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3.6.3.08 Guidelines to the rules for applying the Impairment Tables - assigning an impairment rating

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 assigning an impairment rating to a person’s functional impairment, 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.

Assigning an impairment rating

The following rules must be applied when assigning impairment ratings:

  • ONLY ONE rating can be assigned per Table
  • impairment ratings can only be assigned in accordance with the rating system of the Impairment Tables, that is only 0, 5, 10, 20 or 30 points can be assigned
  • impairment ratings can only be assigned in accordance with the descriptors in each Table
  • ratings cannot be assigned in excess of the maximum rating specified in each Table, and
  • an impairment rating must not be assigned unless all the required descriptors for that level of impairment are satisfied.

When determining which impairment rating applies to a person under a specific Table, the rating that best reflects the level of functional impact resulting from a person’s condition must be applied. In doing so, the descriptors under a specific impairment level must be considered and applied, as set out in the impairment rating level, that is:

  • ALL the points in the impairment rating level must be considered
  • NO descriptors or their parts are to be disregarded.

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, including a person's medical history, investigation results and clinical findings. A person's self-reported symptoms MUST NOT SOLELY BE RELIED UPON. An impairment rating must not be applied unless a person's self-reported functional impacts are consistent with, and supported by, corroborating medical evidence.

In all cases, the required number of descriptors in an impairment rating level MUST be met before a higher level rating can be considered.

Example: A person with osteoarthritis has functional impairment of their hands. Under Table 2 – Upper Limb Function, they meet 4 of the 7 descriptors for an impairment rating of 10 points. They also satisfy 2 of the 20-point descriptors due to severe difficulty using a small object and severe difficulty turning the pages of a book without assistance. They do not satisfy any other required descriptors for the 20 point rating and a rating of 10 points must be assigned, being the highest impairment rating at which the required number of descriptors are met. This is because the person does not meet at least 3 of the 5 descriptors required for a 20-point rating. In this case, 10 points must be assigned and it is incorrect to assign 20 points.

When impairment ratings are applied from multiple Tables, the total work-related impairment is represented by the multiple impairment ratings.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13(1) Assigning an impairment rating, Part 3 Table 2 – Upper Limb Function

Policy reference: SS Guide 3.6.3.20 Guidelines to Table 2 - Upper Limb Function

Hierarchy of descriptors

The rating system is standardised across the Tables as follows:

  • no or minimal functional impact equals an impairment rating of 0 points
  • mild functional impact equals an impairment rating of 5 points
  • moderate functional impact equals an impairment rating of 10 points
  • severe functional impact equals an impairment rating of 20 points, and
  • extreme functional impact equals an impairment rating 30 points.

Similarly, the descriptors in each Table follow an incremental hierarchy, which is expressed by terms that describe increasing levels of difficulty, tied to the impairment rating level, in performing certain activities, to better reflect the level of impairment at each rating. For example:

  • ‘no or minimal difficulty’, ‘without difficulty’, or ‘does not have difficulty’ at 0 points
  • ‘mild difficulty’ at 5 points
  • ‘moderate difficulty’ at 10 points
  • ‘severe difficulty’ at 20 points, and
  • ‘extreme difficulty’ or ‘unable to’ at 30 points.

The hierarchy of descriptors in some Tables take into account additional factors that reflect the severity of an impairment. These may include:

  • a person's ability to perform certain activities unassisted or unaided and/or when using devices (for example, Table 3 – Lower Limb Function), or
  • requirements for equipment or aids (for example, the use of augmentative communication, Table 8 – Communication Function).

As the descriptors follow an incremental hierarchy, an assessment process must follow the same incremental path to establish the appropriate rating for a person's functional impairment, that is, whether the impairment has no or minimal (0 points), mild (5 points), moderate (10 points), severe (20 points) or extreme (30 points) functional impact.

As a first step, all the descriptors for each impairment rating level in the Table under which a person is being assessed should be read as a whole so the descriptors, their relationship and hierarchy in that particular Table are understood.

The next step involves considering the descriptor for 0 points, and continuing to consider the descriptors for progressively higher impairment levels, until it is determined that:

  • a person meets all the required descriptors for a certain impairment rating level, and
  • does not meet all the required descriptors for the next level.

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 IMPAIRMENT RATING LEVEL. No descriptors or their parts are to be disregarded.

When it is determined a person meets all the required descriptors for a certain impairment rating level that rating will be applied. A person cannot be assigned an impairment rating level if they do not meet all required descriptors.

Note: Individual descriptors or their parts must not be applied in isolation from one another. For example, under Table 1 - Functions requiring Physical Exertion and Stamina, when assessing a person against the 10-point descriptor, all points must be considered. In order for the 10 point rating to be applied, a person MUST meet points (1)(a)(i), (1)(a)(ii) OR (1)(a)(iii) and MUST ALSO meet both (1)(b)(i) AND (1)(b)(ii).

Explanation: Where a person’s condition results in no or minimal functional impact, the impairment must be assessed at the 0 point impairment rating level. The allocation of 0 points does not necessarily mean that there is no functional impact whatsoever. It may mean that the descriptors for an impairment rating of 5 points have not been met, and therefore the 0 points applies. This is reflected with the addition of the words ‘or minimal’ at the 0 point impairment rating 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.

Example: A person's impairment is being assessed under Table 2 – Upper Limb Function. The assessor first considers the descriptor for 0 points and is satisfied that the person can pick up, handle, manipulate and use most objects encountered on a daily basis without difficulty. They then progress to considering the descriptors at 5 points. The assessor also finds the person has difficulty handling very small objects, such as coins, and doing up buttons, but they do not meet any other descriptors for that rating. As such, the appropriate impairment rating is 0 points and there is no need for the assessor to proceed any further. The person CANNOT be allocated 5, 10, 20 or 30 points.

Example: A person’s impairment is being assessed under Table 4 – Spinal Function. In accordance with the incremental hierarchy principle, an assessor applies the descriptors in the Table sequentially, starting with the descriptor for 0 points and continues considering the higher-level descriptors. The assessor finds that the person is able to sit in or drive a car for at least 30 minutes and also meets at least one of the required descriptors for a rating of 10 points, but does not meet any of the descriptors for the 20-point rating. The person’s impairment rating is 10 points and the assessor is not required to proceed any further. The person CANNOT be allocated 20 or 30 points.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13 Assigning an impairment rating, Part 3 Table 2 – Upper Limb Function, Part 3 Table 4 – Spinal Function

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

Descriptors involving performing activities

When assessing whether a person can perform an activity described in a descriptor, the descriptor applies where the person can complete or sustain that activity when they would be expected to do so, and not only once or rarely.

Consideration should be given to where a person performs a certain activity because they have to (such as, if they need assistance but do not have anyone to assist them), and the impact of any subsequent symptoms experienced as a result of performing that activity. That is, it would not be reasonable to determine that a person who pushes themselves to perform the activity, despite the adverse consequences of doing so, is capable of completing or sustaining an activity.

Example: If, under Table 4 - Spinal Function, a person is assessed as to whether they can bend down to pick a light object off the floor, such as a piece of paper (0-point descriptor (1)(a)). They are taken as meeting this descriptor only where a person is generally able to do that activity whenever they would normally attempt to perform it.

When a descriptor specifies a person’s inability to perform an activity, it is considered to have been met if the person is unable to do the activity when they would normally be required to do so, unless otherwise specified in the Table.

Example: Under Table 3 - Lower Limb Function, a person is assessed as to whether they have moderate difficulty standing for short periods of time, such as standing in a queue at the supermarket checkout, as specified in descriptor (1)(c) for 10 points. This descriptor is met where the person is unable to do this activity when they would normally be required to do so, for example, as part of their day-to-day activities around the home and the community.

A person may perform a certain activity without assistance because they have no one to assist them. In these situations, a person may push themselves to perform the activity out of necessity. In assigning an impairment rating, consideration must be given to any subsequent symptoms experienced by the person as a result of performing that activity, as an indicator of whether assistance is likely to be required.

Example: A person has difficulty walking around a supermarket, due to the impact of rheumatoid arthritis on their lower limbs. They do not have anyone available to assist them and so they do their shopping alone. Afterwards, they usually experience severe pain and fatigue and cannot walk any significant distance for the rest of the day. In this case, under Table 3 - Lower Limb Function, 20-point descriptor, the person should be considered as having severe difficulty walking around their home and in the community without assistance.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13 Assigning an impairment rating, Part 3 Table 2 – Upper Limb Function, Part 3 Table 4 – Spinal Function

Policy reference: SS Guide 3.6.3.30 Guidelines to Table 3 - Lower Limb Function, 3.6.3.40 Guidelines to Table 4 - Spinal Function

Assessing impairments caused by episodic or fluctuating conditions

Many conditions follow an episodic or fluctuating pattern. A person may experience periods of wellness followed by periods of impairment. The length of each period may also vary.

When assessing episodic or fluctuating impairments and conditions, a rating must be assigned which reflects the overall functional impact of those impairments.

In addition to the guidance on assessing episodic and fluctuating impairments and conditions in Part 2 of the Determination, the introductions to all relevant Impairment Tables note the considerations that must be made around the severity, duration and frequency of the episodes or fluctuations as appropriate. They further highlight that a person’s signs and symptoms may vary over time and as such, corroborating evidence, including information from a wide range of sources, must be considered and the presentation of a person on the day of assessment should not be solely relied upon.

Where a telephone JCA is undertaken a person’s presentation will be more difficult to assess and detailed notes must be taken.

Episodic and fluctuating conditions may present in a number of ways. For some individuals, they may experience recurrent or ‘on again/off again’ episodes of impairment; for others they may experience fluctuations in the severity of their impairment, but the impairment will always be present; for others there may be a progressive degeneration of their condition over time, resulting in a continual decline in function; and for others still, there may be a combination of these presentations.

It is important to remember that the presentation of episodic and fluctuating conditions may vary from individual to individual. Each person should be assessed based on their individual circumstances and the evidence provided in support of their claim.

A range of conditions may present as episodic or fluctuating including, but not limited to; arthritis, some forms of cancer, chronic obstructive pulmonary disease, chronic fatigue syndrome, chronic pain, Crohn's disease, ulcerative colitis, diabetes, epilepsy, fibromyalgia, lupus, depression, anxiety, bipolar disorder, schizophrenia, Meniere's disease, multiple sclerosis, migraines, and Parkinson's disease.

Example: A person has bronchiectasis which is diagnosed, reasonably treated and stabilised for DSP purposes. Over the past 2 years, they normally experience shortness of breath and have to rest frequently when doing the housework. They normally catch the bus to the supermarket and can do their grocery shopping without assistance. They can perform tasks of a sedentary nature, such as working on a computer. Based on these functional impairments, they meet the descriptors for a 10-point impairment rating on Table 1 – Functions requiring Physical Exertion and Stamina.

Four to 5 times a year, they get a chest infection which substantially worsens their condition. During these exacerbations, they are short of breath when performing light physical activities, cannot perform any household activities, and cannot catch the bus without assistance. They have difficulty sustaining any sedentary work for 3 hours at a time, due to increased fatigue. During these periods of exacerbated symptoms, they fulfil the descriptors for a 20-point impairment rating on Table 1 - Functions requiring Physical Exertion and Stamina.

These chest infections usually last for 2 weeks and it takes a further 2 weeks for them to return to their previous functional capacity. At least once a year they have a severe chest infection, which requires hospital admission typically for a one-week period. During the hospital admission, they are unable to perform any activities requiring physical exertion and are prescribed oxygen treatment. It takes 6 to 8 weeks to recover from a severe chest infection.

In total, they spend at least 26 weeks per year (6 months) functioning at a 20-point or worse level of impairment. As this is at least half of a typical year, it would be appropriate to apply a 20-point rating in recognition of their overall level of impairment.

If their chest infections lasted 2 weeks, with one week to recover their normal level of functioning, they would spend 8 to 10 weeks per year functioning at a 20-point or worse level of impairment. As they would spend the majority of the year at the 10-point rating, this would be the appropriate impairment rating level to be applied.

Consideration must also be given to the impacts of post-exertional malaise (PEM). PEM is the worsening of symptoms following physical or mental exertion, in some cases from minor exertion. A person may be able to manage the severity of a flare up through pacing themselves and activity management. However, it is important to consider the functional impact the person experiences even with this.

Explanation: Activity management involves planning a persons daily activities, including daily activities to limit the exertion they experience. This may include, for example, only showering every second day.

It must also be considered if a person experiences delayed symptoms from exertion, which in some cases leaves an individual incapacitated for long periods of time.

Example: A person has Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) which is considered diagnosed, reasonably treated and stabilised for DSP purposes. The person goes to bed at the same time each night and wakes feeling unrefreshed. Some days the person can push themselves to perform day-to-day activities around the home and community, such as showering, brushing their teeth and going to their local shops.

However, most days they have severe difficulty undertaking these activities and need to rest for long periods afterwards. The person has worked as a clerical officer for 10 years, however now finds, more often than not, they have difficulty sustaining work-related tasks for more than 2 hours, without experiencing severe fatigue.

Under Table 1 - Functions requiring Physical Exertion and Stamina, this person would meet (1)(a)(ii) and (1)(b) for a rating of 20 points.

Example: A person has Irritable Bowel Syndrome (IBS) which is a chronic functional gastrointestinal disorder. The condition is currently managed through diet, increasing their soluble fibre intake, and medications, and is considered diagnosed, reasonably treated and stabilised.

However, IBS has impacted their day to day functioning due to recurring abdominal pain and frequent stool passing. They are reluctant to attend work and have taken a total of 3 weeks off work in the last 6 months due to the intensity and frequency of their bowel movements and their inability to access the toilet in a timely manner to attend to their personal care needs. During a flare-up (episode) the person is frequently interrupted by chronic pain at least once every hour. The person typically experiences flare-ups bi-monthly.

Under Table 10 – Digestive and Reproductive Function, this person would meet (1)(a) and (1)(d) for a rating of 20 points. This is due to the frequency of flare-ups (equivalent to 6 months of the year) and the pain experienced during a flare up.

If a person's mental health condition has been stabilised as episodic or fluctuating (as may be the case with conditions such as bipolar affective disorder), the rating that reflects the overall functional impact of the condition, taking into account the severity, duration and frequency of the episodes should be applied.

Note: People with mental health conditions may not have sufficient self-awareness of their impairment and may not be able to accurately describe its effects. In determining the functional impact of mental health conditions, Table 5 - Mental Health Function instructs assessors to:

  • keep the person's self-awareness of their impairment in mind when discussing issues with the person and reading supporting evidence
  • consider evidence from a range of sources, this may include treating health professionals, social or community workers, family and friends, and
  • a person's presentation on the day of the assessment should not be solely relied upon.

Refer to 3.6.3.03 ‘Corroborating Evidence’ for further examples of sources of evidence.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Part 2 - Rules for applying the Impairment Tables, Part 3 Table 1 - Functions requiring Physical Exertion and Stamina, Part 3 Table 5 - Mental Health Function, Part 3 Table 10 - Digestive and Reproductive 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, 3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion and Stamina, 3.6.3.50 Guidelines to Table 5 - Mental Health Function, 3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function

Assessing impairments with no or minimal functional impact

Subsection 13(6) of the Determination states the presence of a diagnosed condition does not necessarily mean there will be an impairment to which an impairment rating may be assigned. To avoid doubt, where a person’s diagnosed condition results in no or minimal impairment, the impairment should be assessed as having no or minimal functional impact and a 0 rating must be assigned.

Example: Medical records provided by a person list hypertension as one of the diagnosed conditions. On assessment, it is determined they have undertaken reasonable treatment over the last 5 years and the condition is stabilised. While the condition will persist for more than 2 years, it is expected to remain stable with ongoing treatment. It would be reasonable to consider this condition diagnosed, reasonably treated and stabilised, therefore the Impairment Tables must be applied. However, as the condition causes no restriction on activities, there is no impact on their functioning. An impairment rating of 0 is assigned under Table 1 - Functions requiring Physical Exertion and Stamina.

Note: When it is determined a person meets the required descriptors for a certain impairment rating level that rating will be applied. A person cannot be assigned an impairment rating level if they do not meet all required descriptors. The allocation of 0 points does not always mean there is no functional impact at all. It may also mean the person does not meet all required descriptors for 5-points.

Example: A person was diagnosed with hypertension 5 years ago. The condition has been treated with medication and lifestyle changes and response to treatment has been generally good. A long-term consequence of the medication is mild fatigue. Therefore, the condition and its treatment have some impact on physical exertion and stamina. However, this is negligible and does not meet the 5-point descriptor under Table 1 - Functions requiring Physical Exertion and Stamina. In this case, an impairment rating of 0 points is assigned under this Impairment Table.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13(6) No or minimal impairment resulting from a condition, Part 3 Table 1 - Functions requiring Physical Exertion and Stamina

Policy reference: SS Guide 3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion and Stamina

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