3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion & Stamina

Summary

Table 1 is used where a person has a functional impairment when performing activities requiring physical exertion or stamina, which results from a condition commonly associated with cardiac or respiratory impairments, fatigue or exhaustion, or other conditions affecting physical exertion or stamina.

The diagnosis of the medical condition causing the impairment must be made by an appropriately qualified medical practitioner. This includes a general practitioner or other specialist such as a cardiology, respiratory, rheumatology or other specialist physician.

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

Interpretation & application of relevant terms

Where the descriptors in Table 1 refer to mobilising in a wheelchair, this includes both manually-propelled wheelchairs and powered mobility aids (such as power assist wheelchair, power wheelchair or mobility scooter).

'Public transport' means any mode of transport that runs to a timetable such as buses, trains, trams and ferries. It excludes taxis or hire cars. A person who is able to use at least one of these modes of transport, having regard only to the level of impairment assessable under Table 1, is considered to be able to use public transport for the purpose of this Table, even if they are precluded from using other modes of public transport. When assessing a person's ability to use public transport it is irrelevant whether the person actually uses public transport, whether public transport is available to the person in their local area and whether the person actually receives assistance.

Similarly, where Table 1 refers to activities such as walking (or mobilising in a wheelchair) to local facilities (e.g. a corner shop, around a shopping mall, a shopping centre or supermarket, larger workplace or education or training campus), it is irrelevant whether such establishments, businesses, buildings or structures actually exist in a person's locality or how they may be labelled. Of relevance is the description of the activity involved. The objective is to measure a person's level of ability having regard to the severity of a person's symptoms (e.g. shortness of breath, fatigue or cardiac pain) when performing certain tasks requiring physical exertion or stamina.

Explanation: The AAT (General Division) applied this approach in its decision in Wilson and Secretary, Department of Social Services (2015) AATA 497.

The 20 and 30-point descriptors in Table 1 use the term 'assistance'. Assistance means assistance from another person, rather than any aids or equipment the person has and usually uses (see 3.6.3.05 (E) Use of aids, equipment & assistive technology).

Explanation: This interpretation of the term 'assistance' has been adopted in a number of decisions by the AAT (General Division), including in Summers and Secretary, Department of Social Services (2014) AATA 165.

Determining the level of functional impact - general rules

As in the other Tables, the descriptors in Table 1 are interlinked in that they follow a consistent incremental hierarchy, which in this Table is expressed, among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities (e.g. no difficulty, occasional difficulty, occasional symptoms, frequent symptoms, unable to, completely unable to).

Consequently, as is the case in applying any other Table, when establishing whether the impairment causes no (0 points), mild (5 points), moderate (10 points), severe (20 points) or extreme (30 points) functional impact, all the descriptors for each impairment rating level in Table 1 should be read as a whole and compared so the descriptors, and their relativity and hierarchy in this Table, are understood.

When determining a person's limitations in relation to conducting 'work tasks', this is taken to refer to any job available in Australia.

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. 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 that 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 lower of those 2 impairment ratings (i.e. the rating at which all the required descriptors are met).

Note: 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 descriptors. NO descriptors or their parts are to be disregarded. However, one of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

For example, to be eligible for 20 points under Table 1 a person must have a SEVERE functional impairment on activities requiring physical exertion and stamina and must usually experience symptoms, such as shortness of breath, fatigue, cardiac pain or chronic pain, when performing light physical activity AND must be unable to do at least one of the activities listed under point (1)(a) AND must also satisfy point (1)(b).

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

Explanation: Where a person meets the required descriptors for 5 points but does not meet sufficient required descriptors for 10 points, the correct impairment rating is 5 points. Their impairment CANNOT be assessed as moderate, severe or extreme and 10, 20 or 30 points cannot be allocated.

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. It would be inappropriate to apply an impairment rating based solely on a person's self-reported functional capacity if this level of functional impairment is not consistent with 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 is not 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. Conversely, where an activity is normally undertaken infrequently (e.g. only once per day or once per week), a person who can perform that activity once per day or once per week, as the case may be; 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.

When Table 1 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 pain, shortness of breath or fatigue. When a person experiences some symptoms or pain when performing an activity this does not mean the person is 'unable' to perform the task. The assessment of the level of pain and symptoms experienced in performing the activity is relevant where the pain and symptoms 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.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 section 11(2) In deciding whether an impairment has no, mild …, section 11(1)(c) If an impairment is considered as falling between …

0-point impairment rating level

The 0-point descriptor specifies the person is able to undertake exercise appropriate to their age for at least 30 minutes at a time (point (1)(a) AND has no difficulty completing physically active tasks in their home and community (point (1)(b).

To meet descriptor point (1)(a), it would not be expected that an older aged person is able to undertake the same level of intensity in exercise as someone aged in their 20's due to reduced stamina or loss of flexibility. Consideration should be given to the level of exercise a generally healthy person of the equivalent age would reasonably be expected to undertake.

5-point impairment rating level

For this rating to be assigned to a person, the person MUST meet at least one of the descriptor points (1)(a)(i) or (1)(a)(ii) AND also descriptor point (1)(b).

10-point impairment rating level

The 10-point descriptor requires that for this rating to be assigned to a person, the person MUST satisfy at least one of the descriptor points (1)(a)(i) or (1)(a)(ii) AND must also meet both descriptor points (1)(b)(i) and (1)(b)(ii).

20-point impairment rating level

The 20-point descriptor requires that any person considered for this rating must satisfy at least one of the requirements set out in (1)(a)(i), (1)(a)(ii), (1)(a)(iii) and (1)(a)(iv) AND must also meet the descriptor point (1)(b).

30-point impairment rating level

The 30-point descriptor includes people who require oxygen treatment (descriptor point 2). If a person requires oxygen treatment such as the use of an oxygen concentrator during the day or to move around, they should be assessed as meeting the 30-point descriptor, without the need to be assessed under descriptor point 1. Likewise if a person does not require oxygen treatment but meets points (1) (a) or (b) they would also meet the 30-point descriptor.

Avoiding double counting

The descriptors in other Tables may also refer to certain activities relating to a person's ability to mobilise such as climbing steps etc., but those Tables measure the impact of impairment where that impairment is different to those assessed under Table 1. For example, some descriptors in Table 3 measure the level of difficulty in walking, climbing stairs or mobilising in a wheelchair due to symptoms affecting the use of lower limbs.

Table 1 may be used to assess the functional impact of chronic pain where there is corroborating medical evidence that chronic pain (affecting one or more body functions) also impacts physical exertion and stamina (e.g. results in fatigue symptoms). However, to avoid double counting, Table 1 should only be used if the level of impairment to a particular function is not adequately assessed by the Table relevant to that function. Therefore, if there is an impact on physical exertion and stamina and a rating has been allocated on other Tables (e.g. Tables 2, 3 and 10), it needs to be carefully considered whether the rating on the other Table already adequately captures the level of impairment. If the answer is NO, then use of Table 1 may be considered, while ensuring that the level of impairment is not overstated. If the answer is YES, there is no need to apply Table 1.

When assessing chronic pain under Table 1, refer to 3.6.3.05 (B) Assessing functional impact of pain. Please also refer to 3.6.3.05 (F) Selecting the applicable Table & assessing impairments. More information about avoiding double counting and supporting examples are also contained in the below sections of this topic, titled: Some conditions causing impairment commonly assessed using Table 1 (Example 3) and Impairments that should not be assessed using Table 1.

If it is unclear how and when to use Table 1 while avoiding double counting, the case should be discussed with the HPAU.

Some conditions causing impairment commonly assessed using Table 1

These include but are not limited to:

  • ischaemic heart disease or coronary artery disease with exercise induced angina
  • cardiac disease which has resulted in chronic cardiac failure, such as cardiomyopathy or some cardiac valvular conditions
  • cardiac arrhythmias that result in exercise induced restrictive symptoms
  • chronic obstructive pulmonary disease (COPD)
  • restrictive lung disorders
  • exercise induced asthma
  • autoimmune conditions such as systemic lupus erythematosus (SLE) and rheumatoid arthritis which impact a person's physical exertion or stamina and no other Table sufficiently captures the impairment
  • chronic fatigue syndrome
  • fibromyalgia
  • chronic kidney disease known as stage 5 kidney disease when requiring dialysis
  • diabetes mellitus.

Example 1: A 45 year old man is diagnosed with morbid obesity. The medical evidence states that this impacts on his ability to perform activities which require physical exertion and stamina. He finds it difficult to walk up stairs or complete lawn mowing without taking a break to rest due to shortness of breath. He is able to perform most work-related tasks, except work which would require heavy manual labour.

The condition is considered fully diagnosed, treated and stabilised and under Table 1, the man's impairment would be rated as 5 points, as the impact on his ability to perform tasks is only mildly affected. Under the 5-point descriptor the man would meet (1)(a)(ii) and (b).

Example 2: A 49 year old woman has been diagnosed with chronic obstructive pulmonary disease. Lung function tests indicate that the condition is causing low airflow to and from the lungs and impacts on the woman's ability to undertake physical activities. The woman experiences shortness of breath when undertaking day to day activities such as sweeping or walking very far outside her home. For example, she is not able to walk to her local shop and return home with a bag of shopping. She can perform light household tasks, such as cooking and doing dishes, and can read, pay bills and use a computer without experiencing shortness of breath.

The condition is considered fully diagnosed, treated and stabilised and under Table 1, the woman would receive an impairment rating of 10 points for the moderate impact the condition has on her ability to function. Under the 10-point descriptor the woman would meet (1)(a)(ii) and (b)(ii).

Example 3: A 55 year old woman has severe deteriorating rheumatoid arthritis. Medication provides limited relief and the doctor has stated she experiences associated chronic pain and fatigue. This condition is systemic in nature and the woman experiences persistent fatigue, chronic inflammation of her joints with swelling, heat and pain, as well as muscle weakness and difficulty sleeping. Medical evidence states that due to fatigue and pain the woman is unable to perform any light day to day household activities and would not be able to perform clerical or sedentary work tasks for a shift of 3 hours.

The condition is considered fully diagnosed, treated and stabilised and under Table 1- Functions requiring Physical Exertion and Stamina, the woman would receive an impairment rating of 20 points as the impact on her ability to function is severe. Under the 20-point descriptor the woman would meet (1) (a) (iv) and (1) (b). To avoid double counting ratings under Table 2-Upper Limb Function and Table 3-Lower Limb Function are not given as Table 1 includes assessment of mobility and capacity to undertake daily activities.

Example 4: A 50 year old man has longstanding type 2 diabetes mellitus and has developed stage 5 chronic kidney disease. He attends a haemodialysis clinic three to four times per week. Each episode of haemodialysis takes approximately 5 hours. After haemodialysis he typically goes home to sleep. His primary symptom is pronounced fatigue. During dialysis, the functional impact on physical exertion and stamina is extreme, as the nature of the treatment renders a person immobile. Before and immediately after dialysis fatigue is severe, and at other times it is moderately severe. Applying the medical evidence and the fluctuating nature of the symptomatology, a rating of 20 impairment points is allocated under Table 1.

Impairments that should not be assessed using Table 1

Non-pathological causes such as lack of fitness that are not associated with a diagnosed medical condition, should not be assessed using Table 1.

Restriction of physical activity due to musculo-skeletal conditions, e.g. severe arthritis, spinal problems, unless the musculo-skeletal Tables 2, 3 or 4 do not sufficiently capture the impairment from any associated impact on physical exertion and stamina.

Assessors need to be mindful not to overstate the level and nature of impairment. Musculo-skeletal conditions can be expected to involve some level of ongoing pain and reduced stamina in addition to a loss of dexterity/flexibility which would all be factors in determining the level of severity of the impairment. This is more evident when assessing a person's ability to undertake the actions described on a repetitive basis rather than a one-off action.

Example 1: A 60 year old man has osteoarthritis in both knees which is fully diagnosed, treated and stabilised. The man experiences loss of flexibility in his knees and pain when bending to sit or on rising from a sitting position as well as when walking any distance. The man requires assistance from his carer within the home and a walking frame with assistance outside his home and is unable to walk far or stand up from a sitting position without assistance from another person.

The condition is considered fully diagnosed, treated and stabilised and under Table 3, the man's impairment would be rated as 20 points, as the impact is severe. Under the 20-point descriptor the man would meet all points under (1)(a) and (1)(b). The descriptor also captures the level of pain resulting from the lower limb impairment.

Example 2: A 58 year old woman has chronic osteoarthritis in both her hands and wrists, which is fully diagnosed, treated and stabilised. She experiences lack of strength in her hands and ongoing chronic pain. This pain affects her ability to handle, move or carry most objects, use a computer keyboard or pen/pencil and turn the pages of a book.

The condition is considered fully diagnosed, treated and stabilised and under Table 2, the woman's impairment would be rated as 20 points due to the severe level of impairment. The woman is unable to perform any of the actions listed in the 20-point descriptor on a repetitive basis due to the loss of dexterity and chronic pain experienced when using her hands and arms. Under the 20-point descriptor the woman would meet all points under (1).

Last reviewed: 21 September 2020