3.6.3.09 Case examples of conditions that may be assessed across multiple tables

Autism spectrum disorder (ASD)

ASD is a developmental disorder often characterised by problems with social interaction and communication, as well as restricted, repetitive patterns of behaviour, interests or activities. The magnitude and severity of the symptoms can vary widely for individuals. A person with a functional impairment caused by this condition would be assessed under the table/s relevant to the impacted function. For example:

• Table 7 - Brain Function can be used to assess the functional impact of cognitive, social interaction and behavioural difficulties if a person has ASD impacting on day-to-day activities but DOES NOT have a meaningful intelligence quotient between 70 and 85.
• Table 9 - Intellectual Function can be used to assess the functional impact of cognitive, social interaction and behavioural difficulties if a person has ASD and a meaningful intelligence quotient between 70 and 85.

To avoid double counting, it is important not to rate the same functional impairment more than once. This means a person therefore should not be assessed under Table 7 – Brain Function and Table 9 – Intellectual Function, but under one of either Table 7 – Brain Function, or Table 9 – Intellectual Function.

Myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS)

A person with CFS (also known as ME) may experience a range of symptoms including persistent fatigue, impaired short-term memory or concentration, muscle or joint pain, and unrefreshing sleep. A person with this condition may have functional impairments in a number of areas, depending on their presenting symptoms. In such cases, all relevant Tables should be used. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if a person experiences limitation in exertion.
• Table 7 - Brain Function can be used if a person presents with issues with concentration, memory difficulties or other neurological symptoms.
• Table 10 - Digestive and Reproductive Function can be used if a person experiences gastrointestinal symptoms such as nausea, bloating, constipation or diarrhoea.

The need to avoid double counting must be considered, for example, if lower limb muscle weakness and limited mobility is due to fatigue and has been assessed under Table 1 - Functions requiring Physical Exertion and Stamina, then a separate rating under Table 3 – Lower Limb Function for lower limb conditions is not appropriate.

Chronic pain

Acute pain is a symptom, which may result in short term loss of functional capacity in one or more areas of the body, but should resolve within a few months. Acute pain should not be assigned an impairment rating under the Tables.

Chronic pain can be a primary chronic pain syndrome, for example, fibromyalgia or chronic regional pain syndrome, and where it has been diagnosed, reasonably treated and stabilised, the assessor should assess any functional impairment using the table relevant to the area of function affected. Chronic pain can also be a symptom of a condition and in these cases, the functional impairment of the pain should be rated using the relevant table/s to capture the appropriate level of impairment while ensuring the level of impairment is not overstated or double counted. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if chronic pain impacts a person's physical exertion and stamina (for example, fatigue symptoms) and is not adequately assessed by another table. Systemic conditions (that is, affecting the whole body) that are causing widespread pain with associated fatigue may be more appropriately assessed on Table 1.
• Either Table 2 - Upper Limb Function, Table 3 - Lower Limb Function or Table 4 - Spinal Function can be used if the pain impacts a person in one of these areas of functioning. These Tables can also be used in combination if the pain impacts the person in multiple areas.
• Table 7 - Brain Function can be used if a person has chronic pain which impacts their memory, attention or concentration. Table 7 can be used in conjunction with other Tables, as required.
• Table 10 - Digestive and Reproductive Function can be used if a person has chronic pelvic pain that impairs their ability to concentrate on, or sustain tasks or work activities.
• Table 14 - Functions of the Skin can be used if a person has chronic pain related to a disorder of, or injury to, the skin.

Diabetes mellitus

A person with diabetes mellitus that is reasonably treated and stabilised may experience a range of functional impairments. In such cases, all relevant Tables should be used. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if diabetes impairs a person's ability to perform and sustain physical activities.
• Table 2 – Upper Limb Function can be used if a person has peripheral neuropathy or vascular disease that affects their upper limb function.
• Table 3 - Lower Limb Function can be used if a person has peripheral neuropathy or vascular disease that affects their lower limb function.
• Table 10 – Digestive and Reproductive Function can be used if a person has gastroparesis.
• Table 12 - Visual Function can be used if a person's vision is affected.
• Table 15 - Functions of Consciousness can be used if a person has frequent hypoglycaemic episodes. However, if the person is experiencing frequent hypoglycaemic episodes, it must first be established whether the diabetes is reasonably treated and stabilised.

Renal failure

A person with renal failure may experience a range of impairments and a number of Tables can be used to assess this. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used where there is functional impairment when performing activities requiring physical exertion and stamina.
• Table 10 - Digestive and reproductive function can be used where there is a functional impairment of the digestive system.
• Table 14 - Functions of the skin can be used where there is a functional impairment relating to the skin, for example, pruritus.

Epilepsy

A person with epilepsy may experience seizures where they have involuntary loss or altered state of consciousness. This condition is primarily assigned a rating on Table 15 - Functions of Consciousness if it is diagnosed, reasonably treated and stabilised. Impairment points could also be applied on Table 7 - Brain Function for cognitive issues relating to epilepsy and antiepileptic medication.

HIV/AIDS

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if there is functional impairment when performing activities requiring physical exertion and stamina.
• Table 2 - Upper Limb Function and/or Table 3 - Lower Limb Function can be used if a person has peripheral neuropathy such as numbness or tingling of fingertips and/or toes.
• Table 5 - Mental Health Function can be used if a person has a functional impairment due to a psychological disorder, such as clinical depression.
• Table 7 - Brain Function can be used if a person has a functional impairment of cognitive function, for example, from neurological conditions such as HIV dementia or HIV encephalopathy.
• Table 10 - Digestive and Reproductive Function can be used if, for example, a person experiences diarrhoea.
• Table 12 - Visual Function can be used if a person has a functional impairment when performing activities involving visual function, such as from mycobacterium avium complex (MAC) which causes visual impairment or blindness.
• Table 14 - Functions of the Skin can be used if there is functional impairment related to the skin.

Hypertension

Hypertension that has been treated does not usually result in functional impairment. Where hypertension results in no or minimal functional impact, a rating of 0 under Table 1 should be assigned.

If severe and treatment resistant hypertension has resulted in other diagnosed, reasonably treated and stabilised secondary conditions, such as damage to the eyes, kidneys or heart, the functional impacts of these conditions should be assessed under the relevant Tables. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina, and
• Table 12 - Visual Function.

Cancer

The functional impact of cancer is variable depending on the body parts or systems involved the nature and effectiveness of treatment, and the extent or stage of the disease. In the assessment of a person with cancer, all relevant Tables should be applied, while avoiding double counting.

People who have terminal cancer, where the average life expectancy of a patient is more likely than not to be 24 months or less and there is a significant reduction in work capacity within this period, are manifestly qualified for DSP.

Migraine

If a person experiences impairment to neurological or cognitive function, (for example, where severe pain may impair the person's abilities with regard to attention and concentration or comprehension), then Table 7 - Brain Function can be used.

Table 1 - Functions requiring Physical Exertion and Stamina may also be suitable.

Miscellaneous ear/nose/throat conditions

Functional impairments resulting from ear, nose and throat conditions would be commonly assessed using Table 8 - Communication Function, and Table 11 - Hearing and Other Functions of the Ear, depending on the individual’s particular circumstances. For example:

• Table 8 - Communication Function can be used if a person's speech production is impaired due to a laryngectomy (removal of larynx or voice box).
• 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.

To avoid double counting, it is important not to assess the same functional impairment more than once.

Class III (morbid) obesity

Class III (morbid) obesity in adults is defined as a body mass index (BMI) of equal to or greater than 40 kg/m2. A BMI of greater than or equal to 40 is generally considered to be incompatible with long term good health, however, does not necessarily correlate with significant functional impact. The functional impact of class III obesity may range from minimal to very significant. In the assessment of a person with class III obesity, the Tables relevant to the area of function affected should be applied. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if the person experiences symptoms (shortness of breath, fatigue, chronic pain) when performing physical activities.
• Table 3 - Lower Limb Function can be used if the person has difficulty walking, using stairs, kneeling or squatting.

Where class III obesity results in no or minimal functional impact, a rating of zero under Table 1 should be assigned.

If class III obesity has resulted in other diagnosed, reasonably treated and stabilised secondary conditions, for example, osteoarthritis of the knee joints, the functional impacts of these conditions should be assigned a rating under the relevant Tables, such as Table 3 – Lower Limb Function.

However, where 2 or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that impairment under a single table. It is not reasonable to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Multiple Sclerosis (MS)

A person with MS may experience a range of symptoms and symptoms from MS can vary between people. In the assessment of a person with MS, all relevant Tables should be applied. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be used if a person has a functional impairment when performing activities requiring physical exertion and stamina.
• Table 2 - Upper Limb Function and/or Table 3 - Lower Limb Function can be used if a person has muscle weakness or loss of coordination that results in impaired upper and/or lower limb function (for example, lifting and manipulating objects or walking).
• Table 7 - Brain Function can be used if the person experiences a functional impairment related to cognitive function, such as memory difficulties.
• Table 13 - Continence Function can be used if a person has a functional impairment related to incontinence of the bladder or bowel.

Stroke

A person who has suffered a stroke may have functional impairments in a number of areas depending on the part/s of the brain that have been damaged. In such cases, assessors should use all of the relevant Tables. For example:

• Table 1 - Functions requiring Physical Exertion and Stamina can be considered if a person experiences symptoms of fatigue (as is often the case with a stroke).
• Table 2 - Upper Limb Function and Table 3 - Lower Limb Function can be used if a person has impaired upper and/or lower limb function.
• Table 7 - Brain Function can be used if a person has impaired cognitive functions, such as difficulty with visuo-spatial functioning, attention or concentration.
• Table 8 - Communication Function can be used if a person has difficulties understanding or producing speech.
• Table 12 – Visual Function can be used if a person has hemianopia (the loss of one half of a vertical visual field).