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This instrument sets out criteria by reference to which the degree of the permanent impairment of an employee resulting from an injury shall be determined, criteria by reference to which the degree of non-economic loss suffered by an employee as a result of an injury or impairment shall be determined, and methods by which the degree of permanent impairment and the degree of non-economic loss, as determined under those criteria, shall be expressed as a percentage.
Administered by: Employment and Workplace Relations
Registered 08 Mar 2023
Tabling HistoryDate
Tabled HR09-Mar-2023
Tabled Senate20-Mar-2023
Table of contents.

Australia Coat of Arms logo

Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0

I, the Hon Tony Burke MP, Minister for Employment and Workplace Relations, make the following instrument.

Dated 7 March 2023

Tony Burke

Minister for Employment and Workplace Relations

 

 



1  Name

                   This instrument is the Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.

2  Commencement

                   This instrument commences on 1 April 2023 (the commencement date).

3  Authority

                   This instrument is made under section 28 of the Safety, Rehabilitation and Compensation Act 1988.

4  Definitions

Note:          A number of expressions used in this instrument are defined in the SRC Act, including the following:

(a)      aggravation (subsection 4(1));

(b)     ailment (subsection 4(1));

(c)      Comcare (subsection 4(1));

(d)     determination (subsection 61(1) and section 99);

(e)      employee (section 5);

(f)      impairment (subsection 4(1));

(g)     injury (subsections 4(3) and 4(8), and sections 5A, 123A and 124);

(h)     non-economic loss (subsection 4(1));

(i)       permanent (subsection 4(1));

(j)       relevant authority (subsection 4(1));

(k)     reviewable decision (subsection 61(1)).

                   In this instrument:

                   Activities of daily living has the meaning given in the approved Guide.

                   AMA4 has the meaning given in the approved Guide.

                   AMA5 has the meaning given in the approved Guide.

                   approved Guide means the Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 set out in Schedule 1 to this instrument.

                   assessor has the meaning given in the approved Guide.

                   binaural hearing loss has the meaning given in the approved Guide.

                   commencement date has the meaning given in section 2 of this instrument.

                   disease has the meaning given in the approved Guide.

                   loss of amenities has the meaning given in the approved Guide.

                   medical treatment has the meaning given in the approved Guide.

                   pain has the meaning given in the approved Guide.

                   repealed Guide has the meaning given in section 7 of this instrument.

                   SRC Act means the Safety, Rehabilitation and Compensation Act 1988.

                   suffering has the meaning given in the approved Guide.

5  Approved Guide

                   The Guide prepared by Comcare, which is set out in Schedule 1 to this instrument, is approved for the purposes of the SRC Act.

Note:          Where a relevant authority or the Administrative Appeals Tribunal is required to assess or re-assess, or review the assessment or re-assessment of, the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee, the provisions of the approved Guide are binding on the relevant authority or the Administrative Appeals Tribunal, as the case may be, in the carrying out of that assessment, re-assessment or review, and the assessment, re-assessment or review shall be made under the relevant provisions of the approved Guide (SRC Act, subsection 28(4)).

6  Application of the approved Guide

             (1)  The approved Guide applies to the assessment or re-assessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 24, 25 or 27 of the SRC Act received by the relevant authority on or after the commencement date.

             (2)  The approved Guide applies to the re-assessment of the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee as a result of an injury or impairment, relating to a claim for compensation under sections 24, 25 or 27 of the SRC Act received by the relevant authority before the commencement date where the request for re-assessment was received on or after the commencement date.

             (3)  For the purposes of subsection (2), a request for re-assessment does not include the following in relation to a determination made under section 24, 25 or 27 of the SRC Act, whether the determination was made before, on or after the commencement date:

                     (a)  a request for reconsideration of that determination under section 62 of the SRC Act;

                     (b)  an application to the Administrative Appeals Tribunal for review of a reviewable decision made in relation to that determination under section 64 of the SRC Act.

             (4)  The approved Guide applies to the assessment or re-assessment of the degree of permanent impairment of an employee resulting from an injury relating to a request under section 25 of the SRC Act received by the relevant authority on or after the commencement date.

             (5)  The approved Guide applies to all reviews by the Administrative Appeals Tribunal of an assessment or re-assessment to which subsection (1), (2) or (4) applies.

7  Repeal

                   The Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 [F2012C00537] (the repealed Guide) is repealed.

Note 1:       The Acts Interpretations Act 1901 (subsection 7(2)) relevantly provides, in effect, that:

(a)      the repeal does not: revive anything not in force or existing at the time at which the repeal takes effect; or affect the previous operation of the repealed Guide, or anything duly done under the repealed Guide; or affect any right, privilege, obligation or liability acquired, accrued or incurred under the repealed Guide; or affect any investigation, legal proceeding or remedy in respect of any such right, privilege, obligation or liability; and

(b)     any such investigation, legal proceeding or remedy may be instituted, continued or enforced, as if the repealed Guide had not been repealed.

Note 2:       The Acts Interpretations Act 1901 applies to the approved Guide and repealed Guide as if it were an Act by operation of the Legislation Act 2003 (subsection 13(1)).


Schedule 1—Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0


Australia Coat of Arms logo under which appears the words Australian Government then Comcare

GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT IMPAIRMENT EDITION 3.0


CONTENTS

List of Tables and Figures  1

List of Tables  1

List of Figures  3

Introduction to Edition 3.0 of the Guide   4

Structure of this Guide   4

Application of this Guide   4

Whole person impairment  4

Entitlements under the SRC Act  5

Non-economic loss  5

Compensation payable   5

Interim and final assessments  5

Increase in degree of whole person impairment  6

Survival of claims  6

Principles of Assessment  7

Impairment and non-economic loss  7

Employability and incapacity  7

Permanent impairment  7

Pre-existing conditions and aggravation   8

Pre-existing conditions and injury other than aggravation, to same body part, system or function   8

The impairment tables  9

Malignancies and conditions resulting in major systemic failure   9

Percentages of impairment  10

Comparing assessments under alternative tables  10

Combined values  10

Calculating the assessment  10

Ordering of additional investigations  10

Exceptions to use of this Guide   11

List of References  12

Glossary  13

Division 1 – Assessment of the degree of the permanent impairment
of an employee resulting from an injury   14

Chapter 1 – The cardiovascular system    14

1.0      Introduction  14

1.1      Coronary artery disease  15

1.2      Hypertension  17

1.2.1      Diastolic hypertension  17

1.2.2      Systolic hypertension  17

1.3      Arrhythmias  18

1.4      Peripheral vascular disease of the lower extremities  19

1.5      Peripheral vascular disease of the upper extremities  20

1.6      Raynaud’s disease  20

Chapter 2 The respiratory system    22

2.0      Introduction  22

2.1      Assessing impairment of respiratory function  22

2.1.1      Measurements  22

2.1.2      Methods of measurement 23

2.1.3      Impairment rating  23

2.2      Asthma and other hyper-reactive airways diseases  24

2.3      Lung cancer and mesothelioma  25

2.4      Breathing disorders associated with sleep  25

Chapter 3 The endocrine system    27

3.0      Introduction  27

3.1      Thyroid and parathyroid glands  27

3.2      Adrenal cortex and medulla  28

3.3      Pancreas (diabetes mellitus) 28

3.4      Gonads and mammary glands  30

Chapter 4 Disfigurement and skin disorders  31

4.0      Introduction  31

4.1      Skin disorders  31

4.2      Facial disfigurement 32

4.3      Bodily disfigurement 33

Chapter 5 Psychiatric conditions  34

5.0      Introduction  34

5.1      Psychiatric conditions  34

Chapter 6 The visual system    36

6.0      Introduction  36

6.1      Central visual acuity  38

6.1.1      Determining the loss of central vision in one eye  38

6.2      Determining loss of monocular visual fields  39

6.3      Abnormal ocular motility and binocular diplopia  40

6.4      Other ocular abnormalities  40

6.5      Other conditions causing permanent deformities causing up to 10% impairment of the whole person  41

6.6      Calculation of visual system impairment for both eyes  41

Chapter 7 Ear, nose and throat disorders  43

7.0      Introduction  43

7.1      Hearing loss  43

7.2      Tinnitus  43

7.3      Olfaction and taste  43

7.4      Speech  44

7.5      Air passage defects  45

7.6      Nasal passage defects  46

7.7      Chewing and swallowing  46

Chapter 8 The digestive system    47

8.0      Introduction  47

8.0.1      Calculation of Body Mass Index (BMI) 47

8.1      Upper digestive tract oesophagus, stomach, duodenum, small intestine and pancreas  48

8.2      Lower gastrointestinal tract colon and rectum   49

8.3      Lower gastrointestinal tract anus  51

8.4      Surgically created stomas  52

8.5      Liver chronic hepatitis and parenchymal liver disease  52

8.6      Biliary tract 54

8.7      Hernias of the abdominal wall 54

Chapter 9 The musculoskeletal system    55

9.0      Introduction  55

PART I – THE LOWER EXTREMITIES – FEET AND TOES, ANKLES, KNEES AND HIPS  57

PART I INTRODUCTION   57

9.1      Feet and toes  58

9.2      Ankles  59

9.3      Knees  60

9.4      Hips  62

9.5      Lower extremity amputations  63

9.6      Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities  64

9.6.1      Spinal nerve root impairment affecting the lower extremity  64

9.6.2      Peripheral nerve injuries affecting the lower extremities  65

9.7      Lower extremity function  66

PART II – THE UPPER EXTREMITIES – HANDS AND FINGERS, WRISTS, ELBOWS AND SHOULDERS  69

PART II INTRODUCTION   69

9.8      Hands and fingers  70

9.8.1      Abnormal motion of digits  70

9.8.2      Sensory losses in the thumb and fingers  74

9.9      Wrists  77

9.10   Elbows  78

9.11   Shoulders  80

9.12   Upper extremity amputations  83

9.13   Neurological impairments affecting the upper extremities  83

9.13.1    Cervical nerve root impairment 84

9.13.2    Specific nerve lesions affecting the upper extremities  86

9.13.3    Chronic pain conditions  87

9.14   Upper extremity function  89

PART III THE SPINE  91

PART III – INTRODUCTION   91

PART III – DEFINITIONS OF CLINICAL FINDINGS FOR DIAGNOSIS-RELATED ESTIMATES IN ASSESSING SPINAL IMPAIRMENT  92

PART III MULTI-LEVEL FRACTURES INVOLVING THE SPINAL CANAL  93

9.15   Cervical spine – diagnosis-related estimates  93

9.16   Thoracic spine – diagnosis-related estimates  95

9.17   Lumbar spine – diagnosis-related estimates  96

9.18   Fractures of the pelvis  98

Chapter 10 – The urinary system    99

10.0   Introduction  99

10.1   The upper urinary tract 99

10.2   Urinary diversion  100

10.3   Lower urinary tract 100

Chapter 11 The reproductive system    103

11.0   Introduction  103

11.1   Male reproductive system   103

11.1.1    Male reproductive organs penis  103

11.1.2    Male reproductive organs scrotum   104

11.1.3    Male reproductive organs testes, epididymes and spermatic cords  104

11.1.4    Male reproductive organs prostate and seminal vesicles  105

11.2   Female reproductive system   105

11.2.1    Female reproductive organs – vulva and vagina  105

11.2.2    Female reproductive organs cervix and uterus  106

11.2.3    Female reproductive organs fallopian tubes and ovaries  107

Chapter 12 The neurological system    108

12.0   Introduction  108

12.1   Disturbances of levels of consciousness and awareness  109

12.1.1    Permanent disturbances of levels of consciousness and awareness  109

12.1.2    Epilepsy, seizures and convulsive disorders  110

12.1.3    Sleep and arousal disorders  110

12.2   Impairment of memory, learning, abstract reasoning and problem solving ability  111

12.3   Communication impairments dysphasia and aphasia  113

12.4   Emotional or behavioural impairments  114

12.5   Cranial nerves  115

12.5.1    The olfactory nerve (I) 115

12.5.2    The optic nerve, the oculomotor and trochlear nerves and the abducens (II, III, IV and VI) 115

12.5.3    The trigeminal nerve (V) 115

12.5.4    The facial nerve (VII) 116

12.5.5    The auditory nerve (VIII) 117

12.5.6    The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII) 118

12.6   Neurological impairment of the respiratory system   119

12.7   Neurological impairment of the urinary system   119

12.8   Neurological impairment of the anorectal system   119

12.9   Neurological impairment affecting sexual function  120

Chapter 13 – The haematopoietic system    121

13.0   Introduction  121

13.1   Anaemia  121

13.2   Leukocyte abnormalities or disease  121

13.3   Haemorrhagic disorders and platelet disorders  123

13.4   Thrombotic disorders  123

Division 2 – Assessment of the degree of non-economic loss suffered
by an employee as a result of an injury or impairment  124

Introduction  124

B1       Pain  125

B2       Suffering  126

B3       Loss of amenities  127

B4       Other loss  128

B5       Loss of expectation of life  128

B6       Calculation of non-economic loss  129

Division 3 – Calculation of the total entitlement to compensation for permanent impairment and non-economic loss  130

Appendix 1 Combined values chart  131

 


LIST OF TABLES AND FIGURES

LIST OF TABLES

Table 1.1: Coronary artery disease  15

Table 1.2.1: Diastolic hypertension  17

Table 1.2.2: Systolic hypertension  18

Table 1.3: Arrhythmias  19

Table 1.4: Peripheral vascular disease of the lower extremities  19

Table 1.5: Peripheral vascular disease of the upper extremities  20

Table 1.6: Raynaud’s disease  21

Table 2.1: Conversion of respiratory function values to impairment 23

Table 2.2: WPI derived from asthma impairment score  25

Table 2.4: WPI derived from obstructive sleep apnoea score  26

Table 3.1: Thyroid and parathyroid glands  27

Table 3.2: Adrenal cortex and medulla  28

Table 3.3: Pancreas (diabetes mellitus) 29

Table 3.4: Gonads and mammary glands  30

Table 4.1: Skin disorders  31

Table 4.2: Facial disfigurement 32

Table 4.3: Bodily disfigurement 33

Table 5.1: Psychiatric conditions  34

Table 6.1: Conversion of the visual system to WPI rating  37

Table 7.2: Tinnitus  43

Table 7.3: Olfaction and taste  44

Table 7.4: Speech  44

Table 7.5: Air passage defects  45

Table 7.6: Nasal passage defects  46

Table 7.7: Chewing and swallowing  46

Table 8.1: Upper digestive tract oesophagus, stomach, duodenum, small intestine and pancreas  48

Table 8.2: Lower gastrointestinal tract colon and rectum   49

Table 8.3: Lower gastrointestinal tract anus  51

Table 8.4: Surgically created stomas  52

Table 8.5: Chronic hepatitis and parenchymal liver disease  52

Table 8.6: Biliary tract 54

Table 8.7: Hernias of the abdominal wall 54

Table 9.1: Feet and toes  58

Table 9.2: Ankles  59

Table 9.3: Knees  61

Table 9.4: Hips  62

Table 9.5: Lower extremity amputations  63

Table 9.6.1: Spinal nerve root impairment affecting the lower extremity  65

Table 9.6.2a: Sensory impairment due to peripheral nerve injuries affecting the lower extremities  65

Table 9.6.2b: Motor impairment due to peripheral nerve injuries affecting the lower extremities  66

Table 9.7: Lower extremity function  67

Table 9.8.1a: Abnormal motion/ankylosis of the thumb IP and MP joints  71

Table 9.8.1b: Radial abduction/adduction/opposition of the thumb abnormal motion/ankylosis  71

Table 9.8.1c: Abnormal motion/ankylosis of the fingers index and middle fingers  72

Table 9.8.1d: Abnormal motion/ankylosis of the fingers ring and little fingers  73

Table 9.8.2a: Sensory losses in the thumb  75

Table 9.8.2b: Sensory losses in the index and middle fingers  75

Table 9.8.2c: Sensory losses in the little finger  76

Table 9.8.2d: Sensory losses in the ring finger  76

Table 9.9.1a: Wrist flexion/extension  77

Table 9.9.1b: Radial and ulnar deviation of wrist joint 78

Table 9.10.1a: Elbow flexion/extension  79

Table 9.10.1b: Pronation and supination of forearm   79

Table 9.11.1a: Shoulder flexion/extension  80

Table 9.11.1b: Shoulder internal/external rotation  81

Table 9.11.1c: Shoulder – abduction/adduction  82

Table 9.12.1: Upper extremity amputations  83

Table 9.12.2: Amputation of digits  83

Table 9.13.1: Cervical nerve root impairment 85

Table 9.13.2a: Specific nerve lesions affecting the upper extremities sensory impairment 86

Table 9.13.2b: Specific nerve lesions affecting the upper extremities motor impairment 87

Table 9.13.3: Chronic pain conditions  88

Table 9.14: Upper extremity function  90

Table 9.15: Cervical spine diagnosis-related estimates  93

Table 9.16: Thoracic spine diagnosis-related estimates  95

Table 9.17: Lumbar spine diagnosis-related estimates  96

Table 9.18: Fractures of the pelvis  98

Table 10.1: The upper urinary tract 99

Table 10.2: Urinary diversion  100

Table 10.3: Lower urinary tract 101

Table 11.1.1: Male reproductive organs penis  103

Table 11.1.2: Male reproductive organs scrotum   104

Table 11.1.3: Male reproductive organs testes, epididymes and spermatic cords  104

Table 11.1.4: Male reproductive organs prostate and seminal vesicles  105

Table 11.2.1: Female reproductive organs vulva and vagina  105

Table 11.2.2: Female reproductive organs cervix and uterus  106

Table 11.2.3: Female reproductive organs fallopian tubes and ovaries  107

Table 12.1.1: Permanent disturbances of levels of consciousness and awareness  109

Table 12.1.2: Epilepsy, seizures and convulsive disorders  110

Table 12.1.3: Sleep and arousal disorders  110

Table 12.2: Impairment of memory, learning, abstract reasoning and problem solving ability  111

Table 12.3: Criteria for rating impairment due to aphasia or dysphasia  113

Table 12.4: Emotional or behavioural impairments  114

Table 12.5.1: The olfactory nerve (I) 115

Table 12.5.3: The trigeminal nerve (V) 116

Table 12.5.4: The facial nerve (VII) 116

Table 12.5.5: The auditory nerve (VIII) 117

Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII) 118

Table 12.6: Neurological impairment of the respiratory system   119

Table 12.7: Neurological impairment of the urinary system   119

Table 12.8: Neurological impairment of the anorectal system   119

Table 12.9: Neurological impairment affecting sexual function  120

Table 13.1: Anaemia  121

Table 13.2: Leukocyte abnormalities or disease  122

Table 13.3: Haemorrhagic disorders and platelet disorders  123

Table 13.4: Thrombotic disorders  123

Table B1: Pain  125

Table B2: Suffering  126

Table B3.1: Mobility  127

Table B3.2: Social relationships  127

Table B3.3: Recreation and leisure activities  128

Table B4: Other loss  128

Table B5: Loss of expectation of life  129

Table B6: Worksheet calculation of non-economic loss  129



INTRODUCTION TO EDITION 3.0 OF THE GUIDE

STRUCTURE OF THIS GUIDE

1            Division 1 is used to assess the degree of the permanent impairment of an employee resulting from an injury.

2            Division 2 is used to assess the degree of non-economic loss suffered by an employee as a result of an injury or impairment.

3            Division 3 is used to calculate the total entitlement to compensation for permanent impairment and non-economic loss based on the assessments completed in Divisions 1 and 2.

4            Appendix 1 is used to obtain the combined value of multiple impairments resulting from a single injury where combination is required.

5            The Principles of Assessment and Glossary contain information relevant to the interpretation and application of Divisions 1 and 2.

APPLICATION OF THIS GUIDE

6            This Guide (including the Principles of Assessment and Glossary) applies to the assessment or re-assessment of the degree of permanent impairment or non-economic loss of an employee relating to all claims and requests under sections 24, 25 or 27 of the SRC Act received by the relevant authority on or after the commencement date and to the review by the Administrative Appeals Tribunal of any such assessment or re-assessment. See sections 2 and 6 of the instrument titled Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 for when this Guide applies to a particular assessment, re-assessment or review.

7            See Edition 2.1 of the Guide (now repealed) for the criteria, methods and application provisions relevant to the assessment or re-assessment of the degree of permanent impairment or non-economic loss of an employee relating to claims and requests under sections 24, 25 or 27 of the SRC Act that were received by the relevant authority prior to the commencement date. Edition 2.1 of the Guide can be accessed via the Federal Register of Legislation here: https://www.legislation.gov.au/Details/F2012C00537.

WHOLE PERSON IMPAIRMENT

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

9            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 24(5) of the SRC 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.

10         Paragraph 28(1)(a) of the SRC Act provides that the Guide may set out criteria by reference to which the degree of the permanent impairment of an employee resulting from an injury shall be determined. Paragraph 28(1)(c) of the Act relevantly provides that methods by which the degree of permanent impairment, as determined under those criteria, shall be expressed as a percentage. Subsection 28(5) of the Act relevantly provides that the percentage of permanent impairment suffered by an employee as a result of an injury ascertained under the methods referred to in paragraph 28(1)(c) may be 0%.

11        Whole person impairment is the methodology used in this Guide in accordance with section 28 of the SRC Act and is therefore the methodology by which the degree of permanent impairment of an employee resulting from an injury is expressed as a percentage. While the employee’s impairment resulting from a particular injury is to be assessed against criteria in this Guide by reference to the functional capacities of a normal healthy person, the degree of permanent impairment of that employee resulting from that particular injury may be assessed as:

a)      0% if there is no increase in the employee’s whole person impairment when assessed in accordance with this Guide; or

b)      less than the threshold for compensation under section 24 of the Act even if there is an increase in the employee’s whole person impairment when assessed in accordance with this Guide.

12         Whole person impairment is assessed under Division 1 of this Guide.

ENTITLEMENTS UNDER THE SRC ACT

13         Where the degree of permanent impairment of the employee (other than a hearing loss) is determined by the relevant authority under subsection 24(5) of the SRC Act to be less than 10%, subsection 24(7) provides that compensation is not payable to the employee under section 24 of the Act.

14         Subsection 24(8) of the SRC Act excludes the operation of subsection 24(7) in relation to impairment constituted by the loss, or the loss of the use, of a finger or toe, or the loss of the sense of taste or smell. The threshold for compensation under section 24 of the Act for an injury resulting in a permanent impairment constituted by such a loss is 1% to 5% WPI under this Guide depending on the nature of the impairment.

15         For injuries suffered by employees after 1 October 2001, subsection 24(7A) of the SRC Act provides, in effect, that, if the injury results in a permanent impairment that is a hearing loss, the 10% threshold does not apply. In those cases:

a)      subsection 24(7A) of the SRC Act provides that compensation is not payable to the employee under section 24 if the relevant authority determines the binaural hearing loss suffered by the employee to be less than 5%;

b)      Section 7.1 (Hearing loss) of this Guide provides that the percentage of binaural hearing loss is converted to a WPI rating by dividing the percentage of binaural hearing loss by 2; and

c)      consequently, the threshold for compensation under section 24 of the SRC Act for an injury resulting in a permanent impairment that is a hearing loss is 2.5% WPI under this Guide.

NON-ECONOMIC LOSS

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

17         Non-economic loss is assessed under Division 2 of this Guide.

COMPENSATION PAYABLE

18         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 of this Guide for calculation of total entitlement to compensation for permanent impairment and non-economic loss.

INTERIM AND FINAL ASSESSMENTS

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

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

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

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

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

INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT

21         Where a final assessment of the degree of permanent impairment has been made by the relevant authority 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 25(4) of the SRC Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of whole person impairment only.

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

a)      Section 7.1 (Hearing loss) of this Guide provides that the percentage of binaural hearing loss is converted to a WPI rating by dividing the percentage of binaural hearing loss by 2; and

b)      consequently, the threshold for additional compensation under section 25 of the SRC Act for an injury resulting in a permanent impairment that is a hearing loss is 2.5% WPI under this Guide.

23         See Application of this Guide above as to assessments of the degree of permanent impairment made under the previous editions of the Guide.

SURVIVAL OF CLAIMS

24         The SRC Act provides for the survival of certain claims for compensation. If an employee suffers an injury resulting in permanent impairment, and the employee dies:

a)      before a claim for permanent impairment compensation has been made the employee’s personal representative may make such a claim (subsections 4(11) and 55(1)); or

b)      after a claim for permanent impairment compensation has been made the employee’s personal representative may continue with the claim (subsections 4(11) and 55(2)).

25         In either case, if an amount of compensation is determined by the relevant authority to be payable under section 24 of the SRC Act in respect of the claim, subject to section 111, the amount is payable to the deceased employee’s estate (subsections 55(3) and 111(1)). No compensation under section 27 would be payable to the deceased employee’s estate for any non-economic loss (subsections 55(4)).


PRINCIPLES OF ASSESSMENT

IMPAIRMENT AND NON-ECONOMIC LOSS

26         In the SRC Act, ‘impairment’ means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function’ (subsection 4(1)). The term 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, damage or malfunction by reference to the functional capacities of a normal healthy person.

27         In the SRC Act, ‘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’ (subsection 4(1)). The term deals with the effects of the impairment on the employee’s life.

28         Non-economic loss may be characterised as the ‘lifestyle effects’ of an injury or 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.

EMPLOYABILITY AND INCAPACITY

29         The concepts of ‘employability’ and ‘incapacity for work’ are not the tests for the assessment of impairment and non- economic loss. Incapacity for work 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.

PERMANENT IMPAIRMENT

30         Compensation is only payable for an impairment resulting from an injury which is permanent. In the SRC Act, ‘permanent’ means ‘likely to continue indefinitely’ (subsection 4(1)).

31         For the purpose of determining whether an impairment is permanent under the SRC Act, the assessor must have regard to all of the matters in subsection 24(2), namely:

a)      the duration of the impairment;

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

c)      whether the employee has undertaken all reasonable rehabilitative treatment for the impairment; and

d)      any other relevant matters.

32         The assessor should also have regard to the nature and effect of the impairment, and the extent, if any, to which it may reasonably be capable of being reduced or removed (including by surgery, medication or rehabilitative treatment).

33         In the case of a deceased employee, the assessor must still have regard to all of the matters specified in subsection 24(2) of the SRC Act. Consequently, assessing the degree of permanent impairment of the employee immediately prior to death will not necessarily be appropriate. For example:

a)      if there was a likelihood of improvement in the employee’s condition or the employee had not undertaken all reasonable rehabilitative treatment for the impairment – the degree of impairment of the employee immediately prior to death will not be appropriate if the degree of permanent impairment resulting from the injury was likely to be less after the improvement or treatment; or

b)      if the injury resulted in systemic failure of vital organs leading to the employee’s death – the degree of impairment of the employee immediately prior to death will be appropriate if the degree of permanent impairment resulting from the injury was not likely to have improved or responded to treatment.

34         Whatever the cause of death, the assessor must only assess the permanent impairment resulting from the injury. The assessor should, where possible, assess the degree of permanent impairment resulting from the injury by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment. For the purposes of the SRC Act and this Guide, death is not an impairment that is compensable under section 24 of the Act. Compensation for an injury resulting in death is dealt with separately in sections 17 and 18 of the Act.

PRE-EXISTING CONDITIONS AND AGGRAVATION

35         Where a pre-existing condition (including an underlying condition or pre-existing injury) is aggravated by employment, such that the aggravation is an injury, only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee. However, an assessment should not be made unless the aggravation is permanent.

36         Where the employee’s impairment is entirely attributable to the pre-existing condition, or to the natural progression of the pre-existing condition, the degree of permanent impairment of the employee resulting from the injury is 0%.

37         Where the pre-existing condition was previously asymptomatic, all the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.

38         Where the pre-existing condition was previously symptomatic, the following method must be applied:

a)      The assessor should, where possible, assess the degree of permanent impairment resulting from the pre-existing condition by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment.

b)      Where it is possible to assess the degree of permanent impairment resulting from the pre-existing condition, the assessor should, where possible, isolate the permanent impairment resulting from the injury (for example, by comparing the degree of permanent impairment resulting from the pre-existing condition with the degree of permanent impairment resulting from the injury to assess whether there has been an increase in the employee’s whole person impairment). Only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.

c)      Where it is not possible to assess the degree of permanent impairment resulting from the pre-existing condition, or it is not possible to isolate the permanent impairment resulting from the injury, the assessment of the degree of permanent impairment of the employee resulting from the injury is to be made by reference to the totality of effects of the pre-existing condition and the injury.

d)      The percentage of permanent impairment suffered by an employee as a result of a particular injury ascertained by applying this method may be 0%.

PRE-EXISTING CONDITIONS AND INJURY OTHER THAN AGGRAVATION, TO SAME BODY PART, SYSTEM OR FUNCTION

39         Where a pre-existing condition (including an underlying condition but excluding a pre-existing injury) results in permanent impairment, and the employee subsequently suffers an injury which results in permanent impairment to the same body part, system or function (but the injury is not an aggravation of the pre-existing condition), only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.

40        In these circumstances, the following method must be applied:

a)      The assessor should, where possible, assess the degree of permanent impairment resulting from the pre-existing condition by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment.

b)      Where it is possible to assess the degree of permanent impairment resulting from the pre-existing condition, the assessor should, where possible, isolate the permanent impairment resulting from the injury (for example, by comparing the degree of permanent impairment resulting from the pre-existing condition with the degree of permanent impairment resulting from the injury to assess whether there has been an increase in the employee’s whole person impairment). Only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.

c)      Where it is not possible to assess the degree of permanent impairment resulting from the pre-existing condition, or it is not possible to isolate the permanent impairment resulting from the injury, the assessment of the degree of permanent impairment of the employee resulting from the injury is to be made by reference to the totality of effects of the pre-existing condition and the injury.

d)      The percentage of permanent impairment suffered by an employee as a result of a particular injury ascertained by applying this method may be 0%.

41         Where a pre-existing injury results in permanent impairment, and the employee subsequently suffers an injury which results in permanent impairment to the same body part, system or function (but the subsequent injury is not an aggravation of the pre-existing injury), the permanent impairment resulting from the pre-existing injury must be disregarded when assessing the degree of permanent impairment of the employee resulting from the subsequent injury. The subsequent injury should be assessed by reference to the functional capacities of a normal healthy person. The WPI rating for the pre-existing injury and the WPI rating for the subsequent injury may be added.

THE IMPAIRMENT TABLES

42         Division 1 of this Guide is based on the concept of whole person impairment which is drawn from the AMA5.

43         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 impairment by reference to the relevant description in this Guide.

44         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.

45         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.

MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE

46         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.

47         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 to this Guide.

PERCENTAGES OF IMPAIRMENT

48         Most tables in Division 1 of this Guide 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%.

49         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 assessor must provide written reason why they consider the selected point within the range as clinically justifiable.

COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES

50         Unless there are instructions in this Guide to the contrary, where two or more tables (or combinations of tables) are equally applicable to an impairment, the relevant authority will determine the degree of permanent impairment under the table or tables which yields or yield the most favourable result to the employee. The assessor (if not the relevant authority) should therefore provide assessments under all applicable tables to allow the relevant authority to make this determination.

COMBINED VALUES

51         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 in Appendix 1 to this Guide unless the notes in the instructions in this Guide specifically stipulate that the scores are to be added. (For instance, see Section 9.8.1 (Abnormal motion of digits).)

52         It is important to note that whenever the notes in the relevant section in Division 1 refer to combined ratings, the combined values chart in Appendix 1 to this Guide must be used, even if no reference is made to the use of that chart.

CALCULATING THE ASSESSMENT

53         Where relevant, a statement is included in the chapters of Division 1 which indicates:

a)      the manner in which tables within that chapter may (or may not) be combined; and

b)      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.

54         There are some special circumstances where addition of scores rather than combination is required. These circumstances are specified in the relevant chapters in this Guide.

ORDERING OF ADDITIONAL INVESTIGATIONS

55         As a general principle, the assessor 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.

EXCEPTIONS TO USE OF THIS GUIDE

56         In the event that an 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 AMA5.

57         An assessment is not to be made using the AMA5 for:

a)      mental and behavioural impairments (psychiatric conditions) see Chapter 5 Psychiatric conditions;

b)      impairments of the visual system see Chapter 6 The visual system;

c)      hearing impairment see Chapter 7 Ear, nose and throat disorders; or

d)      chronic pain conditions, except in the case of migraine or tension headaches see Section 9.13.3 (Chronic pain conditions).

58         In the event that an impairment is of a kind that cannot be assessed in accordance with either the provisions of this Guide or the AMA5 (that is, where an assessment of 0% or more is not possible), the assessor should use their use clinical judgment, comparing measurable permanent impairment resulting from the injury to measurable permanent impairment resulting from similar conditions with similar impairment of body part, system or function.

59         For further information relating to the application of this Guide, please contact the Comcare Scheme Policy and Design Helpdesk on 1300 366 979 or email scheme.policy_helpdesk@comcare.gov.au.


LIST OF REFERENCES

60         Abramson MJ et al, 1996, ‘Evaluation of impairment, disability and handicap caused by respiratory disease’, Australian and New Zealand Journal of Medicine, 26, 697-701.

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

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

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

64         American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/ disability secondary to respiratory disorders’, American Review of Respiratory Diseases, 133, 1205-09

65         American Thoracic Society, 1993, ‘Guidelines for the evaluation of impairment/disability in patients with asthma’, American Review of Respiratory Diseases, 147, 1056-61.

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

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

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

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

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


GLOSSARY

In this Guide:

Activities of daily living means 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.

Aggravation includes acceleration or recurrence (SRC Act, subsection 4(1)). See also the Principles of Assessment.

Ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development) (SRC Act, subsection 4(1)).

AMA4 means the Fourth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (1995) and any errata published prior to the commencement date.

AMA5 means the Fifth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (2001) and any errata published prior to the commencement date.

Assessor in relation to an employee means:

a)       a legally qualified medical practitioner or audiologist, other than the employee, who is registered to practise a health profession with the Australian Health Practitioner Regulation Agency;

b)       the relevant authority in relation to the employee;

c)       a member within the meaning of section 3 of the Administrative Appeals Tribunal Act 1975.

Binaural hearing loss means hearing loss affecting both ears. For the purposes of this Guide, binaural hearing loss does not include tinnitus.

Commencement date has the meaning given in section 2 of the instrument titled Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.

Disease has its ordinary meaning in Division 1 of this Guide.

Impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function (SRC Act, subsection 4(1)). See also the Principles of Assessment.

Injury in relation to an employee means an injury suffered by the employee in respect of which compensation is payable under the SRC Act (SRC Act, subsections 4(3) and 4(8), and sections 5A, 123A and 124).

Loss of amenities in relation to an employee means the effects on the employee’s mobility, social relationships and recreation and leisure activities. See also the Principles of Assessment.

Medical treatment has its ordinary meaning in Division 1 of this Guide.

Non-economic loss (NEL) 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 (SRC Act, subsection 4(1)). See also the Principles of Assessment.

Pain means physical pain.

Permanent means ‘likely to continue indefinitely’ (SRC Act, subsection 4(1)). See also the Principles of Assessment.

SRC Act means the Safety, Rehabilitation and Compensation Act 1988.

Suffering means the mental distress resulting from the injury or impairment.

Whole person impairment (WPI) is the methodology used for expressing the degree of impairment of an employee, resulting from an injury, as a percentage. WPI is based on the AMA5. WPI is a medical quantification of the nature and extent of the effect of an injury on the employee’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. See also the Principles of Assessment.


DIVISION 1 – ASSESSMENT OF THE DEGREE OF THE PERMANENT IMPAIRMENT OF AN EMPLOYEE RESULTING FROM AN INJURY

CHAPTER 1 – THE CARDIOVASCULAR SYSTEM

1.0        Introduction

71         In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

72         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).

73         For the purposes of Chapter 1 The cardiovascular system, activities of daily living are those in Figure 1-A.

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.

74         Chapter 1 The cardiovascular system 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 AMA5.

75         For post-thrombotic syndrome, assessments under Table 1.4: Peripheral vascular disease of the lower extremities and Table 1.5: Peripheral vascular disease of the upper extremities are an alternative to Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system). WPI ratings from Table 1.4 and Table 1.5 may not be combined with a WPI rating from Table 13.4. Table 1.4 and Table 1.5 should be used as the primary guide for assessing peripheral complications of thrombosis.

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

1.1        Coronary artery disease

77         Steps for assessment are as follows.

Step 1

Using Figure 1-B: Symptomatic level of activity in METS according to age and gender, assess 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: Coronary artery disease, 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.

78         Figure 1-B: Symptomatic level of activity in METS according to age and gender may be used for the assessment of symptomatic impairment caused by ischaemic heart disease, hypertension, cardiomyopathy, or rheumatic heart disease.

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

Age and gender

Symptomatic level of activity in METS

1

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

10+

18-30 M

D

D

D

C

C

B

B

B

A

A

18-30 F

D

D

C

C

B

B

A

A

A

 

31-40 M

D

D

D

C

C

B

B

A

A

 

31-40 F

D

D

C

B

B

B

A

 

 

 

41-50 M

D

D

C

C

B

B

A

A

 

 

41-50 F

D

D

C

B

B

A

A

 

 

 

51-60 M

D

D

C

B

B

A

A

A

 

 

51-60 F

D

D

C

B

B

A

A

 

 

 

61-70 M

D

D

C

B

B

A

A

 

 

 

61-70 F

D

D

B

B

A

A

 

 

 

 

70+ M

D

C

B

B

A

 

 

 

 

 

70+ F

D

C

B

A

A

 

 

 

 

 

Table 1.1: Coronary artery disease

See notes to Table 1.1 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.

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

79         Either diastolic hypertension (see Section 1.2.1) or systolic hypertension (see Section 1.2.2) may be assessed, whichever provides the higher WPI rating.

1.2.1    Diastolic hypertension

80         Hypertensive cardiomyopathy can be assessed using the AMA5.

81         Functional class (assessed in accordance with Figure 1-B: Symptomatic level of activity in METS according to age and gender) is the primary criterion for assessment. Level of diastolic blood pressure (DBP) and therapy (see Table 1.2.1: Diastolic hypertension) are secondary criteria for assessment.

82         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 to 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

5.    Drug therapy (continuous) – final column of Table 1.2.1:

+          one drug

++        two drugs

+++      three or more drugs.

1.2.2    Systolic hypertension

83         Hypertensive cardiomyopathy can be assessed using the AMA5.

84         Functional class (assessed in accordance with Figure 1-B: Symptomatic level of activity in METS according to age and gender) is the primary criterion for assessment. Level of systolic blood pressure (SBP) and therapy (see Table 1.2.2: Systolic hypertension) are secondary criteria for assessment.

Table 1.2.2: Systolic hypertension

See note to 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) – final column of Table 1.2.2:

+           one drug

++        two drugs

+++      three or more drugs.

1.3        Arrhythmias

85         Underlying cardiac disease can be assessed using other tables in Chapter 1 The cardiovascular system.

86         Functional class (assessed under Figure 1-C: Definitions of functional class), and therapy (see Table 1.3: Arrhythmias), are used to assess the WPI rating.

Figure 1-C: Definitions of functional class

Functional class

Symptoms (all required)

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 to 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 – final column of Table 1.3:

‘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

87         Amputees should not be assessed under Table 1.4: Peripheral vascular disease of the lower extremities. They should be assessed under Table 9.5: Lower extremity amputations (see Chapter 9 – The musculoskeletal system).

88         A WPI rating from Table 1.4: Peripheral vascular disease of the lower extremities may not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system).

Table 1.4: Peripheral vascular disease of the lower extremities

%WPI

Signs and symptoms

0

The employee experiences neither intermittent claudication nor 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 200m or more at an average pace on level ground.

20

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

30

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

40

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

50

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

60

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

70

The employee experiences ischaemic pain at rest.

1.5        Peripheral vascular disease of the upper extremities

89         Amputees should not be assessed under Table 1.5: Peripheral vascular disease of the upper extremities. They should be assessed under Table 9.12.1: Upper extremity amputations or Table 9.12.2: Amputation of digits (see Chapter 9 – The musculoskeletal system).

90         A WPI rating from Table 1.5: Peripheral vascular disease of the upper extremities may not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system).

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 or unable to exercise.

Not applicable

1.6        Raynaud’s disease

91         Functional class (assessed in accordance with Figure 1-C: Definitions of functional class) is the primary criterion for assessment. Signs of vasospastic disease and therapy (see Table 1.6: Raynaud’s disease) are secondary criteria for assessment.

Figure 1-C: Definitions of functional class

See note to Figure 1-C for further information.

Functional class

Symptoms (all required)

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). It is repeated here for ease of reference

Table 1.6: Raynaud’s disease

See note to Table 1.6 for further information.

%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

2.0        Introduction

92         In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

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

94         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.

95         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.

96         Employees who have permanent respiratory limitation secondary to massive pulmonary embolism should be assessed under Chapter 2 The respiratory system. Any WPI rating awarded in these circumstances may not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system).

2.1        Assessing impairment of respiratory function

2.1.1    Measurements

97         The most commonly recommended measurements for determining respiratory impairment are:

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

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

98         However, the measurements used must be derived from either:

a)      the tests prescribed below where relevant (for example, in assessing asthma); or

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

99         Other measurements commonly used to assess impairment include:

a)      the lung volumes;

b)      total lung capacity (TLC) and residual volume (RV); and

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

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

a)      the elastic and flow resistive properties of the lungs;

b)      respiratory muscle strength;

c)      arterial blood gases;

d)      polysomnography (sleep studies);

e)      echocardiography with estimation of pulmonary artery pressure; and

f)       quantitative ventilation-perfusion scans of the lung.

101     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 <55mm Hg and/or PaCO2 >50mm Hg, despite optimal treatment, is evidence of severe impairment and attracts a WPI rating of 70%.

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

2.1.2    Methods of measurement

103     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:

a)      the Thoracic Society of Australia and New Zealand;

b)      the Australasian Sleep Association; or

c)      the Australian Council on Healthcare Standards.

104     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

105     Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and VOmax. 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.

106     Severity of impairment is rated as shown in Table 2.1: Conversion of respiratory function values to impairment. 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 to Table 2.1 for further information.

%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

107     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.

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

a)      the diagnosis and cause are established;

b)      exposure to the provoking factors is eliminated; and

c)      appropriate treatment of asthma is implemented.

109     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.

110     Permanent impairment should not be assessed until 2 years after cessation of exposure to provoking factors as severity may decrease during this period.

111     An impairment rating scale is set out in Figure 2-A: Calculating asthma impairment score and Table 2.2: WPI derived from asthma impairment score. 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.

112     A score reflecting impairment from asthma is calculated by:

a)      adding the points scored for reduction in FEV1 %P;

and either

i)        change in FEV1 with bronchodilator (reversibility);

or

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

and

b)      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.

113     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.

114     The maximum impairment score from Figure 2-A: Calculating asthma impairment score 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: WPI derived from asthma impairment score.

Figure 2-A: Calculating asthma impairment score

See notes to Figure 2-A for further information.

Score

FEV1, % P
after
bronchodilator

DFEV1, % change in FEV1
with bronchodilator

PD20 or µmol

% 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 the AMA5; 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

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

116     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%.

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

2.4        Breathing disorders associated with sleep

118     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.

119     Obstructive sleep apnoea should be assessed using Table 2.4: WPI derived from obstructive sleep apnoea score. Central sleep apnoea should be assessed using Table 12.1.3: Sleep and arousal disorders (see Chapter 12 –The neurological system).

120     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: Calculating obstructive sleep apnoea score and Table 2.4: WPI derived from obstructive sleep apnoea score). 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).

121     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.

122     The total score derived from Figure 2-B: Calculating obstructive sleep apnoea score 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: WPI derived from obstructive sleep apnoea score.

Figure 2-B: Calculating obstructive sleep apnoea score

See notes Figure 2-B for further information.

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

3.0        Introduction

123     In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

124     The impairment resulting from an endocrine system condition (such as peripheral neuropathy, or peripheral vascular disease) must also be assessed under the relevant tables in other chapters, including tables in Chapter 10 – The urinary system.

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

3.1        Thyroid and parathyroid glands

126     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:

a)      Chapter 4 – Disfigurement and skin disorders; and

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

127     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: Thyroid and parathyroid glands.

128     Where an employee has more than one of the conditions in Table 3.1: Thyroid and parathyroid glands, combine the WPI ratings using the combined values chart (see Appendix 1).

129     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

See note to Table 3.1 for further information.

%WPI

Criteria

0

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

or

Hypoparathyroidism – symptoms and signs readily controlled by medication.

or

Hypothyroidism adequately controlled by replacement therapy.

10–15

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

or

Hyperparathyroidism – persisting mild hypercalcaemia, despite medication.

or

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.

Note 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

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

131     Using the combined values chart (see Appendix 1), WPI ratings derived from Table 3.2: Adrenal cortex and medulla 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.

or

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.

or

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

·         inadequate removal of source of ectopic ACTH secretion.

or

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

or

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)

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

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

134     Using the combined values chart (see Appendix 1), WPI ratings derived under Table 3.1: Thyroid and parathyroid glands and Table 3.2: Adrenal cortex and medulla may be combined with WPI ratings from Table 3.3: Pancreas (diabetes mellitus).

135     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 20µg/minute. Where a 24 hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least two out of three consecutive urine specimens collected.

Table 3.3: Pancreas (diabetes mellitus)

See notes to Table 3.3 for further information.

%WPI

Type

Therapy

Microvascular complications

5

Type 2

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

Microangiopathy is not present.

10

Type 2

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

Microangiopathy and/or significant neuropathy are present.

15

Type 1

Dietary restrictions and insulin give satisfactory control.

Microangiopathy is not present.

20

Type 1

Type 2

Dietary restrictions and insulin give satisfactory control.

Type 2 where dietary restrictions and insulin and/or oral hypoglycaemic agents give satisfactory control.

Microangiopathy and/or significant neuropathy are present.

25

Type 1

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

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

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:

(i)        4%-6% is the non-diabetic range; and

(ii)       <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.    ‘Type 2’ means non-insulin dependent diabetes mellitus.

4.    ‘Type 1’ means insulin dependent diabetes mellitus and other forms of diabetes requiring insulin, such as Cystic Fibrosis related diabetes and Type 3c diabetes.

3.4        Gonads and mammary glands

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

137     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: Gonads and mammary glands.

Table 3.4: Gonads and mammary glands

%WPI

Criteria

0

Diminished or absent level of gonadal hormones in either sex.

or

Abnormally high level of gonadal hormones in either sex.

5

Loss of one or both breasts in male.

or

Loss of whole or part of one breast in female.

or

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

4.0        Introduction

138     In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

139     Impairments assessed under Chapter 4 Disfigurement and skin disorders include those resulting from an endocrine system condition. A WPI rating from a table in Chapter 3 – The endocrine system may be combined with WPI ratings assessed under Chapter 4.

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

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

b)      Table 4.3: Bodily disfigurement;

and the resulting WPI ratings combined.

141     In cases where two or three of Table 4.1: Skin disorders, Table 4.2: Facial disfigurement and Table 4.3: Bodily disfigurement apply to the injury resulting in impairment, WPI ratings from each table may be combined using the combined values chart (see Appendix 1).

142     WPI ratings awarded under Table 4.2: Facial disfigurement may not 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

143     For the purposes of Table 4.1: Skin disorders:

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

b)      ‘constant treatment’ means treatment that continues on a regular basis without interruption; and

c)      ‘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.

144     Column 4 in Table 4.1: Skin disorders is referenced to Figure 4-A: Activities of daily living.

Table 4.1: Skin disorders

%WPI

Signs and symptoms

Requirement for treatment

Column 4 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

See Column 4 in Table 4.1.

%WPI

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.

or

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

5.0        Introduction

145     In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

146     For the purposes of Chapter 5 Psychiatric conditions, activities of daily living are those in Figure 5-A. 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 notes to Table 5.1 for further information.

%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.

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.     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

6.0        Introduction

147     In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.

148     Chapter 6