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3.6.3.150 Guidelines to Table 15 - Functions of Consciousness

Summary

Table 15 is used to assess functional impairment due to involuntary loss of consciousness or altered state of consciousness.

Altered state of consciousness includes instances where a person may not lose consciousness completely and may remain sitting or standing but becomes unaware of their surroundings or actions.

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 neurologist or endocrinologist. Assessments or reports from practitioners specialising in the treatment and management of these conditions (such as clinical nurse consultants or nurse practitioners specialising in diabetes management) can also be provided as supporting evidence of treatment and/or functional impairment. However, the diagnosis must be made by an appropriately qualified medical practitioner as described above.

A PERSON'S SELF-REPORTED SYMPTOMS MUST NOT BE SOLELY RELIED UPON in determining functional impacts of a person's permanent condition (impairment). There must be corroborating medical evidence of the person's impairment.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 15 - Functions of Consciousness

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.

Under the 5-point, 10-point, 20-point and 30-point descriptors in Table 15, the person must have either episodes of involuntary loss of consciousness or altered state of consciousness. Under the 20-point descriptor all of (1)(a), (b), (c) and (d) must apply. Within descriptor (1)(a), the person must meet both of (A) and (B) in either (1)(a)(i) or (1)(a)(ii).

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 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.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 15 - Functions of Consciousness

0-point impairment rating level

The 0-point descriptor specifies the person has NO functional impact from loss of consciousness or altered state of consciousness during waking hours when occupied with a task or activity.

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 from loss of consciousness or altered state of consciousness during waking hours when occupied with a task or activity. The person must meet descriptors (1)(a), (b) and (c). Within the descriptor point (1)(a), they must meet both (A) and (B) in either (i) or (ii).

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 from loss of consciousness or altered state of consciousness during waking hours when occupied with a task or activity. The person must meet descriptors (1)(a), (b), (c) and (d). Within the descriptor point (1)(a), they must meet both (A) and (B) in either (i) or (ii).

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 from loss of consciousness or altered state of consciousness during waking hours when occupied with a task or activity. The person must meet descriptors (1)(a), (b), (c) and (d). Within the descriptor point (1)(a), they must meet both (A) and (B) in either (i) or (ii)

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 from loss of consciousness or altered state of consciousness during waking hours when occupied with a task or activity. The person must meet descriptors (1)(a), (b), (c) and (d). Within the descriptor point (1)(a), they must meet both (A) and (B) in either (i) or (ii).

Some conditions causing impairment commonly assessed using Table 15

These include but are not limited to:

  • epilepsy
  • migraine that results in loss of consciousness or altered states of consciousness
  • diabetes mellitus where due to hypoglycaemic events
  • the person experiences loss of consciousness or altered states of consciousness, or are more rarely unconscious, and
  • narcolepsy.

Example 1: A 27-year-old woman has been diagnosed with epilepsy. She has undergone treatment for this condition and her treating practitioner has outlined that her condition is now stabilised. She continues to experience seizures as a result of this condition, during which she loses consciousness. These seizures occur approximately 6 times per year. Following a seizure, she suffers extreme tiredness and headaches and is often unable to undertake her usual activities for a few days. In the past she has required hospitalisation as a result of a seizure. Between these seizures she is able to perform her regular daily activities but she is unable to obtain a driver's licence given the unpredictability of these seizures. She works part-time as a result of this condition and her employer makes allowances for her work absences when she has suffered a seizure. She is unable to work in a role where she could be at increased risk if she had a seizure, such as using machinery.

The condition is considered fully diagnosed, treated and stabilised. Under Table 15, this woman would receive an impairment rating of 10 points given the moderate impact this condition has on her ability to function. Under the 10-point descriptor this woman would meet (1)(a)(i)(A) and (B) and (1)(b), (c) and (d).

Example 2: A 58-year-old person has had type 2 diabetes for 25 years. They have adhered to dietary requirements and prescribed medications for many years. Their overall blood glucose control has improved over the years and they regularly see an endocrinologist and diabetic educator. Currently, they are prescribed a combination of oral medication and insulin injections. Letters from their endocrinologist over the last 2 to 3 years state that their blood glucose control is 'excellent'. However, despite this improvement they have developed a diabetic autonomic neuropathy with gastroparesis (delayed emptying of the stomach) and hypoglycaemic unawareness (i.e. they are not aware of their low glucose levels, even with severe episodes). The gastroparesis has worsened their blood glucose control. Just before their claim for DSP, their endocrinologist was adjusting the dose of their insulin injections in an effort to reduce the number and severity of hypoglycaemic episodes, however they continued to have 1 to 2 episodes/week. During these episodes, they appeared to be confused and needed help from their partner. The episodes resolved within 20 minutes. They are not able to obtain a driver's licence because of these episodes.

Their type 2 diabetes condition is fully diagnosed, treated and stabilised, as it is a long standing condition and is being appropriately managed. They have developed the irreversible end organ complication of an autonomic neuropathy with frequent hypoglycaemic episodes. This has required adjustments to their medication, which is unavoidable in this situation and the endocrinologist has confirmed that even with further adjustments to the dose of their insulin injections, it is likely that the hypoglycaemic episodes will not reduce in frequency or severity. Under Table 15, an impairment rating of 10 points is appropriate, as descriptors (1)(a)(ii)(A), (B) and (C), and (1)(b), (c) and (d) are met.

Example 3: A 20- year- old person was diagnosed with narcolepsy (a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep) following a sleep study 2 years ago. They had a 7 year history of daytime sleepiness, which was getting worse. When they attended high school, they had difficulty staying awake during classes or exams. After finishing high school, they worked in retail and they often dozed off while still standing up and were dismissed. They developed episodes of cataplexy (sudden loss of muscle tone triggered by intense emotions such as laughter or anger, which may result in facial drooping or falls to the ground) 3 years ago. After the diagnosis of narcolepsy was made, their sleep physician prescribed appropriate medications. This reduced their daytime sleepiness and cataplexy. They were usually able to stay alert, work on a computer and drive without sleep attacks, although they did require a brief nap after returning home from work. Sudden sleep attacks now occur once or twice a year in situations such as meetings and do not require hospitalisation. They have occasional episodes of cataplexy with drooping of the face or head. They were able to work and live alone without needing help from others. They had a conditional driver's licence which required them to maintain their treatment for narcolepsy.

Their narcolepsy condition is fully diagnosed, treated and stabilised. Under Table 15, an impairment rating of 5 points is appropriate, as descriptors (1)(a)(i)(A) and (B), and (1)(b) and (c) are met.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 15 - Functions of Consciousness

Impairments that should not be assessed using Table 15

Table 15 must not be used for migraines which do not result in loss or altered states of consciousness. These are more appropriately assessed under Table 7 – Brain Function.

Act reference: Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 Table 7 - Brain Function

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