3.6.3.07 Case examples for assessing impairment from permanent conditions

Condition/diagnosis Example of Impairment Table use
Autism Spectrum Disorder

Autism Spectrum Disorder is a developmental disorder often characterised by problems with social interaction and communication, as well as restricted, repetitive patterns of behaviour, interests or activities. The magnitude and severity of the symptoms can vary widely for individuals. A person with a functional impairment caused by this condition would be assessed under the table/s relevant to the impacted function. For example:

  • Table 5 - Mental Health Function can be used to assess the functional impact of cognitive, social interaction and behavioural difficulties in circumstances where the level and nature of functional impairment as a result of Autism Spectrum Disorder (without an interpretable intelligence quotient between 70 and 85) is not adequately covered by Table 7, as the descriptors for each level of impairment rating on Table 5 are much broader and are sensitive to novel and social situations.
  • Table 7 - Brain Function can be used to assess the functional impact of cognitive, social interaction and behavioural difficulties if a person has Autism Spectrum Disorder impacting on day-to-day activities but does not have an interpretable intelligence quotient between 70 and 85.
  • Table 9 - Intellectual Function can be used to assess the functional impact of cognitive, social interaction and behavioural difficulties if a person has Autism Spectrum Disorder and an interpretable intelligence quotient between 70 and 85.

To avoid double counting, it is important not to rate the same functional impairment more than once. This means a person therefore should not be assessed under Table 5, Table 7 and Table 9, but under one of either Table 5 or Table 7 or Table 9.

Chronic fatigue

A person with chronic fatigue syndrome (also known as myalgic encephalomyelitis) may experience a range of symptoms including persistent fatigue, impaired short-term memory or concentration, muscle or joint pain, and unrefreshing sleep. A person with this condition may have functional impairments in a number of areas, depending on their presenting symptoms. In such cases all relevant tables should be used. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if a person experiences limitation in exertion.
  • Table 7 - Brain Function can be used if a person presents with issues with concentration, memory difficulties or other neurological symptoms.
  • Table 10 - Digestive and Reproductive Function can be used if a person experiences gastrointestinal symptoms such as nausea, bloating, constipation or diarrhoea.

The need to avoid double-counting must be considered, for example, if lower limb muscle weakness and limited mobility is due to fatigue, then a separate rating under Table 3 for lower limb conditions is not appropriate.

Refer to the Irritable Bowel Syndrome (IBS) case study below for more detail on assessing conditions that have been stabilised as episodic or fluctuating.

If assistance is required to determine the functional impairments caused by this condition, clarification and advice can be sought from a person's treating doctor and/or the HPAU.

Chronic pain

Acute pain is a symptom which may result in short term loss of functional capacity in one or more areas of the body but should resolve within a few months. Chronic pain can be a primary chronic pain syndrome, e.g. fibromyalgia or chronic regional pain syndrome and where it has been fully diagnosed, treated and stabilised, the assessor should assess any loss of functional capacity using the table relevant to the area of function affected. Chronic pain can also be a symptom and when it stems from a permanent condition the functional impact of the pain should be rated using the relevant table/s to capture the appropriate level of impairment while ensuring the level of impairment is not overstated or double counted. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if chronic pain impacts a person's physical exertion and stamina (e.g. fatigue symptoms) and is not adequately assessed by another table. Systemic conditions that are causing widespread pain with associated fatigue may be more appropriately assessed on Table 1.
  • Either Table 2 - Upper Limb Function, Table 3 - Lower Limb Function or Table 4 - Spinal Function can be used if the pain impacts a person in one of these areas of functioning. These tables can also be used in combination if the pain impacts the person in multiple areas.
  • Table 7 - Brain Function can be used if a person has chronic pain which impacts their memory, attention or concentration. Table 7 can be used in conjunction with other tables, as required.
  • Table 10 - Digestive and Reproductive Function can be used if a person has chronic pelvic pain that impairs their ability to concentrate on or sustain tasks or work activities.
  • Table 14 - Functions of the Skin can be used if a person has chronic pain related to a disorder of, or injury to, the skin.

If it is unclear how chronic pain should be rated to avoid double counting, the claim should be referred to the HPAU.

Diabetes mellitus

A person with diabetes mellitus that is fully treated and fully stabilised may experience a range of functional impairments. In such cases, all relevant tables should be used. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if diabetes impairs a person's ability to perform and sustain physical activities
  • Table 3 - Lower Limb Function can be used if a person has peripheral neuropathy or vascular disease that affects their lower limb function.
  • Table 12 - Visual Function can be used if a person's vision is affected.
  • Table 15 - Functions of Consciousness can be used if a person has frequent hypoglycaemic episodes. However, if the person is experiencing frequent hypoglycaemic episodes, it must first be established whether the diabetes is fully treated and fully stabilised.
End-stage renal failure

A person with end-stage renal failure may experience a range of impairments and a number of tables can be used to assess this. For example:

  • Table 1 - Functions requiring physical exertion and stamina can be used where there is functional impairment when performing activities requiring physical exertion and stamina.
  • Table 10 - Digestive and reproductive function can be used where there is a functional impairment of the digestive system.
  • Table 14 - Functions of the skin can be used where there is functional impairment relating to the skin e.g. pruritus.
Epilepsy

A person with epilepsy may experience seizures where they have involuntary loss or altered state of consciousness. This condition is primarily rated on Table 15 Functions of Consciousness if it is fully diagnosed, fully treated and fully stabilised. The tables have severity and frequency built into the rating descriptors. For example, the descriptor for 20 points on Table 15 includes:

  • a person has episodes of involuntary loss of consciousness due to a diagnosed medical condition at least once each month which require first aid measures and may require emergency medication and/or hospitalisation, OR
  • a person has episodes of altered state of consciousness that occur at least once per week during which the person's functional abilities are affected (e.g. the person remains standing or sitting but is unaware of their surroundings or actions during the episode).

Impairment points could also be applied on Table 7 - Brain Function for cognitive issues relating to epilepsy and antiepileptic medication.

Fluctuating mental health conditions

If a person's mental health condition has been stabilised as episodic or fluctuating (as may be the case with conditions such as bipolar affective disorder), the rating that reflects the overall functional impact of the condition, taking into account the severity, duration and frequency of the episodes should be applied. Refer to the irritable bowel syndrome case study below for more detail on assessing conditions that have been stabilised as episodic or fluctuating.

People with mental health conditions may not have good self-awareness of their impairment and may not be able to accurately describe its effects. In determining the functional impact of mental health conditions, Table 5 - Mental Health Function instructs assessors to consider information from a wide range of sources and a person's presentation on the day of the assessment should not be solely relied upon.

HIV/AIDS

A person living with HIV (PLHIV) may present with a range of co-morbidities and functional impairments, even where their condition is fully diagnosed, treated and stabilised. The magnitude and severity of symptoms and side effects from treatment can vary widely for individuals. In the assessment of a person living with HIV, all relevant tables should be applied. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if there is functional impairment when performing activities requiring physical exertion and stamina.
  • Table 2 - Upper Limb Function and/or Table 3 - Lower Limb Function can be used if a person has peripheral neuropathy such as numbness or tingling of fingertips and/or toes.
  • Table 5 - Mental Health Function can be used if a person has a functional impairment due to a psychological disorder, such as clinical depression or bipolar disorder.
  • Table 7 - Brain Function can be used if a person has a functional impairment of cognitive function, for example, from neurological conditions such as HIV dementia or HIV encephalopathy.
  • Table 10 - Digestive and Reproductive Function can be used if, for example, a person experiences diarrhoea.
  • Table 12 - Visual Function can be used if a person has functional impairment when performing activities involving visual function, such as from mycobacterium avium complex (MAC) which causes visual impairment or blindness.
  • Table 14 - Functions of the Skin can be used if there is functional impairment related to the skin.
  • Various tables may be used if the person has diabetes mellitus (refer to the diabetes mellitus case study above).
Hypertension

Fully treated hypertension usually does not result in functional impairment. Where hypertension results in no or minimal functional impact, a rating of zero under Table 1 should be assigned.

If severe and treatment resistant hypertension has resulted in other fully diagnosed, treated and stabilised secondary conditions, such as damage to the eyes, kidneys or heart, the functional impacts of these conditions should be rated under the relevant tables. For example:

  • Table 1 - Functions requiring Physical Exertion and Stamina, and
  • Table 12 - Visual Function.
Irritable Bowel Syndrome (IBS)

IBS is a chronic functional gastrointestinal disorder (i.e. no biochemical or structural abnormalities on investigation) which is rated under Table 10 (Digestive and Reproductive Function). It can be managed with diet, increasing soluble fibre intake, antidepressant medications and psychological therapies. However, whether or not there is impact on day-to-day functioning, the condition can be deemed fully diagnosed, treated and stabilised. IBS is characterised by recurrent abdominal pain or bloating related to defaecation and is associated with a change in stool frequency or appearance. IBS can be associated with considerable distress and patients may even be reluctant to leave the house and attend work, due to concerns that they may not be able to access a toilet in a timely fashion if they have an episode of diarrhoea. Symptoms often fluctuate in intensity, varying from week to week or even day to day. The person may also alternate between having constipation and diarrhoea.

If a person's condition is episodic or fluctuating, a rating should be applied that reflects the overall functional impact of the condition, taking into account the severity, duration and frequency of the episodes.

In determining the functional impact of fluctuating conditions, their impact on a person's ability to reliably perform work over the next 2 years without excessive leave or work absences should be considered. For example:

  • Approximately 2 weeks sick leave in a 26-week period due to episodic or fluctuating IBS is within what is considered reasonable leave.
  • Sick leave of a month or more in a 26-week period due to episodic or fluctuating IBS is considered excessive leave.
Malignancy (cancer)

The functional impact of permanent malignancy is variable depending on the body parts or systems involved the nature and effectiveness of treatment, and the extent or stage of the disease. In the assessment of a person with malignancy, all relevant tables should be applied, while avoiding double-counting.

People who have terminal malignancy, where the average life expectancy of a patient is more likely than not to be 24 months or less and there is a significant reduction in work capacity within this period, are manifestly qualified for DSP.

Migraine

If a person experiences impairment to neurological or cognitive function, then Table 7 - Brain Function can be used. For example, severe pain may impair the person's abilities with regard to attention and concentration or comprehension.

Table 1 - Functions Requiring Physical Exertion and Stamina may also be suitable in some circumstances. The usual approach to episodic or fluctuating conditions would also apply.

Miscellaneous ear/nose/throat conditions

Functional impairments resulting from ear, nose and throat conditions would be commonly assessed using Table 8 - Communication Function and Table 11 - Hearing and Other Functions of the Ear. For example:

  • Table 8 - Communication Function can be used if a person's speech production is impaired due to a laryngectomy (removal of larynx or voice box).
  • Table 11 - Hearing and Other Functions of the Ear can be used if a person's hearing is impaired due to otosclerosis (bone overgrowth in the middle ear) or if their balance is affected due to an inner ear (vestibular) disorder such as Meniere's disease.
Morbid obesity

Morbid obesity (class III obesity) in adults is defined as a body mass index (BMI) of equal to or greater than 40 kg/m2. A BMI of greater than or equal to 40 is generally considered to be incompatible with long term good health, however, does not necessarily correlate with significant functional impact. The functional impact of morbid obesity may range from minimal to very significant. In the assessment of a person with morbid obesity, the tables relevant to the area of function affected should be applied. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if the person experiences symptoms (shortness of breath, fatigue, cardiac pain) when performing physical activities.
  • Table 3 - Lower Limb Function can be used if the person has difficulty walking, using stairs, kneeling or squatting.

Where morbid obesity results in no functional impact, a rating of zero under Table 1 should be assigned.

If morbid obesity has resulted in other fully diagnosed, treated and stabilised secondary conditions, for example, osteoarthritis of the knee joints, the functional impacts of these conditions should be rated under the relevant tables.

However, where 2 or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that impairment under a single table. It is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Multiple Sclerosis (MS)

A person with MS may experience a range of symptoms and symptoms from MS can vary between people. In the assessment of a person with MS, all relevant tables should be applied. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be used if a person has a functional impairment when performing activities requiring physical exertion and stamina.
  • Table 2 - Upper Limb Function and/or Table 3 - Lower Limb Function can be used if a person has muscle weakness or loss of coordination that results in impaired upper and/or lower limb function (e.g. lifting and manipulating objects or walking).
  • Table 7 - Brain Function can be used if the person experiences functional impairment related to cognitive function, such as memory difficulties.
  • Table 13 - Continence Function can be used if a person has a functional impairment related to incontinence of the bladder or bowel.
Stroke (cerebro-vascular accident)

A person who has suffered a stroke (cerebro-vascular accident) may have functional impairments in a number of areas depending on the part/s of the brain that have been damaged. In such cases, assessors should use all of the relevant tables. For example:

  • Table 1 - Functions Requiring Physical Exertion and Stamina can be considered if fatigue is a feature (it often is with a stroke).
  • Table 2 - Upper Limb Function and Table 3 - Lower Limb Function can be used if a person has impaired upper and/or lower limb function.
  • Table 7 - Brain Function can be used if a person has impaired cognitive functions, such as difficulty with visuo-spatial functioning, attention or concentration.
  • Table 8 - Communication Function can be used if a person has difficulties understanding or producing speech.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Part 2 Rule for applying the Impairment Tables, Table 1 - Functions requiring Physical Exertion and Stamina, Table 2 - Upper Limb Function, Table 3 - Lower Limb Function, Table 4 - Spinal Function, Table 5 - Mental Health Function, Table 7 - Brain Function, Table 8 - Communication Function, Table 9 - Intellectual Function, Table 10 - Digestive and Reproductive Function, Table 11 - Hearing and other Functions of the Ear, Table 12 - Visual Function, Table 13 - Continence Function, Table 14 - Functions of the Skin, Table 15 - Functions of Consciousness

Last reviewed: 10 May 2021