3.6.3.30 Guidelines to Table 3 - Lower Limb Function

Summary

Table 3 is used where a person has a functional impairment when performing activities requiring the use of legs or feet in the context of a person's ability to move around in the environment (mobility).

Consistent with this purpose, the descriptors in Table 3 refer to a range of activities relevant to a person's ability to move around, including walking, kneeling, squatting, standing, standing up from a seated position, using stairs, using public transport or using a motor vehicle, and (where applicable) their ability to mobilise with the use of wheelchairs or walking aids.

The descriptors in other Tables may also refer to certain activities relating to a person's mobility but those Tables measure the impact of impairment where the function that is affected is different to those relevant to the application of Table 3. For example, some descriptors in Table 1 measure the level of difficulty in walking, climbing stairs or mobilising in a wheelchair due to symptoms arising from conditions affecting physical exertion or stamina. Table 3 is used to assess the level of difficulty in performing mobility-related activities arising from conditions affecting the use of lower limbs. When another Table is being considered, in addition to Table 3, care must be taken not to double count the impairment.

Table 3 specifies that the lower limbs extend from the hips to the toes.

The diagnosis of the condition must be made by an appropriately qualified medical practitioner. This includes a general practitioner, an orthopaedic surgeon, a rheumatologist, a rehabilitation physician or other relevant specialist.

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

If the person has and usually uses a lower limb prosthesis, the assessment under Table 3 must be undertaken considering what the person can do or has difficulty doing while using this prosthesis.

Interpretation & application of relevant terms

Where the descriptors in Table 3 refer to moving around in or using a wheelchair and to transferring to and from a wheelchair, this includes both manually-propelled wheelchairs and powered mobility aids (such as power assist wheelchair, power wheelchair or mobility scooter).

For the purpose of the Impairment Tables, including Table 3, 'public transport' means any mode of transport that runs to a timetable such as buses, trains, trams and ferries. It excludes taxis or hire cars. A person who is able to use any one of these modes of transport, having regard only to the level of impairment to their lower limbs, is considered to be able to use public transport, even if they are precluded from using other modes of public transport. When assessing a person's ability to use public transport it is irrelevant whether the person actually uses public transport, whether public transport is available to the person and whether the person actually receives assistance.

Similarly, where Table 3 refers to activities such as walking around a shopping mall, a shopping centre or supermarket, or walking to local shops, it is irrelevant whether such businesses, buildings or structures actually exist in a person's locality or how they may be labelled. Of relevance is the description of activity involved. The objective is to measure a person's ability or otherwise to mobilise.

The 10- and 20-point ratings in Table 3 use the term 'assistance'. Assistance means assistance from another person, rather than any aids or equipment the person has and usually uses (refer to 3.6.3.05 'Use of aids, equipment & assistive technology').

Determining the level of functional impact - general rules

As in the other Tables, the descriptors in Table 3 are interlinked in that they follow a consistent incremental hierarchy which in this Table is expressed, among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities (for example, without difficulty, with some difficulty, unable to). The hierarchy of descriptors in Table 3 also takes into account other factors. These include a person's ability to perform certain activities unassisted or unaided and/or when using devices, equipment or aids such as a lower limb prosthesis, a walking stick, other walking aids (for example, a quad stick, crutches, a walking frame) or a wheelchair.

Consequently, as is the case in applying any other Table, in establishing whether the impairment causes no (0 points), mild (5 points), moderate (10 points), severe (20 points) or extreme (30 points) functional impact, all the descriptors for each impairment rating level in Table 3 should be read as a whole and compared so the descriptors, their relativity and hierarchy in this Table are understood.

When determining a person's limitations in relation to conducting 'work tasks', this is taken to refer to any job available in Australia.

The structure of the Tables requires that, in assessing the level of functional impact, a comparison must be made of all of the descriptors for each level of impairment. An assessment starts by considering 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 (that is, the rating at which all the required descriptors are met).

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 the required descriptors for a certain impairment level, the person's impairment cannot be rated at that or any higher level.

In establishing which descriptor in the hierarchy is appropriate in a person's circumstances, that is whether the impairment has no, mild, moderate, severe or extreme functional impact, all the descriptors for each impairment rating level in Table 3 should be read as a whole and compared before an appropriate impairment rating is assigned. Individual descriptors or their parts are not to be applied in isolation from one another.

As is the case in applying the other Impairment Tables, when determining which impairment rating applies to a person under Table 3, the rating that best describes the person's abilities or difficulties must be applied. In determining which impairment rating applies to a person, the descriptor points under a specific impairment level must be considered and applied as set out in the descriptor. ALL the points in the descriptor must be considered. NO descriptor points or their parts are to be disregarded.

An impairment rating can only be assigned if ALL the descriptors for a specific impairment rating are met. For example, if a person meets all the descriptors for 10 points and also meets some but not all descriptors for 20 points, an impairment rating of 20 points cannot be assigned and the correct impairment rating is 10 points.

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.

An activity listed under a descriptor is not 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.

For bilateral conditions where both lower limbs are affected, a single impairment rating under Table 3 should be determined based on the resulting combined functional impairment.

Assessing impairment for persons using wheelchairs or walking aids

Where a person uses a wheelchair or certain walking aids (a quad stick, crutches or walking frame), the correct impairment rating depends, among other factors, upon the extent to which they are independent or dependent on other persons to mobilise while using a wheelchair or walking aids, and to transfer to and from a wheelchair. Within each of the 10- and 20-point impairment ratings, the descriptors state that this impairment rating level 'includes' a person who is either independent or who requires assistance to move around in or to transfer to and from a wheelchair (motorised or non-motorised), or to move around using walking aids.

For the purpose of Table 3, the term 'includes' means that a person who uses a wheelchair or certain walking aids may be included in a class or category of people who can be considered under the criteria for these impairment rating levels and MAY be eligible for either 10 or 20 points subject to their meeting ALL the requirements set out in the descriptors for these ratings. This term does not mean that a person who uses a wheelchair or walking aids automatically satisfies the overall requirements for 10 or 20 points solely because they meet the descriptor point (3) for a rating of 10 points or descriptor point (2) for a 20-point rating.

The use of wheelchairs or walking aids is not in itself an absolute indicator of the level of severity of a person's impairment when performing activities relating to their ability to move around. Individual circumstances do differ, including reasons for which people acquire such devices, frequency of use and the tasks for which they use them. A person may have a number of devices or aids and use different devices or aids for different purposes or not used them at all for certain tasks. While the vast majority of people who use wheelchairs or walking aids do so upon recommendation by appropriate professionals, this equipment can nevertheless be purchased and used in Australia without prescription.

As outlined in 'Determining the level of functional impact - general rules' above, in deciding which impairment rating applies, ALL the descriptor points under a specific impairment rating level must be considered and NO descriptor points or their parts are to be disregarded. If the descriptors at point (3) in the 10-point rating and point (2) in the 20-point rating were read and applied in isolation, any person who uses a wheelchair or walking aids would qualify for at least 10 points under Table 3. This is not consistent with the policy intent.

The policy intent is that a person is not to be automatically allocated an impairment rating of 10 or 20 points solely on the basis that they use certain aids or equipment. The criteria in the descriptor point (3) for a rating of 10 points and in the descriptor point (2) for a 20-point rating are not stand alone and cannot be applied in isolation from the other requirements for these ratings. This intent is reflected in the assessment rule in the Impairment Tables discussed above which stipulates that a person can only be allocated a specific impairment rating if ALL the descriptors for that impairment level are met.

0-point impairment rating level

The 0-point descriptor specifies that there is no functional impact on activities requiring the use of the lower limbs. The person can carry out all activities in descriptor (1).

5-point impairment rating level

The 5-point descriptor requires that for this impairment rating to be assigned to a person, the person must have SOME DIFFICULTY with at least one of the activities in descriptor points (1)(a), (1)(b) or (1)(c) AND also at least one of the descriptor points (2)(a) or (2)(b).

If the person does not meet at least one descriptor point in one or both descriptor points (1) or (2), they cannot be allocated 5 points and the correct impairment rating is 0 points.

10-point impairment rating level

Consistent with the rules outlined above, in deciding whether an impairment of 10 points applies to a person, sufficient applicable descriptors under the 10-point impairment rating level must be considered and applied.

The 10-point descriptor requires that any person considered for this rating must be UNABLE to perform AT LEAST ONE of the activities in descriptor points (1) AND also satisfy descriptor point (2).

20-point impairment rating level

Consistent with the rules outlined above, in deciding whether an impairment rating of 20 points applies to a person, ALL the descriptor points under the 20-point impairment rating level must be considered and applied.

The 20-point descriptor requires that any person considered for this rating must be UNABLE to perform ALL of the activities set out in descriptor point 1(a) and 1(b).

30-point impairment rating level

The 30-point descriptor states the person is unable to mobilise independently. To meet this descriptor the person would be completely unable to mobilise at all without assistance from another person. In comparison, someone who has some ability to mobilise very short distances without assistance (such as around the home) but is unable to do the activities listed in the 20-point descriptor points (1)(a)(i), (1)(a)(ii) or (1)(a)(iii) and requires assistance to use public transport (descriptor point (1)(b)) would meet the 20-point descriptor.

Impact of pain

In determining the functional impact on activities under Table 3, consideration should be given to the impact of pain on the person's ability to undertake these activities. For example, a person may have difficulty using their lower limbs other than for very short periods due to the pain they experience on doing so.

For more information about assessing pain, please refer to 3.6.3.02 'Assessing functional impact of chronic pain'.

Some conditions causing impairment commonly assessed using Table 3

These include but are not limited to:

• lower limb musculoskeletal conditions including specific degenerative joint disease (osteoarthritis)
• other permanent forms of arthritis
• neurological conditions including peripheral neuropathy and strokes or cerebrovascular accidents (CVAs) causing paralysis or loss of strength or sensation
• cerebral palsy or other condition affecting lower limb coordination
• inflammation or injury of the muscles or tendons of the lower limbs
• lower limb amputations or absence of whole or part of lower limb
• long-term effects of musculoskeletal injuries
• some permanent vascular conditions (for example, peripheral vascular disease, varicose veins).

Impairments that should not be assessed using Table 3

Difficulties mobilising independently due to severe visual impairment should not be assessed under this Table if there are no inherent medical conditions affecting the lower limbs. Such impairment should be assessed under Table 12 - Visual Function.