3.6.3.30 Guidelines to Table 3 - Lower Limb Function

Summary

Table 3 is used to assess functional impairment when performing activities requiring the use of legs or feet in the context of a person's ability to move around in the environment (mobility).

Consistent with this purpose, the descriptors in Table 3 refer to a range of activities relevant to a person's ability to move around, including walking, kneeling, squatting, standing, standing up from a seated position, using stairs, using public transport or using a motor vehicle, and (where applicable) their ability to mobilise with the use of wheelchairs or walking aids.

The descriptors in other Tables may also refer to certain activities relating to a person's mobility but those Tables measure the impact of impairment where that impairment is caused by conditions different to those relevant to the application of Table 3. For example, some descriptors in Table 1 measure the level of difficulty in walking, climbing stairs or mobilising in a wheelchair due to symptoms arising from conditions affecting physical exertion or stamina. Table 3 is used to assess the level of difficulty in performing mobility-related activities arising from conditions affecting the use of lower limbs.

Table 3 specifies that the lower limbs extend from the hips to the toes.

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 rheumatologist or rehabilitation physician.

If the person has and usually uses a lower limb prosthesis, the assessment under Table 3 must be undertaken considering what the person can do or has difficulty doing while using this prosthesis.

Interpretation & application of terms

Where the descriptors in Table 3 refer to moving around in or using a wheelchair and to transferring to and from a wheelchair, this includes both manually-propelled wheelchairs and powered mobility aids (such as power assist wheelchair, power wheelchair or mobility scooter).

For the purpose of Impairment Tables, including Table 3, '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 any one of these modes of transport, having regard only to the level of impairment to their lower limbs, is considered to be able to use public transport, 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 and whether the person actually receives assistance.

Similarly, where Table 3 refers to activities such as walking around a shopping mall, a shopping centre or supermarket, or walking to local shops, it is irrelevant whether such businesses, buildings or structures actually exist in a person's locality or how they may be labelled. Of relevance is the description of activity involved. The objective is to measure a person's ability or otherwise to mobilise.

Explanation: The AAT (General Division) applied this approach in its decision in Wilson and Secretary, DSS [2015] AATA 497.

The 10- and 20-point ratings in Table 3 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, DSS [2014] AATA 165.

Determining the level of functional impact - general rules

As in the other Tables, the descriptors in Table 3 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. without difficulty, with some difficulty, unable to). The hierarchy of descriptors in Table 3 also takes into account other factors. These include a person's ability to perform certain activities unassisted or unaided and/or when using devices, equipment or aids such as a lower limb prosthesis, a walking stick, other walking aids (e.g. a quad stick, crutches, a walking frame) or a wheelchair.

In establishing which descriptor in the hierarchy is appropriate in a person's circumstances, that is whether the impairment has no, mild, moderate, severe or extreme functional impact, all the descriptors for each impairment rating level in Table 3 should be read as a whole and compared before an appropriate impairment rating is assigned. Individual descriptors or their parts are not to be applied in isolation from one another.

As is the case in applying the other Impairment Tables, when determining which impairment rating applies to a person under Table 3, the rating that best describes the person's abilities or difficulties must be applied. In determining which impairment rating applies to a person, the descriptor points under a specific impairment level must be considered and applied as set out in the descriptor. ALL the points in the descriptor must be considered. NO descriptor points or their parts are to be disregarded.

An impairment rating can only be assigned if ALL the descriptors for a specific impairment rating are met. For example, if a person meets all the descriptors for 10 points and also meets some but not all descriptors for 20 points, an impairment rating of 20 points cannot be assigned and the correct impairment rating is 10 points.

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 unless the person's self-reported functional impacts are consistent with and supported by the medical evidence available.

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.

For bilateral conditions where both lower limbs are affected, a single impairment rating under Table 3 should be determined based on the resulting combined functional impairment.

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…

Assessing impairment for persons using wheelchairs or walking aids

Where a person uses a wheelchair or certain walking aids (a quad stick, crutches or walking frame), the correct impairment rating depends, among other factors, upon the extent to which they are independent or dependent on other persons to mobilise while using a wheelchair or walking aids, and to transfer to and from a wheelchair. Within each of the 10- and 20-point impairment ratings, the descriptors state that this impairment rating level 'includes' a person who is either independent or who requires assistance to move around in or to transfer to and from a wheelchair, or to move around using walking aids.

For the purpose of Table 3, the term 'includes' means that a person who uses a wheelchair or certain walking aids may be included in a class or category of people who can be considered under the criteria for these impairment rating levels and MAY be eligible for either 10 or 20 points subject to their meeting ALL the requirements set out in the descriptors for these ratings. This term does not mean that a person who uses a wheelchair or walking aids automatically satisfies the overall requirements for 10 or 20 points solely because they meet the descriptor point (3) for a rating of 10 points or (2) for a 20-point rating.

The use of wheelchairs or walking aids is not in itself an absolute indicator of the level of severity of a person's impairment when performing activities relating to their ability to move around. Individual circumstances do differ, including reasons for which people acquire such devices, frequency of use and the tasks for which they use them. A person may have a number of devices or aids and use different devices or aids for different purposes or not used them at all for certain tasks. While the vast majority of people who use wheelchairs or walking aids do so upon recommendation by appropriate professionals, this equipment can nevertheless be purchased and used in Australia without prescription.

As outlined in 'Determining the level of functional impact - general rules' above, in deciding which impairment rating applies, ALL the descriptor points under a specific impairment rating level must be considered and NO descriptor points or their parts are to be disregarded. If the descriptors at point (3) in the 10-point rating and (2) in the 20-point rating were read and applied in isolation, any person who uses a wheelchair or walking aids would qualify for at least 10 points under Table 3. This is not consistent with the policy intent.

The policy intent is that a person is not to be automatically allocated an impairment rating of 10 or 20 points solely on the basis that they use certain aids or equipment. The criteria in the descriptor point (3) for a rating of 10 points and in the descriptor point (2) for a 20-point rating are not stand alone and cannot be applied in isolation from the other requirements for these ratings. This intent is reflected in the assessment rule in the Impairment Tables discussed above which stipulates that a person can only be allocated a specific impairment rating if ALL the descriptors for that impairment level are met.

5-point impairment rating level

The 5-point descriptor requires that for this impairment rating to be assigned to a person, the person must meet at least one of the descriptor points (1)(a), (1)(b) or (1)(c) AND also at least one the descriptor points (2)(a) or (2)(b).

If the person does not meet at least one descriptor point in one or both (1) or (2), they cannot be allocated 5 points and the correct impairment rating is 0 points.

10-point impairment rating level

Consistent with the rules outlined above, in deciding whether an impairment of 10 points applies to a person, ALL the descriptor points under the 10-point impairment rating level must be considered and applied.

The 10-point descriptor requires that any person considered for this rating must satisfy at least one of the descriptor points (1)(a), (1)(b) or (1)(c) AND also descriptor point (2).

If a person usually USES a wheelchair or walking aids, ADDITIONAL considerations and requirements apply in determining whether an impairment rating of 10 points can be assigned. A person must still satisfy at least one of the descriptor points (1)(a), (1)(b) or (1)(c) and descriptor point (2), AND IN ADDITION they must also satisfy the descriptor point (3)(a) (if they use a wheelchair) or descriptor point (3)(b) (if they use walking aids).

If the person who USES a wheelchair or walking aids meets descriptor point (3) BUT does not meet at least one of the descriptor points in (1) and/or descriptor point (2), they cannot be allocated 10 points.

Example 1: A 45 year old man had a left below knee amputation 4 years ago as a result of injuries sustained in an industrial accident. The condition is fully diagnosed, fully treated and fully stabilised.

The man has been using a lower limb prosthesis. He has some difficulty climbing stairs but can otherwise mobilise effectively when using his prosthesis.

He needs to attend frequent and regular medical appointments. The man can walk to these appointments (when using his prosthesis) but usually develops some discomfort and low-grade pain after walking for some time. To avoid the discomfort and pain, he has decided to purchase a wheelchair and use it whenever he goes to the clinic. He moves around independently when using his wheelchair and can independently transfer to and from it.

As this man meets descriptor points (1)(c) and (2)(b) for 5 points under Table 3, the correct impairment rating is 5 points and no higher rating under this Table can be assigned. It would be inappropriate to allocate a rating of 10 points in such circumstances solely on the basis that this man 'meets' the requirements set out in descriptor point (3)(a) under the 10-point impairment rating level. This is consistent with the object of the Impairment Tables being to assess a person's impairment on the basis of what the person can, or could do, not on the basis of what the person chooses to do.

Example 2: A 50 year old woman has difficulties mobilising due to the effects of arthritis affecting joints in her lower limbs. The condition is fully diagnosed, fully treated and fully stabilised.

The woman uses a wheelchair. She usually uses a self-propelled wheelchair to move for short distances. She is able to transfer to and from this wheelchair and to mobilise independently using it. However, for long distances the woman uses a mobility scooter to avoid fatigue. She can independently transfer to and from her scooter and does not require assistance from another person to use a toilet.

As this woman does not require assistance from another person to transfer or to mobilise in a wheelchair, she does not qualify for 20 points under Table 3. She meets descriptor points (1)(a), (2) and (3)(a) for a 10-point rating. The correct impairment rating is therefore 10 points.

20-point impairment rating level

Consistent with the rules outlined above, in deciding whether an impairment rating of 20 points applies to a person, ALL the descriptor points under the 20-point impairment rating level must be considered and applied.

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

If a person who DOES NOT USE a wheelchair or walking aids (e.g. quad stick, crutches or a walking frame) meets all of the requirements set out in (1)(a)(i), (1)(a)(ii) and (1)(a)(iii) AND also meets descriptor point 1(b) under this impairment rating, they are to be allocated 20 points. If such a person does not meet any one of the descriptor points in (1)(a) or does not meet (1)(b), they cannot be allocated 20 points.

If a person usually USES a wheelchair or walking aids, ADDITIONAL considerations and requirements apply in determining whether the person qualifies for an impairment rating of 20 points. The person must meet ALL the descriptor points (1)(a)(i), 1(a)(ii) and (1)(a)(iii) AND point (1)(b), AND IN ADDITION they must also satisfy descriptor point (2)(a) (if they use a wheelchair) or point 2(b) (if they use walking aids). If the person who uses a wheelchair or walking aids meets (2)(a) or (2)(b) but does not meet ALL of the descriptor points in (1)(a) and/or does not meet (1)(b), they cannot be allocated 20 points.

Example: A 25 year old man had a car accident several years ago and sustained crush injuries to his legs. He uses a wheelchair to get around but finds it very difficult to go far without stopping to rest or getting assistance from another person. He also requires assistance from another person to use any form of public transport and to get in and out of his wheelchair and to perform some of his personal care needs, including using a toilet.

The condition is fully diagnosed, treated and stabilised and under Table 3, the man would receive an impairment rating of 20 points due to the severe impact his condition has on his ability to function. Under the 20-point descriptor the man would meet all points under (1)(a), (b) and (2)(a).

30-point impairment rating level

The 30-point descriptor states the person is unable to mobilise independently. To meet this descriptor the person would be completely unable to mobilise at all without assistance from another person. In comparison, someone who has some ability to mobilise very short distances without assistance (such as around the home) but is unable to do the activities listed in the 20-point descriptor points (1)(a)(i), (1)(a)(ii) or (1)(a)(iii) and requires assistance to use public transport (descriptor point (1)(b)) would meet the 20-point descriptor.

Impact of pain

In determining the functional impact on activities under Table 3, consideration should be given to the impact of pain on the person's ability to undertake these activities. For example, a person may have difficulty using their lower limbs other than for very short periods due to the pain they experience on doing so.

For more information about assessing pain, please refer to 3.6.3.05 (B) Assessing functional impact of pain.

Some conditions causing impairment commonly assessed using Table 3

These include but are not limited to:

  • lower limb musculoskeletal conditions including specific degenerative joint disease (osteoarthritis),
  • other permanent forms of arthritis,
  • neurological conditions including peripheral neuropathy and strokes or cerebrovascular accidents (CVAs) causing paralysis or loss of strength or sensation,
  • cerebral palsy or other condition affecting lower limb coordination,
  • inflammation or injury of the muscles or tendons of the lower limbs,
  • lower limb amputations or absence of whole or part of lower limb,
  • long-term effects of musculoskeletal injuries,
  • some permanent vascular conditions (e.g. peripheral vascular disease, varicose veins).

Impairments that should not be assessed using Table 3

Difficulties mobilising independently due to severe visual impairment should not be assessed under this Table if there are no inherent medical conditions affecting the lower limbs. Such impairment should be assessed under Table 12 - Visual Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 3 - Lower Limb Function, Table 4 - Spinal Function, Table 12 - Visual Function

Last reviewed: 15 August 2016