3.6.3.10 Guidelines to Table 1 - Functions requiring Physical Exertion and Stamina

Summary

Table 1 is used to assess the functional impact of a condition when performing activities requiring physical exertion or stamina.

Conditions causing impairment commonly assessed using Table 1

Conditions assessed under Table 1 are commonly associated with cardiac or respiratory impairments, fatigue or exhaustion, or other conditions affecting physical exertion or stamina. These include but are not limited to:

• ischaemic heart disease or coronary artery disease with exercise induced angina
• cardiac disease which has resulted in cardiac failure, such as cardiomyopathy or some cardiac valvular conditions
• cardiac arrhythmias that result in exercise induced restrictive symptoms
• chronic obstructive pulmonary disease (COPD)
• restrictive lung disorders
• exercise induced asthma
• autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis which impact a person's physical exertion or stamina and no other Table sufficiently captures the impairment
• myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS)
• fibromyalgia
• lymphoedema
• chronic pain
• renal failure
• diabetes mellitus.

Diagnosis & evidence

The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner and supported by corroborating medical evidence. This includes a GP or other specialist, such as a cardiology, respiratory, rheumatology or other specialist physician.

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.

Examples of corroborating medical evidence for the purposes of Table 1 include, but are not limited to:

• a report from the person’s treating doctor
• a report from a medical specialist confirming diagnosis of conditions commonly associated with cardiac or respiratory impairment (such as, cardiac failure, cardiomyopathy, ischaemic heart disease, chronic obstructive airways/pulmonary disease, asbestosis, mesothelioma, or lung cancer)
• a report from a medical specialist confirming the diagnosis of conditions commonly associated with fatigue or exhaustion, such as diabetes mellitus, renal failure, end stage organ failure, widespread/metastatic cancer, chronic pain, ME/CFS, lymphoedema and fibromyalgia, and providing details of treatment, functional impact and prognosis
• results of exercise, cardiac stress, treadmill testing or actimetry linked blood pressure and heart rate monitoring.

Interpretation & application of relevant terms

Where the descriptors in Table 1 refer to mobilising in a wheelchair, this includes both manually-propelled wheelchairs and powered mobility aids (such as, power assist wheelchair, power wheelchair or mobility scooter).

'Public transport' means any mode of transport that runs to a timetable, such as buses, trains, trams and ferries. It excludes community transport, taxis, rideshare or hire cars. A person who is able to use at least one of these modes of transport, having regard only to the level of impairment assessable under Table 1, is considered to be able to use public transport for the purpose of this Table, even if they are precluded from using other modes of public transport. When assessing a person's ability to use public transport it is irrelevant whether the person actually uses public transport, whether public transport is available to the person in their local area and whether the person actually receives assistance.

‘Local’ facilities refer to those which are restricted to a particular area or neighbourhood (for example a corner shop, a shopping centre or supermarket, workplace or education or training campus). Of relevance is the short distance a person would need to travel to such a location.

Similarly, where Table 1 refers to activities such as walking (or mobilising in a wheelchair) to local facilities, it is irrelevant whether such establishments, businesses, buildings or structures actually exist in a person's locality or how they may be labelled. Of relevance is the description of the activity involved. The objective is to measure the level of functional impact having regard to the severity of a person's symptoms (for example, shortness of breath, fatigue or pain) when performing certain tasks requiring physical exertion or stamina.

‘Full range of activities’ refers to the usual activities a person would expect to undertake during the normal course of their day. This will vary from individual to individual but may involve things such as household duties (such as, cooking and cleaning), commuting to and from work, and undertaking work tasks.

‘Heavier household activities’ refers to activities within the household that are strenuous and require mobility. This may include scrubbing a bathroom, vacuuming more than one room or mowing the lawn.

Where a descriptor in Table 1 refers to ‘work-related tasks’ this is taken to mean tasks that relate to work, education or training activities and are typically clerical, sedentary or stationary.

The 20 and 30-point descriptors in Table 1 use the term 'assistance'. Assistance is defined in the instrument as assistance from another person, rather than any aids, equipment or assistive technology the person may use, unless specified otherwise (3.6.3.05).

Determining the level of functional impact - 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, consideration must be given to 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 follow an incremental hierarchy, which is expressed, among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities. In this Table they are expressed as: no or minimal difficulty, mild difficulty, moderate difficulty, severe difficulty and unable to. 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. Consideration must be given to the differentiation between the descriptors including the examples (if any) given in each. When it is determined that the 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.

Where several descriptor points must apply for that rating the word 'and' links the descriptor points. However, one of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

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.

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.

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 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.

When Table 1 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 pain, shortness of breath or fatigue. When a person experiences some symptoms or pain when performing an activity this does not mean the person is 'unable' to perform the task. The assessment of the level of pain and symptoms experienced in performing the activity is relevant where the pain and symptoms 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.

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’).

Impairment ratings for Table 1

0-point impairment rating level

The 0-point descriptor requires that the person have NO OR MINIMAL functional impact on activities requiring physical exertion or stamina.

To be assigned this rating, the person MUST meet descriptors (1)(a), (b) and (c). That is, the person is able to undertake exercise appropriate to their age for at least 30 minutes at a time (point (1)(a)) AND has no or minimal difficulty completing physically active tasks in their home and community (point (1)(b)) AND can undertake personal care activities, such as showering or bathing and these activities do not prevent the person from undertaking a full range of activities in the same day (point (1)(c)).

To meet descriptor (1)(a), it would not be expected that an older aged person is able to undertake the same level of intensity in exercise as someone aged in their 20's due to reduced stamina or loss of flexibility. Consideration should be given to the level of exercise a generally healthy person of the equivalent age would reasonably be expected to undertake.

5-point impairment rating level

The 5-point descriptor requires that the person have a MILD functional impact on activities requiring physical exertion or stamina.

For this rating to be assigned, the person MUST meet descriptor (1)(a) AND at least one of (1)(a)(i), or (1)(a)(ii) AND also descriptor (1)(b).

10-point impairment rating level

The 10-point descriptor requires that the person have a MODERATE functional impact on activities requiring physical exertion or stamina.

For this rating to be assigned, the person MUST meet descriptor (1)(a) AND at least one of (1)(a)(i), (1)(a)(ii) or (1)(a)(iii) AND must also meet both descriptors(1)(b)(i) and (1)(b)(ii).

20-point impairment rating level

The 20-point descriptor requires that the person have a SEVERE functional impact on activities requiring physical exertion or stamina.

For this rating to be assigned, the person MUST meet descriptor (1)(a) AND at least one of the (1)(a)(i), (1)(a)(ii), (1)(a)(iii) or (1)(a)(iv) AND must also meet descriptor (1)(b).

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact on activities requiring physical exertion or stamina.

For this rating to be assigned, the person MUST meet at least one of the descriptors at (1)(a), (b), (c) or (d).

The 30-point descriptor includes people who have been medically assessed as requiring Oxygen treatment. If a person requires oxygen treatment, such as the use of an oxygen concentrator during the day or to move around, as per the 30-point descriptor note they should be assessed as meet the 30-point rating, at 1(b).

Avoiding double counting

The descriptors in other Tables may also refer to certain activities relating to a person's ability to mobilise such as climbing steps etc., but those Tables measure the impact of impairment where that impairment is different to those assessed under Table 1. For example, some descriptors in Table 3 - Lower limb function measure the level of difficulty a person has walking, climbing stairs or mobilising in a wheelchair due to symptoms affecting the use of lower limbs.

Restriction of physical activity due to musculoskeletal conditions for example, severe arthritis, spinal problems, should not be assessed under Table 1 unless the musculoskeletal tables (Table 2 – Upper Limb Function, Table 3 – Lower Limb Function and Table 4 – Spinal Function) do not sufficiently capture the impairment from any associated impact on physical exertion or stamina.

Where the condition causes loss of muscular endurance in a specific body system, the loss of function should be reflected on the relevant Table, to avoid double counting.

Table 1 may be used to assess the functional impact of chronic pain where there is corroborating medical evidence that chronic pain (affecting one or more body functions) also impacts physical exertion and stamina (for example where the condition results in fatigue symptoms). However, to avoid double counting, Table 1 should only be used if the level of impairment to a particular function is not adequately assessed by the Table relevant to that function. Therefore, if there is an impact on physical exertion and stamina and a rating has been allocated on other Tables (such as, Table 2 – Upper Limb Function, Table 3 – Lower Limb Function and Table 10 - Digestive and Reproductive Function), it needs to be carefully considered whether the rating on the other Table already adequately captures the level of impairment. If this is not the case, then use of Table 1 may be considered, while ensuring that the level of impairment is not overstated. If the level of impairment has been adequately captured under other Tables, there is no need to apply Table 1.

When assessing chronic pain under Table 1, (refer to 3.6.3.02 ’Assessing functional impact of chronic pain’). Please also refer to 3.6.3.06. More information about avoiding double counting and supporting examples are also contained in the below sections of this topic, titled ‘Examples of Table 1 assessment’ (see Example 3 below) and ‘Impairments that should not be assessed using Table 1’.

If it is unclear how and when to use Table 1 while avoiding double counting, the case should be discussed with the HPAU.

Examples of Table 1 assessment

Impairments that should not be assessed using Table 1

Non-pathological causes, such as lack of fitness that are not associated with a diagnosed medical condition, should not be assessed using Table 1.

Restriction of physical activity due to musculo-skeletal conditions, for example, severe arthritis, spinal problems, unless the musculo-skeletal Tables 2, 3 or 4 do not sufficiently capture the impairment from any associated impact on physical exertion and stamina.

Assessors need to be mindful not to overstate the level and nature of impairment. Musculo-skeletal conditions can be expected to involve some level of ongoing pain and reduced stamina in addition to a loss of dexterity/flexibility, which would all be factors in determining the level of severity of the impairment. This is more evident when assessing a person's ability to undertake the actions described on a repetitive basis rather than a one-off action.

A single joint injury would generally be assessed on the specific table while a global arthritic condition would be rated on Table 1.