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Guides & Guidelines as amended, taking into account amendments up to Seafarers Rehabilitation and Compensation Act 1992 - Guide to the Assessment of Permanent Impairment Edition 2.1 - Variation No. 1 of 2011
Administered by: Attorney-General's
Registered 08 Aug 2012
Start Date 01 Dec 2011

 

 

 

 

 

 

 

SEAFARERS REHABILITATION AND COMPENSATION

ACT 1992 – GUIDE TO THE ASSESSMENT OF THE

DEGREE OF PERMANENT IMPAIRMENT –

EDITION 2.1 (CONSOLIDATION 1)

 

 

This consolidation incorporates the Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Degree of Permanent Impairment (Edition 2.1) (02/11/2011) (‘Edition 2.1’) as prepared by the Seafarers Safety, Rehabilitation and Compensation Authority and approved by the Minister for Tertiary Education, Skills, Jobs and Workplace Relations on 2 November 2011 with effect from 1 December 2011 and as varied by the Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of Permanent Impairment Edition 2.1 Variation 1 of 2011 (‘Variation 1 of 2011’) as prepared by the Seafarers Safety, Rehabilitation and Compensation Authority and approved by the Minister for Tertiary Education, Skills, Jobs and Workplace Relations on 29 November 2011 with effect from 1 December 2011

 

NOTES:

1.         Edition 2.1 and Variation 1 of 2011 were each prepared by the Seafarers Safety, Rehabilitation and Compensation Authority under subsection 42(1) of the Seafarers Rehabilitation and Compensation Act 1992 and approved by the Minister under subsection 42(3) of that Act.

2.         Edition 1 was registered on the Federal Register of Legislative Instruments as F2011L02387 and Variation 1 of 2011 was registered as F2011L02517.

3.         This compilation was prepared on 30 November 2011 in accordance with section 34 of the Legislative Instruments Act 2003 substituting paragraph 3 (Application of the Guide) to Edition 2.1 as in force on 1 December 2011.


 

 

Guide to the Assessment of the Degree of Permanent Impairment

 

 

Edition 2.1

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction to Edition 2.1 of the Guide

 

1. Authority. 9

2. Structure of this guide. 9

3. Application of this guide. 10

4. Whole person impairment (WPI). 11

5. Entitlements under the SRC Act. 11

6. Non-economic loss. 11

7. Compensation Payable. 11

8. Interim and final assessments . 12

9. Increase in degree of whole person impairment. 12

Contents. 14

List of tables and figures. 15

List of references. 19

Principles of assessment. 20

1. Impairment and non-economic loss. 21

2. Employability and incapacity. 21

3. Permanent impairment. 21

4. Pre-existing conditions and aggravation. 22

5. The impairment tables. 22

6. Malignancies and conditions resulting in major systemic failure. 22

7. Percentages of impairment. 23

8. Comparing assessments under alternative tables. 23

9. Combined values. 23

10. Calculating the assessment. 23

11. Ordering of additional investigations. 24

12. Exceptions to use of this guide. 24

Glossary. 25


Division 1
Assessment of the degree of an employee’s permanent impairment resulting from an injury. 27

1.0 Introduction. 27

1.1 Coronary artery disease. 30

1.2 Hypertension. 33

1.2.1 Diastolic hypertension. 33

1.2.2 Systolic hypertension. 34

1.3 Arrhythmias. 35

1.4 Peripheral vascular disease of the lower extremities. 36

1.5 Peripheral vascular disease of the upper extremities. 37

1.6 Raynaud’s disease. 38

2.0 Introduction. 41

2.1 Assessing impairment to respiratory function. 41

2.1.1 Measurements. 41

2.1.2 Methods of measurement. 42

2.1.3 Impairment rating. 42

2.2 Asthma and other hyper-reactive airways diseases. 44

2.3 Lung cancer and mesothelioma. 46

2.4 Breathing disorders associated with sleep. 46

3.0 Introduction. 49

3.1 Thyroid and parathyroid glands. 49

3.2 Adrenal cortex and medulla. 50

3.3 Pancreas (diabetes mellitus). 52

3.4 Gonads and mammary glands. 54

4.0 Introduction. 56

4.1 Skin disorders. 56

4.2 Facial disfigurement. 58

4.3 Bodily disfigurement. 59

5.0 Introduction. 61

5.1 Psychiatric conditions. 62

6.0 Introduction. 65

6.1 Central visual acuity. 68

6.1.1 Determining the loss of central vision in one eye. 69

6.2 Determining loss of monocular visual fields. 70

6.3 Abnormal ocular motility and binocular diplopia. 71

6.4 Other ocular abnormalities. 71

6.5 Other conditions causing permanent deformities causing up to 10% impairment of the whole person. 72

6.6 Calculation of visual system impairment for both eyes. 72

7.0 Introduction. 76

7.1 Hearing loss. 76

7.2 Tinnitus. 76

7.3 Olfaction and taste. 77

7.4 Speech. 77

7.5 Air passage defects. 78

7.6 Nasal passage defects. 79

7.7 Chewing and swallowing. 80

8.0 Introduction. 82

8.1 Upper digestive tractoesophagus, stomach, duodenum, small intestine and pancreas. 84

8.2 Lower gastrointestinal tractcolon and rectum.. 86

8.3 Lower gastrointestinal tractanus. 89

8.4 Surgically created stomas. 90

8.5 Liverchronic hepatitis and parenchymal liver disease. 91

8.6 Biliary tract. 92

8.7 Hernias of the abdominal wall. 93

9.0 Introduction. 96

Part IIntroduction. 98

9.1 Feet and toes. 99

9.2 Ankles. 101

9.3 Knees. 102

9.4 Hips. 104

9.5 Lower extremity amputations. 106

9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities. 108

9.6.1 Spinal nerve root impairment affecting the lower extremity. 109

9.6.2 Peripheral nerve injuries affecting the lower extremities. 109

9.7 lower extremity function.................................................................... 111


part ii—introduction................................................................................. 114

9.8 hands and feet........................................................................................ 115

9.8.1 abnormal motion of digits................................................................. 115

9.8.2 sensory losses in the thumb and finger........................................... 119

9.9 wrists..................................................................................................... 121

9.10 elbows................................................................................................... 122

9.11 Shoulders. 124

9.12 upper extremity amputATIONS............................................................. 127

9.13 NEUROLOGICAL IMPAIRMENTS AFFECTING THE UPPER EXTERMITIES........... 129

9.13.1 CERVICAL NERVE ROOT IMPARIMENT...................................................... 130

9.13.2 SPECIFIC NERVE LESIONS AFFECTING THE UPPER EXTREMITIES............... 132

9.13.3 COMPLEX REGIONAL PAIN SYNDROME..................................................... 134

9.14 UPPER EXTREMITY FUNCTION................................................................... 137

Part III—Introduction. 141

Part III—Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment. 142

Part IIIMulti-level fractures involving the spinal canal. 144

9.15 Cervical spinediagnosis-related estimates. 144

9.16 Thoracic spinediagnosis-related estimates. 146

9.17 Lumbar spinediagnosis-related estimates. 148

9.18 Fractures of the pelvis. 150

10.0 Introduction. 152

10.1 The Upper Urinary Tract. 152

10.2 urinary diversion................................................................................ 154

10.3 lower urinary tract............................................................................ 155

11.0 Introduction. 158

11.1 Male reproductive system.. 158

11.1.1 Male reproductive organspenis. 159

11.1.2 Male reproductive organsscrotum.. 159

11.1.3 Male reproductive organstestes, epididymes and spermatic cords. 160

11.1.4 Male reproductive organsprostate and seminal vesicles. 161

11.2 Female reproductive system.. 162

11.2.1 Female reproductive organsvulva and vagina. 163

11.2.2 Female reproductive organscervix and uterus. 164

11.2.3 Female reproductive organsfallopian tubes and ovaries. 165

12.0 Introduction. 167

12.1 Disturbances of levels of consciousness and awareness. 169

12.1.1 Permanent disturbances of levels of consciousness and awareness. 169

12.1.2 Epilepsy, seizures and convulsive disorders. 169

12.1.3 Sleep and arousal disorders. 170

12.2 Impairment of memory, learning, abstract reasoning and problem solving ability   171

12.3 Communication impairments—dysphasia and aphasia. 174

12.4 Emotional or behavioural impairments. 175

12.5 Cranial nerves. 177

12.5.1 The olfactory nerve (I). 177

12.5.2 The optic nerve, the oculomotor and trochlear nerves and the abducens (II, III, IV and VI). 177

12.5.3 The trigeminal nerve (V). 178

12.5.4 The facial nerve (VII). 179

12.5.5 The auditory nerve (VIII). 180

12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII). 181

12.6 Neurological impairment of the respiratory system.. 182

12.7 Neurological impairment of the urinary system.. 183

12.8 Neurological impairment of the anorectal system.. 183

12.9 Neurological impairment affecting sexual function. 184

13.0 Introduction. 186

13.1 Anaemia. 186

13.2 Leukocyte abnormalities or disease. 186

13.3 Haemorrhagic disorders and platelet disorders. 189

13.4: Thrombotic disorders. 189

Division 2 Guide to the assessment of non-economic loss. 190

Introduction. 191

B1. Pain. 192

B2. Suffering. 193

B3. Loss of amenities. 194

B4. Other loss. 196

B5. Loss of expectation of life. 196

B6. Calculation of non-economic loss. 197


Division 3 Calculation of total entitlement under Section 24 and Section 27  198

Appendix 1 Combined values chart. 200

Part 1 Appendix 1:  Combined Values Chart. 201


1. Authority

Division 4 of Part II (sections 39 to 42) of the Seafarers Rehabilitation and Compensation Act 1992 (the Seafarers 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 and the degree of non-economic loss determined by employers under the provisions of the approved guide: 

‘approved Guide’ is defined by section 3 of the Seafarers Act as meaning:

(a)  the document, prepared by the Authority in accordance with section 42 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 42(1), 42(2) and 42(3) of the Seafarers Act, which provide that:

(1) The Authority 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 must 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 must be determined; and

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

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

(3)  A document prepared by the Authority 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 ‘edition 2.1 of the guide’. This guide is binding on employers and the Administrative Appeals Tribunal (subsection 42(4)).

2. Structure of this guide

This guide has three divisions:

DIVISION 1      Division 1 (see page 27) is used to assess the degree of an employee’s permanent impairment resulting from an injury

DIVISION 2      Division 2 (see page 190) is used to assess the degree of an employee’s non-economic loss resulting from impairment

DIVISION 3      Division 3 (see page 198) is used to calculate the total entitlement based on the assessments completed in Divisions 1 and 2.

The principles of assessment (see pages 21-24) and glossary (see pages 25-26) of this guide contain information relevant to the interpretation and application of Divisions 1 and 2.


3. Application of this guide

The Guide to the Assessment of the Degree of Impairment prepared by the Seafarers Safety, Rehabilitation and Compensation Authority under subsection 42(1) of the Seafarers Act and approved by the Minister for Transport and Communications on 17 June 1993 is referred to as the ‘first edition of the guide’.

 

The first edition of the guide was revoked and the second edition of the guide applied in relation to permanent impairment claims made under sections 39, 40 or 41 of the Seafarers Act on and from 1 March 2006.  Claims under those sections received on or before 28 February 2006 continue to be determined under the provisions of the first edition of the guide.

 

The second edition of the guide is revoked on and from 1 December 2011 and edition 2.1 of the guide applies on and from that date.  This edition varies the second edition by addressing medical ambiguities identified by medical practitioners using the second edition of the guide, addressing various errata and providing a 10% impairment rating for all tables within the guide.  Edition 2.1 of the Guide does not change the structure of the second edition of the guide or the composition of benefits payable.

 

Except as provided below, Edition 2.1 of the guide applies to permanent impairment claims under sections 39, 40 or 41 of the Seafarers Act received by the employer on and from 1 December 2011.

 

Where a request by an employee (as defined in section 4 of the Seafarers Act) pursuant to subsection 40(1) of the Seafarers Act (in respect of interim payment of permanent impairment compensation) is received by an employer on or after 1 December 2011, but relates to a claim under section 39 of the Seafarers Act that was received by the employer on or before 28 February 2006, that request must be determined under the provisions of the first edition of the guide.

 

Where a request by an employee pursuant to subsection 40(1) of the Seafarers Act (in respect of interim payment of permanent impairment compensation) is received by an employer on or after 1 December 2011, but relates to a claim under section 39 of the Seafarers Act that was received by the employer on or after 1 March 2006 but before 1 December 2011, that request must be determined under the provisions of the second edition of the guide.

 

Where a claim for compensation pursuant to subsections 40(4) or 40(5) of the Seafarers Act (in respect of a subsequent increase in the degree of permanent impairment) is received by the employer on or after 1 December 2011, that claim must be determined under the provisions of this edition of the guide, notwithstanding that the initial claim for compensation for permanent impairment may have been determined under the provisions of the previous editions of this guide.

 

However, where the initial claim for compensation for permanent impairment was determined under the provisions of the first or second 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 on non-economic loss shall not be less than the degree of permanent impairment or degree of non-economic loss that was determined under the provisions of first or second edition of the guide unless that determination would not have been made but for a false statement or misrepresentation of a person.


4. Whole Person Impairment (WPI)

Prior to 1993, the Seamen’s Compensation Act 1911 (the 1911 Act) (repealed with the coming into effect of the Seafarers Act) provided for the payment of lump sum compensation where a seafarer (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 previous editions, is for the purposes of expressing the degree of impairment as a percentage, based on the concept of ‘whole person impairment’. Subsection 39(5) of the Seafarers Act provides for the determination of the degree of permanent impairment of the employee resulting from an injury, 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 this guide.

5. Entitlements under the Seafarers Act

Where the degree of permanent impairment of the employee determined under subsection 39(5) of the Seafarers Act is less than 10%, paragraph 39(7) of the Seafarers Act provides that compensation is not payable to the employee under section 39 of that Act.

Subsection 39(8) of the Seafarers Act excludes the operation of subsection 39(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.

6. Non-economic loss

Subsection 41(1) of the Seafarers 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 41.

Non-economic loss is assessed under Division 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 (see Division 3 for calculation of total entitlement).


8. Interim and final assessments

On the written request of the employee under subsection 40(1) of the Seafarers 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%

·         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 40(3) of the Seafarers 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 in respect of the same injury, the employee may request, pursuant to subsection 40(4) of the Seafarers Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of impairment only.

See section 3 above (application of this guide) as to assessments of the degree of permanent impairment made under the previous editions of the guide.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLAIMS FOR

PERMANENT IMPAIRMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Table of contents

List of tables and figures                                                                         15

List of references.................................................................................. 19

Principles of assessment.................................................................... 20

Glossary............................................................................................ 25
Division 1      Assessment of the degree of an employee’s
permanent impairment resulting from an injury
................. 27

Chapter 1   – The cardiovascular system................................ 27

Chapter 2   – The respiratory system..................................... 40
Chapter 3   – The endocrine system....................................... 48
Chapter 4   – Disfigurement and skin disorders........................ 55
Chapter 5   – Psychiatric conditions........................................ 60

Chapter 6   – The visual system............................................ 64

Chapter 7   – Ear, nose and throat disorders........................... 75
Chapter 8   – The digestive system........................................ 81
Chapter 9   – The musculoskeletal system............................... 94
Chapter 10 – The urinary system......................................... 151
Chapter 11 – The reproductive system.................................. 157
Chapter 12 – The neurological system................................... 166

Chapter 13 – The haematopoietic system.............................. 185

Division 2      Guide to the assessment of non-economic loss................ 190

Division 3      Calculation of total entitlement....................................... 198

Appendix 1:  Combined values chart........................................................ 200

Index............................................................................................... 204


List of tables and figures

Division 1 – Assessment of degree of an employee’s permanent impairment resulting from injury

Chapter 1 – The cardiovascular system

Figure 1-A:    Activities of daily living.... 29

Figure 1-B:    Symptomatic level of activity in METS according to age and gender                 30

Table 1.1:      Coronary artery disease 31

Table 1.2.1:  Diastolic hypertension .... 33

Table 1.2.2:  Systolic hypertension ..... 34

Figure 1-C:    Definitions of functional class                  35

Table 1.3:      Arrhythmias ................ 35

Table 1.4                                     Peripheral vascular disease of the lower extremities        36

Table 1.5:     Peripheral vascular disease of the upper extremities                 37

Figure 1-C:    Definitions of functional class          38

Table 1.6:      Raynaud’s Disease ........ 39

Chapter 2 – The respiratory system

Table 2.1:      Conversion of respiratory function values to impairment            43

Figure 2-A:  . Calculating asthma impairment score         45

Table 2.2:  ... Whole person impairment derived from asthma impairment score         46

Figure 2-B:  . Calculating obstructive sleep apnoea score 47

Table 2.4  .... Whole person impairment derived from obstructive sleep apnoea score 47

Chapter 3 – The endocrine system

Table 3.1       Thyroid and parathyroid glands       50

Table 3.2       Adrenal cortex and medulla           51

Table 3.3:      Pancreas (diabetes mellitus) 52

Table 3.4:      Gonads and mammary glands         54

Chapter 4 – Disfigurement and skin disorders

Table 4.1:      Skin disorders .............. 57

Figure 4-A:    Activities of daily living.... 57

Table 4.2:      Facial disfigurement ...... 58

Table 4.3:      Bodily disfigurement....... 59

Chapter 5 – Psychiatric conditions

Figure 5-A:    Activities of daily living.... 61

Table 5.1:      Psychiatric conditions ..... 62

Chapter 6 – The visual system

Figure 6-A:    Steps for calculating impairment of the visual system      66

Table 6.1:      Conversion of the visual system to whole person impairment rating       67

Figure 6-B:    Revised LogMar equivalent for different reading cards     68

Figure 6-C:    Percentage loss of central vision in one eye          69

Figure 6-D:    Normal extent of the visual field     70

Figure 6-E:    Percentage loss of ocular motility of one eye in diplopia fields     71

Figure 6-F:    Calculation of visual system impairment for both eyes     73

 

List of tables and figures continues over page


List of tables and figures (continued)

Chapter 7 – Ear, nose and throat disorders

Table 7.2:      Tinnitus........................ 76

Table 7.3:      Olfaction and taste......... 77

Table 7.4:      Speech........................ 78

Table 7.5:      Air passage defects....... 79

Table 7.6:      Nasal passage defects.... 79

Table 7.7:      Chewing and swallowing.. 80

Chapter 8 – The digestive system

Figure 8-A:    Activities of daily living.... 82

Figure 8-B:    Body mass index criteria. 83

Table 8.1:     Upper digestive tract: Oesophagus, stomach, duodenum, small intestine and pancreas 84

Table 8.2:     Lower gastrointestinal tract: Colon and rectum      86

Table 8.3:     Lower gastrointestinal tract: Anus    89

Table 8.4:      Surgically created stomas...           90

Table 8.5:      Liver (Chronic hepatitis and parenchymal liver disease)    91

Table 8.6:      Biliary tract.................. 92

Table 8.7:     Hernias of the abdominal wall         93

Chapter 9 – The musculoskeletal system

Figure 9-A     Activities of daily living.... 96

Figure 9-B     Tables of normal ranges of motion of joints         97

Table 9.1:      Feet and toes............... 99

Table 9.2:      Ankles ...................... 101

Table 9.3:      Knees........................ 103

Table 9.4:      Hips........................... 104

Table 9.5:     Lower extremity amputations         106

Figure 9-C:    Grading system........... 108

Table 9.6.1:   Spinal nerve root impairment affecting the lower extremity        109

Table 9.6.2a: Sensory impairment due to peripheral nerve injuries affecting the lower extremities    110

Table 9.6.2b: Motor impairment due to peripheral nerve injuries affecting the lower extremities       110

Table 9.7:      Lower extremity function...           112

Table 9.8.1a: Abnormal motion/ankylosis of the thumb – IP and MP joints        115

Table 9.8.1b: Radial abduction/adduction/ opposition of the thumb – Abnormal motion/ankylosis       116

Table 9.8.1c: Abnormal motion/ankylosis of the fingers – Index and middle fingers     117

Table 9.8.1d: Abnormal motion/ankylosis of the fingers – Ring and little fingers          117

Table 9.8.2a: Sensory losses in the thumb 119

Table 9.8.2b: Sensory losses in the index and middle fingers      119

Table 9.8.2c: Sensory losses in the little finger     120

Table 9.8.2d: Sensory losses in the ring finger     120

Table 9.9.1a: Wrist flexion/extension.. 121

Table 9.9.1b: Radial and ulnar deviation of wrist joint      122

Table 9.10.1a:Elbow flexion/extension. 123

Table 9.10.1b: Pronation and supination of forearm         123

Table 9.11.1a: Shoulder flexion/extension 125

Table 9.11.1b: Shoulder flexion/extension internal/external rotation of  shoulder        126

List of Tables and Figures continues over page


List of tables and figures (continued)

Table 9.11.1c: Abduction/adduction of shoulder     127

Table 9.12.1: Upper extremity amputations          128

Table 9.12.2: Amputation of digits..... 128

Figure 9-D:    Grading system........... 129

Table 9.13.1: Cervical nerve root impairment       131

Table 9.13.2a:Specific nerve lesions affecting the upper extremities – Sensory impairment    133

Table 9.13.2b:..... Specific nerve lesions a affecting the upper extremities – Motor impairment        134

Figure 9-E     Diagnostic criteria for CRPS           135

Figure 9-F     Impairment grading for CRPS         136

Table 9.14     Upper extremity function 138

Table 9.15:    Cervical spine – Diagnosis-related estimates                   144

Table 9.16:    Thoracic spine – Diagnosis-related estimates         146

Table 9.17:    Lumbar spine – Diagnosis-related estimates          148

Table 9.18:    Fractures of the pelvis.. 150

Chapter 10 – The urinary system

Table 10.1:    The upper urinary tract. 153

Table 10.2:    Urinary diversion.......... 154

Table 10.3:    Lower urinary tract...... 156

Chapter 11 – The reproductive system

Table 11.1.1: Male reproductive organs – Penis              159

Table 11.1.2: Male reproductive organs – Scrotum         159

Table 11.1.3: Male reproductive organs – Testes, epididymes and spermatic cords                160

Table 11.1.4: Male reproductive organs – Prostate and seminal vesicles           161

Table 11.2.1: Female reproductive organs – Vulva and vagina              163

Table 11.2.2: Female reproductive organs – Cervix and uterus             164

Table 11.2.3: Female reproductive organs – Fallopian tubes and ovaries           165

Chapter 12 – The neurological system

Figure 12-A: Activities of daily living.. 168

Table 12.1.1: Permanent disturbances of levels of consciousness and awareness                 169

Table 12.1.2: Epilepsy, seizures and convulsive disorders           169

Table 12.1.3: Sleep and arousal disorders 170

Table 12.2:    Impairment of memory, learning, abstract reasoning and problem solving ability                                                    171

Figure 12-B: Clinical Dementia Rating (CDR)        172

Table 12.3:    Criteria for rating impairment due to aphasia or dysphasia         174

Table 12.4:    Emotional or behavioural impairments        176

Table 12.5.1: The olfactory nerve (I). 177

Table 12.5.3: The trigeminal nerve (V) 178

Table 12.5.4: The facial nerve (VII)... 179

Table 12.5.5: The auditory nerve (VIII)...           180

Figure 12-C:  % WPI modifiers for episodic conditions     181

Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)      182

List of Tables and Figures continues over page

List of tables and figures (continued)

Table 12.6:    Neurological impairment of the respiratory system 182

Table 12.7:    Neurological impairment of the urinary system      183

Table 12.8:    Neurological impairment of the anorectal system   183

Table 12.9:    Neurological impairment affecting sexual function  184

Chapter 13 – The haematopoietic system

Table 13.1:    Anaemia..................... 186

Figure 13-A: Activities of daily living.. 187

Table 13.2:    Leukocyte abnormalities or disease  188

Table 13.3:    Haemorrhagic disorders and platelet disorders      189

Table 13.4:    Thrombotic disorders.... 189

Division 2 – Guide to the assessment of non-economic loss

Table B1:      Pain........................... 192

Table B2:      Suffering.................... 193

Table B3.1:    Mobility...................... 194

Table B3.2:    Social relationships....... 195

Table B3.3:    Recreation and leisure activities       195

Table B4:      Other loss................... 196

Table B5:      Loss of expectation of life..           196

B6:              Worksheet
Calculation of non-economic loss     197

Division 3 – Final calculation of entitlements under section 24 and section 25

 

C1:              Worksheet ......................
Final calculation of entitlements       199

Appendices

Appendix 1    Combined values chart.. 201

 

 

 



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.

 

 



 

Principles of assessment

                                                                                                  Page no.    

1.  Impairment and non-economic loss ............................................ 21

2.  Employability and incapacity ..................................................... 21

3.  Permanent impairment ............................................................ 21

4.  Pre-existing conditions and aggravation ...................................... 22

5.  The impairment tables ............................................................. 22

6.   Malignancies and conditions resulting in major systemic failure........ 22

7.  Percentages of impairment ...................................................... 23

8.  Comparing assessments under alternative tables .......................... 23

9.    Combined values .................................................................... 23

        10.  Calculating the assessment ....................................................... 23

11.  Ordering of additional investigations ........................................... 24

12.  Exceptions to use of this guide .................................................. 25

 

 

 


 

1.   Impairment and non-economic loss

Under section 3 of the Seafarers Act, impairment means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily 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 by reference to the functional capacities of a normal healthy person.

 

Non-economic loss is assessed in accordance with Division 2 (page 190) of this guide, and deals with the effects of the impairment on the employee’s life. Under section 3 of the Seafarers Act, non economic loss, for 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’. 

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 section 3 of the Seafarers Act ‘permanent’ means ‘likely to continue indefinitely’. Subsection 39(2) of the Seafarers 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

(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

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 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 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 Appendix 1.

 


7.   Percentages of impairment

Most tables in Division 1 provide impairment values expressed as fixed percentages. Where such 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%.

Where a table provides for impairment values within a range, consideration will need to be given to all criteria applicable to the condition, which includes performing activities of daily living and an estimate of the degree to which the medical impairment interferes with these activities. In some cases, additional information may be required to determine where to place an individual within the range. The person conducting the assessment must provide written reason why he or she considers the selected point within the range as clinically justifiable.

For further information relating to the application of this guide, please contact the Comcare Permanent Impairment Guide Helpdesk on 1300 366 979 or email PI.Guide@comcare.gov.au.

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 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 115). 

Where there is an initial injury (or pre-existing condition) which results in impairment, and a second injury which results in impairment to the same bodily part, system or function the pre-existing impairment must be disregarded when assessing the degree of impairment of the second injury. The second injury should be assessed by reference to the functional capacities of a normal healthy person. The final scores are then added together.

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 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 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 this guide. 

12. Exceptions to use 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 this guide, the assessment is to be made under the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

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

·         chronic pain conditions, except in the case of migraine or tension headaches. (For complex regional pain syndromes affecting the upper extremities, see Chapter 9 – 9.13.3 Complex regional pain syndrome, see page 134).

Any reference in this guide to the American Medical Association’s Guides to the Evaluation of Permanent Impairment is a reference to the 5th edition 2001.

 

 

 

 



Glossary

Definitions in italics are from section 3 of the Seafarers 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.

Impairment                      means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily 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 anything 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    is the methodology used for expressing the degree of impairment of a person, resulting from an injury, as a percentage. 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.

 

 


 

 

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.............................................................................. 29

1.1.... Coronary artery disease.............................................................. 30

1.2.... Hypertension............................................................................. 33

1.2.1 Diastolic hypertension......................................................... 33

1.2.2 Systolic hypertension.......................................................... 34

1.3 ... Arrhythmias.............................................................................. 35

1.4 ... Peripheral vascular disease of the lower extremities......................... 36

1.5 ... Peripheral vascular disease of the upper extremities......................... 37

1.6 ... Raynaud’s Disease..................................................................... 38

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


1.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26).

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 American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

For post-thrombotic syndrome, assessments under Tables 1.4 and 1.5 are an alternative to Table 13.4: Thrombotic disorders. 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 immediately following Table 1.1 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 35).

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, on page 34) may be assessed, whichever provides the higher WPI rating.

 

1.2.1 Diastolic hypertension

Hypertensive cardiomyopathy can be assessed using the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

Functional class (determined in accordance with Figure 1-B) is the primary criterion for assessment. Level of diastolic blood pressure (DBP) and therapy (see Table 1.2.1) 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 American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

Functional class (determined in accordance with Figure 1-B, see page 30) 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), 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

Amputees should not be assessed under Table 1.4. They should be assessed under Table 9.5: Lower extremity amputations.

A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic disorders.

 

Table 1.4:  Peripheral vascular disease of the lower extremities

% WPI

Signs and symptoms

0

The employee experiences neither intermittent claudication nor ischaemic pain at rest.

5

The employee has no difficulty with distances but experiences ischaemic pain on climbing either steps or gradients.

10

The employee experiences claudication on walking 200 metres or more at an average pace on level ground.

20

The employee experiences claudication on walking more than 100 but less than 200 metres at average pace on level ground.

30

The employee experiences claudication on walking more than 75 but less than 100 metres at average pace on level ground.

40

The employee experiences claudication on walking more than 50 but less than 75 metres at average pace on level ground.

50

The employee experiences claudication on walking more than 25 but less than 50 metres at average pace on level ground.

60

The employee experiences claudication on walking less than 25 metres at average pace on level ground.

70

The employee experiences ischaemic pain at rest.

 


1.5  Peripheral vascular disease of the upper extremities

Amputees should not be assessed under Table 1.5. They should be assessed under Table 9.12.1: Upper extremity amputations, or Table 9.12.2: Amputation of digits.

A WPI rating from Table 1.5 must not be combined with a WPI rating from Table 13.4: Thrombotic disorders.

 

Table 1.5  Peripheral vascular disease of the upper extremities

% WPI

Symptoms

Signs

5

Either no claudication or transient oedema.

Calcification of arteries on X-ray.

10

Either no claudication or persistent oedema controlled by support.

Dilatation of either arteries or veins.

15

As above.

Either loss of pulse or healed ulcer or surgery.

20

Either claudication on strenuous exercise or persistent oedema uncontrolled by support.

Either calcification of arteries on X-ray or dilatation of either arteries or veins.

30

As above.

Superficial ulcer.

40

As above.

Either deep or widespread ulcer or surgery.

45

Claudication on mild-moderate exertion.

Either calcification of arteries on X-ray or dilatation of either arteries or veins.

50

As above.

Superficial ulcer.

55

As above.

Either deep or widespread ulcer or surgery.

60

Rest pain/unable to exercise.

not applicable

 


1.6  Raynaud’s Disease

Functional class (determined according to Figure 1-C below) is the primary criterion for assessment. Signs of vasospastic disease and therapy (see Table 1.6) are secondary criteria for assessment.

 

Figure 1-C: Definitions of functional class

See note immediately following Figure 1-C.

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.

 

Note to Figure 1-C

1. Figure 1-C also appears in Section 1.3 – Arrhythmias, page 35). It is repeated here for ease of reference.

 


Table 1.6: Raynaud’s Disease

See note immediately following Table 1.6. 

% WPI

Functional Class

Signs

Therapy

5

I

Nil.

Nil.

10

I

Nil.

Drug(s).

15

I

Nil.

Surgery.

20

II

Neither ulceration nor trophic changes.

Drug(s).

25

II

Either ulceration or trophic changes.

Drug(s).

30

II

not applicable

Surgery.

35

III

Neither ulceration nor trophic changes.

Drug(s).

40

III

Either ulceration or trophic changes.

Drug(s).

45

III

not applicable

Surgery.

50

IV

not applicable

not applicable

 

Note to Table 1.6

 

1. Therapy – final column of Table 1.6:

Surgery includes sympathectomy and local debridement.

Drug(s) means continuous therapy with one or more drugs.


Chapter 2 – The respiratory system

                                                                                                                                                                                                          Page no.

2.0     Introduction.............................................................................. 41

2.1  .. Assessing impairment to respiratory function.................................. 41

2.1.1.. Measurements................................................................. 41

2.1.2 . Methods of measurement.................................................. 42

2.1.3.. Impairment rating............................................................. 42

2.2.... Asthma and other hyper-reactive airways diseases.......................... 44

2.3.... Lung cancer and mesothelioma..................................................... 46

2.4.... Breathing disorders associated with sleep....................................... 46

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


2.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26).

The measure of impairment is the reduction in physiological function below that found in health. 

Respiratory impairment is quantified by the degree to which measurements of respiratory function are changed by the compensable injury or injuries, relative to values obtained in a healthy reference population of similar individuals. 

Conditions such as chronic obstructive airways disease and chronic bronchitis are to be assessed according to the methods used to measure loss of respiratory function. 

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.

2.1  Assessing impairment of respiratory function

2.1.1 Measurements

The most commonly recommended measurements for determining respiratory impairment are:

·         spirometry with measurement of the forced expiratory volume at 1 second (FEV1) and forced vital capacity (FVC)

·         the transfer factor, or diffusing capacity of the lung, for carbon monoxide (TlCO), measured by the single breath method. 

However, the measurements used must be derived from either:

·         the tests prescribed below where relevant (for example, in assessing asthma)

·         where a test is not prescribed, from tests appropriate to assessing the impairments caused by the particular compensable condition or conditions.

Other measurements commonly used to assess impairment include:

·         the lung volumes

·         total lung capacity (TLC) and residual volume (RV)

·         the response to a maximum exercise test including measurement of the oxygen consumption at the maximum workload able to be achieved (vO2max), and the degree of arterial oxygen desaturation during exercise.

On occasion, other measurements may be needed to define impairment accurately. For example:

·         the elastic and flow resistive properties of the lungs

·         respiratory muscle strength

·         arterial blood gases

·         polysomnography (sleep studies)

·         echocardiography with estimation of pulmonary artery pressure

·         quantitative ventilation-perfusion scans of the lung.

 

Measurement of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO2 and PaCO2 respectively) are not usually required to assign impairment ratings accurately. However, individual variation may result in severe impairment in gas exchange when other measures of function indicate only moderate impairment. Arterial PaO2 of <55 mm Hg and/or PaCO2 >50 mm Hg, despite optimal treatment, is evidence of severe impairment and attracts a WPI rating of 70%. 

Measurements of arterial blood gases should be performed on two occasions, with the employee seated.

2.1.2  Methods of measurement

Measurements must be performed in a manner consistent with the methods used by a respiratory function laboratory accredited by one or more of the following bodies:

·         the Thoracic Society of Australia and New Zealand

·         the Australian Sleep Society

·         the Australian Council on Health Care Standards 

Methods of measurement should conform to internationally recognised standards in relation to the equipment used, the procedure, and analysis of the data. Reference values (‘predicted’ normal values) should be representative of the healthy population and be appropriate for ethnicity where possible. Laboratories providing measurements used to assess impairment should state the method(s) of measurement used, and the source of the reference values used.

2.1.3  Impairment rating

Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and vO2max. These professional groups include the Thoracic Society of Australia and New Zealand (Abramson, 1996), the American Thoracic Society (American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986), and the American Medical Association (2001). In general, measurements are expressed as a percentage of the predicted value (%P) and, where several measurements are performed, the most abnormal result is used to classify the degree of impairment.

Severity of impairment is rated as shown in Table 2.1. This generic table can be used to assign WPI ratings using any valid measurement for which there are predicted normal data.

 

Table 2.1: Conversion of respiratory function values to impairment

See note immediately following Table 2.1

% WPI

Respiratory function %P

0

>85

10

85 to 76

20

75 to 66

30

65 to 56

40

55 to 51

50

50 to 44

60

45 to 41

70

40 to 36

80

35


Note to Table 2.1

1. %P = percentage of mean value for healthy individuals of the same age, height and sex.  

 

 


2.2  Asthma and other hyper-reactive airways diseases

Assessment of impairment due to asthma can be confounded by the natural history of occupational asthma, by variably severe airflow obstruction, and therefore variable FEV1, and by response to treatment.

For hyper-reactivity of airways due to occupational exposures, assessment of impairment is made after:

·         the diagnosis and cause are established

·         exposure to the provoking factors is eliminated

·         appropriate treatment of asthma is implemented.

Appropriate treatment follows the guidelines in the Asthma Management Handbook 2002 (National Asthma Council, 2002, 5th edition, Melbourne: National Asthma Council of Australia), a later edition of those guidelines, or later guidelines widely accepted by the medical profession as representing best practice.

Permanent impairment should not be assessed until two years after cessation of exposure to provoking factors as severity may decrease during this period.

An impairment rating scale is set out in Figure 2-A and Table 2.2. The scale used in Figure 2-A and Table 2.2 is modified to account for frequency of increased impairment from asthma despite optimal treatment.

A score reflecting impairment from asthma is calculated by:

·         adding the points scored for reduction in FEV1 %P

and either

·           change in FEV1 with bronchodilator (reversibility)

or

·           degree of bronchial hyperreactivity defined by the cumulative dose of metacholine, or histamine, required to decrease baseline FEV1 by at least 20%

and

·           measurement of FEV1, or peak flow (PF) rate, measured by the employee morning and evening, before and after aerosol bronchodilator, for at least 30 days.

 

The number of days on which any valid measurement of FEV1 or PF is less than 0.85 x the mean of the six highest values of FEV1 or PF during the monitoring period is to be expressed as a percentage of total days in the monitoring period. 

The maximum impairment score from Figure 2-A below is 11. One additional point is given, yielding a score of 12, if asthma cannot be controlled adequately with maximal treatment. The score from Figure 2-A is converted to a WPI rating using Table 2.2.

 

Figure 2-A:  Calculating Asthma Impairment Score

See notes immediately following Figure 2-A

 

Score

FEV1, % P

after bronchodilator

DFEV1, % Change in FEV1 with bronchodilator

PD20

or mmol

% of Days Lowest FEV1* is 0.85 highest FEV1

0

>85

<10

>4.0

<6

1

76 to 85

10 to 19

0.26 to 4.0

6 to 24

2

66 to 75

20 to 29

0.063 to 0.25

25 to 34

3

56 to 65

30

0.062

35 to 44

4

55

 

 

45

 

Notes to Figure 2-A

1. Figure 2-A is based on scales proposed by: the American Thoracic Society (1993), as adapted in Tables 5-9 and 5-10 of American Medical Association’s Guides to the Evaluation of Permanent Impairment (5th edition, 2001); and the Thoracic Society of Australia and New Zealand (Abramson, 1996).

2. %P = percent predicted normal value.

3. PD20 = cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV1.

4. * monitored twice daily before and after aerosol bronchodilator for at least 30 days during adequate

treatment.

5. % of days = proportion of days any value of FEV1 (or of peak flow rate) is less than highest repeatable FEV1

(or peak flow rate) x 0.85.

 


Table 2.2:  WPI derived from asthma impairment score

% WPI

Asthma impairment score

0

0

10

1

20

2

30

3

40

4

45

5

50

6

55

7

60

8

65

9

70

10

75

11

80

12

 

2.3  Lung cancer and mesothelioma

Employees with lung cancers (other than mesothelioma) are considered severely impaired at the time of diagnosis and are given a WPI rating of 70%.

If there is evidence of tumour, or if tumour recurs one year after diagnosis is established, then the employee remains severely impaired and the WPI rating is increased to 80%.

Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.

2.4  Breathing disorders associated with sleep

Some disorders such as obstructive sleep apnoea, central sleep apnoea, and hypoventilation during sleep, can cause impairment which is not quantifiable by standard measurements of respiratory function such as spirometry, diffusing capacity, or response to exercise.

Obstructive sleep apnoea should be assessed using Table 2.4. Central sleep apnoea should be assessed using Table 12.1.3: Sleep and arousal disorders.

An overnight sleep study is used to define the severity of sleep-related disorders of breathing and can be used to define impairment after appropriate treatment has been implemented. During the overnight sleep study there is continuous monitoring of breathing pattern, respiratory effort, arterial oxygen saturation, electrocardiogram, and sleep state. Results of sleep studies cannot readily be expressed in terms of a percentage of predicted values. Consequently, impairment is rated by assigning scores to the degree of abnormality at sleep study (Figure 2-B, and Table 2.4). These ratings are based on frequency of disordered breathing, frequency of sleep disturbance, degree of hypoxaemia and, as appropriate, hypercapnoea during sleep. In addition, degree of daytime sleepiness is assessed using the Epworth sleepiness scale (Johns, 1991).

 

Where vascular morbidity is present (for example, high blood pressure or myocardial infarction) and is attributable to sleep apnoea, impairment should be assessed using the relevant table in Chapter 1 – The cardiovascular system.

The total score derived from Figure 2-B below is the sum of the scores from each column: the maximum score is 12. This score is converted to a WPI rating using Table 2.4 below.

 

Figure 2-B:  Calculating obstructive sleep apnoea score

See notes immediately following Figure 2-B.

Score

Epworth sleepiness score

Apnoeas + hypopnoeas/hr of sleep

Respiratory arousals*/hr of sleep

Cumulative sleep time, mins, with SaO2 <90% #

0

<5

<5

<5

0

1

5 to 10

5 to 15

5 to 15

<15

2

11 to 17

16 to 30

16 to 30

15 to 45

3

>17

>30

>30

>45

 

Notes to Figure 2-B

1. *An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory effort related arousal, as defined by the American Academy of Sleep Medicine (1999).

2.  #SaO2 = arterial oxygen saturation measured with a pulse oximeter.

 

Table 2.4:  WPI derived from obstructive sleep apnoea score

 

% WPI

Sleep apnoea score

0

0

10

1

20

2

30

3

40

4

45

5

50

6

55

7

60

8

65

9

70

10

75

11

80

12

 


 

 

Chapter 3 – The endocrine system

                                                                                                          Page no.

3.0     Introduction.............................................................................. 49

3.1  .. Thyroid and parathyroid glands..................................................... 49

3.2  .. Adrenal cortex and medulla.......................................................... 50

3.3  .. Pancreas (diabetes mellitus)......................................................... 52

3.4  .. Gonads and mammary glands...................................................... 54

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


3.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26).

The degree of impairment caused by secondary conditions (such as peripheral neuropathy, or peripheral vascular disease) accompanying an endocrine system condition must also be assessed under the relevant tables in other chapters, including tables in Chapter 10 – The urinary system.

In this circumstance, using the combined values chart (Appendix 1), WPI ratings derived from the relevant tables in other chapters are combined with WPI ratings from tables in Chapter 3.

3.1  Thyroid and parathyroid glands

Hyperthyroidism is not considered to cause permanent impairment because the condition is usually amenable to treatment. Where visual and/or cosmetic effects resulting from exophthalmos persist following correction of the hyperthyroidism, a WPI rating may be derived from:

·         Chapter 4 – Disfigurement and skin disorders

·         Chapter 6 – The visual system (see section 6.5 - Other conditions causing permanent deformities causing up to 10% impairment of the whole person).

Hyperparathyroidism is usually amenable to correction by surgery. If surgery fails, or the employee cannot undergo surgery for sound medical reasons, long-term therapy may be needed. If so, permanent impairment can be assessed after stabilisation of the condition with medication, in accordance with the criteria in Table 3.1 below.

Where an employee has more than one of the conditions in Table 3.1 below, combine the WPI ratings using the combined values chart (see Appendix 1).

Permanent secondary impairment resulting from persistent hyperparathyroidism (such as renal calculi or renal failure) should be assessed under the relevant system (for example, Chapter 10 – The urinary system).


 

Table 3.1 Thyroid and Parathyroid Glands

% WPI

Criteria

0

Hyperparathyroidism – symptoms and signs readily controlled by medication or other treatment such as surgery.

 

Hypoparathyroidism – symptoms and signs readily controlled by medication.

 

Hypothyroidism adequately controlled by replacement therapy.

10 - 15

Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy.

 

Hyperparathyroidism – persisting mild hypercalcaemia, despite medication.

 

Hypoparathyroidism – symptoms and signs such as intermittent hyper or hypocalcaemia not readily controlled by medication.

30

Hyperparathyroidism – persisting severe hypercalcaemia with serum calcium above 3.0mmol/l, despite medication.

Notes to Table 3.1

1.    Assessors should refer to the principles of assessment for guidance on awarding an impairment value within a range.

3.2  Adrenal cortex and medulla

Where Cushing’s syndrome is present, Table 3.2 below should be used to evaluate impairment from the general effects of hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).

Using the combined values chart (see Appendix 1), WPI ratings derived from Table 3.2 may be combined with WPI ratings for specific associated secondary impairments (for example, fractures or diabetes mellitus).

 

Table 3.2 Adrenal cortex and medulla

% WPI

Criteria

0

Cushing’s syndrome – surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion.

 

Phaeochromocytoma – benign tumour, surgically removed or removable where hypertension has not led to the development of permanent cardiovascular disease.

5

Hypoadrenalism – symptoms and signs readily controlled with replacement therapy.

 

Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15 mg of prednisolone per day) where glucocorticoids will be required long-term.

10

Cushing’s syndrome – surgically corrected by removal of pituitary adenoma or adrenal carcinoma.

15

Cushing’s syndrome – due to:

·         bilateral adrenal  hyperplasia treated by adrenalectomy; or

·         large doses of glucocorticoids (for example, equivalent of at least 15 mg of prednisolone per day) where glucocorticoids will be required long-term; or

·         inadequate removal of source of ectopic ACTH secretion.

 

Phaeochromocytoma – malignant tumour where signs and symptoms of catecholamine excess can be controlled by blocking agents.

 

Hypoadrenalism – recurrent episodes of adrenal crisis during acute illness or in response to significant stress.

70

Phaeochromocytoma – metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be controlled by blocking agents or other treatment.

 

 

 

 

 

 


3.3  Pancreas (diabetes mellitus)

Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6 – The visual system.

Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter 10 – The urinary system.

Using the combined values chart (see appendix 1), WPI ratings derived under Table 3.1 and Table 3.2 may be combined with WPI ratings from Table 3.3 below.

Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20 mg/minute. Where a 24 hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least 2 out of 3 consecutive urine specimens collected.

 

Table 3.3:  Pancreas (diabetes mellitus)

See notes to Table 3.3 immediately following table.

% WPI

Type

Therapy

Microvascular complications

5

Type 2 (NIDDM)

Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control.

Microangiopathy is not present.

10

Type 2 (NIDDM)

Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control.

Microangiopathy and/or significant neuropathy are present.

15

Type 1 (IDDM)

Dietary restrictions and insulin give satisfactory control.

Microangiopathy is not present.

20

Type 1 (IDDM)

Type 2 (NIDDM)

Dietary restrictions and insulin give satisfactory control

 

Type 2 (NIDDM) where dietary restrictions & insulin &/or oral hypoglycaemic agents give satisfactory control.

Microangiopathy and/or significant neuropathy are present.

25

Type 1 (IDDM)

Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.

Microangiopathy is not present.

30

Type 1 (IDDM)

Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.

Microangiopathy is present.

40

Type 1 (IDDM)

Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.

Microangiopathy is present as well as significant neuropathy.

50

 

Symptomatic hypoglycaemia due to metastatic tumour (usually insulinoma), uncontrolled by medication (such as diazoxide).

 

 

Notes to Table 3.3

1. For the purposes of Table 3.3, the degree of control is defined by reference to the glycated haemoglobin measurement (HbA1c) where:

·     4%-6% is the non-diabetic range

·     <8% is indicative of satisfactory control for the purposes of this table.

2. ‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with quality of life to a considerable degree.

3. ‘NIDDM’ means non-insulin dependent diabetes mellitus.

4. ‘IDDM’ means insulin dependent diabetes mellitus.

 


3.4  Gonads and mammary glands

Impairments resulting from inability to reproduce, and other impairments associated with gonadal dysfunction, are assessed under Chapter 11 – The reproductive system.

Loss of one or both breasts in females should also be assessed using Table 4.3: Bodily disfigurement (see Chapter 4 – Disfigurement and skin disorders). Using the combined values chart (see Appendix 1), a WPI rating derived from Table 4.3 may be combined with a WPI rating derived from Table 3.4 below.

 

Table 3.4:  Gonads and mammary glands

% WPI

Criteria

 

0

Diminished or absent level of gonadal hormones in either sex.

Abnormally high level of gonadal hormones in either sex.

 

 

5

Loss of one or both breasts in male.

Loss of whole or part of one breast in female.

Gynaecomastia in male where pain interferes with everyday activities – not controlled by medication.

10

Loss of whole or part of both breasts in female.

 

 


Chapter 4 –Disfigurement and Skin Disorders

                                                                                                          Page no.

4.0     Introduction.............................................................................. 56

4.1     Skin disorders........................................................................... 56

4.2     Facial disfigurement................................................................... 58

4.3     Bodily disfigurement................................................................... 59

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


4.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26).

Impairments assessed under Chapter 4 include those caused by secondary conditions accompanying an endocrine system condition. A WPI rating from a table in Chapter 3 – The endocrine system should be combined with WPI ratings resulting from the secondary conditions assessed under Chapter 4.

Loss of one or both breasts in females should be assessed under both:

·         Table 3.4:  Gonads and mammary glands (see Chapter 3 – The endocrine system)

·         Table 4.3:  Bodily disfigurement

·         and the resulting WPI ratings combined.

In cases where two or three of Tables 4.1, 4.2 and 4.3 apply, WPI ratings from each table can be combined using the combined values chart (see Appendix 1).

WPI ratings awarded under Table 4.2 cannot be combined with WPI ratings arising under section 6.4 –Other ocular abnormalities, or section 6.5 – Other conditions causing permanent deformities causing up to 10% impairment of the whole person (see Chapter 6 – The visual system).

4.1  Skin disorders

For the purposes of Table 4.1: Skin disorders:

·         ‘intermittent treatment’ means a course of treatment leading to a break, treatment alternately ceasing and beginning again

·         ‘constant treatment’ means treatment that continues on a regular basis without interruption

·         ‘complex treatment’ means treatment that requires regular and close supervision, usually by a dermatologist. Such supervision could involve regular blood tests and relevant regular physical examinations, such as blood pressure measurement. Complex treatments would be expected to have potential adverse side effects. Categories of drugs forming a part of, or the whole of, complex treatment would include high doses of systemic corticosteroids, or immunosuppressive medications such as azathioprine, methotrexate and cyclosporin. Phototherapy, photochemotherapy, or photophoresis, would also be considered complex treatments.

Column 4 in Table 4.1 is referenced to Figure 4-A: Activities of daily living, immediately below the table.

 

Table 4.1:  Skin disorders

% WPI

Signs and symptoms

Requirement for treatment

Activities of daily living affected

0

Absent.

None, intermittent.

up to 2

5

Absent.

Constant.

up to 2

5

Intermittent.

Intermittent or constant.

up to 2

 

10

Present on a daily basis for periods aggregating 3 or more months per year, but less than 6 months per year.

Intermittent or constant.

1 or more

 

15

Present on a daily basis for period aggregating 6 or more months per year, but less than 9 months per year.

Intermittent or constant.

1 or more

 

20

Present on a daily basis for periods aggregating 9 months per year or more.

Intermittent or constant.

1 or more

 

25

Present on a daily basis for periods aggregating 9 months per year or more.

Constant.

4 or more

 

30

Present on a daily basis for period aggregating 9 months per year or more.

Constant and complex.

6 or more

 

Figure 4-A: Activities of daily living

No.

Activities

Examples

1

Self care, personal hygiene.

Bathing, grooming, dressing, eating, eliminating.

2

Communication.

Hearing, speaking, reading, writing, using keyboard.

3

Physical activity.

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

4

Sensory function.

Tactile feeling.

5

Hand functions.

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

6

Travel.

Driving or travelling as a passenger.

7

Sexual function.

Participating in desired sexual activity.

8

Sleep.

Having a restful sleep pattern.

9

Social and recreational.

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

4.2  Facial disfigurement

 

Table 4.2:  Facial disfigurement

% WPI

Criteria

0

No structural changes.

Normal facial appearance.

Hyperpigmentation, depigmentation, redness or telangiectasis occupying less than 10% of facial area (excluding actinic damage).

Scarring that does not significantly alter the appearance of the face.

5

Hyperpigmentation, depigmentation, redness or telangiectasis occupying 10% or more of the facial area (excluding actinic damage);

or

Scars and/or skin grafts occupying less than 5% of facial area that significantly alter the appearance of the face;

or

Depressed cheek, nasal or frontal bones.

Total or partial loss of one external ear.

10

Scars and/or skin grafts occupying 5-15% of facial area that significantly alter the appearance of the face;

or

Total or partial loss of both external ears;

or

Loss of less than 50% of the nose.

15

Scars and/or skin grafts occupying 15-25% of facial area that significantly alter the appearance of the face;

or

Loss of 50-75% of the nose.

20

 

 

Scars and/or skin grafts occupying more than 25% of facial area that significantly alter the appearance of the face;

or

Loss of more than 75% of the nose.

 


4.3  Bodily disfigurement

 

Table 4.3:  Bodily disfigurement

% WPI

Criteria

0

Normal body appearance.

Scars and/or skin grafts occupying less than 10% of body area.

5

Scars and/or skin grafts occupying 11% to 20% of body surface.

10

Scars and/or skin grafts occupying 21% to 40% of body area;

or

Tissue loss causing noticeable unilateral alteration of body silhouette.

15

Scars and/or skin grafts occupying 41% to 60% of body area.

20

Scars and/or skin grafts occupying 61% to 80% of body area;

or

Tissue loss causing noticeable bilateral alteration of body silhouette.

25

Scars and/or skin grafts occupying more than 80% of body surface area.

 


Chapter 5 – Psychiatric Conditions

                                                                                                          Page no. 

         5.0     Introduction.............................................................................. 61

         5.1     Psychiatric conditions.................................................................. 62    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


5.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26)

For the purposes of Chapter 5, activities of daily living are those in Figure 5-A (see below). The examples provided below are not exhaustive and should not be seen as a substitute for assessor discretion when making decisions about impairment ratings.

 

Figure 5-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.

 


5.1  Psychiatric Conditions

Table 5.1:  Psychiatric conditions

See note to Table 5.1, immediately after Table.

% WPI

Description of Level of Impairment

0

Reactions to stresses of daily living without loss of personal or social efficiency

and

Capable of performing activities of daily living without supervision or assistance.

5

Despite the presence of one of the following employee is capable of performing activities of daily living without supervision or assistance:

·         reactions to stresses of daily living with minor loss of personal or social efficiency

·         lack of conscience directed behaviour without harm to community or self

·         minor distortions of thinking.

10

Despite the presence of more than one of the following employee is capable of performing activities of daily living without supervision or assistance:

·         reactions to stresses of daily living with minor loss of personal or social efficiency

·         lack of conscience directed behaviour without harm to community or self

·         minor distortions of thinking.

15

Any one of the following accompanied by a need for some supervision and direction in activities of daily living:

·         reactions to stresses of daily living which cause modification to daily living patterns

·         marked disturbances in thinking

·         definite disturbance in behaviour.

20

Any two of the following accompanied by a need for some supervision and direction in activities of daily living:

·         reactions to stresses of daily living which cause modification of daily living patterns

·         marked disturbance in thinking

·         definite disturbance in behaviour.

25

All of the following accompanied by a need for some supervision and direction in activities of daily living:

·         reactions to stresses of daily living which cause modification of daily living patterns

·         marked disturbances in thinking

·         definite disturbances in behaviour.

Table 5.1 continued on following page

 


Table 5.1 (continued)


% WPI

Description of level of impairment

 

·          

30

Any one of the following accompanied by a need for supervision and direction in activities of daily living:

·         hospital dischargees who require daily medication or regular therapy to avoid readmission

·         loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community.

40

More than one of the following accompanied by a need for supervision and direction in activities of daily living:

·         hospital dischargees who require daily medication or regular therapy to avoid readmission

·         loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community.

50

One of the following:

·         severe disturbances of thinking and/or behaviour entailing potential or actual harm to self and/or others

·         need for supervision and direction in a confined environment.

60

Both of the following:

·         severe disturbances of thinking and/or behaviour which entail potential or actual harm to self and/or others

·         need for supervision and direction in a confined environment.

90

Very severe disturbance in all aspects of thinking and behaviour requiring constant supervision and care in a confined environment, and assistance with all activities of daily living

 

Notes to Table 5.1.

1.                        1. Table 5.1 includes psychoses, neuroses, personality disorders and other diagnosable conditions. The assessment should be made on optimum medication at a stage where the condition is reasonably stable.

2. Supervision means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.

3. Assistance means the provision of assistance to the employee in performing the activities of daily living by a suitable person, responsible in whole or in part for the care of the employee.

4. Direction means the provision of direction to the employee by a suitably qualified person, responsible in whole or in part for the care of the employee

5. Suitable person means a person capable of responsibly caring for the employee in an appropriate way.

6. Suitably qualified person means a person with the necessary qualifications, experience and skills to provide appropriate direction to the employee. Such persons include medical practitioners, nursing staff and clinical psychologists.


Chapter 6 – The Visual System

                                                                                                          Page no.

         6.0       Introduction............................................................................ 65

              Steps in determining whole person impairment of the visual system.. 66

6.1       Central visual acuity.................................................................. 68

         6.1.1   Determining the loss of central vision in one eye................... 69

6.2       Determining loss of monocular visual fields................................... 70

6.3       Abnormal ocular motility and binocular diplopia............................... 71

6.4       Other ocular abnormalities......................................................... 71

6.5       Other conditions causing permanent deformities and causing up to
10% impairment of the whole person                                            72

6.6       Visual impairment system for both eyes....................................... 72

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.0  Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 21-24) and the definitions contained in the glossary (see pages 25-26).

Chapter 6 provides a standard method for examining the visual system, and for calculating the extent of any visual impairment. Impairment is any loss or abnormality in the anatomy or function of the visual system. The visual system includes the eyes, the ocular adnexa, and the visual pathways.

All visual tests are standardised and impairment assessment follows a strict protocol in order to ensure that different ophthalmologists can closely reproduce results. Wherever possible, impairment assessment should be performed by an ophthalmologist.

Visual impairment exists when there is deviation from any of the normal functions of the eye.

Among the types of visual impairment listed below, the first three (6.1-6.3) contribute the most to the overall impairment (numbers correspond to sections in Chapter 6):

6.1   Central visual acuity for near and far objects

6.2   Monocular visual field

6.3   Ocular motility

6.4   Other ocular abnormalities

6.5           Other conditions involving permanent deformities causing up to 10% impairment of the whole person.

Impairments assessed under Chapter 6 include those caused by secondary conditions accompanying an endocrine system condition. An impairment assessed under Chapter 3 – The endocrine system should be combined with those resulting from the secondary conditions assessed under Chapter 6.

WPI ratings from Table 4.2: Facial disfigurement, cannot be combined with WPI ratings arising from either:

·         section 6.4 – Other ocular abnormalities

·         section 6.5 – Other conditions causing permanent deformities causing up to 10% impairment of the whole person.

Facial nerve injury complicated by visual changes, such as occurs with corneal desiccation and scarring, rates as a significant impairment. Such an impairment is assessed under Chapter 6 and a resulting WPI rating may be combined with a WPI rating from Table 12.5.4: The facial nerve (VII).


Steps in determining whole person impairment.

 

See Figure 6-A below for steps in deriving a visual system impairment rating. Use Table 6.1 to convert a visual system impairment rating to a WPI rating.

 

Figure 6-A:  Steps for calculating impairment of the visual system

Step 1

Determine and record the percentage loss of central vision for each eye separately, combining the losses of near and distance vision. Refer to
Figure 6-C.

Step 2

Determine and record the percentage loss of visual fields for each eye separately (monocular) or for both eyes together (binocular).

Step 3

Using the combined values chart (see Appendix 1), combine the results from Step 1 and Step 2 for each eye if any central vision and visual field impairment is present.

Step 4

Determine and record the percentage loss of ocular motility.

Step 5

Using the combined values chart (see Appendix 1), combine the result of Step 3 with Step 4 if there is any ocular motility impairment.

Step 6

Determine and record the percentage loss if other ocular impairments are present.

Step 7

Using the combined values chart (see Appendix 1), combine the result of Step 5 with Step 6 if any other ocular impairment is present.

Step 8

Determine the visual impairment for both eyes. The visual impairment for both eyes is calculated by the formula:

3 x (impairment of better eye) + (impairment of worse eye)  = visual system impairment

                                               4

Alternatively use Figure 6-F.

Step 9

Convert the visual impairment for both eyes to a WPI rating using Table 6.1.

Step 10

Using the combined values chart (see Appendix 1), combine the result of Step 9 with any impairment (up to 10% maximum) arising from other conditions causing permanent deformities

 


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).

Visual

system

Whole

person

Visual

system

Whole

person

Visual

system

Whole

person

Visual

system

Whole

person

0

0

 

 

 

 

 

 

1

1

26

25

51

48

76

72

2

2

27

25

52

49

77

73

3

3

28

26

53

50

78

74

4

4

29

27

54

51

79

75

5

5

30

28

55

52

80

76

6

6

31

29

56

53

81

76

7

7

32

30

57

54

82

77

8

8

33

31

58

55

83

78

9

8

34

32

59

56

84

79

10

9

35

33

60

57

85

80

11

10

36

34

61

58

86

81

12

11

37

35

62

59

87

82

13

12

38

36

63

59

88

83

14

13

39

37

64

60

89

84

15

14

40

38

65

61

90

85

16

15

41

39

66

62

91

85

17

16

42

40

67

63

92

85

18

17

43

41

68

64

93

85

19

18

44

42

69

65

94

85

20

19

45

42

70

66

95

85

21

20

46

43

71

67

96

85

22

21

47

44

72

68

97

85

23

22

48

45

73

69

98

85

24

23

49

46

74

70

99

85

25

24

50

47

75

71

100

85

 


6.1  Central visual acuity

A Snellen test chart is used to measure the distance of visual acuity. The test distance is six metres.

The near vision is measured using a LogMar reading card. If Near Snellen, Jaeger, Sloan or Roman reading cards are used the results need to be converted to LogMar (see Figure 6-B below). The distance in the near reading test is not fixed: the reading distance should be recorded by the ophthalmologist.

Central vision should be tested and recorded for distant and near objects. The employee should be refracted and tested with loose lenses, phoropter, or with his/her own glasses provided their correction is accurate.

If an employee wears contact lenses each day and wishes to wear them for the test, this is acceptable for measuring acuity. In certain ocular conditions (particularly in the presence of corneal abnormalities) contact lens-corrected vision may be better than that obtained with spectacle correction. However, if an employee does not already wear contact lenses, they should not be fitted for an impairment assessment.

 

Figure 6-B:  Revised LogMar equivalent for different reading cards

LogMar

Near Snellen

Equivalent to Snellen

N.

Points Roman

Revised Jaeger standard

0.3

14/14

6/6

N5

3

1

0.4

14/18

6/7.5

N6

4

2

0.5

14/21

6/9

N7

5

3

0.6

14/24

6/12

N8

6

4

0.65

14/28

6/15

N9

7

5

0.7

14/35

6/18

N10

8

6

0.725

14/40

6/24

N12

9

7

0.75

14/45

6/30

N15

10

8

0.8

14/60

6/36

N17

11

9

0.9

14/70

6/48

N18

12

10

1.0

14/80

6/60

N20

13

11

1.1

14/88

6/90

N24

14

12

1.3

14/112

6/120

N40

21

13

1.6

14/140

6/240

N80

23

14

 

 


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.

Step 1

Measure the central acuity for distance and near, correcting for any refractive errors and presbyopia, and record the result.

Step 2

Consult Figure 6-C below to derive the overall loss, combining the values for corrected near and distance acuities.

Step 3

If monocular aphakia or pseudoaphakia is present then add 50% to the percentage loss of Central Vision obtained from Figure 6-C.

 

Figure 6-C:  Percentage loss of central vision in one eye

 

Revised LogMar standard for near vision

Distance Vision (metric 6)

0.3

0.4

0.4

0.5

0.6

0.7

0.7

0.7

0.8

0.9

1.0

1.1

1.3

1.6

6/5

0

0

3

4

5

25

27

30

40

43

44

45

48

49

6/6

0

0

3

4

5

25

27

30

40

43

44

46

48

49

6/7.5

3

3

5

6

8

28

30

33

43

45

46

48

50

52

6/10

5

5

8

9

10

30

32

35

45

48

49

50

53

54

6/12

8

8

10

11

13

33

35

38

48

50

51

53

55

57

6/15

13

13

15

16

18

38

40

43

53

55

56

58

60

62

6/20

16

16

18

20

22

41

44

46

56

59

60

61

64

65

6/22

18

18

21

22

23

43

46

48

58

61

62

63

66

67

6/24

20

20

23

24

25

45

47

50

60

63

64

65

68

69

6/30

25

25

28

29

30

50

52

55

58

68

69

70

73

74

6/38

30

30

33

34

35

55

57

60

70

73

74

75

78

79

6/50

34

34

37

38

39

59

61

64

74

77

78

79

82

83

6/60

40

40

43

44

45

65

67

70

80

83

84

85

88

89

6/90

43

43

45

46

48

68

70

73

83

85

86

88

90

92

6/120

45

45

48

49

50

70

72

75

85

88

89

90

93

94

6/240

48

48

50

51

53

73

75

78

88

90

91

93

95

97

 


6.2  Determining loss of monocular visual fields

There are many ways of measuring the visual field. The most common are the manual Goldman Field and the Humphrey, Octopus and Medmont computerised field analysers. If using a computerised field it is necessary to test at least a 30-2 threshold.

An Esterman Binocular Field is suitable for the majority of visual field impairment assessments. The field is tested with the employee wearing spectacles and both eyes open. The binocular field result is determined by using the Esterman 120-unit binocular grid, and the dot count is multiplied by 5/6 to obtain the percentage of retained or lost field. Note that binocular field-testing is not recommended when diplopia is present.

If the automated 30-2 threshold field is normal, and the ocular history and examination do not suggest lesions that would affect the outer part of the field, it is then acceptable to conclude that the entire field is normal. Whatever technique is used to measure the visual field, the test should be performed by an ophthalmologist.

The normal visual field meridians in each of eight principal meridians are given in Figure 6-D below. The total, summed over 8 meridians is 500. 

 

Figure 6-D:  Normal extent of the visual field

Direction of vision

Degrees of field

Temporally

85

Down temporally

85

Direct down

65

Down nasally

50

Nasally

60

Up nasally

55

Direct up

45

Up temporally

55

Total

500

 

The percentage of retained vision is calculated using the following steps.

Step 1

Add the extent of the visual field along each of the eight meridians (while considering the maximum normal values for the meridians given in Figure 6-D).

Step 2

Divide by five to determine the percentage of visual field perception that remains.

Step 3

To obtain the percentage of visual field loss, subtract the percentage of visual field remaining from 100%.

 

These steps are based upon the following formulae:

    Total visual field = percentage of remaining visual field

           5

    100 - (percentage of remaining visual field) = percentage of visual field lost


6.3  Abnormal ocular motility and binocular diplopia

Diplopia within the central 30° is measured by an ophthalmologist with a Tangent screen. Unless there is diplopia within 30° of the centre of fixation, the diplopia does not cause significant visual impairment. The exception is when looking downwards. Double vision within the central 20° signifies the maximum loss of ocular motility (that is, a 50% loss of ocular motility in one eye).

If the diplopia is not within the central 20º, the presence of diplopia is then plotted along the eight 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

If an ocular adnexal disturbance or deformity interferes with visual function and is not reflected in diminished visual acuity, decreased visual fields, or ocular motility abnormalities with diplopia, then the significance of the disturbance or deformity should be evaluated by an examining ophthalmologist. In that situation, using the combined values chart (see Appendix 1), an ophthalmologist may combine up to an additional 10% impairment for each affected eye.

Problems in the visual system should also be taken into account where they result in symptoms such as epiphora, photophobia, metamorphopsia, and convergence insufficiency.

 


6.5  Other conditions involving permanent deformities causing up to 10% impairment of the whole person

 

Using the combined values chart (see Appendix 1), an additional WPI of up to 10% may be combined with WPI ratings for conditions such as permanent deformities of the orbit, scars, and other cosmetic deformities that do not otherwise alter ocular function. 

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)

4

= impairment of visual system

 

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 row for the better eye.

For example, for a 40 per cent impairment of one eye and 10 per cent impairment of the other eye, read down the table until you come to the large value (40 per cent). Follow across the row until it is intersected with the column designated by 10 per cent at the bottom of the page (18 per cent). Thus, the impairment to the visual system is 18 per cent.


% Impairment worse eye

0

0