Incapacity Benefit and Cardio-respiratory function.

The Incapacity Benefit Handbook for Approed Doctors divides this criteria into heart disease and chest disease. It reminds doctors that the key adjectives are "severely" and "persistently".

with regard to heart disease, the guidance ponts out that if symptoms persist despite high levels of medication, multiple therapies or second line treatments then it is likely that the condition is sufficently severe so as to be exempt.

The guidance instructs doctors to consider exemption when one or more of the following is identified-

• The presence of both symptomatic ischaemic and valvular heart disease;
• The presence of cardionyopathy or treatment-unresponsive cardiac failure;
• Assistance from another person required at a level of personal care;
• Unstable angina unresponsive to medical therapy or coronary angioplasty;
• Orthopnoea, dyspnoea on mild exertion (eg walking indoors, dressing/washing;
• Additional disablement from respiratory, renal or hepatic disease, arteriosclerosis, or anaemia;

The guidance indicates that doctors should not normally recommend exemption in heart disease cases for longer than 12-18 months as this allows sufficient time for surgical intervention.

With regard to chest disease the guidance lists the following indicators where exemption should be considered-

• Orthopnoea, cyanosis, dyspnoea at rest, dyspnoea on minimal exertion (e.g. dressing/washing, walking indoors).
• Assistance from another person required at a level of personal care.
• Domiciliary oxygen used on a regular daily basis.
• Maximal therapy, including inhaled therapy (e.g. need for regular use of high dose nebulised steroids).
• Peak expiratory flow rate (PEFR) 60% or more below predicted value for age, consistent with other evidence.
• Frequent hospital admissions for respiratory disease.
• Recent weight loss without dieting.
• Additional disablement from cardiac disease, anaemia, or severe thoracic.

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