3.6.3.110 Guidelines to Table 11 - Hearing and Other Functions of the Ear

Summary

Table 11 is used to assess the functional impact of a condition when performing activities involving hearing function or other functions of the ear (such as balance).

Conditions causing impairment commonly assessed using Table 11

These include but are not limited to:

• congenital deafness
• presbyacusis
• acoustic neuroma
• side-effects of medication, including chemotherapy
• Meniere's disease
• head and neck cancer
• tinnitus, and
• noise-induced hearing loss.

Diagnosis & evidence

The diagnosis of the condition must be made by an appropriately qualified medical practitioner and supported by corroborating medical evidence. Corroborating evidence may be provided by an audiologist, neurosurgeon, neurologist or an ear, nose and throat (ENT) specialist.

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 11 include, but are not limited to:

• a report from the person’s treating doctor
• a report from a medical specialist (such as, an ENT specialist neurologist or neurosurgeon) confirming diagnosis of conditions associated with hearing impairment or other impaired function of the ear (such as, congenital deafness, presbyacusis, acoustic neuroma, head or neck cancer, side-effects of medication including chemotherapy, Meniere's disease or neurological conditions)
• results of audiological assessment undertaken by a qualified audiologist, audiometrist or ENT specialist.

If the person uses a prescribed hearing aid, cochlear implant or other assistive listening device, they must be assessed on their ability to undertake activities listed in Table 11 while using any device that they have and usually use.

In determining whether a person has received reasonable treatment for their impairment, consideration should be given to the aids and equipment or other assistive devices they have and usually use. For example, if a person would benefit significantly from an assistive listening device but chooses not to use one, consideration should be given to whether they have received reasonable treatment and if their impairment can be considered reasonably treated and stabilised.

If the person uses a recognised sign language (such as Auslan) or other non-verbal communication method as a result of hearing loss, Table 11 should be used.

Interpretation & application of relevant terms

‘Average volume’ refers to the normal conversational volume a person would speak without raising their voice, or speaking more loudly and clearly than is natural to them.

‘Average level of background noise’ refers to noise that would be expected in a grocery store, coffee shop, or another conversation being held in close proximity.

‘No background noise’ refers to being in a person’s home or quiet open space where there are little to no other noises.

Determining the level of functional impact - rules

When establishing whether a person’s impairment causes no or minimal (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, which is expressed among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities. These levels are expressed as, no or minimal difficulty, mild difficulty, moderate difficulty, severe difficulty and extreme difficulty. Some Tables also represent an increase in frequency of symptoms, which is reflective of the impairment rating level.

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 or minimal 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 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 the 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 a person's impairment level must be based on the available medical evidence including a person's medical history, investigation results and clinical findings. A person's self-reported symptoms must not solely be 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 medical conditions’).

Impairment Ratings for Table 11

0-point impairment rating level

The 0-point descriptor requires that the person have NO OR MINIMAL functional impact on activities involving hearing function or other functions of the ear.

For this rating to be assigned, the person must meet both descriptors (1)(a) and (1)(b).

5-point impairment rating level

The 5-point descriptor requires that the person have MILD functional impact on activities involving hearing function or other functions of the ear.

For this rating to be assigned the person must meet EITHER descriptors (1)(a) and (b) OR descriptor (2).

10-point impairment rating level

The 10-point descriptor requires that the person have a MODERATE functional impact on activities involving hearing function or other functions of the ear.

For this rating to be assigned, the person must meet EITHER descriptors (1)(a), (1)(b) and (1)(c) OR descriptor (2).

20-point impairment rating level

The 20-point descriptor requires that the person have a SEVERE functional impact on activities involving hearing function or other functions of the ear.

For this rating to be assigned, the person must meet EITHER descriptors (1)(a), (1)(b), (1)(c), and (1)(d) or descriptor (2).

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact on activities involving hearing function or other functions of the ear.

For this rating to be applied, the person must meet all of descriptors (1)(a),(1)(b) and (1)(c).

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 11 assessment

Impairments that should not be assessed using Table 11

Impairment in communication function that is not due to hearing function or other functions of the ear would be more appropriately assessed under Table 8 - Communication Function.