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repealed Guide has the meaning given in section 7 of this instrument.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
GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT IMPAIRMENT EDITION 3.0
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
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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%.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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 |
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
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
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 (VO2 max), 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.
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.
105 Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and VO2 max. 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 |
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
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.
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. |
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.
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
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)
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. |
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. |
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
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. |
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.