3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function

Summary

Table 10 is used to assess the functional impairment of a condition related to digestive or reproductive system functions.

Conditions causing impairment commonly assessed using Table 10

Digestive conditions may include cancer and other diseases that affect the mouth, salivary glands, oesophagus, stomach, intestines (small or large intestine), pancreas, liver, gall bladder, bile ducts, rectum or anus.

A 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 (such as, Crohn's disease and Ulcerative Colitis)
• chronic pancreatitis.

Reproductive system conditions may include gynaecological diseases and urological conditions such as:

• endometriosis
• pelvic inflammatory disease
• ovarian cancer
• cervical cancer
• endometrial cancers
• testicular or prostate cancer.

Diagnosis & evidence

The diagnosis of the condition must be made by an appropriately qualified medical practitioner and supported by corroborating medical evidence. This includes a GP, a gastroenterologist, gynaecologist, or other relevant specialist.

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 evidence for the purposes of Table 10 include, but are not limited to, the following:

• a report from the person's treating doctor
• a report from a medical specialist (such as, a gastroenterologist, a gynaecologist, an urologist or an oncologist) confirming diagnosis of a digestive or reproductive system condition
• results of investigations (such as, X-Rays or other imagery, endoscopy or colonoscopy).

Interpretation & application of relevant terms

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

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 (such as, 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, urinary hesitancy, frequent urination, menorrhagia or dysmenorrhea
• associated personal care needs include, but are not limited to, strategies to relieve pain, more frequent menstrual care, or needing to be near toilet facilities at all times.

Determining the level of functional impact - rules

Table 10 is different to most of the other Tables used to assess functional 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 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, a comparison must be made of 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 in each Table follow an incremental hierarchy, which is expressed among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities. These levels are expressed as: no or minimal difficulty, mild difficulty, moderate difficulty, severe difficulty and extreme difficulty. Some Tables also represent an increase in frequency of symptoms, which is reflective of the impairment rating level.

The 5, 10, 20 and 30-point descriptors refer to the number or frequency of absences a person may have from work, education or training activities. The 5-point descriptors states the person is sometimes (less than once per month) absent and the 10-point descriptor states the person is often (once per month) absent. The 20-point descriptor states the person is frequently (twice or more per month) absent and the 30-point descriptor states the person is rarely able to attend. 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.

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. 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.

However, one of several descriptors may be sufficient for that rating when the word 'or' links the descriptors. In other cases, a prescribed number of descriptors may be required for that rating to apply (for example, 'the person has moderate difficulty carrying out at least 4 of the following').

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 descriptor. 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 a 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 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. 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.

Where a Table 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 symptoms. When a person experiences some symptoms when performing an activity this does not mean the person is 'unable' to perform the task. The assessment of the symptoms experienced in performing the activity is relevant where they 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 10

0-point impairment rating level

The 0-point descriptor requires that the person have NO OR MINIMAL functional impact from symptoms associated with a digestive or reproductive system condition.

For this rating to be assigned, the person must meet descriptor (1). That is, the person must not usually be interrupted at work or other activity by symptoms or personal care needs associated with a digestive or reproductive system condition.

5-point impairment rating level

The 5-point descriptor requires that the person have a MILD functional impact from symptoms associated with a digestive or reproductive system condition.

For this rating to be assigned, the person must meet either descriptor (1)(a) or (1)(b).

10-point impairment rating level

The 10-point descriptor requires that the person have a MODERATE functional impact from symptoms associated with a digestive or reproductive system condition.

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

20-point impairment rating level

The 20-point descriptor requires that the person have a SEVERE functional impact from symptoms associated with a digestive or reproductive system condition.

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

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact from symptoms associated with a digestive or reproductive system condition.

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

Avoiding double counting

Double counting of impairments must be avoided (see 3.6.3.06 'Rating multiple conditions with common impairments & double counting').

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

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.

As the impact of digestive and reproductive functions on attention and concentration is specifically considered under the descriptors for a rating under Table 10, no further rating can be applied under Table 7 – Brain Function. 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 - Functions requiring Physical Exertion and Stamina. Double counting is to be avoided and multiple Tables would not be used unless other conditions causing functional impacts specific to Table 1 - Functions requiring Physical Exertion and Stamina or Table 7 – Brain Function are present.

Examples of Table 10 assessment

Impairments that should not be assessed using Table 10

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