3.6.3.140 Guidelines to Table 14 - Functions of the Skin

Summary

Table 14 is used to assess functional impairment when performing activities requiring healthy, undamaged skin.

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 dermatologist or burns specialist.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining the 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

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.

For example, the 10-point descriptor in Table 14 states that at least one of the following applies while the 20-point descriptor states 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.

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 capacity if this level of functional impairment is not consistent with the medical evidence available.

Each of the descriptors must be considered in relation to the adaptations to daily activities that the person has to make as a result of their condition.

0-point impairment rating level

The 0-point descriptor specifies the person has NO functional impact on activities requiring healthy, undamaged skin.

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 activities requiring healthy, undamaged skin. Minor adaptations to some daily activities are required and at least one of the following descriptor points (1)(a), (b) or (c) apply.

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 activities requiring healthy, undamaged skin. The person has made adaptations to several daily activities and at least one of the following descriptor points (1)(a), (b), (c) or (d) applies. If the person can perform the listed activities in (1)(a), (b), (c) or (d) with the use of sun protection, then 10 points should not be assigned.

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 activities requiring healthy, undamaged skin. Regarding the person's significant modifications to, or the inability to, perform daily activities, at least 2 of the following descriptor points apply (1)(a), (b), (c), (d) or (e).

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 on activities requiring healthy, undamaged skin. The person has to make major modifications to most daily activities or is unable to perform most daily activities, requires repeated assistance throughout the day and could not attend work, education, or training for a continuous period of at least 3 hours as at least one of the following (1)(a), (b) or (c) must apply.

Some conditions causing impairment commonly assessed using Table 14

These include but are not limited to:

  • burns
  • severe eczema, psoriasis or dermatitis
  • chronic pruritus
  • allodynia
  • ulceration or diabetic foot ulcers, and
  • skin cancer, or long term effects of skin cancer treatment.

Example: A 57- year- old male has had varicose veins and swelling of his lower legs for several years. In the last 12 months, he has also developed chronic varicose eczema, with recurrent venous ulcerations and infections. These conditions have been appropriately diagnosed by his general practitioner. A vascular surgeon has confirmed that varicose vein surgery is contraindicated due to his other medical conditions (type 2 diabetes, obesity and a heart condition). He has had appropriate conservative management with compressive leg stockings, dressings, and antibiotics as needed. The dressings need to be changed several times per week and this frequency has not changed for the last 6 months. He needs help from his partner with dressing changes and he needs to allow 30 minutes for this. His partner also has to assist him daily with putting on the compressive stockings, and it usually takes 5-10 minutes to fit them each day. He is able to wear closed-in sneakers, but uses those with Velcro to make them easier to remove. He reported that he is unable to wear thongs because of his compression stockings, but has no other restrictions in clothing relating to dressings and compression stockings, and is able to wear long pants if they are loose fitting. His general practitioner has advised him to elevate his legs for several short periods each day to reduce the leg swelling and to avoid prolonged standing.

This condition is considered to be fully diagnosed, treated and stabilised. Under Table 14, the assigned impairment rating would be 10 points, as he has moderate difficulties performing daily activities due to lesions on the skin, which require creams or dressings, and limit movement or comfort. Under the 10-point descriptor, he would meet descriptor (1)(c).

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