Federal Register of Legislation - Australian Government

Primary content

Guides & Guidelines as made
Comcare has prepared a second edition of the Guide setting out the criteria for assessing the degree of permanent impairment of injured employees.
Administered by: Education, Employment and Workplace Relations
General Comments: The Guide to the Assessment of the Degree of Permanent Impairment (Second edition) was approved by the Minister for Employment and Workplace Relations on 8 September 2005 and the approval commences on 30 September 2005: see Supporting Material.
Registered 30 Sep 2005
Tabling HistoryDate
Tabled Senate05-Oct-2005
Tabled HR10-Oct-2005
Date of repeal 01 Dec 2011
Repealed by Safety, Rehabilitation and Compensation Act 1988 - Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1
This Legislative Instrument has been subject to a Motion to Disallow:
Motion Date:
02-Dec-2005
Expiry Date:
29-Mar-2006
House:
Senate
Details:
Full
Resolution:
Negatived
Resolution Date:
29-Mar-2006
Resolution Time:
Provisions:
Table of contents.
Skip Navigation Links.
Collapse TextText
Second edition
Comcare
Acknowledgements
Introduction to second edition of the Guide
1. Authority ............................................................................................... iii
4. Whole Person Impairment (WPI) ................................................ v
5. Entitlements under the SRC Act .................................................. v
6. Non-economic loss ............................................................................. v
7. Compensation Payable ..................................................................... v
8. Interim and Final Assessments ..................................................... v
9. Increase in Degree of Whole Person Impairment ................ vi
1. Authority
2. Structure of this Guide
4. Whole Person Impairment (WPI)
6. Non-economic loss
9. Increase in Degree of Whole Person Impairment
See section 3 above (Application of this Guide) as to assessments of the degree of permanent impairment made under the first edition of the Guide.
PART 1
CLAIMS FOR
PERMANENT IMPAIRMENT
OTHER THAN DEFENCE-RELATED
CLAIMS
PART 1
Table of Contents
Glossary................................................................................................................. 15
Division 1 Assessment of the Degree of an Employee’s
Permanent Impairment Resulting from an Injury......... 17
Chapter 6 – The Visual System............................................... 47
Division 2 Guide to the Assessment of Non-Economic Loss........ 151
Division 3 Calculation of Total Entitlement....................................... 159
Index to Part 1...................................................................................................... 161
Appendix 1: Combined Values Chart........................................................... 169
PART 1
List of Tables and Figures
Chapter 2 – The Respiratory System
Chapter 3 – The Endocrine System
Table 4.3: Bodily Disfigurement.................... 43
Chapter 5 – Psychiatric conditions
Chapter 7 – Ear, Nose and Throat Disorders
Table 7.7: Chewing and Swallowing............. 63
Chapter 8 – The Digestive System
Table 8.1: Upper Digestive Tract:
Part 1
Chapter 9 – The Musculoskeletal System
Chapter 10 – The Urinary System
Table 10.2: Urinary Diversion........................ 120
Table 10.3: Lower Urinary Tract.................... 122
Chapter 11 – The Reproductive System
Table 11.1.1: Male Reproductive Organs –
Penis.............................................. 124
Table 11.1.3: Male Reproductive Organs –
Testes, Epididymes and
Spermatic Cords........................... 125
Table 11.1.4: Male Reproductive Organs – Prostate and Seminal
Vesicles......................................... 125
Chapter 12 – The Neurological System
Part 1
Table 12.2: Impairment of Memory,
Learning, Abstract Reasoning
and Problem Solving Ability...... 133
Table 12.5.5: The Auditory Nerve (VIII).......... 143
Division 2 – Guide to the Assessment of
Non-Economic Loss
PART 1
List of references
PART 1
Principles of Assessment
1. Impairment and Non-Economic Loss ..................................... 11
2. Employability and Incapacity ..................................................... 12
3. Permanent Impairment ................................................................. 12
4. Pre-Existing Conditions and Aggravation ............................ 12
5. The Impairment Tables ................................................................ 12
6. Malignancies and conditions resulting in major
systemic failure................................................................................ 13
7. Percentages of Impairment ......................................................... 13
8. Comparing Assessments under Alternative Tables .......... 13
9. Combined Values ............................................................................ 13
11. Ordering of Additional Investigations .................................... 14
1. Impairment and Non-Economic Loss
2. Employability and Incapacity
3. Permanent Impairment
4. Pre-Existing Conditions and Aggravation
5. The Impairment Tables
6. Malignancies and conditions resulting in major systemic failure
7. Percentages of Impairment
8. Comparing Assessments under Alternative Tables
9. Combined Values
10. Calculating the Assessment
11. Ordering of Additional Investigations
12. Exceptions to use of Part 1 of this Guide
Glossary
Whole person impairment (or WPI) means the medical effects of an injury or disease. WPI is based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment. WPI is a medical quantification of the nature and extent of the effect of an injury or disease on a person’s functional capacity including Activities of Daily Living. This Guide presents descriptions of impairments in chapters and tables according to body system. The extent of each impairment is expressed as a percentage value of the functional capacity of a normal healthy person.
Assessment of the Degree
of an Employee’s Permanent Impairment
Resulting from an Injury
Chapter 1 – The Cardiovascular System
1.2.... Hypertension.......................................................................................... 23
Figure 1-A: Activities of Daily Living
Figure 1-B (see below) may be used for the assessment of symptomatic impairment caused by ischaemic heart disease, hypertension, cardiomyopathy, or rheumatic heart disease.
Figure 1-B: Symptomatic Level of Activity in METS According to Age and Gender
Table 1.1: Coronary Artery Disease
Notes to Table 1.1
1. In Table 1.1, not applicable means the criterion is not applicable to the specified level of impairment.
2. Pathology – Column 3.
3. Drug Therapy (continuous) – Column 4.
4. Intervention – Column 5.
1.2 Hypertension
1.2.1 Diastolic Hypertension
Table 1.2.1: Diastolic Hypertension
See note immediately following Table 1.2.1 for explanation of symbols
used in the final column (Drug Therapy).
Note to Table 1.2.1
1. Drug Therapy (continuous) – final column of Table 1.2.1:
1.2.2 Systolic Hypertension
Table 1.2.2: Systolic Hypertension
See note immediately following Table 1.2.2 for explanation of symbols
used in the final column (Drug Therapy).
1. Drug Therapy (continuous):
1.3 Arrhythmias
Underlying cardiac disease can be assessed using other tables in Chapter 1.
Figure 1-C: Definitions of Functional Class
Table 1.3: Arrhythmias
See note immediately following Table 1.3 for explanation of symbols
used in the final column (Therapy).
Note to Table 1.3
1. Therapy – column 3:
1.4 Peripheral Vascular Disease of the Lower Extremities
A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).
Table 1.4: Peripheral Vascular Disease of the Lower Extremities
1.5 Peripheral Vascular Disease of the Upper Extremities
Table 1.5 Peripheral Vascular Disease of the Upper Extremities
1.6 Raynaud’s Disease
Figure 1-C: Definitions of Functional Class
See note to Figure 1-C immediately following Figure.
Table 1.6: Raynaud’s Disease
See note immediately following Table 1.6.
Note to Table 1.6
1. Therapy – final column of Table 1.6:
Chapter 2 – The Respiratory System
2.0 Introduction............................................................................................. 29
2.0 Introduction
Employees who have permanent respiratory limitation secondary to massive pulmonary embolism should be assessed under Chapter 2. Any WPI rating awarded in these circumstances must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).
2.1.1 Measurements
2.1.2 Methods of Measurement
Table 2.1: Conversion of Respiratory Function Values to Impairment
See note immediately following Table 2.1
2.2 Asthma and other Hyper-reactive Airways Diseases
2-A is converted to a WPI rating using Table 2.2 (below).
Figure 2-A: Calculating Asthma Impairment Score
See notes immediately following Figure 2-A
2.3 Lung Cancer and Mesothelioma
2.4 Breathing Disorders Associated with Sleep
Figure 2-B: Calculating Obstructive Sleep Apnoea Score
See notes immediately following Figure 2-B.
Notes to Figure 2-B
Chapter 3 – The Endocrine System
3.0 Introduction............................................................................................. 35
3.2 .. Adrenal Cortex and Medulla............................................................ 37
3.3 .. Pancreas (Diabetes Mellitus)........................................................... 38
Table 3.1 Thyroid and Parathyroid Glands
3.2 Adrenal Cortex and Medulla
Table 3.2 Adrenal Cortex and Medulla
3.3 Pancreas (Diabetes Mellitus)
Table 3.4: Gonads and Mammary Glands
Chapter 4 –Disfigurement and Skin Disorders
4.0 Introduction............................................................................................ 41
4.1 Skin Disorders...................................................................................... 42
4.2 Facial Disfigurement.......................................................................... 43
4.3 Bodily Disfigurement.......................................................................... 43
4.1 Skin Disorders
Table 4.1: Skin Disorders
Figure 4-A: Activities of Daily Living - See Column 4 in Table 4.1
4.2 Facial Disfigurement
Table 4.2: Facial Disfigurement
4.3 Bodily Disfigurement
Table 4.3: Bodily Disfigurement
Chapter 5 – Psychiatric Conditions
5.0 Introduction and Table 5.1............................................................... 45
Figure 5-A: Activities of Daily Living
Table 5.1: Psychiatric conditions
Table 5.1 continued on following page
Chapter 6 – The Visual System
Steps in Determining Whole Person Impairment of
6.1 Central Visual Acuity.................................. ...................................... 50
6.1.1 Determining the Loss of Central Vision in One Eye..................... 51
6.2 Determining Loss of Monocular Visual Fields....................... 52
6.3 Abnormal Ocular Motility and Binocular Diplopia.............. 53
6.4 Other Ocular Abnormalities.......................................................... 53
6.5 Other Conditions Causing Permanent Deformities
and Causing up to 10% Impairment of the Whole
Person..................................................................................................... 54
See Figure 6-A below for steps in deriving a visual system impairment rating. Use Table 6.1 (following Figure 6-A) to convert a visual system impairment rating to a WPI rating.
Figure 6-A: Steps for Calculating Impairment of the Visual System
Table 6.1: Conversion of the Visual System to Whole Person Impairment Rating
Source: American Medical Association Guides to the Evaluation of Permanent Impairment (4th edition, 1995, Table
6, Chapter 8, page 218).
6.1 Central Visual Acuity
Figure 6-B: Revised LogMar Equivalent for Different Reading Cards
6.1.1 Determining the Loss of Central Vision in One Eye
The following steps are taken to determine loss of central vision in one eye.
Figure 6-C: Percentage Loss of Central Vision in One Eye
6.2 Determining Loss of Monocular Visual Fields
Figure 6-D: Normal Extent of the Visual Field
6.3 Abnormal Ocular Motility and Binocular Diplopia
If the double vision is not within the central 20º, the presence of diplopia is then plotted along the 8 meridians (see Figure 6-E below). The largest percentage on any of the meridians in which there is double vision is the impairment percentage for loss of ocular motility.
Figure 6-E: Percentage Loss of Ocular Motility of one Eye in Diplopia Fields
Adapted from American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1995,Chapter 8, page 217.
6.4 Other Ocular Abnormalities
6.6 Calculation of Visual System Impairment for Both Eyes
Figure 6-F (from the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Chapter 8, page 219, 4th edition, 1995) is on the three following pages.
Figure 6-F was established using the equation:
3 x (impairment value of better eye) + (impairment value of worse eye) = impairment of visual system
4
Percentages for the worse eye are read from the side of the table.
Percentages for the better eye are read from the bottom of the table.
The impairment of the visual system is at the intersection of the column for the worse eye and the column for the better eye.
Figure 6-F: Calculation of Visual System Impairment for Both Eyes
Source: American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1995 Chapter 8, page 219.
Chapter 7 – Ear, Nose and Throat Disorders
7.0 Introduction.......................................................................................... 59
7.1 ... Hearing Loss........................................................................................ 59
7.2 ... Tinnitus................................................................................................... 60
7.3 ... Olfaction and Taste........................................................................... 60
7.4 ... Speech..................................................................................................... 61
7.5 ... Air Passage Defects........................................................................... 62
7.6 ... Nasal Passage Defects..................................................................... 62
7.7 ... Chewing and Swallowing................................................................ 63
7.1 Hearing Loss
7.2 Tinnitus
Table 7.2: Tinnitus
7.3 Olfaction and Taste
Table 7.3: Olfaction and Taste
7.4 Speech
7.5 Air Passage Defects
7.6 Nasal Passage Defects
Table 7.6: Nasal Passage Defects
7.7 Chewing and Swallowing
For the same condition, WPI ratings derived from Table 7.7 may not be combined with WPI ratings from Table 12.5.6: The Glossopharyngeal, Vagus, Spinal Accessory and Hypoglossal Nerves (see page 145, Chapter 12 – The Neurological System).
Table 7.7: Chewing and Swallowing
Chapter 8 – The Digestive System
Figure 8-B: Body Mass Index Criteria
8.1 Upper Digestive Tract:
Oesophagus, Stomach, Duodenum, Small Intestine and Pancreas
Table 8.1: Upper Digestive Tract:
Oesophagus, Stomach, Duodenum, Small Intestine and Pancreas
See notes to Table 8.1 at top of following page.
8.2 Lower Gastrointestinal Tract: Colon and Rectum
Table 8.2: Lower Gastrointestinal Tract – Colon and Rectum
See notes to Table 8.2 on following page, immediately below Table.
8.3 Lower Gastrointestinal Tract – Anus
Table 8.3: Lower Gastrointestinal Tract – Anus
8.4 Surgically Created Stomas
Table 8.4: Surgically Created Stomas
Note to Table 8.4
8.5 Liver: Chronic Hepatitis and Parenchymal Liver Disease
Table 8.5: Liver (Chronic Hepatitis and Parenchymal Liver Disease)
See notes to Table 8.5 immediately following Table.
Notes to Table 8.5.
8.6 Biliary Tract
Table 8.6: Biliary Tract
See note to Table 8.6 immediately following Table.
Note to Table 8.6.
8.7 Hernias of the Abdominal Wall
Table 8.7: Hernias of the Abdominal Wall
Note to Table 8.7
1. Hernias should be assessed only after surgical repair, except where there are sound medical reasons for repair not being undertaken.
Figure 9-A: Activities of Daily Living
Figure 9-B: Tables of normal ranges of motion of joints
Notes to Figure 9-E
Chapter 10 – The Urinary System
10.0 Introduction...................................................................................... 1119
10.1 The Upper Urinary Tract.............................................................. 120
10.2 Urinary Diversion............................................................................. 120
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).
Impairments assessed under Chapter 10 include those caused by secondary conditions accompanying an endocrine system condition. An impairment assessed under Chapter 3 – The Endocrine System (see page 35) should be combined with those resulting from the secondary conditions assessed under Chapter 10.
10.1 The Upper Urinary Tract
Table 10.1: The Upper Urinary Tract
Criteria (criteria in BOTH Category A and Category B must be satisfied if present)
10.2 Urinary Diversion
Table 10.2: Urinary Diversion
10.3 Lower urinary tract
Table 10.3: Lower Urinary Tract
Chapter 11 – The Reproductive System
11.0 Introduction........................................................................................... 123
11.1 Male Reproductive System............................................................. 123
Spermatic Cords............................................................................ 125
11.2 Female Reproductive System......................................................... 126
11.2.1 Female Reproductive Organs – Vulva and Vagina..................... 126
11.2.2 Female Reproductive Organs – Cervix and Uterus.................... 127
11.2.3 Female Reproductive Organs – Fallopian Tubes and
Ovaries........................................................................................... 128
11.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).
11.1 Male Reproductive System
Table 11.1.1: Male Reproductive Organs – Penis
11.1.2 Male Reproductive Organs – Scrotum
Skin disorders such as dermatitis, or tinea, affecting the scrotal skin are assessed under Table 4.1: Skin Disorders (page 42, Chapter 4 – Disfigurement and Skin Disorders). Table 11.1.2 is not used to assess these conditions.
Table 11.1.2: Male Reproductive Organs – Scrotum
Table 11.1.3: Male Reproductive Organs – Testes, Epididymes and Spermatic Cords
11.1.4 Male Reproductive Organs – Prostate and Seminal Vesicles
Table 11.1.4: Male Reproductive Organs – Prostate and Seminal Vesicles
11.2 Female Reproductive System
Table 11.2.1: Female Reproductive Organs – Vulva and Vagina
11.2.2 Female Reproductive Organs – Cervix and Uterus
Table 11.2.2: Female Reproductive Organs – Cervix and Uterus
Notes to Table 11.2.2
11.2.3 Female Reproductive Organs – Fallopian Tubes and Ovaries
Table 11.2.3: Female Reproductive Organs – Fallopian Tubes and Ovaries
Chapter 12 – The Neurological System
Notes Regarding Station, Gait and Movement Disorders...................... 131
12.1 Disturbances of Levels of Consciousness and
Awareness.............................................................................................. 131
12.1.1 Permanent Disturbances of Levels of
Consciousness and Awareness..................................................... 131
12.1.2 Epilepsy, Seizures and Convulsive Disorders............................. 131
12.1.3 Sleep and Arousal Disorders........................................................ 132
12.2 Impairment of Memory, Learning, Abstract Reasoning
and Problem Solving Ability........................................................... 133
12.3 Communication.................................................................................... 135
12.3.1 Comprehension of Speech and Language Symbols .................... 135
12.3.2 Production of Speech and Language Symbols............................. 137
12.4 Emotional or Behavioural Impairments..................................... 139
12.5.1 The Olfactory Nerve (I)................................................................ 140
12.5.2 The Optic Nerve, the Oculomotor and Trochlear
Nerves, and the Abducens (II, III, IV and VI)........................... 140
12.5.3 The Trigeminal Nerve (V)............................................................ 141
12.5.4 The Facial Nerve (VII)................................................................. 142
12.5.5 The Auditory Nerve (VIII)........................................................... 143
12.5.6 The Glossopharyngeal, Vagus, Spinal Accessory
and Hypoglossal Nerves (IX, X, XI and XII)............................. 144
12.7 Neurological Impairment of the Urinary System.................... 145
12.8 Neurological Impairment of the Anorectal System............... 146
12.9 Neurological Impairment Affecting Sexual Function........... 146
12.1 Disturbances of Levels of Consciousness and Awareness
12.1.1 Permanent Disturbances of Levels of Consciousness and Awareness
12.1.2 Epilepsy, Seizures and Convulsive Disorders
12.1.3 Sleep and Arousal Disorders
Central sleep apnoea should be assessed using Table 12.1.3 below. Obstructive sleep apnoea should be assessed using Table 2.4: Whole Person Impairment Derived from Obstructive Sleep Apnoea Score (see page 33, Chapter 2 – The Respiratory System).
Table 12.1.3: Sleep and Arousal Disorders
12.2 Impairment of Memory, Learning, Abstract Reasoning and Problem
Table 12.2: Impairment of Memory, Learning, Abstract Reasoning and
Problem Solving Ability
Figure 12-B: Clinical Dementia Rating (CDR)
From American Medical Association’s Guides to the Evaluation of Permanent Impairment (5th edition, 2001).
12.3 Communication
12.3.1 Comprehension of Speech and Language Symbols
A WPI rating from Table 12.3.1 may not be combined with a WPI rating from Table 12.3.2: Production of Speech and Language Symbols (see page 138). The higher of the WPI ratings from Table 12.3.1 and Table 12.3.2 is used.
Table 12.3.1: Comprehension of Speech and Language Symbols
12.3.2 Production of Speech and Language Symbols
Table 12.3.2: Production of Speech and Language Symbols
12.4 Emotional or Behavioural Impairments
Table 12.4: Emotional or Behavioural Impairments
12.5.1 The Olfactory Nerve (I)
Table 12.5.1: The Olfactory Nerve (I)
12.5.2 The Optic Nerve, the Oculomotor and Trochlear Nerves and the Abducens (II, III,
IV and VI)
12.5.3 The Trigeminal Nerve (V)
Table 12.5.3: The Trigeminal Nerve (V)
12.5.4 The Facial Nerve (VII)
Table 12.5.4: The Facial Nerve (VII)
12.5.5 The Auditory Nerve (VIII)
Table 12.5.5: The Auditory Nerve (VIII)
Figure 12-C: % WPI Modifiers for Episodic Conditions
12.5.6 The Glossopharyngeal, Vagus, Spinal Accessory and Hypoglossal Nerves (IX, X, XI
and XII)
X, XI and XII)
Table 12.6: Neurological Impairment of the Respiratory System
12.7 Neurological Impairment of the Urinary System
Table 12.7: Neurological Impairment of the Urinary System
12.8 Neurological Impairment of the Anorectal System
Table 12.8: Neurological Impairment of the Anorectal System
12.9 Neurological Impairment Affecting Sexual Function
Table 12.9: Neurological Impairment Affecting Sexual Function
Chapter 13 – The Haematopoietic System
13.0 Introduction ......................................................................................... 147
13.1 Anaemia.................................................................................................. 147
13.2 Leukocyte Abnormalities or Disease.......................................... 148
13 .2.. Haemorrhagic Disorders and Platelet Disorders.................. 149
13.4 Thrombotic Disorders....................................................................... 150
13.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).
13.1 Anaemia
Table 13.1: Anaemia
13.2 Leukocyte Abnormalities or Disease
The same principle applies to other conditions of the haematopoietic system where organ systems are impaired by the disease process and impairment can be assessed using other chapters of the Guide.
‘Activities of Daily Living’ are activities which an employee needs to perform to function in a non-specific environment (that is, to live). Performance of Activities of Daily Living is measured by reference to primary biological and psychosocial function.
For the purposes of Table 13.2: Leukocyte Abnormalities or Disease (see following page), Activities of Daily Living are those in Figure 13-A below.
Figure 13-A: Activities of Daily Living
Table 13.2: Leukocyte Abnormalities or Disease
13.3 Haemorrhagic Disorders and Platelet Disorders
Table 13.3: Haemorrhagic Disorders and Platelet Disorders
13.4: Thrombotic Disorders
Table 13.4: Thrombotic Disorders
PART 1
Division 2
Guide to the Assessment of
Non-Economic Loss
Table B1: Pain
B2 Suffering
Table B2: Suffering
B3 Loss of amenities
Table B3.1: Mobility
Table B3.2: Social Relationships
Table B3.3: Recreation and Leisure Activities
B4 Other Loss
B5 Loss of Expectation of Life
B6 Calculation of non-economic loss
B6: Worksheet – Calculation of non-economic loss
STEP 1 – Calculation of Total Score from Division 2 Tables
TABLE
SCORE
FACTOR
FINAL SCORE
Table B1: Pain
x 0.5 =
B3 – Amenities of Life
B3.1: Mobility Score
B3.2: Social Relationships
x 0.6 =
Table B4: Other Loss
x 1.0 =
TOTAL OF SCORES =
STEP 2 – Conversion of Total of Scores to a Percentage
OR
15
PART 1
Division 3
Calculation of Total Entitlement under
Section 24 and Section 27
C1: Worksheet – Calculation of Total Entitlement
CALCULATE TOTAL WHOLE PERSON IMPAIRMENT ENTITLEMENT
PART 1
A
B
C
D
F
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
Part 1
Appendix 1
Combined Values Chart
Part 1 - Combined Values Chart
Part 1 Appendix 1: Combined Values Chart
Source: American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th edition, page 604.
Part 1 - Combined Values Chart (continued)
PART 2
Table of Contents
Glossary.............................................................................................................. 179
Division 1 Impairment................................................................................. 181
6... Visual System....................................................................... 193
Division 2 Non-Economic Loss.................................................................. 223
Index to Part 2.................................................................................................. 231
PART 2
2. Respiratory System
3. Endocrine System
5. Psychiatric Disorders
7. Ear, Nose and Throat Disorders
8. Digestive System
PART 2
Principles of Assessment
1. Impairment and Non-Economic Loss ................................... 176
2. Employability and Incapacity .................................................. 177
3. Permanent........................................................................................ 177
4. The Impairment Tables............................................................... 177
5. Gradations of Impairment......................................................... 177
6. Combined Impairments.............................................................. 177
7. Double Assessment....................................................................... 177
8. Comparing Assessments under Alternative Tables ........ 178
9. Inapplicability of Part 2 of this Guide.................................... 178
11. Transitional Cases........................................................................ 178
12. Likelihood of Reduction in Degree of Impairment.......... 178
1. Impairment and Non-Economic Loss
2. Employability and Incapacity
3. Permanent
4. The Impairment Tables
5. Gradations of Impairment
6. Combined Impairments
7. Double Assessment
8. Fingers and Toes
9. Inapplicability of Part 2 of this Guide
10. Interim Assessments
11. Transitional Cases
12. Likelihood of Reduction in Degree of Impairment
13. Aggravation
Glossary
Impairment
1. CARDIO-VASCULAR SYSTEM
TABLE 1.1: Assessments of Symptomatic Activity Levels
MALE
FEMALE
TABLE 1.2: Peripheral Vascular Disease
TABLE 1.3: Varicose Veins, Deep Venous Thrombosis, Oedema, Ulceration
TABLE 2.1: Ventilatory Function
FIGURE 2.1: Prediction Nomogram - Males
FIGURE 2.2: Prediction Nomogram - Females
TABLE 3.1
4. SKIN DISORDERS
TABLE 4.1
TABLE 4.2: Facial Disfigurement
5. PSYCHIATRIC CONDITIONS
TABLE 5.1
6. VISUAL SYSTEM
TABLE 6.1: Disorders of Visual Acuity
7. EAR, NOSE AND THROAT DISORDERS
TABLE 7.1: Hearing
TABLE 7.2: Miscellaneous Ear, Nose and Throat Disorders
TABLE 8.1: Disorders of the Oesophagus, Duodenum, Stomach, Small Intestine, Pancreas, Colon, Rectum and Anus
TABLE 8.2: Disorders of the Liver and Biliary Tract
TABLE 8.3: Fistulae and Herniae
9. MUSCULO-SKELETAL SYSTEM
TABLE 9.1: Upper Extremity
TABLE 9.2: Lower Extremity
TABLE 9.3: Amputations and/or Total Loss of Function
TABLE 9.4: Limb Function – Upper Limb
TABLE 9.5: Limb Function – Lower Limb
TABLE 9.6: Spine
10. URINARY SYSTEM
TABLE 10.1: Upper Urinary Tract
TABLE 10.2: Lower Urinary Tract
TABLE 11.1: MALE
TABLE 11.2: FEMALE
TABLE 11.3: Mammary Glands
Cranial Nerves
TABLE 12.1
These tables should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to the assessment of the consequences of neurological injury or disease.
Communication
TABLE 12.2: Comprehension
TABLE 12.3: Expression
Notes:
TABLE 12.4: Memory
TABLE 12.5: Reasoning
TABLE 13.1: Intermittent Conditions
TABLE 13.2: Malignancies
Part 2
Appendix 1
Combined Values Chart
Part 2 - Combined Values Chart
Part 2 - Appendix 1: Combined Values Chart
Source: American Medi cal Association’s Guides to the Evaluation of Permanent Impairment, 5th edition, page 604.
Part 2 - Combined Values Chart (continued)
PART 2
Division 2
Non-Economic Loss
TABLE 2: LOSS OF AMENITIES
Mobility
Social Relationships
Recreation and Leisure Activities
TABLE 3: Other Loss
TABLE 4; Loss of Expectation of Life
TABLE 5: Combined Value Calculation
CALCULATION OF TOTAL OF SCORES
Table 1 - Pain and Suffering
Table 2 - Amenities of Life
Table 3 - Other Loss
Table 4 - Loss of Expectation of Life
TABLE 6: Final Calculation
PART 2
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W

 

 

 

Safety, Rehabilitation and Compensation Act 1988

 

Subsection 28 (1)

 

Guide to the Assessment of the

Degree of Permanent Impairment

 

 

Comcare prepares the following Guide to the Assessment of the Degree of Permanent Impairment (“second edition of the Guide”) under subsection 28 (1) of Safety, Rehabilitation and Compensation Act 1988.

 

The second edition of the Guide will come into operation in the manner specified in section 3 of the Introduction to the second edition of the Guide: Application of this Guide.

 

Dated: 1 September 2005

 

 

 

The seal of Comcare was affixed

in the presence of:

 

 

 

 

 

Barbara Bennett

Chief Executive Officer

 

 

 


 

 

Guide to

the Assessment

of the Degree of Permanent Impairment

 

 

Second edition

 

 

 

 

 

Comcare

 

 

 

 


 

 

 

 

 

 

 

 

Acknowledgements

 

Comcare gratefully acknowledges the valuable contribution to this Guide by:

 

  • Dr Dwight Dowda

 

  • Mr John Trungove

 

  • Sparke Helmore, solicitors

 

  • The Australian Government Solicitor

 

  • All the medical specialists and associations who have provided input and assistance in the compiling of this document over a number of years

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction to second edition of the Guide

 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Page no             

 

 

         1. Authority ............................................................................................... iii

         2. Structure of this Guide .................................................................... iii

         3. Application of this Guide ................................................................ iv

4. Whole Person Impairment (WPI) ................................................ v

5. Entitlements under the SRC Act .................................................. v

6. Non-economic loss ............................................................................. v

7. Compensation Payable ..................................................................... v

8. Interim and Final Assessments ..................................................... v

9. Increase in Degree of Whole Person Impairment ................ vi

            Part 1  –     Claims For Permanent Impairment

                         Other Than Defence-Related Claims............................ 1

         Part 2  – ....................................... Defence-related Claims For

                         Permanent Impairment................................................... 173

 

 

 



1. Authority

 

Division 4 of Part II (sections 24 to 28) of the Commonwealth’s Safety, Rehabilitation and Compensation Act 1988 (the SRC Act) provides for payment of lump sum compensation for permanent impairment and non-economic loss resulting from a work related injury.

 

The amount of compensation payable (if any) is to be assessed by reference to the degree of permanent impairment or the degree of non-economic loss determined by Comcare under the provisions of the approved Guide: 

 

“approved Guide” is defined by section 4 of the SRC Act as meaning:

(a)   the document, prepared by Comcare in accordance with section 28 under the title “Guide to the Assessment of the Degree of Permanent Impairment”, that has been approved by the Minister and is for the time being in force; and

(b)   if an instrument varying the document has been approved by the Minister—that document as so varied.

 

Authority for this document rests therefore in subsections 28(1), 28(2) and 28(3) of the SRC Act, which provide that:

(1)   Comcare may, from time to time, prepare a written document, to be called the “Guide to the Assessment of the Degree of Permanent Impairment”, setting out:

(a)     criteria by reference to which the degree of the permanent impairment of an   

    employee resulting from an injury shall be determined;

(b)     criteria by reference to which the degree of non-economic loss suffered by an  

                     employee as a result of an injury or impairment shall be determined; and

(c)        methods by which the degree of permanent impairment and the degree of non economic loss, as determined under those criteria, shall be expressed as a percentage.

(2)   Comcare may, from time to time, by instrument in writing, vary or revoke the approved Guide.

(3)   A document prepared by Comcare under subsection (1), and an instrument under subsection (2), have no force or effect unless and until approved by the Minister

 

This document is the new Guide to the Assessment of the Degree of Permanent Impairment.  It may be referred to as ‘this Guide or ‘second edition of the Guide’). This Guide is binding on Comcare, licensed authorities and corporations, and the Administrative Appeals Tribunal (subsection 29 (4).

 

2. Structure of this Guide

 

This Guide is divided into two Parts:

 

Part 1 - Claims for Permanent Impairment other than Defence-related Claims

 

This Part deals with the assessment of claims other than defence-related claims as defined in Part XI of the SRC Act.   That is, claims made under the SRC Act by employees who are not members of the Defence Force.

 

Part 2 - Defence-related Claims for Permanent Impairment

 

This Part deals with the assessment of defence-related claims as defined in Part XI of the SRC Act.  That is, claims made under the SRC Act by members of the Defence Force in relation to injuries which occurred during defence service before 1 July 2004.

 

Part 1 of the Guide has three divisions:

DIVISION 1       Division 1 (see Part 1, page 17) is used to assess the degree of an employee’s permanent impairment resulting from an injury;

DIVISION 2       Division 2 (see Part 1, page 151) is used to assess the degree of an employee’s non-economic loss resulting from impairment;

DIVISION 3       Division 3 (see Part 1, page 159) is used to calculate the total entitlement based on the assessments completed in Divisions 1 and 2.

The Principles of Assessment (see page 11) and Glossary (see page 15) in Part 1 of this Guide contain information relevant to the interpretation and application of Part 1, Divisions 1 & 2.

Part 2 of this Guide has two divisions:

DIVISION 1       Division 1 (see Part 2, page 173) is used to assess the degree of an employee’s permanent impairment resulting from an injury; and

DIVISION 2       Division 2 (see Part 2, page 223) is used to assess the degree of an employee’s non-economic loss resulting from impairment;

The Principles of Assessment (see page 176) and Glossary (see page 179) in Part 2 of this Guide contain information relevant to the interpretation and application of Part 2, Divisions 1 and 2.

 

3. Application of this Guide

 

The Guide to the Assessment of the Degree of Permanent Impairment prepared by the Commission for the Safety, Rehabilitation and Compensation of Commonwealth Employees under subsection 28 (1) of the Commonwealth Employees’ Rehabilitation and Compensation Act 1988 and approved by the Minister of State for Industrial Relations by notice in writing dated 27 July 1989 is referred to as the “first edition of the Guide”.  

 

Except as provided below, the first edition of the Guide is revoked in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of claims under those sections received by the relevant authority after 28 February 2006.   Claims under those sections received on or before 28 February 2006 will be determined under the provisions of the first edition of the Guide.

 

Part 1 of this Guide will apply on and from 1 March 2006 in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of claims under those sections, other than defence-related claims, received by the relevant authority after 28 February 2006.

 

Part 2 of this Guide will apply on and from 1 March 2006 in relation to determinations made under sections 24, 25 or 27 of the SRC Act in respect of defence-related claims under those sections received by the relevant authority after 28 February 2006.

 

Where a request by an employee pursuant to subsection 25 (1) of the SRC Act is received by the relevant authority after the revocation date but relates to a claim under section 24 that was received by the authority on or before the revocation date, that request will be determined under the provisions of the first edition of the Guide.

 

Where a claim for compensation pursuant to subsections 25(4) or 25 (5) of the SRC Act (in respect of a subsequent increase in the degree of permanent impairment) is received by the relevant authority after the revocation date, that claim will be determined under the provisions of this Guide, notwithstanding that the initial claim for compensation for permanent impairment may have been determined under the provisions of the first edition of the Guide

 

However, where the initial claim for compensation for permanent impairment was determined under the provisions of the first edition of the Guide, in determining whether or not there has been any subsequent increase in the degree of permanent impairment, the degree of permanent impairment or the degree of non-economic loss shall not be less than the degree of permanent impairment or degree of non-economic loss determined under the provisions of the first edition of the Guide unless that determination would not have been made but for a false statement or misrepresentation of a person. 

 

In this Guide, “relevant authority” and “defence-related claims” have the same meaning as defined in section 4 and Part XI of the SRC Act and “revocation date” means 28 February 2006.

4. Whole Person Impairment (WPI)

 

Prior to 1988, the Compensation (Commonwealth Government Employees) Act 1971 (repealed with the coming into effect of the SRC Act) provided for the payment of lump sum compensation where an employee suffered the loss of, or loss of efficient use of, a part of the body or faculty, as specified in a table of maims. The range of conditions compensated was exclusive and did not reflect the broad range of work-related injuries and diseases.

 

This Guide, like the first edition, is based on the concept of ‘whole person impairment’.  Subsection 24(5) of the SRC Act provides for the determination of the degree of permanent impairment of the employee, that is, the employee as a whole person.  The whole person impairment concept, therefore, provides for compensation for the permanent impairment of any body part, system or function to the extent to which it permanently impairs the employee as a whole person.

 

Whole person impairment is assessed under Division 1 of Parts 1 and 2 of this Guide.

 

5. Entitlements under the SRC Act

 

Where the degree of permanent impairment of the employee (other than a hearing loss) determined under subsection 24(5) of the SRC Act is less than 10 per cent, paragraph 24(7) (b) of the Act provides that compensation is not payable to the employee under section 24 of that Act.

 

Subsection 24(8) of the Act excludes the operation of subsection 24(7) in relation to impairment resulting from the loss, or the loss of the use, of a finger or toe, or the loss of the sense of taste or smell.

 

For injuries suffered by employees after 1 October 2001, subsection 24(7A) of the Act provides that, if the injury results in a permanent impairment that is a hearing loss, the 10% threshold does not apply. In those cases, subsection 24(7A) provides that there is no compensation payable if the permanent impairment that is binaural hearing loss is less than 5%.

 

6. Non-economic loss

 

Subsection 27(1) of the SRC Act provides that where there is liability to pay compensation in respect of a permanent impairment, additional compensation for non-economic loss is payable in accordance with section 27.

 

Non-economic loss is assessed under Division 2 of Parts 1 and 2 of this Guide.

 

7. Compensation Payable

 

The maximum level of payment is prescribed in the legislation and indexed annually on 1 July in accordance with the Consumer Price Index.  Compensation is calculated at the rate applicable at the time of the assessment (In Part 1 of this Guide, see Division 3 for calculation of total entitlement).

 

8. Interim and Final Assessments

 

On the written request of the employee under subsection 25 (1) of the SRC Act, an interim determination must be made of the degree of permanent impairment suffered and an assessment made of an amount of compensation payable to the employee, where:

·         a determination has been made that an employee has suffered a permanent impairment as a result of an injury;

·         the degree of that impairment is equal to or more than 10%; and

·         a final determination of the degree of permanent impairment has not been made.

 

When a final determination of the degree of permanent impairment is made, there is payable to the employee, under subsection 25 (3) of the SRC Act, an amount equal to the difference, if any, between the final determination and the interim assessment.

 

9. Increase in Degree of Whole Person Impairment

 

Where a final assessment of the degree of permanent impairment has been made and the level of whole person permanent impairment subsequently increases by 10% or more, the employee may request, pursuant to subsection 25 (4) of the SRC Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of impairment only.

 

For injuries suffered by employees after 1 October 2001, pursuant to subsection 25 (5) of the SRC Act, if the injury results in a permanent impairment that is a hearing loss, there may be a further amount of compensation payable if there is a subsequent increase in the binaural hearing loss of 5% or more.

 

See section 3 above (Application of this Guide) as to assessments of the degree of permanent impairment made under the first edition of the Guide.


 

 

 

 

 

 

 

 

PART 1

 

CLAIMS FOR

PERMANENT IMPAIRMENT

OTHER THAN DEFENCE-RELATED

CLAIMS

 

 

 


 

 

 

 

 

 

 


 

PART 1

 

Table of Contents

 

List of Tables and Figures..................................................................................... 5

 

List of references..................................................................................................... 9

 

Principles of Assessment................................................................................. 11

 

Glossary................................................................................................................. 15

 

Division 1   Assessment of the Degree of an Employee’s
                   Permanent Impairment Resulting from an Injury......... 17

 

Chapter 1   – The Cardiovascular System............................... 19

 

Chapter 2   – The Respiratory System..................................... 29

 

Chapter 3   – The Endocrine System........................................ 35

 

Chapter 4   – Disfigurement and Skin Disorders................... 41

 

Chapter 5   – Psychiatric Conditions........................................ 45

 

Chapter 6   – The Visual System............................................... 47

 

Chapter 7   – Ear, Nose and Throat Disorders...................... 59

 

Chapter 8   – The Digestive System.......................................... 65

 

Chapter 9   – The Musculoskeletal System............................. 73

 

Chapter 10 – The Urinary System........................................... 119

 

Chapter 11 – The Reproductive System............................... 123

 

Chapter 12 – The Neurological System................................. 129

 

Chapter 13 – The Haematopoietic System............................ 147

 

Division 2   Guide to the Assessment of Non-Economic Loss........ 151

 

Division 3   Calculation of Total Entitlement....................................... 159

 

Index to Part 1...................................................................................................... 161

 

Appendix 1:  Combined Values Chart........................................................... 169

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

 

PART 1

 

List of Tables and Figures

 

Division 1 – Assessment of Degree and Employee’s Permanent Impairment Resulting from Injury

 

Chapter 1 – The Cardiovascular System

 

Figure 1-A:            Activities of Daily Living............. 19

Figure 1-B:            Symptomatic Level of Activity

                                in METS According to Age and

                                Gender  ........................................... 21

Table 1.1:               Coronary Artery Disease ............. 21

Table 1.2.1:            Diastolic Hypertension ................ 23

Table 1.2.2:            Systolic Hypertension ................. 24

Figure 1-C:            Definitions of Functional Class .. 25

Table 1.3:               Arrhythmias ................................... 25

Table 1.4                Peripheral Vascular Disease

                                of the Lower Extremities ..............  26

Table 1.5:               Peripheral Vascular Disease

                                of the Upper Extremities               26

Figure 1-C:            Definitions of Functional Class.. 27

Table 1.6:               Raynaud’s Disease ....................... 27

 

Chapter 2 – The Respiratory System

 

Table 2.1:               Conversion of Respiratory

............................... Function Values to

............................... Impairment ..................................... 31

Figure 2-A:  ......... Calculating Asthma Impairment

............................... Score ............................................... 32

Table 2.2:  ............ Whole Person Impairment

............................... Derived from Asthma

............................... Impairment Score .......................... 32

Figure 2-B:  ......... Calculating Obstructive Sleep

............................... Apnoea Score ................................ 33

Table 2.4  ............. Whole Person Impairment

............................... Derived from Obstructive

............................... Sleep Apnoea Score ..................... 33

 

Chapter 3 – The Endocrine System

 

Table 3.1                Thyroid and Parathyroid

                                Glands ............................................. 36

Table 3.2                Adrenal Cortex and Medulla ....... 37

Table 3.3:               Pancreas (Diabetes Mellitus)....... 38

Table 3.4:               Gonads and Mammary Glands .... 39

 

Chapter 4 – Disfigurement and Skin Disorders

 

Table 4.1:               Skin Disorders ............................... 42

Figure 4-A:            Activities of Daily Living............. 42

Table 4.2:               Facial Disfigurement ..................... 43

Table 4.3:               Bodily Disfigurement.................... 43

 

Chapter 5 – Psychiatric conditions

 

Figure 5-A:            Activities of Daily Living............. 45

Table 5.1:               Psychiatric conditions ................. 45

 

Chapter 6 – The Visual System

 

Figure 6-A:            Steps for Calculating

                                Impairment of the Visual

                                System ............................................ 49

Table 6.1:               Conversion of the Visual

                                System to Whole Person

                                Impairment Rating ......................... 49

Figure 6-B:            Revised LogMar Equivalent for Different Reading Cards             50

Figure 6-C:            Percentage Loss of Central

                                Vision in One Eye ......................... 51

Figure 6-D:            Normal Extent of the Visual

                                Field................................................. 52

Figure 6-E:             Percentage Loss of Ocular

                                Motility of one Eye in

                                Diplopia Fields............................... 53

Figure 6-F:             Calculation of Visual System Impairment for Both Eyes                55

 

Chapter 7 – Ear, Nose and Throat Disorders

 

Table 7.2:               Tinnitus........................................... 60

Table 7.3:               Olfaction and Taste....................... 60

Table 7.4:               Speech............................................. 61

Table 7.5:               Air Passage Defects...................... 62

Table 7.6:               Nasal Passage Defects.................. 62

Table 7.7:               Chewing and Swallowing............. 63

 

Chapter 8 – The Digestive System

 

Figure 8-A:            Activities of Daily Living............. 65

Figure 8-B:            Body Mass Index Criteria............. 66

Table 8.1:               Upper Digestive Tract:

      Oesophagus, Stomach,

      Duodenum, Small Intestine

      and Pancreas.................................. 67

Table 8.2:               Lower Gastrointestinal Tract:

                                Colon and Rectum......................... 68

Table 8.3:               Lower Gastrointestinal Tract:

                                Anus................................................ 70

Table 8.4:               Surgically Created Stomas............ 70

Table 8.5:               Liver (Chronic Hepatitis and Parenchymal Liver Disease)            71

Table 8.6:               Biliary Tract.................................... 72

Table 8.7:               Hernias of the Abdominal

                                Wall.................................................. 72

 

List of Tables and Figures continues over page

 

Part 1

List of Tables and Figures

(continued)

 

Chapter 9 – The Musculoskeletal System

 

Figure 9-A             Activities of Daily Living............. 74

Figure 9-B             Tables of normal ranges of

                                motion of joints.............................. 74

Table 9.1:               Feet and Toes................................. 77

Table 9.2:               Ankles ............................................ 78

Table 9.4:               Knees............................................... 79

Table 9.4:               Hips.................................................. 80

Table 9.5:               Lower Extremity Amputations..... 81

Figure 9-C:            Grading System.............................. 82

Table 9.6.1:            Spinal Nerve Root Impairment Affecting the Lower Extremity     82

Table 9.6.2a:          Sensory Impairment due to

                                Peripheral Nerve Injuries

                                Affecting the Lower

                                Extremities....................................... 83

Table 9.6.2b:         Motor Impairment due to

                                Peripheral Nerve Injuries

                                Affecting the Lower

                                Extremities....................................... 83

Table 9.7:               Lower Extremity Function............. 85

Table 9.8.1a:          Abnormal Motion/Ankylosis

                                of the Thumb –

                                IP and MP joints............................ 87

Table 9.8.1b:         Radial Abduction/Adduction/ Opposition of the Thumb –

                                Abnormal Motion/Ankylosis...... 88

Table 9.8.1c:          Abnormal Motion/Ankylosis

                                of the Fingers –

                                Index and Middle Fingers............. 89

Table 9.8.1d:         Abnormal Motion/Ankylosis

                                of the Fingers –

                                Ring and Little Fingers.................. 89

Table 9.8.2a:          Sensory Losses in the Thumb..... 92

Table 9.8.2b:         Sensory Losses in the Index &

                                Index & Middle Fingers................ 92

Table 9.8.2c:          Sensory Losses in the Little

      Finger............................................... 92

Table 9.8.2d:         Sensory Losses in the Ring

      Finger............................................... 92

Table 9.9.1a:          Wrist Flexion/Extension................ 94

Table 9.9.1b:         Radial and Ulnar Deviation

                                of Wrist Joint.................................. 94

Table 9.10.1a:        Elbow Flexion/Extension............... 96

Table 9.10.1b:       Pronation and Supination of

   Forearm............................................ 96

Table 9.11.1a:        Shoulder Flexion/Extension.......... 98

Table 9.11.1b:       Shoulder Flexion/Extension

Internal/External Rotation of Shoulder             98

Table 9.11.1c:        Abduction/Adduction of

                                Shoulder.......................................... 99

Table 9.12.1:          Upper Extremity

                                Amputations................................. 100

Table 9.12.2:          Amputation of Digits.................. 100

Figure 9-D:            Grading System............................ 101

Table 9.13.1:          Cervical Nerve Root

                                Impairment.................................... 102

Table 9.13.2a:        Specific Nerve Lesions Affecting

                                the Upper Extremities –

                                Sensory Impairment..................... 104

Table 9.13.2b:       Specific Nerve Lesions

                                Affecting the Upper Extremities –

                                Motor Impairment........................ 104

Figure 9-E              Diagnostic Criteria for CRPS...... 106

Figure 9-F              Impairment Grading for CRPS.... 106

Table 9.14              Upper Extremity Function........... 109

Table 9.15:             Cervical Spine –

                                Diagnosis-Related Estimates..... 114

Table 9.16:             Thoracic Spine –

                                Diagnosis-Related Estimates..... 115

Table 9.17:             Lumbar Spine –

                                Diagnosis-Related Estimates..... 116

Table 9.18:             Fractures of the Pelvis................ 117

 

Chapter 10 – The Urinary System

 

Table 10.1:             The Upper Urinary Tract............ 120

Table 10.2:             Urinary Diversion........................ 120

Table 10.3:             Lower Urinary Tract.................... 122

 

Chapter 11 – The Reproductive System

 

Table 11.1.1:          Male Reproductive Organs –

                                Penis.............................................. 124

Table 11.1.2:          Male Reproductive Organs – Scrotum             124

Table 11.1.3:          Male Reproductive Organs –

                                Testes, Epididymes and

                                Spermatic Cords........................... 125

Table 11.1.4:          Male Reproductive Organs – Prostate and Seminal

                                Vesicles......................................... 125

Table 11.2.1:          Female Reproductive

                                Organs – Vulva and Vagina....... 126

Table 11.2.2:          Female Reproductive

                                Organs – Cervix and Uterus....... 127

Table 11.2.3:          Female Reproductive

                                Organs – Fallopian Tubes

                                and Ovaries................................... 128

 

Chapter 12 – The Neurological System

 

Figure 12-A:          Activities of Daily Living........... 130

Table 12.1.1:          Permanent Disturbances of

                                Levels of Consciousness

                                and Awareness............................ 131

 

List of Tables and Figures continues over  page

Part 1

List of Tables and Figures

(continued)

 

Table 12.1.2:          Epilepsy, Seizures and

                                Convulsive Disorders................. 131

Table 12.1.3:          Sleep and Arousal Disorders..... 132

Table 12.2:             Impairment of Memory,

                                Learning, Abstract Reasoning

                                and Problem Solving Ability...... 133

Figure 12-B:          Clinical Dementia Rating

                                (CDR)............................................. 134

Table 12.3.1:          Comprehension of Speech

                                and Language Symbols.............. 136

Table 12.3.2:          Production of Speech and

                                Language Symbols...................... 138

Table 12.4:             Emotional or Behavioural Impairments             139

Table 12.5.1:          The Olfactory Nerve (I)............... 140

Table 12.5.3:          The Trigeminal Nerve (V)........... 141

Table 12.5.4:          The Facial Nerve (VII)................. 142

Table 12.5.5:          The Auditory Nerve (VIII).......... 143

Figure 12-C:          % WPI Modifiers for

                                Episodic Conditions.................... 144

Table 12.5.6:          The Glossopharyngeal,

                                Vagus, Spinal Accessory

                                and Hypoglossal Nerves

                                (IX, X, XI and XII)....................... 145

Table 12.6:             Neurological Impairment of

                                the Respiratory System............... 145

Table 12.7:             Neurological Impairment of

                                the Urinary System...................... 145

Table 12.8:             Neurological Impairment of

                                the Anorectal System.................. 146

Table 12.9:             Neurological Impairment

                                Affecting Sexual Function.......... 146

 

Chapter 13 – The Haematopoietic System

Table 13.1:             Anaemia........................................ 147

Figure 13-A:          Activities of Daily Living........... 148

Table 13.2:             Leukocyte Abnormalities or

                                Disease.......................................... 149

Table 13.3:             Haemorrhagic Disorders and

                                Platelet Disorders......................... 150

Table 13.4:             Thrombotic Disorders................. 150

 

Division 2 – Guide to the Assessment of

Non-Economic Loss

 

Table B1:               Pain................................................ 152

Table B2:               Suffering........................................ 153

Table B3.1:            Mobility......................................... 155

Table B3.2:            Social Relationships.................... 155

Table B3.3:            Recreation and Leisure

                                Activities....................................... 155

Table B4:               Other Loss.................................... 156

Table B5:               Loss of Expectation of Life......... 156

B6: Worksheet     Calculation of

                                non-economic loss...................... 157

 

Division 3 – Final Calculation of Entitlements

Under Section 24 and Section 25

 

C1: Worksheet     Final Calculation of

                                Entitlements.................................. 159

 

Appendices

 

Appendix 1           Combined Values Chart.............. 169

 

 

 

 

 





PART 1

 

List of references

 

Abramson MJ et al, 1996, Aust NZ J Med, 26, 697-701.

 

American Academy of Sleep Medicine, 1999, ‘Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research’, 1999, Sleep, 22, 667-689.

 

American Medical Association, 1995, Guides to the Evaluation of Permanent Impairment, 4th edition, Chicago: American Medical Association.

 

American Medical Association, 2001, Guides to the Evaluation of Permanent Impairment, 5th edition, Chicago: American Medical Association.

 

American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/disability secondary to respiratory disorders’, Am Rev Respir Dis, 133, 1205-09

 

American Thoracic Society, 1993, ‘Guidelines for the evaluation of impairment/disability in patients with asthma’, Am Rev Respir Dis, 147, 1056-61.

 

Cummings J, Mega M, Gary K, Rosenberg-Thompson S, Carusi D, Gornbein J, ‘The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia’, Neurology, 1994, 44, 2308-2314.

 

Ensalada LH, ‘Complex regional pain syndrome’, in Brigham CR, ed, The Guides Casebook, Chicago, Ill: American Medical Association, 1999, 14.

 

Johns MW, 1991, ‘A new method for measuring daytime sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.

 

Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11), 2412-2414.

 

National Asthma Council, 2002, Asthma Management Handbook 2002, 5th edition, Melbourne: National Asthma Council of Australia.

 

 




 

PART 1

 

Principles of Assessment

 

 

                                                                                                                                                                                                                                                      Page no.             

1.  Impairment and Non-Economic Loss ..................................... 11

2.  Employability and Incapacity ..................................................... 12

3.  Permanent Impairment ................................................................. 12

4.  Pre-Existing Conditions and Aggravation ............................ 12

5.  The Impairment Tables ................................................................ 12

6.   Malignancies and conditions resulting in major

systemic failure................................................................................ 13

 

7.  Percentages of Impairment ......................................................... 13

8.  Comparing Assessments under Alternative Tables .......... 13

9.     Combined Values ............................................................................ 13

        10.  Calculating the Assessment ........................................................ 14

11.  Ordering of Additional Investigations .................................... 14

12.  Exceptions to use of this Guide ................................................. 14

 

 

1.     Impairment and Non-Economic Loss

 

Under subsection 4(1) of the SRC Act, impairment means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function’. It relates to the health status of an individual and includes anatomical loss, anatomical abnormality, physiological abnormality, and psychological abnormality. The degree of impairment is assessed by reference to the impact of that loss on the normal efficient functioning of the whole person.

 

Non-economic loss is assessed in accordance with Part 1, Division 2 (page 151) of this Guide, and deals with the effects of the impairment on the employee’s life. Under subsection 4(1) of the SRC Act, for an employee who has suffered an injury resulting in a permanent impairment, it means:

 

‘loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware’. 

 

Non-economic loss may be characterised as the ‘lifestyle effects’ of an impairment. ‘Lifestyle effects’ are a measure of an individual’s mobility and enjoyment of, and participation in, social relationships, and recreation and leisure activities. The employee must be aware of the losses suffered. While employees may have equal ratings of whole person impairment it would not be unusual for them to receive different ratings for non-economic loss because of their different lifestyles.

 

2.     Employability and Incapacity

 

The concepts of ‘employability’ and ‘incapacity’ are not the tests for the assessment of impairment and non-economic loss. Incapacity is influenced by factors other than the degree of impairment and is compensated by weekly payments which are separate and independent to permanent impairment entitlements.


 

3.     Permanent Impairment

 

Compensation is only payable for impairments which are permanent. Under subsection 4(1) of the SRC Act ‘permanent’ means ‘likely to continue indefinitely’. Subsection 24(2) of the SRC Act provides that for the purposes of determining whether an impairment is permanent, the following matters shall be considered:

 

(a)  the duration of the impairment;

(b)  the likelihood of improvement in the employee’s condition;

(c)    whether the employee has undertaken all reasonable rehabilitative treatment for the

       impairment; and

(d)  any other relevant matters.

 

Thus, a loss, loss of the use, damage, or malfunction, will be permanent if it is likely, in some degree, to continue indefinitely. For this purpose, regard shall be had to any medical opinion concerning the nature and effect (including possible effect) of the impairment, and the extent, if any, to which it may reasonably be capable of being reduced or removed.

 

4.     Pre-Existing Conditions and Aggravation

 

Where a pre-existing or underlying condition is aggravated by a work-related injury, only the impairment resulting from the aggravation is to be assessed.  However, an assessment should not be made unless the effects of the aggravation of the underlying or pre-existing condition are considered permanent.  In these situations, the pre-existing or underlying condition would usually have been symptomatic prior to the work-related injury and the degree of permanent impairment resulting from that condition is able to be accurately assessed.

 

If the employee’s impairment is entirely attributable to the pre-existing or underlying condition, or to the natural progression of such a condition, the assessment for permanent impairment is nil. 

 

Where the pre-existing or underlying condition was previously asymptomatic, all the permanent impairment arising from the work-related injury is compensable.

 

5.     The Impairment Tables

 

Part 1, Division 1 of this Guide is based on the concept of whole person impairment which is drawn from the American Medical Association’s Guides to the Evaluation of Permanent Impairment (see the 5th edition, 2001).

 

Division 1 assembles into groups, according to body system, detailed descriptions of impairments. The extent of each impairment is expressed as a percentage value of the whole, normal, healthy person. Thus, a percentage value can be assigned to an employee’s impairment by reference to the relevant description in this Guide.

 

It may be necessary in some cases to have regard to a number of Chapters within Part 1 of this Guide when assessing the degree of whole person impairment which results from an injury.

 

Where a table specifies a degree of impairment because of a surgical procedure, the same degree of impairment applies if the same loss of function has occurred due to a different medical procedure or treatment. 

 

6.     Malignancies and conditions resulting in major systemic failure

 

Conditions such as cancer, HIV infection, diabetes, asbestosis, mesothelioma and others, often with terminal consequences, may result in failure or impairment of multiple body parts or systems.


 Assessments should be made of the impairment suffered in each of the affected body parts and systems and combined using the Combined Values Chart in Part 1, Appendix 1.

 

7.     Percentages of Impairment

 

Each table in Part 1, Division 1 contains impairment values expressed as percentages. Where a table is applicable in respect of a particular impairment, there is no discretion to choose an impairment value not specified in that table. For example, where 10% and 20% are the specified values, there is no discretion to determine the degree of impairment as 15%.

 

8.     Comparing Assessments under Alternative Tables

 

Unless there are instructions to the contrary, where two or more tables (or combinations of tables) are equally applicable to an impairment, the decision-maker must assess the degree of permanent impairment under the table or tables which yields or yield the most favourable result to the employee.

 

9.     Combined Values

 

Impairment is system or function based.  A single injury may give rise to multiple losses of function and, therefore, multiple impairments. When more than one table applies in respect of that injury, separate scores should be allocated to each functional impairment. To obtain the whole person impairment in respect of that injury, those scores are then combined using the Combined Values Chart (see Part 1, Appendix 1) unless the notes in the relevant section specifically stipulate that the scores are to be added (For instance, see 9.8.1 at page 87). 

 

Where two or more injuries give rise to the same whole person impairment only a single rating should be given.   For example, impairments resulting from separate injuries to the left and right knees are initially assessed separately under Tables 9.3 and then, in accordance with the notes at Part 1 – Introduction to Chapter 9 on page 74, the impairments are combined using the Combined Values Chart to obtain the overall impairment for the lower extremity function which is taken to be a single whole person impairment.   Alternatively, a whole person impairment value can be obtained using the method set out in Table 9.7 (which treats the injuries to both knees as the same impairment*) and this value can then be compared to the combined value previously obtained to determine which is the most beneficial.  [* The notes on page 84 to Table 9.7 provide: ‘A single assessment only may be made under Table 9.7, irrespective of whether one or two extremities are affected by the injury’]

 

However, where two or more injuries give rise to different whole person impairments, each injury is to be assessed separately and the final scores for each injury (including any combined score for a particular injury) added together.

 

It is important to note that whenever the notes in the relevant section refer to combined ratings, the Combined Values Chart must be used, even if no reference is made to the use of that Chart.

 

 

 

10.                      Calculating the Assessment

 

Where relevant, a statement is included in the Chapters of Part 1, Division 1 which indicates:

·        the manner in which tables within that Chapter may (or may not) be combined;

·        whether an assessment made in that Chapter can be combined with an assessment made in another Chapter in assessing the degree of whole person impairment.

 

There are some special circumstances where addition of scores rather than combination is required. These circumstances are specified in the relevant sections and tables in Part 1 of this Guide.

 

11.                      Ordering of Additional Investigations

 

As a general principle, the assessing medical practitioner should not order additional radiographic or other investigations solely for impairment evaluation purposes, unless the investigations are specifically required in the relevant chapter of Part 1 of this Guide

 

12.                      Exceptions to use of Part 1 of this Guide

 

In the event that an employee’s impairment is of a kind that cannot be assessed in accordance with the provisions of Part 1 of this Guide, the assessment is to be made under the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.

 

An assessment is not to be made using the American Medical Association’s Guides to the Evaluation of Permanent Impairment for:

·         mental and behavioural impairments (psychiatric conditions);

·         impairments of the visual system;

·         hearing impairment; or

·         chronic pain conditions, except in the case of migraine or tension headaches.  (For complex regional pain syndromes affecting the upper extremities, see Part 1, Chapter 9 – 9.13.3 Complex Regional Pain Syndrome, see page 105).

 

Any reference in this Guide to the American Medical Association’s Guides to the Evaluation of Permanent Impairment is a reference to the edition current at the time of assessment, unless there is reference to a specific edition.

 

 

 

 

 


 

 


Glossary

 

 

Definitions in italics are from subsection 4(1) of the SRC Act.

 

Activities of Daily Living           are those activities that an employee needs to perform to function in a non-specific environment (that is, to live). Performance of Activities of Daily Living is measured by reference to primary biological and psychosocial function.

 

Ailment                                    means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development).

 

Disease                                    means

                                                      (a) any ailment suffered by an employee; or

                                                      (b) the aggravation of any such ailment;

being an ailment or an aggravation that was contributed to in a material degree by the employee’s employment by the Commonwealth or a licensed corporation.

 

Impairment                               means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function.

 

Injury                                       means

                                                      (a) a disease suffered by an employee; or

(b) an injury (other than a disease) suffered by an employee,

being a physical or mental injury arising out of, or in the course of, the employee’s employment; or

(c) an aggravation of a physical or mental injury (other than a

disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), being an aggravation that arose out of, or in the course of, that employment;

but does not include any such disease, injury or aggravation suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment.

 

Loss of Amenities                     means the effects on mobility, social relationships and recreation and leisure activities.

 

Non-economic loss                    in relation to an employee who has suffered an injury resulting in a permanent impairment, means loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware.

 

 

Glossary continues on following page


 

Glossary (continued)

 

Pain                                         means physical pain.

 

Suffering                                  means the mental distress resulting from the accepted conditions or impairment.

 

Whole person impairment          (or WPI) means the medical effects of an injury or disease. WPI is based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment. WPI is a medical quantification of the nature and extent of the effect of an injury or disease on a person’s functional capacity including Activities of Daily Living. This Guide presents descriptions of impairments in chapters and tables according to body system. The extent of each impairment is expressed as a percentage value of the functional capacity of a normal healthy person.  


 

 

 

 

 

 

 

 

PART 1

 

Division 1

 

Assessment of the Degree
of an Employee’s Permanent Impairment
Resulting from an Injury

 

 



Chapter 1 – The Cardiovascular System

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Page no.                   

1.0    Introduction............................................................................................. 19

1.1... Coronary Artery Disease................................................................... 21

1.2.... Hypertension.......................................................................................... 23

1.2.1 Diastolic Hypertension...................................................................... 23

1.2.2 Systolic Hypertension........................................................................ 24

1.3 .. Arrhythmias............................................................................................ 25

1.4 .. Peripheral Vascular Disease of the Lower Extremities........ 26

1.5 ... Peripheral Vascular Disease of the Upper Extremities......... 26

1.6 .. Raynaud’s Disease............................................................................... 27

 

 

1.0  Introduction

 

In conducting an assessment, the assessor must have regard to the Principles of Assessment (see pages 11-14) and the definitions contained in the Glossary (see pages 15-16).

 

WPI ratings derived from tables in this Chapter may be combined with WPI ratings from other tables where there is co-existent disease (for example, cardiomyopathy, ischaemic heart disease, congenital heart disease, valvular heart disease).

 

‘Activities of Daily Living’ are activities which an employee needs to perform to function in a non-specific environment (that is, to live). Performance of Activities of Daily Living is measured by reference to primary biological and psychosocial function.

 

For the purposes of Chapter 1, Activities of Daily Living are those in Figure 1-A (see below).

 

Figure 1-A: Activities of Daily Living

 

Activity

Examples

Self care, personal hygiene.

Bathing, grooming, dressing, eating, eliminating.

Communication.

Hearing, speaking, reading, writing, using keyboard.

Physical activity.

Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising.

Sensory function.

Tactile feeling.

Hand functions.

Grasping, holding, pinching, percussive movements, sensory discrimination.

Travel.

Driving or travelling as a passenger.

Sexual function.

Participating in desired sexual activity.

Sleep.

Having a restful sleep pattern.

Social and recreational.

Participating in individual or group activities, sports activities, hobbies.

 

Chapter 1 does not cover impairments arising from cardiomyopathy, congenital heart disease, valvular heart disease, and pericardial heart disease. Where relevant, the degree of impairment arising from these conditions should be assessed in accordance with the appropriate table from the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.

 

For post-thrombotic syndrome, assessments under Tables 1.4 and 1.5 (peripheral vascular disease, see page 26) are an alternative to Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System). WPI ratings from Tables 1.4 and 1.5 must not be combined with a WPI rating from Table 13.4.  Tables 1.4 and 1.5 should be used as the primary guide for assessing peripheral complications of thrombosis.

 

Employees who have permanent cardiac limitation secondary to massive pulmonary embolism should be assessed under Chapter 1. A WPI rating assessed in these circumstances may not be combined with a rating from Table 13.4.


1.1  Coronary Artery Disease

 

Steps for assessment are as follows.

 

Step 1

Using Figure 1-B (see below), determine the symptomatic level of activity in METS according to age and gender. Figure 1-B may be used to assess conditions affecting left ventricular function (LVF) (including ischaemic heart disease, rheumatic heart disease, and hypertension).

Step 2

Using Table 1.1 (see below), refer to any one of pathology (column 3), drug therapy (column 4), or intervention (column 5), to identify the degree of impairment within the range of impairments for that symptomatic level of activity.

 

Figure 1-B (see below) may be used for the assessment of symptomatic impairment caused by ischaemic heart disease, hypertension, cardiomyopathy, or rheumatic heart disease.

 

Figure 1-B: Symptomatic Level of Activity in METS According to Age and Gender

 

Age and

Gender

Symptomatic Level of Activity in METS

1

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

10+

18-30 M

D

D

D

C

C

B

B

B

A

A

18-30 F

D

D

C

C

B

B

A

A

A

 

31-40 M

D

D

D

C

C

B

B

A

A

 

31-40 F

D

D

C

B

B

B

A

 

 

 

41-50 M

D

D

C

C

B

B

A

A

 

 

41-50 F

D

D

C

B

B

A

A

 

 

 

51-60 M

D

D

C

B

B

A

A

A

 

 

51-60 F

D

D

C

B

B

A

A

 

 

 

61-70 M

D

D

C

B

B

A

A

 

 

 

61-70 F

D

D

B

B

A

A

 

 

 

 

70+ M

D

C

B

B

A

 

 

 

 

 

70+ F

D

C

B

A

A

 

 

 

 

 

 

 

Table 1.1: Coronary Artery Disease

 

See notes to Table 1.1 on following page for further details regarding abbreviations and

symbols used in Columns 3, 4 and 5.

 

Column 1

 

% WPI

 

Column 2

 

Level of Activity in METS for

Age and Gender

Column 3

 

Pathology

 

Column 4

 

Drug Therapy

 

Column 5

 

Intervention

 

5

A

not applicable

not applicable

not applicable

10

A

+

+

not applicable

15

A

++

++

PTCA

20

A

+++

+++

CABG/Tx

25

B

+

+

not applicable

30

B

++

++

PTCA

40

B

+++

+++

CABG/Tx

50

C

+

+

not applicable

60

C

++

++

PTCA

65

C

+++

+++

CABG/Tx

75

D

+

+

not applicable

85

D

++

++

PTCA

95

D

+++

+++

CABG/Tx

Notes to Table 1.1

 

1. In Table 1.1, not applicable means the criterion is not applicable to the specified level of impairment.

 

2. Pathology – Column 3.

(i)         Coronary Artery Disease:

+       either <50% stenosis in one or more coronary arteries, or single vessel disease > 50% stenosis (except proximal left anterior descending [LAD] and left main coronary artery [LMCA]);

++     either >50% stenosis in two vessels, or >50% stenosis in proximal LAD, or <50% stenosis in LMCA;

+++   either >50% stenosis in 3 vessels, or LMCA >50% stenosis, or severe diffuse end organ disease.

 

(ii)       Ischaemic Left Ventricular Dysfunction:

+        left ventricular ejection fraction (LVEF) 40-50%;

++     LVEF 30-40%;

+++   either LVEF < 30%, or LV aneurysm.

 

(iii)    Myocardial Infarction (MI):

+        no previous MI;

++     previous possible MI (equivocal changes in ECG/cardiac enzymes);

+++   previous definite MI (unequivocal changes in ECG/cardiac enzymes: typical evolution of ST/T segments, or development of significant Q waves, or enzyme rise > 3 times upper limit of normal).

 

(iv)      Arrhythmias

Assessed under Table 1.3 – Arrhythmias (see page 25).

 

3. Drug Therapy (continuous) – Column 4.

+       one or two drugs;

++     three or four drugs;

+++ five or more drugs.

 

4. Intervention – Column 5.

PTCA means percutaneous transluminal coronary angioplasty and/or stenting.

CABG means coronary artery bypass grafting.

Tx means heart transplant.

 

 


1.2  Hypertension

 

Either diastolic hypertension (section 1.2.1 below) or systolic hypertension (section 1.2.2, see following page) may be assessed, whichever provides the highest WPI rating.

 

1.2.1    Diastolic Hypertension

 

Hypertensive cardiomyopathy can be assessed using the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.

 

Functional class (determined in accordance with Figure 1-B, see page 21) is the primary criterion for assessment. Level of diastolic blood pressure (DBP) and therapy (see Table 1.2.1 below) are secondary criteria for assessment.

 

For assessment use either usual DBP, or therapy, for a given functional class, whichever provides the greater WPI rating. If DBP is consistently >120 on optimal therapy, one higher functional class may be assigned.

 

Table 1.2.1:  Diastolic Hypertension

 

See note immediately following Table 1.2.1 for explanation of symbols

used in the final column (Drug Therapy).

 

 

% WPI

Level of Activity in METS for

Age and Gender

 

Usual DBP

 

Drug Therapy

5

A

>90

+

10

A

>100

++

15

A

>110

+++

20

B

>90

+

25

B

>100

++

30

B

>110

+++

35

C

>90

+

40

C

>100

++

45

C

>110

+++

50

D

>90

+

55

D

>100

++

60

D

>110

+++

 

Note to Table 1.2.1

 

1. Drug Therapy (continuous) – final column of Table 1.2.1:

+       one drug;

      ++     two drugs;

+++  three or more drugs.

 

 


1.2.2    Systolic Hypertension

 

Hypertensive cardiomyopathy can be assessed using the edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment current at the time of assessment.

 

Functional class (determined in accordance with Figure 1-B, see page 21) is the primary criterion for assessment. Level of systolic blood pressure (SBP) and therapy (see Table 1.2.2 below) are secondary criteria for assessment.

 

Table 1.2.2:  Systolic Hypertension

 

See note immediately following Table 1.2.2 for explanation of symbols

used in the final column (Drug Therapy).

 

 

% WPI

Symptomatic Level of Activity in METS for Age and Gender

 

Usual SBP

 

Drug Therapy

5

A

>160

+

10

A

>160

++

15

A

>160

+++

20

B

>170

+

25

B

>170

++

30

B

>170

+++

35

C

>180

+

40

C

>180

++

45

C

>180

+++

50

D

>190

+

55

D

>190

++

60

D

>190

+++

 

Note to Table 1.2.2

 

1. Drug Therapy (continuous):

      +       one drug;

      ++     two drugs;

      +++  three or more drugs.

 

 


1.3  Arrhythmias

 

Underlying cardiac disease can be assessed using other tables in Chapter 1.

 

Functional class (determined under Figure 1-C below), and therapy (see Table 1.3 below), are used to determine the WPI rating.

 

Figure 1-C: Definitions of Functional Class

 

Functional Class

Symptoms

I

No limitation of physical activity.

II

Slight limitation of physical activity.

Comfortable at rest and with ordinary, light Activities of Daily Living.

Greater activity causes symptoms.

III

Marked limitation of physical activity.

Comfortable at rest.

Ordinary activity causes symptoms.

IV

Inability to carry out any physical activity without discomfort.

 

 

Table 1.3:  Arrhythmias

 

See note immediately following Table 1.3 for explanation of symbols

used in the final column (Therapy).

 

% WPI

Functional Class

Therapy

5

I

Nil

10

I

Drug(s)

15

I

Surgery/cath/PPM/Device

20

II

Nil

30

II

Drug(s)

40

II

Surgery/cath/PPM/Device

45

III

Nil

50

III

Drug(s)

55

III

Surgery/cath/PPM/Device

60

IV

not applicable

 

Note to Table 1.3

 

1. Therapy – column 3:

‘cath’ means either catheter ablation or catheter-associated therapy for arrhythmia;

‘PPM’ means permanent pacemaker;

‘Device’ means implanted defibrillator.

 

 


1.4  Peripheral Vascular Disease of the Lower Extremities

 

Amputations should not be assessed under Table 1.4. They should be assessed under Table 9.5: Lower Extremity Amputations (see page 81, Chapter 9 – The Musculoskeletal System).

 

A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic Disorders (see page 150, Chapter 13 – The Haematopoietic System).

 

Table 1.4:  Peripheral Vascular Disease of the Lower Extremities

 

% WPI

Signs and Symptoms

0

The employee experiences neither intermittent claudication nor pain at rest.

5

The employee has no difficulty with distances but experiences ischaemic pain