3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function

Summary

Table 10 is used where a person has a functional impairment related to digestive or reproductive system functions. The diagnosis of the condition must be made by an appropriately qualified medical practitioner. This includes a general practitioner,a gastroenterologist, gynecologist, or other relevant specialist.

If a person has impairment related to both digestive and reproductive system functions a single rating under Table 10 should be assigned that reflects the overall functional impairment.

A person who has a permanent condition impacting digestive or reproductive system functions may be assessed under Table 10. This includes conditions of the digestive and reproductive systems (e.g. conditions of the stomach, bowel and liver), but also includes conditions of internal organs outside these systems, which may impact on digestive or reproductive systems. Examples may include chronic kidney disease and some autoimmune disorders. This is consistent with the Tables being function-based rather than diagnosis-based. Further examples of conditions causing impairments that may be rated under Table 10 are listed at the end of these Guidelines.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining functional impacts of the person's permanent condition. There must be corroborating medical evidence of the person's impairment.

Determining the level of functional impact - general rules

Table 10 is different to most of the other Tables used to assess impairment for DSP purposes in that Table 10 specifically recognises the impact of impairments and their treatment on a person's attention and concentration.

When determining which impairment rating applies to a person the rating that best describes the person's abilities or difficulties must be applied. In applying the descriptors, each descriptor sets out how the points within it are to apply.

For example, the 5-point descriptor in Table 10 states that 'at least one of the following applies'. The 10-point, 20-point and 30-point descriptors state that 'at least 2 of the following apply'.

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. An assessment starts by considering the descriptors for 0 points and, if a person has more than 'no 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 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 lower of those 2 impairment ratings (i.e. the rating at which all the required descriptors are met).

Note: 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 descriptor. NO descriptors or their parts are to be disregarded however, one of several descriptor points may be sufficient for that rating when the word 'or' links the descriptors.

Note: If a person's impairment does not meet sufficient 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 sufficient required descriptors for 10 points, the correct impairment rating is 5 points. The person's impairmentĀ CANNOT be assessed as moderate, severe or extreme for the purposes of DSP and neither 10, 20 nor 30 points can be allocated.

Determination of the descriptor that best fitsĀ a 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 solely be relied on. It would be inappropriate to apply an impairment rating based solely on a person's self-reported functional history if this level of functional impairment is not consistent with the medical evidence available.

The 10-point and 20-point descriptors refer to the amount of absences a person may have. The 10-point descriptor states the person is often (once per month) absent and the 20-point descriptor states the person is frequently (twice or more per month) absent. One absence is taken to be one day and so where the person has frequent absences of 2 or more days, even where these are consecutive days, this would equate to absences of twice or more per month.

Where the descriptors make reference to symptoms or personal care needs associated with the digestive or reproductive system functional impact, the following information may be of assistance.

For digestive system functional impacts:

  • associated symptoms include, but are not limited to, pain, discomfort, nausea, vomiting, diarrhoea, constipation, reflux, heartburn, indigestion or fatigue
  • associated personal care needs include, but are not limited to, the need to take medications when symptoms occur, care of special feeding equipment (e.g. Percutaneous Endoscopic Gastrostomy (PEG) button or special feeding tube), special diets or feeding solutions, strategies to relieve pain, additional toileting and personal hygiene needs.

For reproductive system functional impacts:

  • associated symptoms include, but are not limited to, pain, fatigue, menorrhagia or dysmenorrhea,
  • associated personal care needs include, but are not limited to, strategies to relieve pain or more frequent menstrual care.

0-point impairment rating level

The 0-point descriptor specifies that a person has NO functional impact on work-related or daily activities due to symptoms or personal care needs associated with a digestive or reproductive system functions.

5-point impairment rating level

The 5-point descriptor requires that there is a MILD functional impact on work-related or daily activities due to symptoms or personal care needs associated with digestive or reproductive system functions and at least (1)(a) or (1)(b) applies.

10-point impairment rating level

The 10-point descriptor requires that there is a MODERATE functional impact on work-related or daily activities due to symptoms or personal care needs associated with digestive or reproductive functions and at least two of (1)(a), (1)(b), or (1)(c) apply.

20-point impairment rating level

The 20-point descriptor requires that there is a SEVERE functional impact on work-related or daily activities due to symptoms or personal care needs associated with digestive or reproductive system functions. At least two of (1)(a), (1)(b), (1)(c) or (1)(d) apply.

30-point impairment rating level

The 30-point descriptor requires that there is an EXTREME functional impact on work-related or daily activities due to symptoms or personal care needs associated with digestive or reproductive functions and at least two of (1)(a), (1)(b), (1)(c) or (1)(d) apply.

Some conditions causing impairment commonly assessed using Table 10

A permanent condition resulting in functional impairment related to digestive system functions may include diseases in or remote from the digestive tract, which have significant impacts on digestive function such as:

  • reflux oesophagitis
  • refractory peptic ulcer disease
  • established chronic liver disease
  • chronic nausea and poor appetite from kidney disease
  • irritable bowel syndrome
  • inflammatory bowel disease (Crohn's disease, Ulcerative Colitis)
  • established chronic pancreatic disease, abdominal hernias.

As the impact of digestive and reproductive functions on attention and concentration is specfically considered under the descriptors for a rating under Table 10, no further rating can be applied under Table 7. Likewise, the impact of digestive and reproductive functions on pain and stamina is specifically taken into account under the descriptors for a rating under Table 10, so no further rating can be applied under Table 1. Double-counting is to be avoided and multiple Tables would not be used unless other conditions causing functional impacts specific to Table 1 or Table 7 are present.

Reproductive system conditions may include gynecological disease as well asconditions of the male reproductive system including but not limited to:

  • severe and intractable endometriosis
  • pelvic inflammatory disease
  • ovarian cancer
  • testicular cancer.

Example 1: A 45-year-old man suffers from Crohn's disease. He was diagnosed with this condition several years ago and the medical evidence indicates he has undergone surgery in relation to this condition, due to suffering a blockage of the intestine. His current treatment consists of medication to alleviate the symptoms and sometimes a course of short term steroids during periods of active symptoms. He experiences intermittent periods of aggravation of his symptoms in between periods of remission. A report from his treating specialist outlines that he experiences these periods of active symptoms on an average of once a month. During this time he is unable to attend work due to the severity of active symptoms, for at least one day. During periods of remission he is able to attend work reliably but his attention and concentration are interrupted by symptoms of abdominal pain and discomfort on a daily basis. During the periods of active symptoms, he experiences symptoms of severe abdominal pain and diarrhoea along with fatigue, nausea and loss of appetite. His attention and concentration are often reduced by the symptoms and he often loses weight during these times.

The condition is considered fully diagnosed, treated and stabilised and under Table 10, this man would receive an impairment rating of 10 points due to the moderate impact his condition has on his ability to function. Under the 10-point descriptor he would meet (1)(a) and (c).

Example 2: A 25-year-old woman has a diagnosis of endometriosis. She has undergone hormone therapy and currently takes medication to alleviate the symptoms. In the past, she has undergone a pelvic laparoscopy but her symptoms came back following this operation. Her symptoms include constant chronic pelvic pain which increases in severity once a month with menstruation. During this time she is unable to attend work for about 1 week and she usually needs to take another day or 2 off work at other times each month. Daily pain is intermittently severe and and briefly interrupts her attention and concentration at least once per hour during working hours. It occurs on both sides of the pelvis, radiating to the lower back. Her specialist has recommended she undergo a hysterectomy due to the severity of her symptoms but the woman has chosen not to undertake this form of treatment, due to the fact that she wants to try to have children in the near future. Also, there is still a risk that her symptoms can come back even after undergoing this procedure.

The condition is considered fully diagnosed, treated and stabilised and under Table 10, this woman would receive 20 points, due to the fact that her attention and concentration are frequently reduced by her pain symptoms and she is frequently absent from work due to her condition. Under the 20-point descriptor this woman would meet (1)(a) and (d).

Example 3: A 50-year-old person has longstanding type 1 diabetes mellitus and, as a result has developed gastroparesis. Gastroparesis causes slowed emptying of the stomach, in this case due to diabetic autonomic neuropathy. A gastroenterologist confirmed the diagnosis 2 years ago. The person has appropriately managed this condition including through optimising blood glucose control and the use of medications to accelerate gastric emptying, hence the condition is fully diagnosed, treated and stabilised. Gastroparesis makes this person feel nauseous with vomiting after meals several times per week. They also have acid reflux and abdominal bloating after most meals. As a result of this they have lost weight. The symptoms of nausea, acid reflux and bloating affect the person at least once a day, but not every hour, reducing their ability to focus and concentrate on tasks. About once a month, the nausea and vomiting are worse than usual and the person cannot leave home on those days.

The person suffers from nausea, vomiting, acid reflux and bloating due to diabetic gastroparesis. As there is an impact on the digestive system from their diabetes, a 10-point rating can be applied under Table 10. Under the 10-point descriptor, descriptors (1)(a) and (1)(c) apply to the person.

Example 4: A 45-year-old person lives in a rural area and has had chronic kidney disease for 5 years. They have had stage 5 (previously known as end-stage) kidney disease for the last 2 years and have required dialysis for the last 18 months. A renal specialist and a dialysis nurse monitor the person's kidney condition. The person's home water supply is not suitable for peritoneal or haemodialysis and they therefore have to make a 100km return-trip from their home to the nearest dialysis centre and back 3 times per week. The person does not have a driving licence and relies on lifts from friends to make the return journey each time. The person is unable to arrange lifts about 1-2 times per month, which means they regularly miss 1-2 dialysis sessions each month. This means that the results of their dialysis are inconsistent leading to increased episodes of nausea, vomiting and poor appetite. This condition is fully diagnosed, treated and stabilised as the person's irregular attendance for dialysis sessions is due to factors outside their control. After a missed dialysis session, the person has constant nausea and vomits 1-2 times on that day and the next day until their next dialysis session. On other days they are nauseous at least once per day, but not every hour and the nausea interferes with their attention and concentration on tasks. The nausea and vomiting is due to their chronic kidney disease and as there is an impact on the digestive system from their kidney disease, a rating can be considered under Table 10. 10 points can be assigned as descriptors (1)(a) and (1)(c) apply to the person.

Rating multiple impairments resulting from a single condition

A single medical condition may result in multiple functional impairments which can be assigned ratings from more than one table.

Explanation: A person with renal impairment may experience a range of symptoms and symptoms vary between people. In the assessment of a person with renal impairment assessors should apply all of the relevant Tables, taking care to avoid double counting, that is, when using more than one Table to assess multiple impairments resulting from a single condition, impairment ratings for the same impairment must not be assigned under more than one Table.

Impairments that should not be assessed using Table 10

If a person requires continence or ostomy care and has an ileostomy or colostomy they should be assessed under Table 13 - Continence Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 10 - Digestive and Reproductive Function, Table 13 - Continence Function

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