3.6.3.130 Guidelines to Table 13 - Continence Function

Summary

Table 13 is used to assess functional impairment related to incontinence of the bladder or bowel.

The diagnosis of the condition must be made by an appropriately qualified medical practitioner. This includes a general practitioner or 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 permanent condition. There must be corroborating medical evidence of the person's impairment.

Table 13 should be used if a person has an ileostomy or colostomy and requires continence or ostomy care.

Determining the level of functional impact - general rules

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

The descriptors in Table 13 use the term 'assistance'. Assistance means assistance from another person, rather than any aids or equipment the person has and usually uses (see 3.6.3.05 (E) Use of aids, equipment & assistive technology).

Under the 5-point, 10-point, 20-point and 30-point descriptors in Table 13, the person must have impairment in either bladder or bowel continence function (or both) or they must use a continence aid. The points within each descriptor are applied differently within each descriptor.

For example, under the 5-point descriptor at least one of the points (a - f) must apply. Under the 10-point descriptor, one or more of (2), (3) or (4) must apply and within each of these, both (a) and (b) must apply. Under the 20-point descriptor, one or more of (2), (3) or (4) must apply and within each of these, one or more of (a), (b) or (c) must 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 the 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. Their impairment CANNOT be assessed as moderate, severe or extreme 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 based solely on a person's self-reported functional history if this level of functional impairment is not consistent with the medical evidence available.

Where the descriptors refer to the person's condition affecting the comfort and attention of co-workers, this can apply even if the person does not work. Consideration should be given to whether the descriptor would be more than likely to apply if the person did work.

Example: A 58-year-old woman has previously given vaginal birth to 5 full-term babies. As a result of birth canal trauma, she 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 she no longer suffers 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 woman wears a continence pad to prevent minor faecal soiling of her underwear. Episodes of minor faecal incontinence occur at least once per day, with significant associated offensive odour, including from excessive frequent flatus. In a workplace setting, odour and intermittent noises would be likely to affect the comfort or attention of co-workers and cause embarrassment to the woman herself.

The condition is considered fully diagnosed, treated and stabilised and under Table 13, this woman would receive an impairment rating of 20 points due to the severe impact this condition has on her work-related functioning. Under the 20-point descriptor this condition would meet descriptor points (3)(a) 'the person's condition may affect the comfort or attention of co-workers' and (b)' the person has minor leakage from the bowel … every day'.

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. For example, a person who has a mild impairment to bladder function (i.e. meets one of descriptors (1)(a), (b) or (c) in the 5 point rating, but does not meet both descriptors (2)(a) and (b) in the 10 point rating) and who has a moderate impairment to bowel function (meeting descriptors (3)(a) and (b) in the 10 point rating), should be assigned an impairment rating of 10 points under Table 13.

0-point impairment rating level

The 0-point descriptor specifies the person has NO functional impact on maintaining continence of the bladder and bowel.

5-point impairment rating level

The 5-point descriptor specifies that for this impairment rating to be assigned to a person the person has a MILD functional impact on maintaining continence of the bladder or bowel. At least one of the following (1)(a), (b), (c), (d), (e) or (f) applies.

10-point impairment rating level

The 10-point descriptor specifies that for this impairment rating to be assigned to a person the person has a MODERATE functional impact on maintaining continence of the bladder or bowel. At least (a) and (b) under either (2), (3) or (4) applies.

20-point impairment rating level

The 20-point descriptor specifies that for this impairment rating to be assigned to a person the person has a SEVERE functional impact on maintaining continence of the bladder or bowel. At least one of either (a), (b) or (c) under either (2), (3) or (4) applies.

30-point impairment rating level

The 30-point descriptor specifies that for this impairment rating to be assigned to a person the person has an EXTREME functional impact and is completely unable to maintain continence of the bladder or bowel. At least one of either (2), (3) or one of either (4)(a) or (b) applies.

Some 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
  • brain injuries, and
  • severe intellectual disability.

Example: A 45-year-old woman has a 5 year history of stress urinary incontinence, which has gradually worsened over the years. Initially, she had frequent episodes of stress incontinence on standing up, and also with coughing or lifting, and needed to use continence pads and change them twice daily. Her GP thought her incontinence was related to her 2 previous vaginal deliveries and she was referred to a physiotherapist for pelvic floor muscle training program. Six months later, her stress incontinence had only slightly improved and she was referred to a urogynaecologist. The urogynaecologist performed a mid-urethral sling procedure. Three months later her stress incontinence has significantly improved and now has minor leakage from the bladder with lifting. This occurs once a day and she needs to wear a panty liner to avoid staining her underwear.

This condition is considered to be fully diagnosed, treated and stabilised, and under Table 13, a 5 point impairment rating is assigned due to the mild functional impact of this condition. Descriptor (1)(a): 'minor leakage from the bladder (e.g. a small amount of urine when coughing or sneezing) at least once a day, but not every hour' is met at this level.

Example: A 62-year-old man developed urinary incontinence following a radical prostatectomy for prostate cancer 1 year ago. He had stress urinary incontinence with physical exertion or coughing, nocturnal incontinence and constant leakage of urine. He also had urge urinary incontinence 2 to 3 times weekly, when he was unable to access a toilet in a timely manner. Initially the urinary incontinence was severe and he needed to change full continence pads 3 to 4 times daily. He has had appropriate investigation and management, as recommended by his urologist. This included pelvic floor muscle training and bladder retraining programs, and medication. His urinary incontinence has improved and he now only has minor stress incontinence several times daily and he no longer has constant urine leakage or urge incontinence. He finds this condition embarrassing and worries that others may smell the odour of urine, so he changes continence pads once or twice during every day, as soon as possible after an episode of incontinence.

His urinary incontinence condition is considered fully diagnosed, treated and stabilised and under Table 13, an impairment rating of 10 points is assigned due to the moderate functional impact of this condition. Descriptors (2)(a): 'minor bladder leakage several times each day' and (2)(b): 'the bladder incontinence results in interruptions to work on most days' are met at this level.

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 2011 Table 13 - Continence Function, Table 10 - Digestive and Reproductive Function

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