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.

3.6.3.80 Guidelines to Table 8 - Communication Function

Summary

Table 8 is used to assess the functional impact of a condition affecting communication functions.

Table 8 refers to communication in a person's main language. This is the language a person most commonly uses. This may be the language the person uses at home or their first language and should be their most fluent language.

Table 8 covers both receptive communication, which is understanding language, as well as expressive communication, which is producing speech. Table 8 also covers the use of alternative or augmentative communication, such as sign language, technology that produces electronic speech or the use of symbols or a note taker to assist in communication.

If the person uses recognised sign language or other non-verbal communication method as a result of hearing loss only, the person’s hearing and communication function should be assessed using Table 11 – Hearing and other Functions of the Ear.

If the impairment affecting communication function is due to impairment in intellectual function, the person must be assessed under Table 9 – Intellectual Function.

Policy reference: SS Guide 3.6.3.90 Guidelines to Table 9 - Intellectual Function, 3.6.3.110 Guidelines to Table 11 - Hearing and Other Functions of the Ear

Conditions causing impairment commonly assessed using Table 8

There are a range of conditions a person may have which cause impairment affecting communication that can be appropriately assessed using Table 8. These include but are not limited to:

  • stroke (cerebrovascular accident (CVA))
  • other acquired brain injury that has damaged the speech/language centre of the brain, causing for example, dysphasia or, aphasia
  • cerebral palsy
  • eurodegenerative conditions
  • head, neck or throat cancer
  • damage to the speech-related structures of the mouth, vocal cords or larynx.

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, a neurologist, a rehabilitation physician, an ear nose and throat surgeon or other relevant specialist.

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, which can include speech pathologist reports.

Examples of corroborating evidence for the purposes of Table 8 include, but are not limited to:

  • a report from the person’s treating doctor
  • a specialist assessment by a speech pathologist, neurologist or psychologist
  • a report from a medical specialist confirming diagnosis of conditions associated with communication impairment
  • results of diagnostic tests (such as, X-Rays or other imagery)
  • results of functional assessments.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 8 - Communication 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

‘Main language’ means the language that the person most commonly uses ‘day-to-day language’ has the same meaning.

‘Communication’ or ‘communication functions’ means receptive communication (understanding language) or expressive communication (producing speech).

Determining the level of functional impact - general 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.

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. This does not necessarily mean all descriptors must be met, but all must be considered to determine which descriptors apply to the person’s impairment.

While every descriptor requires consideration, in order to compare and contrast the descriptors to determine which impairment rating best reflects the level of functional impact resulting from a person’s condition. Each Table provides specific instructions on the number of descriptors to be met in order to assign a particular impairment rating. Determination of a person's impairment level must be based on the corroborating evidence provided by the person, including the person's medical history, investigation results and clinical findings.

The descriptors in each Table follow an incremental hierarchy, which is expressed among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities. These levels are expressed as: no or minimal difficulty, mild difficulty, moderate difficulty, severe difficulty and extreme difficulty. Some Tables also represent an increase in frequency of symptoms, which is reflective of the impairment rating level.

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

However, one of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors. In other cases, a prescribed number of descriptors may be required for that rating to apply (for example, ‘the person has moderate difficulty carrying out at least 4 of the following’).

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 descriptors. NO descriptors or their parts are to be disregarded.

For example, to be assigned 5 points under Table 8, a person must have mild functional impact on communication in the person’s main language. The person has some mild difficulty understanding complex words and long sentences, such as a complex news article OR has mild difficulty in producing speech and has minor difficulty with being understood due to content or speech production arising from, for example, a stutter or stammer, or vocal cord, or larynx damage.

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 the 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 the 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 10, 20 or 30 points cannot be allocated.

Determination of the descriptor that best fits a person's impairment level must be based on the available medical evidence including the person's medical history, investigation results and clinical findings and observations made during the assessment process. A person's self-reported symptoms must not be solely relied on. 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.

Where a Table refers to a person being unable to perform certain tasks, the term 'unable' is not intended to mean that the task is unable to be performed without some symptoms. When a person experiences some symptoms when performing an activity this does not mean the person is 'unable' to perform the task. The assessment of the symptoms experienced in performing the activity is relevant where they are severe enough for the person to not be physically able to perform the activity on a repetitive or habitual basis, and not once or rarely.

Only one rating should be assigned from Table 8 even if the communication or language impairment is both receptive and expressive in nature.

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 3.6.3.08 ‘Assessing impairments caused by episodic or fluctuating medical conditions’).

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 8 – Communication 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 8

0-point impairment rating level

The 0-point descriptor requires that a person has NO OR MINIMAL functional impact on communication in the person's main language.

For this rating to be assigned, the person MUST meet descriptor (1). The person’s speech must usually be understood by those who speak the same language and have no or minimal difficulty understanding or engaging in meaningful conversation.

5-point impairment rating level

The 5-point descriptor requires that the person have a MILD functional impact on communication in the person's main language.

For this rating to be assigned, at least one of the descriptors (1)(a) or (1)(b) must apply.

10-point impairment rating level

The 10-point descriptor requires that the person have a MODERATE functional impact on communication in the person's main language.

For this rating to be assigned, either descriptor (1)(a)(i) or (1)(a)(ii), (1)(b) or (1)(c) must apply.

20-point impairment rating level

The 20-point descriptor requires that the person must have a SEVERE functional impact on communication in the person's main language.

For this rating to be assigned, either: (1)(a), (1)(b) or (2) must apply. If (1)(b) applies, then at least one of descriptors (1)(b)(i), (1)(b)(ii), (1)(b)(iii) or (1)(b)(iv) must apply. If (2) applies, then at least one of descriptors (2)(a), (2)(b), (2)(c) or (2)(d) must apply.

30-point impairment rating level

The 30-point descriptor requires that the person must have an EXTREME functional impact on communication in the person's main language.

For this rating to be assigned, either (1)(a), (1)(b) or (2) must apply. If (1)(a) applies, then at least one of descriptors (1)(a)(i), (1)(a)(ii), or (1)(a)(iii) must apply. If (1)(b) applies, then at least one of descriptors (1)(b)(i), (1)(b)(ii), (1)(b)(iii), or (1)(b)(iv) must apply. If (2) applies, then at least one of descriptors (2)(a), (2)(b), or (2)(c) must apply.

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 8 - Communication Function

Avoiding double counting

Double counting of impairments must be avoided (see 3.6.3.06 ‘Rating multiple conditions with common impairments & double counting’). Table 11 - Hearing and Other Functions of the Ear can be used if a person's hearing is impaired due to otosclerosis (bone overgrowth in the middle ear) or if their balance is affected due to an inner ear (vestibular) disorder, such as Meniere's disease.

Table 12 – Visual Function can be used if the person has difficulty communicating due impairment of visual function.

Policy reference: SS Guide 3.6.3.06 Guidelines to the rules for applying the Impairment Tables - selecting the applicable Table & assessing impairments, 3.6.3.110 Guidelines to Table 11 - Hearing and Other Functions of the Ear, 3.6.3.120 Guidelines to Table 12 - Visual Function

Examples of Table 8 assessment

Example 1: An 18-year old has a diagnosed condition of cerebral palsy. The medical evidence states that as a result of this condition the person's speech is slurred. Sometimes they have difficulty being understood in certain situations so they use an electronic voice output device at these times.

The condition is considered diagnosed, reasonably treated and stabilised, and under Table 8, this person would be assigned an impairment rating of 10 points due to the moderate impact this condition has on their communication function. Under the 10-point descriptor, this would meet (1)(c).

Due to their condition of cerebral palsy, the person also has impairment in functioning of their lower and upper limbs. Consideration would be given to whether they would also receive an impairment rating for these impairments under Table 2 - Upper Limb Function and Table 3 - Lower Limb Function.

Example 2: A 55-year old was treated for laryngeal carcinoma 6 months before applying for DSP. Treatment included a total laryngectomy, primary tracheo-oesophageal puncture (TEP) and insertion of an indwelling voice prosthesis. The person had no post-operative complications and is generally well, with no evidence of recurrence or metastatic spread of the carcinoma. The person’s cancer prognosis has been assessed as good.

The person's post-laryngectomy speech quality, achieved with the guidance of a speech pathologist, is intelligible and closely resembles laryngeal speech. They need to manually cover the tracheal stoma while speaking, and have good hand dexterity. They have pre-existing well-managed chronic obstructive pulmonary disease (COPD), including mild emphysema, due to a long-term smoking history. They have occasional problems with speech volume and production due to shortness of breath, particularly during COPD exacerbations.

Due to the post-laryngectomy condition this person would receive a rating of 5 points under Table 8 due to the mild impact on communication function. Under the 5-point descriptor this person would meet (1)(b).

Due to their condition of well-controlled COPD, this person also has impaired functioning under Table 1 - Functions requiring Physical Exertion and Stamina.

Example 3: A 60-year old experienced a stroke one year ago, which has had a range of impacts, including on their speech clarity. Despite intensive rehabilitation including speech therapy, unfamiliar people are unable to understand their speech and they have severe difficulty effectively conversing with people. Due to this, they rely upon their partner or children to speak on their behalf at appointments, shops and so forth. This person meets (1)(b)(ii) due to the severe functional impact on communication and would be assigned 20 points.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 1 - Functions requiring Physical Exertion and Stamina, Table 2 - Upper Limb Function, Table 3 - Lower Limb Function, Table 8 - Communication Function

Policy reference: SS Guide 3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion and Stamina, 3.6.3.20 Guidelines to Table 2 - Upper Limb Function, 3.6.3.30 Guidelines to Table 3 - Lower Limb Function

Impairments that should not be assessed using Table 8

There are a range of conditions a person may have which cause impairment affecting communication but should not be assessed using Table 8. These include but are not limited to:

  • impairment affecting communication function as a result of hearing loss only
  • impairment affecting communication function as a result of impairment in intellectual function only
  • fluency or competency difficulties in using the spoken English language.

People who use recognised sign language or other non-verbal communication as a result of hearing loss only are more appropriately assessed under Table 11 - Hearing and Other Functions of the Ear. If a person's impairment affecting communication function is due to impairment in intellectual function, it is more appropriately assessed under Table 9 - Intellectual Function.

Explanation: A non-English speaking person who is fluent in another language and does not have a condition affecting their communication function should not receive a rating under Table 8. The Table measures impacts on communication function in the person’s main language.

A person with impairment to neurological and/or cognitive function should be assessed under Table 7 – Brain Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 8 - Communication Function, Table 9 - Intellectual Function, Table 11 - Hearing and other Functions of the Ear

Policy reference: SS Guide 3.6.3.90 Guidelines to Table 9 - Intellectual Function, 3.6.3.110 Guidelines to Table 11 - Hearing and Other Functions of the Ear

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