3.6.3.140 Guidelines to Table 14 - Functions of the Skin

Summary

Table 14 is used to assess functional impairment related to disorders of, or injury to, the skin.

The diagnosis of the condition must be made by an appropriately qualified medical practitioner. This includes a general practitioner or medical specialists such as a dermatologist or burns specialist.

Determining the level of functional impact

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be applied. In applying the descriptors, each descriptor sets out how the points within it are to apply.

For example, the 10-point descriptor in Table 14 states that at least one of the following applies while the 20-point descriptor states that at least 2 of the following apply.

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 solely be relied on. It would be inappropriate to apply an impairment rating based solely on a person's self-reported functional history if this level of functional impairment is not consistent with the medical evidence available.

An activity listed under a descriptor is not taken to have been performed if it can only be done once or rarely.

Each of the descriptors must be considered in relation to the adaptations to daily activities that the person has to make as a result of their condition.

The descriptors give an example of allodynia as a condition that causes nerve pain. Allodynia is pain, generally on the skin, which is caused by something that would not normally cause pain, such as wearing clothing. Depending on severity, this condition may affect a person's ability to wear appropriate clothing likely to be required in a workplace.

Some conditions causing impairment commonly assessed using Table 14

These include but are not limited to:

  • burns,
  • severe eczema, psoriasis or dermatitis,
  • allodynia,
  • severe cellulitis,
  • necrotising fasciitis.

Example: A 35 year old male suffered third-degree burns to his upper body as a result of a car accident 5 years ago. He underwent major skin graft surgery following the accident and continues to have impairment as a result, when performing his daily activities. The medical evidence states that the resulting scarring affects his ability to move both his arms and upper body. It also affects his ability to carry out fine motor skills using either of his hands. He needs assistance with daily activities including getting dressed, taking care of his personal hygiene and cooking and cleaning for himself. He has a carer who attends his home once a day to assist him with these tasks. He also has difficulty undertaking work tasks such as using a computer keyboard and uses assistive technology which converts his speech to text. Due to the ongoing pain and sensitivity of the resulting scarring he cannot wear any clothing on his arms, which would be required in a workplace environment.

The condition is considered fully diagnosed, treated and stabilised and under Table 14, this man would receive an impairment rating of 20 points due to the significant modifications he has to make to his daily activities and the severe impact this condition has on performing activities using his hands and upper body. Under the 20-point descriptor this man would meet (1)(b) and (e).

Last reviewed: 2 January 2018