3.6.3.40 Guidelines to Table 4 - Spinal Function

Summary

Table 4 is used where a person has a functional impairment when performing activities involving spinal function. Spinal function involves bending or turning the back, trunk or neck.

The diagnosis of the condition must be made by an appropriately qualified medical practitioner. This includes a general practitioner, an orthopaedic surgeon, a rheumatologist, a rehabilitation physician, or other relevant specialist.

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.

Double-counting of impairments must be avoided (see 3.6.3.05 (F)). The Table 4 descriptors are to be met only from spinal conditions.

Interpretation & application of relevant terms

The 10-point descriptor in Table 4 uses 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 4 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, some difficulty, difficulty, severe difficulty, unable to).

Consequently, as is the case in applying any other Table, in establishing which descriptor in Table 4 is appropriate to a person's circumstances, that is whether the impairment has no (0 points), mild (5 points), moderate (10 points), severe (20 points) or extreme (30 points) functional impact, an assessment process under this Table should follow the same incremental path.

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 the persons meets all the required descriptors at that level, 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 assessment stops at that point, The appropriate impairment rating applicable to the person's circumstances will be the highest 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 descriptor. 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.

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 therefore neither 10, 20 nor 30 points can 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 solely be 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.

When determining whether the person is able to undertake the activities listed under the descriptors, consideration must be given to whether the person suffers pain on undertaking the activities. For example, under the 20-point descriptor, if a person is able to remain seated for 10 minutes but suffers significant pain on doing so, it should be considered that the person is therefore unable to remain seated for at least 10 minutes.

Chronic pain could be either a symptom of a permanent condition impacting spinal function or a permanent condition itself. When assessing chronic pain under Table 4, please refer to 3.6.3.05 (B) Assessing functional impact of pain.

Consideration must also be given to whether the person can undertake the activity on a repetitive or habitual basis (see 3.6.3.05 (G) Descriptors involving performing activities). For example, under the 20-point descriptor, if a person is able to bend forward to pick up a light object from a desk or table but after doing this once has to rest their back and is unable to bend forward for the remainder of the day it should be considered that the person is therefore unable to do this activity.

An activity listed under a descriptor is not taken to have been performed if it can only be done once or rarely- the person needs to be able to usually perform such activity whenever they would normally attempt it.

0-point impairment rating level

The 0-point descriptor specifies the person has no functional impact on activities involving spinal function.

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).

If the person does not meet at least one descriptor point, they cannot be allocated 5 points and the correct impairment rating is 0 points.

10-point impairment rating level

The 10-point descriptor requires that for this impairment rating to be assigned to a person, The person is able to sit in or drive a car for at least 30 minutes and one of either (a), (b), (c) or (d) must apply.

In relation to descriptor (1) (a), the reference to 'sustain overhead activities' is intended to measure the level of difficulty the person has in looking up, NOT reaching up (e.g. to carry out a task such as hanging out washing or counting items on an overhead shelf, which requires the person to look upwards for a period of time). That is, it is a measure of spinal function, NOT upper limb function.

20-point impairment rating level

The 20-point descriptor requires that for this impairment rating to be assigned to a person, the person must be unable to do at least one of the activities listed at (1)(a), (1)(b), (1)(c), or (1)(d). The person must not be able to perform the listed activity at all, rather than not be able to sustain the activity as required in the 10 point rating level.

In relation to descriptor (1) (b) the person must EITHER be unable to turn their head at all without moving their trunk OR be unable to bend their neck at all without moving their trunk.

In relation to descriptor (1) (c) a light object refers to any object that would weigh no more than 1 kilo.

30-point impairment rating level

The 30-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) or (1)(b).

The person must be completely unable to perform activities involving spinal function, to undertake the most basic of daily activities.

Some conditions causing impairment commonly assessed using Table 4

These include but are not limited to:

  • spinal cord injury
  • spinal stenosis
  • cervical spondylosis and radiculopathy
  • lumbar radiculopathy
  • herniated or ruptured spinal disc
  • spinal cord tumours
  • arthritis or osteoporosis involving the spine.

Example: A 50 year old woman has been diagnosed with spondylosis and spinal cord tumour in her lumbar spine. Both these conditions result in functional impairment when the woman performs activities involving her spine. The woman takes regular medication to alleviate her symptoms but even with medication she continues to experience significant pain when undertaking daily activities. Her specialist has recommended spinal surgery but due to the high risks involved in this procedure the woman has decided not to undertake the surgery. This woman is unable to bend forward to pick up a light object such as a cup of coffee, placed at knee height without experiencing significant pain in her lower back. While she can remain seated for more than 30 minutes, she cannot sit for extended periods, such as a long car journey without a break to stand and move around to relieve the pressure on her lower spine.

The conditions are considered fully diagnosed, treated and stabilised. As both conditions cause the same functional impact a single impairment rating is given under Table 4, of 10 points, due to the moderate overall functional impact these conditions have on her ability to function. Under the 10-point descriptor the woman would meet (1)(c).

Impairments that should not be assessed using Table 4

Impairment, such as restrictions on overhead tasks, resulting from a shoulder or other upper limb condition should be rated under Table 2. Similarly, impairment, such as restrictions on bending tasks, resulting from a lower limb condition should be rated under Table 3.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 2 - Upper Limb Function, Table 3 - Lower Limb Function, Table 4 - Spinal Function

Last reviewed: 10 August 2020