The Guides to Social Policy Law is a collection of publications designed to assist decision makers administering social policy law. The information contained in this publication is intended only as a guide to relevant legislation/policy. The information is accurate as at the date listed at the bottom of the page, but may be subject to change. To discuss individual circumstances please contact Services Australia.

3.6.3.70 Guidelines to Table 7 - Brain Function

Summary

Table 7 is used to assess the functional impact of a condition related to neurological or cognitive function.

People with an autism spectrum disorder (ASD), or fetal alcohol spectrum disorder (FASD) must be assessed using Table 7 unless they have a meaningful intelligence quotient (IQ) of between 70 and 85, then the person must be assessed under Table 9 – Intellectual Function, as their condition has resulted in an intellectual impairment originating before they turned 18 years of age.

A person with cognitive impairment whose IQ is not most meaningfully summarised by a full scale IQ (for example, this could be due to a significant variation in their cognitive profile) may be assessed using Table 7.

Cognitive assessments can be complex. Assistance may be required in interpreting test results that are included in psychological, neuropsychological or educational reports. In such cases, consultation with a Services Australia psychologist, or the HPAU should be undertaken.

Conditions causing impairment commonly assessed using Table 7

These include but are not limited to:

  • chronic pain affecting cognitive function
  • acquired brain injury (ABI)
  • stroke (cerebrovascular accident (CVA))
  • conditions resulting in dementia
  • brain tumours
  • some neurodegenerative disorders
  • ASD without a meaningful IQ
  • FASD without a meaningful full-scale IQ of 85 or below
  • myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
  • attention deficit hyperactivity disorder (ADHD) manifesting with predominantly attention and concentration problems.

Diagnosis & evidence

The diagnosis of the condition must be made by an appropriately qualified medical practitioner and supported by corroborating medical evidence. This includes a GP or other medical specialists, such as a neurologist, rehabilitation physician, or psychiatrist.

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

Examples of corroborating evidence for the purposes of Table 7 include, but are not limited to:

  • a report from the person’s treating doctor
  • a report from a specialist health practitioner supporting the diagnosis of conditions associated with neurological or cognitive impairment, such as an acquired brain injury, stroke (cerebrovascular accident (CVA)), conditions resulting in dementia, tumour in the brain, some neurodegenerative disorders, chronic pain, ME/CFS, ADHD or ASD
  • results of diagnostic tests (such as, Magnetic Resonance Imagery (MRI), Computerised (Axial) Tomography (CT) scans, Electroencephalography (EEG))
  • results of cognitive function assessments
  • interviews with the person and those providing care or support to the person.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 7 - Brain Function

Policy reference: SS Guide 3.6.3.03 Guidelines to the rules for applying the Impairment Tables - information that must be taken into account in applying the Tables

Interpretation & application of relevant terms

Where the descriptors use the term 'assistance', assistance is defined in the instrument as assistance from another person, rather than any aids, equipment or assistive technology the person may use, unless specified otherwise (3.6.3.05).

Explanation: This interpretation of the term assistance has been consistently adopted in a number of decisions, including by the Federal Court in Secretary, Department of Social Services v Doherty (2022) FCA 1242.

Where the descriptors in Table 7 refer to ‘interactive assistance’, this means the person requires prompting to undertake tasks or self-care, typically in the form of a phone call that requires a response or attendance at a person’s home.

Self-stimulatory behaviour - refers to repetitive behaviours that help an individual self-soothe when stressed or otherwise cope with their emotions. This can manifest as a wide variety of behaviours including but not limited to movements or sounds, such as flapping hands or flicking or snapping fingers, rearranging objects, humming and whistling.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 7 - Brain Function

Policy reference: SS Guide 3.6.3.05 Guidelines to the rules for applying the Impairment Tables - use of aids, equipment & assistive technology

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.

Each descriptor in Table 7 contains the same 10 domains of neurological or cognitive impairment including:

  • memory
  • attention and concentration
  • problem solving and cognitive flexibility
  • planning
  • decision making
  • comprehension
  • visuo-spatial function
  • behavioural regulation
  • social skills, and
  • self-awareness.

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.

As in the other Tables, the descriptors follow an 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 (for example, no significant problems, mild difficulties, moderate difficulties, severe difficulties and extreme difficulties) or increasing level of assistance and/or supervision required (without assistance, occasional assistance, frequent interactive assistance and supervision, continual interactive assistance and supervision).

Each descriptor contains examples of brain function for each domain. These examples are not prescriptive or exhaustive. The examples are not to be treated as a further descriptor. Rather, examples are suggesting one possible impact from a set of possible impacts, which indicate the level of impairment required to meet the descriptor. A person may have impairment in undertaking other activities not listed in examples, to an equivalent degree. The examples reflect a person's severity of impairment at each rating level. If a similar example applies to a person but is not specifically listed in the descriptor, the person must have an equivalent level of severity of impairment in order for the descriptor to be met.

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 a 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 a person's circumstances will be the rating at which all the required descriptors are met.

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 all 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 all required descriptors for 10 points, the correct impairment rating is 5 points. Their impairment CANNOT be assessed as moderate, severe or extreme for the purposes of DSP and 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 be solely relied upon. 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.

It is particularly important in the assessment of people with neurological or cognitive conditions that the person's presentation on the day of the assessment must not be solely relied upon. This is because the person may not have sufficient self awareness of their cognitive function or may not be able to accurately describe its effects, which must be considered when discussing issues with the person and reading supporting evidence. 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 also 3.6.3.08 ‘Assessing impairments caused by episodic or fluctuating medical conditions’).

A person's concentration, memory, or other aspects of cognitive function may be impacted by chronic pain or its treatment. Medications taken for chronic pain or other conditions can impact cognitive function. Where these impacts arise from a diagnosed, reasonably treated and stabilised condition or these impacts are due to side effects of treatment and are likely to persist for more than 2 years, consideration should be given to a rating under Table 7. If the cognitive impact of the condition, chronic pain or medications is more than mild, further clarification should be sought from the treating doctor and/or HPAU. It would normally be expected that changes would be made in management regimes to minimise these effects.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13(2) In deciding whether an impairment has no …, section 13(1)(c) a rating must not be assigned …, Table 7 – Brain Function

Policy reference: SS Guide 3.6.3.02 Guidelines to the rules for applying the Impairment Tables - applying the Tables, 3.6.3.03 Guidelines to the rules for applying the Impairment Tables - information that must be taken into account in applying the Tables, 3.6.3.08 Guidelines to the rules for applying the Impairment Tables - assigning an impairment rating

Impairment Ratings for Table 7

0-point impairment rating level

The 0-point descriptor requires that the person have NO OR MINIMAL functional impact resulting from a neurological or cognitive condition.

For this rating to be assigned, the person MUST meet descriptor (1). That is they must have NO SIGNIFICANT problems with memory, attention, concentration, problem solving and cognitive flexibility, visuo-spatial function, planning, decision making, comprehension, self-awareness, social skills or behavioural regulation.

5-point impairment rating level

The 5-point descriptor requires that the person must have a MILD functional impact resulting from a neurological or cognitive condition.

For this rating to be assigned, the person MUST be able to complete most activities of daily living without assistance AND have MILD difficulties with at least 2 descriptors at (1)(a), (b), (c), (d), (e), (f), (g), (h), (i), or (j).

10-point impairment rating level

The 10-point descriptor requires that the person must have a MODERATE functional impact resulting from a neurological or cognitive condition.

For this rating to be assigned, the person MUST only require occasional (less than once a day) assistance with activities of daily living AND have MODERATE difficulties with at least 2 descriptors at (1)(a), (b), (c), (d), (e), (f), (g), (h), (i) or (j).

20-point impairment rating level

The 20-point descriptor requires that the person must have a SEVERE functional impact resulting from a neurological or cognitive condition.

For this rating to be assigned, the person MUST require frequent (at least once per day) interactive assistance and supervision and have SEVERE difficulties with at least 2 descriptors at (1)(a), (b), (c), (d), (e), (f), (g), (h), (i) or (j).

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact resulting from a neurological or cognitive condition.

For this rating to be assigned, the person MUST need continual interactive assistance and supervision and have EXTREME difficulties with at least 2 of the descriptors at (1)(a), (b), (c), (d), (e), (f), (g), (h), (i) or (j).

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 8(1) The impairment of a person must be assessed …, Table 7 – Brain Function

Avoiding double counting

Double counting of impairments must be avoided (see 3.6.3.06 ‘Rating multiple conditions with common impairments & double counting’).

Policy reference: SS Guide 3.6.3.06 Guidelines to the rules for applying the Impairment Tables - selecting the applicable Table & assessing impairments

Examples of Table 7 assessment

Example 1: A 58-year old was diagnosed with post-herpetic neuralgia following an episode of shingles 2 years ago. They suffer from frequent burning pain in the affected dermatome (areas of skin on your body that rely on specific nerve connections on the spine) which covers part of the back of the right forearm and hand. Symptoms persist despite extensive treatment from their neurologist and the chronic pain clinic. Their sleep is often affected and their medical records state there is a moderate impact on attention and concentration as a result of chronic pain. They continue long-term treatment with medication and takes oxycodone, which have been prescribed by their treating doctor, as required. Non-narcotic analgesics had no beneficial effect on their pain. They have difficulty using a pen, doing up buttons, unscrewing the lid on a bottle and picking up 1.0 L of liquid. They require occasional assistance from their partner to complete some daily tasks due to impaired concentration, as they are easily distracted from tasks, especially when other things are happening in the background. Their memory is also affected and their partner has to remind them about appointments and completing tasks, such as putting the bin out. The condition is considered diagnosed, reasonably treated and stabilised. This person would be assigned a rating of 10 points under Table 7, due to the moderate impact their condition of chronic neuropathic pain and its treatment has on their cognitive function and the resulting assistance required. Under the 10-point descriptor they meet (1)(a) memory and (1)(b) – attention and concentration. As they also have difficulties with using the affected upper limb, a rating under Table 2 Upper Limb Function – is also appropriate. A rating of 10 points is assigned as they met descriptors (1)(a), (c), (d) and (g).

Example 2: A 20-year old has a diagnosed condition of ASD. The medical evidence outlines that as a result of their condition they have occasional difficulty controlling their behaviour in routine situations. For example, when grocery shopping, they can lose their temper for minor reasons including a shop assistant misunderstanding them. They have difficulties engaging in social interactions, often missing nonverbal cues, talking over others, taking things literally and struggling to empathise with others. They lack self-awareness of the extent of their difficulties in these circumstances. This person has undergone an assessment of intellectual functioning and has above average intelligence. They are particularly skilled in the area of computer programming and can become entrenched in such activity at the expense of other tasks. While they live alone, their mother needs to visit a couple of times per week to ensure they attend to their household duties, and also provides assistance with household shopping, cleaning and bill paying. The condition is considered diagnosed, reasonably treated and stabilised. This person would be assigned 10 points under Table 7, due to the moderate impact their condition of ASD has on their ability to function and their resultant need for occasional assistance. Under the 10-point descriptor they meet (1)(a), (h), (i) and (j). They would not be rated under Table 9 as they do not present with a meaningful IQ score of 70-85.

Example 3: A 27-year old suffers from regular migraines. They were first diagnosed with this condition at around 8 years of age and their migraines have significantly impacted their functioning for almost 20 years. The condition has responded poorly to the past preventative and acute episode treatments recommended by their neurologist, and is not expected to significantly improve within the next 2 years. This person experiences unpredictable severe migraines approximately once or twice a fortnight. These migraines leave them bedridden for periods of between 6 to 24 hours. They prefer to live with their parents, as they need occasional assistance, especially when they are having an acute episode. They are unable to reliably plan to attend future events, due to the unpredictable nature of their migraines. When they are having an acute migraine, they are unable to concentrate and are unable to tolerate bright light or loud noises. In between migraine episodes they live without any functional impairment. Past attempts at working full-time have been short lived due to absences as a result of their condition.

The condition is considered diagnosed, reasonably treated and stabilised. This is an episodic condition and they are severely impaired during the acute episode and recovery period, but at other times they can function normally. This person would be assigned 10 points under Table 7 due to the overall moderate functional impact of the migraines and their need for occasional assistance and supervision. Under the 10-point descriptor they would meet (1)(b) and (d).

Example 4: A 62-year old had a right cerebral infarct and they presented with a left sided hemiplegia. They spent 2 weeks in an acute stroke unit where it was observed that they would often forget to put their left arm into a sleeve, ignore visitors seated to their left, only ate the food on the right hand side of their plate and would bump into walls on their left when the physiotherapist was performing mobility rehabilitation. The neurologist asked them to draw a clock and they only drew the right side, so a left sided spatial neglect was diagnosed. They were transferred to a stroke rehabilitation unit where they spent the next 2 months. With appropriate rehabilitation, the left sided spatial neglect improved, although they still had to be reminded about looking to the left.

Six months after the stroke the neurologist reported that there had been some improvement in the left sided spatial neglect and further significant improvement was unlikely within the next 2 years. When they were asked to draw a clock they drew the entire clock, but with more detail on the right side. The person tended to walk close to the wall on the left, as they were fearful of bumping into objects or people on that side that they had failed to notice and to assist them their partner usually accompanied them when they left the house. The stroke has affected the person’s memory and they are very forgetful, get lost in unfamiliar places and their partner needs to accompany them when they leave the house. Their partner had to frequently remind them to comb their hair and brush their teeth on their left side. They were unable to have a driving licence, as the neurologist considered that they would not be safe when making turns to the left and using roundabouts. They also had trouble following directions. Their partner received a CP, as they required frequent assistance and supervision.

The spatial neglect is considered to be diagnosed, reasonably treated and stabilised, as the evidence from the neurologist indicated that no significant functional improvement was expected within the next 2 years. This person would be assigned a 20-point rating under Table 7 due to the severe functional impact of the spatial neglect. They would meet descriptors (1)(a) and (g) at the 20-point impairment level.

Example 5: A 32-year old fell off a stepladder and hit their head on a concrete driveway. They were unconscious when the ambulance arrived and spent the following 24 hours in a coma. They had sustained an extensive frontal lobe intracerebral haematoma. They spent 4 weeks in an acute neurosurgical unit and were then transferred to a brain injury rehabilitation unit. They had a further 3 months of inpatient rehabilitation and were then discharged to their parents' home. The rehabilitation medicine discharge summary stated they had had a severe traumatic brain injury (TBI). They continued with appropriate outpatient rehabilitation. Six months after the accident, they made an application for a DSP. Their rehabilitation medicine specialist reported that there may be a slight improvement over the next 2 years, but any improvement was unlikely to be significant. This was consistent with the initial severe injury. They continued to live with their parents and would be unable to live independently. They needed frequent assistance and supervision on a daily basis:

  • They needed to be reminded verbally about appointments, even though they kept a diary and appointments were listed on a calendar.
  • They could not safely cook their own meals, as they forgot to turn off the gas burners and used metal bowls in the microwave.
  • Their parents had to assist with financial management and were listed as their Centrelink payment and correspondence nominees.
  • They were unable to plan a visit to a friend or what to buy them for a birthday present.
  • They were unable to follow basic instructions on using a computer and could not complete basic tasks, such as reading emails. They were also easily distracted after around 10 minutes.
  • If they got frustrated they often responded with verbal abuse.
  • They could not understand why they were no longer able to drive the family car and could become very irritable about this.
  • They had difficulties engaging in social interactions, often missing nonverbal cues, talking over others, taking things literally and struggling to empathise with others.

The TBI is considered to be diagnosed, reasonably treated and stabilised, as the rehabilitation medicine specialist said that no significant functional improvement was expected within the next 2 years. This person would receive a 30-point rating under Table 7 due to the extreme functional impact of their TBI. They need continual interactive assistance and supervision, and while only 2 descriptors need to be met for the rating to apply, the following descriptors (1)(a), (b), (c), (d), (e), (f), (h), (i) and (j) were met at the 30-impairment point level.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 2 – Upper Limb Function, Table 7 - Brain Function, Table 9 – Intellectual Function

Policy reference: SS Guide 3.6.3.20 Guidelines to Table 2 - Upper Limb Function, 3.6.3.90 Guidelines to Table 9 - Intellectual Function

Impairments that should not be assessed using Table 7

Table 7 must not be used for people who have an impairment of intellectual function unless the person has an additional condition affecting neurological or cognitive function. These people are more appropriately assessed under Table 9 - Intellectual Function.

People with an ASD, or FASD who also have a meaningful full scale IQ ranging from 70-85 are more appropriately assessed under Table 9 - Intellectual Function, as their condition results in an intellectual impairment originating before they turned 18 years of age.

ADHD manifesting with predominantly behavioural problems should be assessed under Table 5 – Mental Health Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 7 - Brain Function, Table 9 - Intellectual Function

Policy reference: SS Guide 3.6.3.90 Guidelines to Table 9 - Intellectual Function

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