3.6.3.130 Guidelines to Table 13 - Continence Function
Summary
Table 13 is used to assess a person's functional impact of a diagnosed condition related to incontinence of the bladder or bowel.
Table 13 should be used if a person has an ileostomy or colostomy and requires continence or stoma care.
Conditions causing impairment commonly assessed using Table 13
These include but are not limited to:
- some gynaecological conditions
- prostate enlargement or malignancy
- gastrointestinal conditions
- incontinence resulting from spinal cord conditions
- spina bifida
- neurodegenerative conditions
- multiple sclerosis, and
- brain injuries.
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 or other medical specialists, such as a urogynaecologist, gynaecologist, urologist or gastroenterologist.
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 this Table include, but are not limited to:
- a report from the person’s treating doctor
- a report from a medical specialist, particularly in cases of moderate or severe incontinence, (such as, urogynaecologist, gynaecologist, urologist, gastroenterologist) confirming diagnosis of conditions associated with incontinence (such as, some gynaecological conditions, prostate enlargement or malignancy, gastrointestinal conditions or malignancy, incontinence resulting from paraplegia, spina bifida, or neurodegenerative conditions)
- assessments and reports from practitioners specialising in the treatment and management of incontinence (such as, urologists, urogynaecologists, continence nurse, continence physiotherapists).
Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 13 - Continence 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
Interpretation & application of relevant terms
The 5 and 20-point descriptors in Table 13 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).
‘Daily 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 personal care activities, household duties (for example, cooking or cleaning), commuting to and from work, and undertaking work tasks.
‘Community or social environments’ involve being near or interacting with others, such as attendance at work, using public transport or facilities that require close proximity such as a lift (elevator).
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, 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.
Table 13 is scaled against increasing frequency and severity of symptoms and management of continence aids.
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.
Where several descriptors must apply for a rating the word 'and' links the descriptor. 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. 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.
Explanation: Where a person meets the required descriptors for 5 points but does not meet all 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 neither 10, 20 nor 30 points can be allocated.
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 solely be relied on. It would be inappropriate to apply an impairment rating 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. 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. If a person has impairment to both bladder and bowel function, only a single rating should be applied, having regard to the impairment that causes the most impact on function.
Example: A person has a mild impairment to bladder function meets one of descriptors (1)(a), (1)(b) or (1)(c) in the 5-point descriptor , but does not meet both descriptors (2)(a) and (2)(b) in the 10-point rating. They also have a moderate impairment to bowel function and meets descriptors (3)(a) and (3)(b) in the 10-point rating but do not meet any of the descriptors at the 20-point rating. This person would be assigned an impairment rating of 10 points under Table 13 based on the moderate impact of their bowel condition.
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’).
Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 section 13(2) In deciding whether an impairment has no, mild …, section 13(1)(c) a rating must not be assigned …, Table 13 – Continence Function
Policy reference: SS Guide 3.6.3.02 Guidelines to the rules for applying the Impairment Tables - applying the Tables, 3.6.3.03 Guidelines to the rules for applying the Impairment Tables - information that must be taken into account in applying the Tables, 3.6.3.08 Guidelines to the rules for applying the Impairment Tables – assigning an impairment rating
Impairment ratings for Table 13
0-point impairment rating level
The 0-point descriptor requires that the person have NO OR MINIMAL functional impact on maintaining continence of the bladder and bowel.
For this rating to be assigned, the person must meet both descriptors (1)(a) and (1)(b).
5-point impairment rating level
The 5-point descriptor requires that the person have a MILD functional impact on maintaining continence of the bladder or bowel.
The person is required to have a MILD functional impact in at least one area of continence function; either the bladder, bowel or continence aids.
For this rating to be assigned, the person must meet at least one of descriptors (1)(a), (1)(b), (1)(c), (1)(d), (1)(e) or (1)(f).
10-point impairment rating level
The 10-point descriptor requires that the person have a MODERATE functional impact on maintaining continence of the bladder or bowel.
The person is required to have a MODERATE functional impact in at least one area of continence function; either the bladder, bowel or continence aids. For this rating to be assigned, the person must meet either descriptor (2), (3) or (4). If the person is using descriptor (2), then both (2)(a) and (2)(b) must be met. If the person is using descriptor (3), then both (3)(a) and (3)(b) must be met. If the person is using descriptor (4), then both (4)(a) and (4)(b) must be met.
20-point impairment rating level
The 20-point descriptor requires that the person have a SEVERE functional impact on maintaining continence of the bladder or bowel.
The person is required to have a SEVERE functional impact in at least one area of continence function; either the bladder, bowel or continence aids.
For this rating to be assigned, the person must meet either descriptor (2), (3) or (4). If the person is using descriptor (2), then either (2)(a), (2)(b) or (2)(c) must be met. If the person is using descriptor (3), then either (3)(a), (3)(b) or (3)(c) must be met. If the person is using descriptor (4), then either (4)(a), (4)(b) or (4)(c) must be met.
30-point impairment rating level
The 30-point descriptor requires that the person have an EXTREME functional impact and be completely unable to maintain continence of the bladder or bowel.
For this rating to be assigned the person must meet descriptor (1) as well as at least descriptor (2), (3) or (4).
Avoiding double counting
Double counting of impairments must be avoided (see 3.6.3.06 ‘Rating multiple conditions with common impairments & double counting’).
Examples of Table 13 assessment
Example 1: A 58-year old person has previously given vaginal birth to 5 full-term babies. As a result of birth canal trauma, they developed severe pelvic floor deficiency with both urinary and faecal incontinence symptoms. These problems eventually required a major surgical procedure, which was performed 5 years ago. The operation was of substantial benefit and they no longer suffer from urinary incontinence, however anal sphincter function remains deficient and further surgery within the next 2 years has been ruled out on gynaecological and proctologist advice. The person wears a continence pad to prevent minor faecal soiling of their underwear. Episodes of minor faecal incontinence (minor leakage from the bowel) occur at least once per day, enough to soil the underwear if a continence pad was not worn, but not their outer clothes and with significant associated offensive odour, including from excessive frequent flatus. Due to these issues they have severe difficulty travelling to or participating in community activities.
The condition is considered diagnosed, reasonably treated and stabilised and under Table 13, this person would receive an impairment rating of 20 points due to the severe impact this condition has on their work-related functioning. Under the 20-point descriptor this condition would meet descriptor points (3)(a) and (3)(b).
Example 2: A 45-year old has a 5-year history of stress urinary incontinence, which has gradually worsened over the years. Initially, they had frequent episodes of stress incontinence on standing up, and with coughing or lifting, and needed to use continence pads and change them twice daily. They were referred to a physiotherapist for a pelvic floor muscle training program. Six months later, their stress incontinence had only slightly improved and they were referred to a urogynaecologist. The urogynaecologist performed a mid-urethral sling procedure. Three months later their stress incontinence has significantly improved and they now experience only minor leakage from the bladder with lifting. This occurs once a day and the person needs to wear a panty liner to avoid staining their underwear.
This condition is considered to be diagnosed, reasonably treated and stabilised, and under Table 13, a 5-point impairment rating is assigned due to the mild functional impact of this condition. The person meets descriptor point (1)(a).
Example 3: A 62-year old developed urinary incontinence following a radical prostatectomy for prostate cancer 1 year ago. The person had stress urinary incontinence with physical exertion or coughing, nocturnal incontinence and constant leakage of urine. They also had urge urinary incontinence 2 to 3 times weekly, when they were unable to access a toilet in a timely manner. Initially the urinary incontinence was severe and they needed to change continence pads 3 to 4 times daily. They had appropriate investigation and management, as recommended by their urologist. This included pelvic floor muscle training and bladder retraining programs, and medication. Their urinary incontinence has improved and they now only have minor stress incontinence several times daily and no longer has constant urine leakage or urge incontinence. The person finds this condition embarrassing and worries that others may smell the odour of urine, so they change continence pads once or twice during every day, as soon as possible after an episode of incontinence.
The person’s urinary incontinence condition is considered diagnosed, reasonably treated and stabilised and under Table 13, an impairment rating of 10 points is assigned due to the moderate functional impact of this condition. The person meets descriptor points (2)(a) and (2)(b).
Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 13 - Continence Function
Impairments that should not be assessed using Table 13
Conditions that relate to digestive function which do not result in continence difficulties must be rated on Table 10 - Digestive and Reproductive Function.
Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 Table 10 - Digestive and Reproductive Function
Policy reference: SS Guide 3.6.3.100 Guidelines to Table 10 - Digestive and Reproductive Function