3.6.3.140 Guidelines to Table 14 - Functions of the Skin

Summary

Table 14 is used to assess the functional impact of a condition related to disorders of, or injury to, the skin.

Conditions causing impairment commonly assessed using Table 14

These include but are not limited to:

• burns
• eczema, psoriasis or dermatitis
• chronic pruritus
• allodynia
• venous skin ulceration or diabetic foot ulcers
• graft versus host disease
• chronic pain stemming from conditions of the skin, and
• skin cancer, such as melanoma, or long term effects of skin cancer treatment.

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 dermatologist, burns specialist or oncologist.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining the 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 (such as, dermatologist, burns specialist or oncologist) confirming diagnosis of dermatological conditions, burns, or cancer (such as, melanoma, graft versus host disease)
• assessments or reports from practitioners specialising in the treatment and management of these conditions (such as, dermatologists, burn specialists, registered nurses, physiotherapists, pain management specialists and occupational therapists).

Interpretation & application of relevant terms

‘Normal daily activities’ or ‘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 household duties (for example, cooking or cleaning), commuting to and from work, and undertaking work tasks.

‘Higher than normal precautions’ means activities above and beyond that expected to be required in a particular situation. For many people, wearing sunscreen, covering up with clothing and seeking shade would be usual appropriate precautions to reduce their sun exposure. Someone who needs to take higher than normal precautions due to a condition may need a water resistant sunscreen with a higher SPF rating, covering up with UV rated clothing or may even have to limit the time they spend outdoors.

The 30-point descriptor in Table 14 uses 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).

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.

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, mild difficulties, moderate difficulties, severe difficulties and unable to.

At the 5, 10, 20 and 30-point impairment rating levels reference is also made to a person’s heightened level of sensitivity to sunlight and precautions required to manage risks of exposure.

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.

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 the person's impairment does not meet all 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 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. An impairment rating must not be applied unless a 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.

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.

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 conditions’).

Impairment Ratings for Table 14

0-point impairment rating level

The 0-point descriptor requires that the person have NO OR MINIMAL functional impact on activities involving functions of the skin.

For this rating to be assigned, the person must be able to perform the activities at descriptor (1) with no or minimal difficulty.

5-point impairment rating level

The 5-point descriptor requires that the person have a MILD functional impact on activities involving functions of the skin.

For this rating to be assigned, minor adaptations to some daily activities are required and the person must meet at least one of descriptors (1)(a), (b) or (c).

10-point impairment rating level

The 10-point descriptor requires s that the person have a MODERATE functional impact on activities involving functions of the skin.

For this rating to be assigned, the person must make adaptations to several daily activities and the person must meet at least one of descriptors (1)(a), (b), (c) or (d).

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 requires that the person have a SEVERE functional impact on activities involving functions of the skin.

For this rating to be applied, the person must make significant modifications to, or be unable to perform daily activities and at least 2 of the descriptors (1)(a), (b), (c), (d) or (e) apply.

30-point impairment rating level

The 30-point descriptor requires that the person have an EXTREME functional impact on activities involving functions of the skin.

For this rating to be assigned, the person must makes major modifications to most daily activities or is unable to perform most daily activities, requires repeated assistance throughout the day and cannot attend work, education, or training for a continuous period of at least 3 hours and the person must meet at least one of descriptors (1)(a), (b) or (c).

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 14 assessment