3.6.3.70 Guidelines to Table 7 - Brain Function

Summary

Table 7 is used to assess functional impairment related to neurological or cognitive function.

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

People with an Autism Spectrum Disorder (ASD), Foetal Alcohol Syndrome (FAS), or Foetal Alcohol Spectrum Disorder (FASD) ) can be assessed using Table 7. However, if they have a low intelligence quotient (IQ) of between 70 and 85 the person should be assessed under Table 9.

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.

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

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.

Determining the level of functional impact - general rules

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be applied.

Each descriptor in Table 7 contains various domains of neurological or cognitive impairment including: memory, attention and concentration, problem solving, planning, decision making, comprehension, visuo-spatial function, behavioural regulation and self awareness.

In determining which descriptor applies to the person, at least one of the domains must apply to the person in line with the level of severity stated under (1) (i.e. no, mild, moderate, severe, extreme difficulties). Additionally, as stated under (1) the level of assistance and supervision a person requires must also be considered. 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.

The descriptors in Table 7 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).

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 fully diagnosed, 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. Double-counting must be avoided.

When assessing the impact of chronic pain on cognitive function under Table 7, please refer to 3.6.3.05 (B) Assessing functional impact of pain.

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 a person has more than 'no 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 lower of those 2 impairment ratings (i.e. the 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. 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 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. 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.

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 SHOULD NOT BE SOLELY RELIED UPON. This is because with some conditions such as dementia, the person may have insufficient insight and minimise the condition's impacts. Impacts of conditions can fluctuate over time and the severity, duration and frequency of the episodes or fluctuations must be taken into account when determining the rating that best reflects the person's overall functional ability (see 3.6.3.05 (G) Assessing impairments caused by episodic or fluctuating medical conditions). In determining the work-related impairment for such fluctuating conditions, consideration should be given to the impact on the person's ability to reliably sustain work over 2 years without significant absences.

When determining a person's limitations in relation to conducting 'work tasks', this is taken to refer to any job available in Australia.

0-point impairment rating level

The 0-point descriptor specifies the person has no functional impact on activities resulting from a neurological or cognitive function.

5-point impairment rating level

The 5-point descriptor specifies that the person must be able to complete most of the day-to-day activities without assistance and has MILD difficulties with at least one of the following descriptor points (1) (a), (b), (c), (d), (e), (f).

10-point impairment rating level

The 10-point descriptor specifies that the person needs occasional (less than once a day) assistance with day to day activities and has MODERATE difficulties in at least one of following descriptor points (1) (a), (b), (c), (d), (e), (f), (g), (h), (j).

20-point impairment rating level

The 20-point descriptor specifies that the person needs frequent (at least once per day) assistance and supervision and has SEVERE difficulties in at least one of the following descriptor points (1) (a), (b), (c), (d), (e), (f), (g), (h), (j).

30-point impairment rating level

The 30-point descriptor specifies that the person needs continual assistance and supervision and has EXTREME difficulties in at least one of the following descriptor points (1) (a), (b), (c), (d), (e), (f), (g), (h), (j).

Some 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 with no low IQ
  • FAS or FASD without an interpretable full-scale IQ 85 or below
  • migraine that results in impairment to neurological or cognitive function (but not loss of consciousness or altered states of consciousness)
  • attention deficit hyperactivity disorder manifesting with predominantly attention and concentration problems.

Example 1: A 58 year old woman was diagnosed with post-herpetic neuralgia following an episode of shingles 2 years ago. She suffers from frequent burning pain in the affected dermatome which covers part of the back of the right forearm and hand. Symptoms persist despite extensive treatment from her neurologist and the chronic pain clinic. Sleep may be affected and her medical records state there is a moderate impact on attention and concentration as a result of chronic pain. She continues long-term treatment with gabapentin and nortriptyline and takes oxycodone as required. Non-narcotic analgesics had no beneficial effect on pain. She has difficulty using a pen, doing up buttons, unscrewing the lid on a bottle and picking up 1L of liquid. She requires occasional assistance from her partner to complete some daily tasks due to impaired concentration. The condition is considered fully diagnosed, treated and stabilised. This person would receive an impairment rating of 10 points under Table 7, due to the moderate impact her condition of chronic neuropathic pain and its treatment has on her cognitive function and the resulting assistance required. Under the 10-point descriptor she meets (1)(b). The difficulties with using the affected upper limb led to a rating of 10 impairment points under Table 2, meeting descriptors (1)(a), (c), (d) and (f).

Example 2: A 20 year old male has a diagnosed permanent condition of ASD. The medical evidence outlines that as a result of his condition he has occasional difficulty controlling his behaviour in routine situations. For example, when grocery shopping, he can lose his temper for minor reasons including a shop assistant misunderstanding him. He has difficulties engaging in social interactions, often missing nonverbal cues, talking over others, taking things literally and struggling to empathise with others. He lacks self-awareness of the extent of his difficulties in these circumstances. This person has undergone an assessment of intellectual functioning and has above average intelligence. He is particularly skilled in the area of computer programming and can become entrenched in such activity at the expense of other tasks. While he lives alone, his mother needs to visit a couple of times per week to ensure he attends to his household duties, providing assistance with household shopping, cleaning and bill paying. The condition is considered fully diagnosed, treated and stabilised. This person would receive an impairment rating of 10 points under Table 7, due to the moderate impact his condition of ASD has on his ability to function and his resultant need for occasional assistance. Under the 10-point descriptor he would meet both (1)(h) and (j). He would not be rated under Table 9 as he does not present with low intellectual function.

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

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

Example 4: A 62-year-old male had a right cerebral infarct and they presented with a left sided hemiplegia. He spent 2 weeks in an acute stroke unit where it was observed that he would often forget to put his left arm into a sleeve, ignore visitors seated to his left, only ate the food on the right hand side of his plate and would bump into walls on his left when the physiotherapist was performing mobility rehabilitation. The neurologist asked him to draw a clock and he only drew the right side, so a left sided spatial neglect was diagnosed. He was transferred to a stroke rehabilitation unit where he spent the next 2 months. With appropriate rehabilitation, the left sided neglect improved, although he 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 neglect and further significant improvement was unlikely within the next 2 years. When he was asked to draw a clock they drew the entire clock, but with more detail on the right side. The man tended to walk close to the wall on the left, as he was fearful of bumping into objects or people on that side that he had failed to notice and his partner usually accompanied him when he left the house. His partner had to frequently remind him to comb his hair and brush his teeth on his left side. He was unable to have a driving licence, as the neurologist considered that he would not be safe when making turns to the left and using roundabouts. He also had trouble following directions. His partner received a carer payment, as he required frequent assistance and supervision. He made a claim for a DSP several weeks after the 6-month review by the neurologist.

The spatial neglect is considered to be fully diagnosed, treated and stabilised, as the neurologist said that no significant functional improvement was expected within the next 2 years. This person would receive a 20 point rating under Table 7 due to the severe functional impact of the spatial neglect. He needs daily assistance and supervision, and met the descriptor (g) for visuo-spatial function at the 20-point impairment level.

Example 5: A 32-year-old man fell off a stepladder and hit his head on a concrete driveway. He was unconscious when the ambulance arrived and spent the following 24 hours in a coma. He had sustained an extensive frontal lobe intracerebral haematoma. He spent 4 weeks in an acute neurosurgical unit and was then transferred to a brain injury rehabilitation unit. He had a further 3 months of inpatient rehabilitation and was then discharged to his parents' home. The rehabilitation medicine discharge summary stated that he had had a severe traumatic brain injury (TBI). He continued with appropriate outpatient rehabilitation. Six months after the accident, he made an application for a DSP. His 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. He continued to live with his parents and would be unable to live independently. He needed frequent assistance and supervision on a daily basis:

  • He needed to be reminded verbally about appointments, even though he kept a diary and appointments were listed on a calendar.
  • He could not be trusted to cook their own meals, as they forgot to turn off the gas burners and used metal bowls in the microwave.
  • His parents had to assist with his financial management and were his Centrelink nominees.
  • He was unable to plan a visit to a friend or what to buy them for a birthday present.
  • He was unable to follow basic instructions on using a computer and could not complete even basic tasks such as reading emails. He was also easily distracted after more than about 10 minutes.
  • If he got frustrated he often responded with verbal abuse.
  • He could not understand why he was no longer able to drive the family car and could become very irritable about this.

The TBI is considered to be fully diagnosed, 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 20-point rating under Table 7 due to the severe functional impact of their TBI. He needs daily assistance and supervision, and while only one descriptor needs to be met, the following descriptors (a), (b), (c), (d), (e), (f), (h) and (j) were met at the 20-impairment point level.

Impairments that should not be assessed using Table 7

People with an ASD, FAS or FASD who also have an interpretable 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.

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.

Last reviewed: 10 May 2021