm values convert through Table 16-3 and leg values through Table 17-3.
Other permitted body-system impairments are combined only after each value has been converted to WPI and checked for duplication.
Verified category and table examples
These short examples show how the published method works. They do not predict an individual assessment.
| Finding or category | Published value or method | Source |
|---|---|---|
| Coronary heart disease Class 3 example | 30-49% WPI | AMA5 Table 3-6a, subject to NSW Chapter 15 |
| Vascular impairment of an arm | Convert UEI to WPI through AMA5 Table 16-3 | NSW Guidelines paragraph 15.7 |
| Vascular impairment of a leg | Convert LEI to WPI through AMA5 Table 17-3 | NSW Guidelines paragraph 15.7 |
Worked illustrations
How the assessment method can operate
These paraphrased illustrations explain the published method. They are not estimates of another worker's WPI.
Illustration: one severe exercise result does not decide the whole cardiac class
Assumed findings: A worker with stable accepted coronary disease has objective arterial obstruction, requires medication to prevent angina, develops symptoms with heavy exertion, and has an existing exercise result of about 4 METs.
Method and arithmetic: The obstruction, medication and symptom pattern support Class 3 under AMA5 Table 3-6a, a range of 30-49% WPI. The 4-MET result is a more severe feature, but by itself does not satisfy all Class 4 requirements; it may support a point toward the upper part of Class 3 if the complete evidence warrants it.
What the illustration shows: The assessor must identify the table criteria and explain the precise point rather than choosing a class from one number. This paraphrased illustration is not an estimate.
Method source: NSW Guidelines paragraphs 15.1-15.5; AMA5 Chapter 3, Table 3-6a
What does not establish WPI by itself
These matters can remain medically and practically important, but they do not replace the measurements or category requirements in the applicable method.
- chest pain, palpitations, breathlessness, fatigue or a heart-disease label without the objective evidence required by the selected table
- one MET, ejection-fraction or imaging result treated as the entire class without considering the remaining criteria
- an extremity impairment percentage incorrectly reported as WPI
- an exercise test ordered solely to manufacture an impairment percentage
- assessment before adequate investigation or cardiovascular stability
Evidence checklist
The assessor should receive enough material to test the accepted injury, stability, measurable impairment and any deduction.
- the accepted injury or disease description and any insurer liability decisions
- contemporaneous GP, hospital and treating-specialist records
- relevant investigations, pathology, procedure reports and treatment history
- earlier impairment assessments and evidence about any pre-existing impairment
- a current clinical opinion explaining stability and whether material improvement remains likely
- cardiology or vascular specialist reports identifying the diagnosis, stability and applicable class
- ECG, echocardiography, ejection-fraction, angiography, valve, aortic and vascular investigation reports
- existing exercise testing, medication, diet, intervention and treatment-response records
- regional vascular examination and calculation sheets showing UEI or LEI conversion where relevant
Common insurer or report disputes
A disagreement about cardiovascular WPI may concern the accepted diagnosis, the body-system findings, the selected method, a deduction or the way another impairment was handled. The report should identify the disputed step rather than leave the percentage unexplained.
- the diagnosis is rated without the required objective evidence
- an extremity percentage is reported as WPI without conversion
- the selected percentage within a broad range is unexplained
- the assessment proceeds despite inadequate investigations
Sources for this assessment guide
The public NSW Guidelines control where they modify AMA5. AMA5 table references below identify the method without reproducing the proprietary table in full.
- NSW Guidelines Chapter 15, paragraphs 15.1-15.8: clinical judgment, MMI, investigations, exercise testing and extremity conversion.
- AMA5 Chapter 3, including Tables 3-1 and 3-5 to 3-11: heart and aortic class methods, subject to NSW modifications.
- AMA5 Chapter 4 and Tables 4-4 to 4-5: arterial and regional vascular methods, subject to NSW conversion rules.
Questions to ask when the report comes back
These questions help identify whether the report explains its method and evidence. They do not replace medical or legal advice about the particular assessment.
- Which AMA5 cardiovascular category was used?
- Why was the specific point within the range selected?
- Was a regional vascular value converted correctly?
- Are investigations adequate and the condition stable?
How this connects to thresholds and strategy
In a cardiovascular claim, SIRA's permanent impairment thresholds must be applied to the accepted injury and the supported body-system percentage. The general thresholds are 11% or more permanent impairment for physical injury and 15% or more for primary psychological injury; secondary psychological injury is treated differently. A threshold is an eligibility checkpoint, not a promised payment.
A low cardiovascular WPI opinion may affect weekly-payment planning, treatment time-limit issues, dispute posture and whether work injury damages threshold advice is required. Before the opinion is relied on, check the relevant measurements, body-system method, deduction and practical consequences.
Questions workers often ask
Does a cardiovascular diagnosis automatically establish WPI?
No. The report must apply the relevant category to stable clinical findings and investigations.
Can the assessor order a stress test just to calculate WPI?
NSW paragraph 15.3 says it is not the assessor’s role to order exercise stress testing purely for impairment evaluation. Existing testing can still be useful.
How is vascular impairment of a leg converted?
A lower-extremity value from the vascular table must be converted to WPI through AMA5 Table 17-3.
How is thoracic outlet syndrome assessed?
NSW paragraph 15.8 directs it to the upper-extremity method in AMA5 Chapter 16 and NSW Chapter 2.
General information only
This information is general in nature and is not legal advice. You should obtain advice about your own circumstances before relying on a WPI percentage, accepting a lump sum offer, or responding to an insurer decision.
Reviewed by NSW Work Injury Claims - a branch of Stephen Young Lawyers.
Related injury and impairment pages
Need a WPI assessment checked?
If the percentage does not match the accepted injury, treatment history, imaging, surgery, work duties or current restrictions, get the report checked before accepting the insurer position.