3.6.3.150 Guidelines to Table 15 - Functions of Consciousness

Summary

Table 15 is used to assess the functional impact of a condition due to involuntary loss of consciousness or altered state of consciousness, such as epilepsy, some forms of migraine, transient ischaemic attacks, or brain tumours.

Conditions causing impairment commonly assessed using Table 15

These include but are not limited to:

• epilepsy
• brain tumours
• cardiac or other forms of syncope
• migraine that results in loss of consciousness or altered states of consciousness and
• narcolepsy.

Diagnosis & evidence

The diagnosis of the condition must be made by an appropriately qualified medical practitioner and supported by corroborating medical evidence. This includes a GP or other medical specialists, such as a neurologist or endocrinologist. Assessments or reports from practitioners specialising in the treatment and management of these conditions (such as, clinical nurse consultants or nurse practitioners specialising in diabetes management) can also be provided as corroborating evidence of treatment and/or functional impairment. However, the diagnosis must be made by an appropriately qualified medical practitioner as described above.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining functional impacts of a person's condition (impairment). There must be corroborating medical evidence of the person's impairment.

Examples of corroborating evidence for the purposes of Table 15 include, but are not limited to:

• a report from the person’s treating doctor
• a report from a medical specialist (such as, neurologist, endocrinologist or other physician) confirming diagnosis of conditions associated with episodes of loss of or altered state of consciousness (such as, epilepsy, transient ischaemic attacks, some forms of migraine, brain tumours, narcolepsy, or cardiac or other forms of syncope)
• assessments or reports from practitioners specialising in the treatment and management of these conditions (such as, neurologists, endocrinologists, or registered nurses).

Interpretation & application of relevant terms

‘Altered state of consciousness’ includes instances where a person may not lose consciousness completely and may remain sitting or standing but becomes unaware of their surroundings or actions.

‘Usual activities’ refers to the activities a person would expect to undertake during the normal course of their day. This will vary from individual to individual but may involve things such as household duties (for example, cooking or cleaning), commuting to and from work, and undertaking work tasks.

Where a descriptor in Table 15 refers to ‘work-related activities’, this is taken to mean tasks that relate to work, education or training activities and are typically clerical, sedentary or stationary.

Determining the level of functional impact - rules

When establishing whether a person’s impairment causes no (0 points), mild (5 points), moderate (10 points), severe (20 points) or extreme (30 points) functional impact, each descriptor and all its paragraphs for an impairment rating level in the Table must be read as a whole.

The structure of the Tables requires that, in assessing the level of functional impact, a comparison must be made of all the descriptors for each level of impairment. This does not necessarily mean all descriptors must be met, but all must be considered to determine which descriptors apply to the person’s impairment.

While every descriptor requires consideration, in order to compare and contrast the descriptors to determine which impairment rating best reflects the level of functional impact resulting from a person’s condition. Each Table provides specific instructions on the number of descriptors to be met in order to assign a particular impairment rating. Determination of a person's impairment level must be based on the corroborating evidence provided by the person, including the person's medical history, investigation results and clinical findings.

The descriptors in each Table follow an incremental hierarchy based on frequency of episodes and capacity to perform usual activities. These are further clarified in each descriptor as to the expected frequency (such as, more than twice per year, more than twice each year but not every month, at least once each month etc.)

When determining a person's limitations in relation to conducting 'work tasks', consideration must be given to a person's ability to undertake the task, regardless of whether or not it is part of work they do or have done previously. 'Work' is taken to refer to any work that exists in Australia, even if not within the person’s locally accessible labour market.

An assessment starts by considering the descriptors for 0 points, and if a person has more than 'no functional impact', the descriptors for 5 points are then considered, and so on for the descriptors for higher impairment levels. When it is determined the person meets all the required descriptors for a certain impairment rating level, but does not meet all the required descriptors for the next impairment rating level, the appropriate impairment rating applicable to the person's circumstances will be. the rating at which all the required descriptors are met.

Where several descriptors must apply for a rating the word 'and' links the descriptor. However, one of several descriptors may be sufficient for that rating when the word 'or' links the descriptors.

Note 1: Individual descriptors or their parts must not be applied in isolation from one another.

In determining whether the required descriptors for a specific impairment level are met or not, ALL the descriptors for that level must be considered and applied as set out in the descriptor. NO descriptors or their parts are to be disregarded.

Note 2: The descriptors must be applied sequentially to allocate an impairment rating - the incremental hierarchy of descriptors MUST NOT be ignored. As mentioned above, the assessment process involves applying the 0-point descriptors first and continuing to apply the descriptors for higher impairment levels, until all the required descriptors for a certain impairment rating level are met.

Note 3: If the person's impairment does not meet all required descriptors for a certain impairment level, the person's impairment cannot be rated at that level or at any higher level.

Determination of the descriptor that best fits the person's impairment level must be based on the available medical evidence including the person's medical history, investigation results and clinical findings. A person's self-reported symptoms must not be solely relied on. An impairment rating must not be applied unless the person's self-reported functional impacts are consistent with and supported by the medical evidence available.

In determining the level of functional impact, care should be taken to distinguish between activities that the person does not do as opposed to activities that they have difficulty performing because of their impairment.

An activity listed under a descriptor cannot be taken as being able to be performed if it can only be performed once or rarely - the person needs to be able to usually perform such activity whenever they would normally attempt it or be required to perform it. Where an activity is usually required to be performed repetitively, a person who can only perform such activity once and is then unable to perform the activity again when required will be taken to be unable to perform this activity. Equally, where an activity is normally undertaken infrequently (for example, only once per day or once per week), a person who can perform that activity once per day or once per week, is not unable to perform the activity merely because they are unable to perform the activity repetitively or with greater frequency than would normally be required.

Where a Table refers to a person being unable to perform certain tasks, the term 'unable' is not intended to mean that the task is unable to be performed without some symptoms. When a person experiences some symptoms when performing an activity this does not mean the person is 'unable' to perform the task. The assessment of the symptoms experienced in performing the activity is relevant where they are severe enough for the person to not be physically able to perform the activity on a repetitive or habitual basis, and not once or rarely.

When assessing episodic or fluctuating impairments and conditions, a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate (see 3.6.3.08 ‘Assessing impairments caused by episodic or fluctuating conditions’).

Impairment Ratings for Table 15

0-point impairment rating level

The 0-point descriptor requires that the person have NO functional impact from loss of consciousness or altered state of consciousness.

For this rating to be assigned, the person must meet descriptor (1).

5-point impairment rating level

The 5-point descriptor requires that the person have a MILD functional impact from loss of consciousness or altered state of consciousness.

For this rating to be assigned, the person must meet descriptors (1)(a)(i) and (1)(a)(ii) as well as (1)(b) and (1)(c).

10-point impairment rating level

The 10-point descriptor requires that the person have a MODERATE functional impact from loss of consciousness or altered state of consciousness.

For this rating to be assigned, the person must meet either (1)(a)(i)(A) and (B) OR (1)(a)(ii)(A) and (B). The person must also meet descriptors (1)(b), (1)(c) and (1)(d).

20-point impairment rating level

The 20-point descriptor requires that the person have a SEVERE functional impact from loss of consciousness or altered state of consciousness.

For this rating to be assigned, the person must meet either (1)(a)(i)(A) and (B) OR (1)(a)(ii)(A) and (B). The person must also meet descriptors (1)(b), (1)(c) and (1)(d).

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact from loss of consciousness or altered state of consciousness.

For this rating to be assigned, the person must meet either (1)(a)(i)(A) and (B) OR (1)(a)(ii)(A) and (B). The person must also meet descriptors (1)(b), (1)(c) and (1)(d).

Avoiding double counting

Double counting of impairments must be avoided (see 3.6.3.06 ‘Rating multiple conditions with common impairments & double counting’).

Examples of Table 15 assessment

Impairments that should not be assessed using Table 15

Table 15 must not be used for migraines, which do not result in loss or altered states of consciousness. These are more appropriately assessed under Table 1 - Functions requiring Physical Exertion & Stamina or Table 7 – Brain Function.