3.6.3.07 Case Examples of Table Use for 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. The magnitude and severity of the symptoms can vary widely for individuals. A person with this condition would be assessed according to their presenting symptoms. For example:
It is important not to rate the same functional impairment twice and a person therefore must not be assessed under both Table 7 and Table 9.
|Cerebro-vascular accident (stroke)||
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:
A person with chronic fatigue syndrome (myalgic encephalomyelitis) may experience a range of symptoms including exhaustion, persistent weakness, pain and neurological problems such as confusion. A person with this condition may have functional impairments in a number of areas, depending on their presenting symptoms. In such cases, assessors should use all of the relevant Tables. For example:
If assistance is required to determine the functional impairments caused by this condition, assessors should seek clarification and advice from the person's treating doctor and/or the Health Professional Advisory Unit.
Acute pain is a symptom which may result in short term loss of functional capacity in more than one area of the body but should resolve itself within a few months.
Chronic pain can be a condition 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:
If it is unclear how chronic pain should be rated to avoid double counting, the claim should be discussed with the Health Professional Advisory Unit.
Dementia is rated under Table 7 (Brain Function) and is a progressive condition that causes a person's abilities to deteriorate over time. The progress of dementia varies between individuals. In some cases, a person's abilities will deteriorate rapidly over a few months, while in other cases a person's abilities will deteriorate more slowly over a number of years. The speed at which a person's abilities are deteriorating should be taken into account in assessing the functional impact of their condition.
The abilities of people with dementia may change from day to day, or even within the same day. If the person's condition is stabilised as episodic or fluctuating, the assessor should apply the rating that reflects the overall functional impact of the impairments, taking into account the severity, duration and frequency of the episodes.
In determining the functional impact of fluctuating conditions, assessors should consider their impact on the person's ability to reliably perform work over the next 2 years without excessive leave or work absences. For example:
A person with diabetes mellitus that is fully treated but poorly controlled may experience a range of functional impairments. In such cases, assessors should use all of the relevant Tables. For example:
A person with epilepsy may experience seizures where they have involuntary loss or altered state of consciousness. This condition is rated under Table 15 (Functions of Consciousness). The Tables have severity and frequency built into the rating descriptors. For example the descriptor for 20 points on Table 15 includes:
|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 assessor should apply the rating that reflects the overall functional impact of the impairments, taking into account the severity, duration and frequency of the episodes. Refer to dementia case study above 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 not to rely solely on a person's presentation on the day of the assessment.
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, assessors should apply all of the relevant Tables. For example:
Fully treated hypertension usually does not result in functional impairment. Where hypertension results in no functional impact, a rating of zero under Table 1 should be assigned.
If severe and untreated 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 (e.g. Table 12 - Visual Function and Table 1 - Functions requiring Physical Exertion and Stamina).
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, assessors should apply all of the relevant Tables.
People who have terminal malignancy, where the average life of a patient with the condition is 24 months or less, are manifestly qualified for DSP.
Different types of migraine may or may not result in a loss of consciousness or altered state of consciousness and this guides Table selection.
If the migraines do not result in a loss of consciousness but the 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 ability with regard to attention and concentration or comprehension.
If the person experiences loss of consciousness or altered states of consciousness as a result of the migraines, then Table 15-Functions of Consciousness can be used.
If the person experiences an altered state of consciousness as a result of a migraine, this may mean that awareness of their surroundings or actions is diminished but they may not completely lose consciousness and may remain sitting or standing.
|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 Function). For example:
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, assessors should apply the Tables relevant to the area of function affected. For example:
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.
A person with multiple sclerosis (MS) may experience a range of symptoms and symptoms from MS can vary between people. In the assessment of a person with MS, assessors should apply all of the relevant Tables. For example:
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 46, Table 12 - Visual Function,, Table 13 - Continence Function, Table 14 - Functions of the Skin, Table 15 - Functions of Consciousness