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