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.

3.6.3.06 Guidelines to the rules for applying the Impairment Tables - selecting the applicable Table & assessing impairments

Summary

This topic provides guidance on Part 2 of the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 (the Determination), which sets out rules that are to be complied with in applying the Impairment Tables. This topic has headings emphasising significant principles and concepts when selecting the applicable Impairment Table to assess a person’s impairments, which underpin provisions contained in the Determination. It also provides guidance on the concepts and practical application of the DSP eligibility criteria contained in the SSAct.

This topic does not restate the definitions contained in Part 1 of the Determination. These definitions are to be accessed directly from the Determination.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Part 1 - Preliminary, Part 2 - Rules for applying the Impairment Tables

Selection steps

Once it has been determined a person has a diagnosed, reasonably treated and stabilised physical, intellectual or psychiatric condition and the resulting impairment is more likely than not, in light of available evidence, to persist for more than 2 years an appropriate Table or Tables can be selected.

Table selection is made by applying the following steps:

  • identify the loss of function, then
  • refer to the appropriate Table related to the function affected, then
  • identify the correct impairment rating.

The Table specific to the impairment being rated must always be applied to that impairment unless the instructions in a Table specify otherwise.

When identifying the loss of function, consideration should be given to the ongoing side effects from prescribed medication and treatment when the impairment from, or related to, the side effects is not expected to significantly improve. The rules contained in this section reinforce the concept that the Tables are designed to assess a person’s impairment and not their conditions.

Example 1: Epilepsy that is largely, but not completely controlled on medication may result in episodes of loss of consciousness once or twice a year. Additionally, persisting side effects of long-term epilepsy medication may moderately impact memory causing a person to often forget to complete regular daily tasks or misplacing items necessitating assistance less than once a day from another person with daily activities. In this case, Table 15 - Functions of Consciousness and Table 7 - Brain Function can both be considered, with care taken to avoid double counting.

The Table specific to the loss of function must always be used unless the instructions in that Table specify otherwise.

Example 2: The introduction to Table 8 - Communication Function specifically instructs that if a person uses recognised sign language or other non-verbal communication method as a result of hearing loss only, the person's communication function is to be assessed using Table 11 - Hearing and other Functions of the Ear.

Policy reference: SS Guide 3.6.3.70 Guidelines to Table 7 - Brain Function, 3.6.3.80 Guidelines to Table 8 - Communication Function, 3.6.3.110 Guidelines to Table 11 - Hearing and Other Functions of the Ear, 3.6.3.150 Guidelines to Table 15 - Functions of Consciousness

Rating multiple impairments resulting from a single condition

The number of conditions does not always correspond to the number of impairments.

A single condition may result in multiple functional impairments, for which ratings can be assigned from more than one Table.

Note: Where a single condition causes multiple impairments, these impairments are to be assessed on all relevant Tables.

Example 1: A person who has had a stroke (cerebrovascular accident or CVA) may be assessed on a number of different Tables depending on the effects of the stroke. For example, if they have impacts on their upper and lower limbs, ratings from both Table 2 - Upper Limb Function and Table 3 - Lower Limb Function would be appropriate.

Example 2: Renal failure may be assessed under a number of Tables depending on the functional impairment experienced by the individual. Table 10 - Digestive and Reproductive Function is to be used if there are gastrointestinal symptoms, Table 1 - Functions requiring Physical Exertion and Stamina is to be used if there are problems with performing activities requiring physical exertion or stamina and Table 14 - Functions of the Skin is to be used if there are skin symptoms, such as pruritus.

When using more than one Table to assess multiple functional impairments resulting from a single condition, to avoid the risk of double counting, care must be taken to ensure different Tables are used to assess distinct functional impairments, and are not used to rate the same functional impairment more than once.

Below are further examples of multiple Table use. Please refer to 3.6.3.09 for more detail of these examples.

Example 3: Multiple Sclerosis - A person who has multiple sclerosis may have functional impairments in a number of areas depending on which part/s of the nervous system are affected, for example, cognitive difficulty, visual problems, constipation and muscle spasms.

Example 4: Diabetes - A person with treatment-resistant diabetes mellitus may experience a range of functional impairments, for example, fatigue, urinary frequency, numbness of hands and fingers, and episodes of confusion.

Example 5: Cirrhosis of the liver - A person with cirrhosis of the liver may experience a range of functional impairments including fatigue, nausea, fluid retention in the abdomen and legs, and cognitive difficulty.

Example 6: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) – A person may experience cognitive dysfunction or ‘brain fog’ as well as difficulties with activities involving physical exertion or stamina.

Policy reference: SS Guide 3.6.3.09 Case examples of conditions that may be assessed across multiple tables, 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, 3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function, 3.6.3.140 Guidelines to Table 14 - Functions of the Skin

Rating multiple conditions with common impairments & double counting

Only ONE impairment rating can be assigned from the same Table, even if multiple conditions are assessed on that Table. To assign more than one rating would amount to double counting.

Where 2 or more conditions have common functional impact/s, the overall impact/s of the conditions must be assessed under a single Table relevant to that function. A single impairment rating reflecting the overall impact on the affected function must be assigned on that Impairment Table.

See also 3.6.3.03 ‘Culturally appropriate considerations’ and ‘Assessing co-morbid conditions’.

Below are further examples of multiple conditions with common impairments and how they may be considered, and assigned an impairment rating.

Example 1: A person has heart disease and chronic lung disease, with symptoms of heart palpitations, low blood pressure and shortness of breath. All these symptoms impact on the person’s physical endurance and ability to undertake routine activities of daily living and to move around their home and community. The overall impact of these 2 conditions (their common and combined effect) is to be rated on Table 1 - Functions requiring Physical Exertion and Stamina. To avoid double counting, a combined impairment rating for both conditions must be assigned on Table 1 - Functions requiring Physical Exertion and Stamina.

Example 2: A person has spondylosis affecting the cervical spine, and also suffers chronic lower back pain. Both conditions have an overall impact on spinal function; therefore a single, combined impairment rating must be assigned from Table 4 - Spinal Function.

Example 3: A person has 3 conditions, all considered diagnosed, reasonably treated and stabilised for DSP purposes. They experience pain in the right calf when walking (intermittent claudication) due to peripheral vascular disease, significant right knee symptoms due to osteoarthritis, and an impairment due to chronic ligamentous instability affecting the left ankle. While the person suffers from 3 distinct conditions affecting both legs, the overall functional impact is on function of the lower limbs. Therefore, only a single, combined rating must be assigned under Table 3 - Lower Limb Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 12 Selecting the applicable Table and assessing impairments, Table 1 - Functions requiring Physical Exertion and Stamina, Table 3 – Lower Limb Function, Table 4 - Spinal 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 Impairment Tables, 3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion and Stamina, 3.6.3.30 Guidelines to Table 3 - Lower Limb Function, 3.6.3.40 Guidelines to Table 4 - Spinal Function

Other situations where double counting may occur

Double counting can also occur when more than one Table is applied to assess a single functional impairment resulting from a single condition, or a common functional impairment resulting from more than one condition.

This situation tends to occur when a single condition is inappropriately assessed as causing an additional functional impairment.

Example: A mental health condition, which has been rated 10 points on Table 5 – Mental Health Function due to a moderate functional impact on mental health function, including moderate difficulties with concentration, task completion and decision-making, must not additionally be rated on Table 7 – Brain Function for those same impairments.

Note: Double counting can also occur when there is an 'either-or' choice between Tables under which a particular impairment could potentially be assessed but a rating is inappropriately applied instead from both Tables.

Example: A person with inflammatory bowel disease has well-controlled abdominal symptoms, but continues to experience severe fatigue. They have difficulty sustaining sedentary work activities, are absent from work several times a month, and may struggle with heavier activities of daily living. Ratings could be made on either Table 1 – Functions requiring Physical Exertion and Stamina, or Table 10 – Digestive and Reproductive Function, but must not be applied from both Tables.

To minimise the risk of double counting in such situations, certain Tables contain instructions on how to avoid it.

Example: Table 4 - Spinal Function instructs that this Table's descriptors are to be met only from spinal conditions, and that restrictions on overhead activities resulting from shoulder conditions are to be rated under Table 2 - Upper Limb Function, and restrictions resulting from hip conditions and lumbar spine conditions (such as, nerve pain and lower limb weakness) should be rated under Table 3 – Lower Limb Function.

Example: Table 7 - Brain Function instructs that a person with autism spectrum disorder (ASD), who has an IQ of more than 85 or who does NOT have a meaningful IQ score of 70-85, is to be assessed under Table 7. It further instructs that Table 7 is not to be used when a person has an impairment of intellectual function already assessed under Table 9 - Intellectual Function, unless they have an additional condition affecting neurological or cognitive function.

Correspondingly, Table 9 instructs that a person with either ASD or fetal alcohol spectrum disorder who DOES HAVE a meaningful IQ score of 70-85, should be assessed under Table 9.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 12 Selecting the applicable Table and assessing impairments, Table 1 - Functions requiring Physical Exertion and Stamina, Table 2 – Upper Limb Function, Table 3 – Lower Limb Function, Table 4 - Spinal Function, Table 5 – Mental Health Function, Table 7 - Brain Function, Table 8 - Communication Function, Table 9 - Intellectual Function, Table 10 - Digestive and Reproductive Function, Table 11 - Hearing and other Functions of the Ear, Table 14 - Functions of the Skin, Table 15 - Functions of Consciousness

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, 3.6.3.40 Guidelines to Table 4 - Spinal Function, 3.6.3.50 Guidelines to Table 5 - Mental Health Function, 3.6.3.70 Guidelines to Table 7 - Brain Function, 3.6.3.90 Guidelines to Table 9 - Intellectual Function, 3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function

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