Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 (Cth)
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
Contents
1 Name
2 Commencement
3 Authority
4 Definitions
5 Approved Guide
6 Application of the approved Guide
7 Repeal
Schedule 1—Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
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repealed Guide has the meaning given in section 7 of this instrument.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
CONTENTS
List of Tables and Figures
List of Tables
List of Figures
Introduction to Edition 3.0 of the Guide
Structure of this Guide
Application of this Guide
Whole person impairment
Entitlements under the SRC Act
Non-economic loss
Compensation payable
Interim and final assessments
Increase in degree of whole person impairment
Survival of claims
Principles of Assessment
Impairment and non-economic loss
Employability and incapacity
Permanent impairment
Pre-existing conditions and aggravation
Pre-existing conditions and injury other than aggravation, to same body part, system or function
The impairment tables
Malignancies and conditions resulting in major systemic failure
Percentages of impairment
Comparing assessments under alternative tables
Combined values
Calculating the assessment
Ordering of additional investigations
Exceptions to use of this Guide
List of References
Glossary
Division 1 – Assessment of the degree of the permanent impairment of an employee resulting from an injury
Chapter 1 – The cardiovascular system
1.0 Introduction
1.1 Coronary artery disease
1.2 Hypertension
1.2.1 Diastolic hypertension
1.2.2 Systolic hypertension
1.3 Arrhythmias
1.4 Peripheral vascular disease of the lower extremities
1.5 Peripheral vascular disease of the upper extremities
1.6 Raynaud’s disease
Chapter 2 – The respiratory system
2.0 Introduction
2.1 Assessing impairment of respiratory function
2.1.1 Measurements
2.1.2 Methods of measurement
2.1.3 Impairment rating
2.2 Asthma and other hyper-reactive airways diseases
2.3 Lung cancer and mesothelioma
2.4 Breathing disorders associated with sleep
Chapter 3 – The endocrine system
3.0 Introduction
3.1 Thyroid and parathyroid glands
3.2 Adrenal cortex and medulla
3.3 Pancreas (diabetes mellitus)
3.4 Gonads and mammary glands
Chapter 4 – Disfigurement and skin disorders
4.0 Introduction
4.1 Skin disorders
4.2 Facial disfigurement
4.3 Bodily disfigurement
Chapter 5 – Psychiatric conditions
5.0 Introduction
5.1 Psychiatric conditions
Chapter 6 – The visual system
6.0 Introduction
6.1 Central visual acuity
6.1.1 Determining the loss of central vision in one eye
6.2 Determining loss of monocular visual fields
6.3 Abnormal ocular motility and binocular diplopia
6.4 Other ocular abnormalities
6.5 Other conditions causing permanent deformities causing up to 10% impairment of the whole person
6.6 Calculation of visual system impairment for both eyes
Chapter 7 – Ear, nose and throat disorders
7.0 Introduction
7.1 Hearing loss
7.2 Tinnitus
7.3 Olfaction and taste
7.4 Speech
7.5 Air passage defects
7.6 Nasal passage defects
7.7 Chewing and swallowing
Chapter 8 – The digestive system
8.0 Introduction
8.0.1 Calculation of Body Mass Index (BMI)
8.1 Upper digestive tract – oesophagus, stomach, duodenum, small intestine and pancreas
8.2 Lower gastrointestinal tract – colon and rectum
8.3 Lower gastrointestinal tract – anus
8.4 Surgically created stomas
8.5 Liver – chronic hepatitis and parenchymal liver disease
8.6 Biliary tract
8.7 Hernias of the abdominal wall
Chapter 9 – The musculoskeletal system
9.0 Introduction
PART I – THE LOWER EXTREMITIES – FEET AND TOES, ANKLES, KNEES AND HIPS
PART I – INTRODUCTION
9.1 Feet and toes
9.2 Ankles
9.3 Knees
9.4 Hips
9.5 Lower extremity amputations
9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities
9.6.1 Spinal nerve root impairment affecting the lower extremity
9.6.2 Peripheral nerve injuries affecting the lower extremities
9.7 Lower extremity function
PART II – THE UPPER EXTREMITIES – HANDS AND FINGERS, WRISTS, ELBOWS AND SHOULDERS
PART II – INTRODUCTION
9.8 Hands and fingers
9.8.1 Abnormal motion of digits
9.8.2 Sensory losses in the thumb and fingers
9.9 Wrists
9.10 Elbows
9.11 Shoulders
9.12 Upper extremity amputations
9.13 Neurological impairments affecting the upper extremities
9.13.1 Cervical nerve root impairment
9.13.2 Specific nerve lesions affecting the upper extremities
9.13.3 Chronic pain conditions
9.14 Upper extremity function
PART III – THE SPINE
PART III – INTRODUCTION
PART III – DEFINITIONS OF CLINICAL FINDINGS FOR DIAGNOSIS-RELATED ESTIMATES IN ASSESSING SPINAL IMPAIRMENT
PART III – MULTI-LEVEL FRACTURES INVOLVING THE SPINAL CANAL
9.15 Cervical spine – diagnosis-related estimates
9.16 Thoracic spine – diagnosis-related estimates
9.17 Lumbar spine – diagnosis-related estimates
9.18 Fractures of the pelvis
Chapter 10 – The urinary system
10.0 Introduction
10.1 The upper urinary tract
10.2 Urinary diversion
10.3 Lower urinary tract
Chapter 11 – The reproductive system
11.0 Introduction
11.1 Male reproductive system
11.1.1 Male reproductive organs – penis
11.1.2 Male reproductive organs – scrotum
11.1.3 Male reproductive organs – testes, epididymes and spermatic cords
11.1.4 Male reproductive organs – prostate and seminal vesicles
11.2 Female reproductive system
11.2.1 Female reproductive organs – vulva and vagina
11.2.2 Female reproductive organs – cervix and uterus
11.2.3 Female reproductive organs – fallopian tubes and ovaries
Chapter 12 – The neurological system
12.0 Introduction
12.1 Disturbances of levels of consciousness and awareness
12.1.1 Permanent disturbances of levels of consciousness and awareness
12.1.2 Epilepsy, seizures and convulsive disorders
12.1.3 Sleep and arousal disorders
12.2 Impairment of memory, learning, abstract reasoning and problem solving ability
12.3 Communication impairments – dysphasia and aphasia
12.4 Emotional or behavioural impairments
12.5 Cranial nerves
12.5.1 The olfactory nerve (I)
12.5.2 The optic nerve, the oculomotor and trochlear nerves and the abducens (II, III, IV and VI)
12.5.3 The trigeminal nerve (V)
12.5.4 The facial nerve (VII)
12.5.5 The auditory nerve (VIII)
12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)
12.6 Neurological impairment of the respiratory system
12.7 Neurological impairment of the urinary system
12.8 Neurological impairment of the anorectal system
12.9 Neurological impairment affecting sexual function
Chapter 13 – The haematopoietic system
13.0 Introduction
13.1 Anaemia
13.2 Leukocyte abnormalities or disease
13.3 Haemorrhagic disorders and platelet disorders
13.4 Thrombotic disorders
Division 2 – Assessment of the degree of non-economic loss suffered by an employee as a result of an injury or impairment
Introduction
B1 Pain
B2 Suffering
B3 Loss of amenities
B4 Other loss
B5 Loss of expectation of life
B6 Calculation of non-economic loss
Division 3 – Calculation of the total entitlement to compensation for permanent impairment and non-economic loss
Appendix 1 – Combined values chart
LIST OF TABLES AND FIGURES
LIST OF TABLES
Table 1.1: Coronary artery disease
Table 1.2.1: Diastolic hypertension
Table 1.2.2: Systolic hypertension
Table 1.3: Arrhythmias
Table 1.4: Peripheral vascular disease of the lower extremities
Table 1.5: Peripheral vascular disease of the upper extremities
Table 1.6: Raynaud’s disease
Table 2.1: Conversion of respiratory function values to impairment
Table 2.2: WPI derived from asthma impairment score
Table 2.4: WPI derived from obstructive sleep apnoea score
Table 3.1: Thyroid and parathyroid glands
Table 3.2: Adrenal cortex and medulla
Table 3.3: Pancreas (diabetes mellitus)
Table 3.4: Gonads and mammary glands
Table 4.1: Skin disorders
Table 4.2: Facial disfigurement
Table 4.3: Bodily disfigurement
Table 5.1: Psychiatric conditions
Table 6.1: Conversion of the visual system to WPI rating
Table 7.2: Tinnitus
Table 7.3: Olfaction and taste
Table 7.4: Speech
Table 7.5: Air passage defects
Table 7.6: Nasal passage defects
Table 7.7: Chewing and swallowing
Table 8.1: Upper digestive tract – oesophagus, stomach, duodenum, small intestine and pancreas
Table 8.2: Lower gastrointestinal tract – colon and rectum
Table 8.3: Lower gastrointestinal tract – anus
Table 8.4: Surgically created stomas
Table 8.5: Chronic hepatitis and parenchymal liver disease
Table 8.6: Biliary tract
Table 8.7: Hernias of the abdominal wall
Table 9.1: Feet and toes
Table 9.2: Ankles
Table 9.3: Knees
Table 9.4: Hips
Table 9.5: Lower extremity amputations
Table 9.6.1: Spinal nerve root impairment affecting the lower extremity
Table 9.6.2a: Sensory impairment due to peripheral nerve injuries affecting the lower extremities
Table 9.6.2b: Motor impairment due to peripheral nerve injuries affecting the lower extremities
Table 9.7: Lower extremity function
Table 9.8.1a: Abnormal motion/ankylosis of the thumb – IP and MP joints
Table 9.8.1b: Radial abduction/adduction/opposition of the thumb – abnormal motion/ankylosis
Table 9.8.1c: Abnormal motion/ankylosis of the fingers – index and middle fingers
Table 9.8.1d: Abnormal motion/ankylosis of the fingers – ring and little fingers
Table 9.8.2a: Sensory losses in the thumb
Table 9.8.2b: Sensory losses in the index and middle fingers
Table 9.8.2c: Sensory losses in the little finger
Table 9.8.2d: Sensory losses in the ring finger
Table 9.9.1a: Wrist flexion/extension
Table 9.9.1b: Radial and ulnar deviation of wrist joint
Table 9.10.1a: Elbow – flexion/extension
Table 9.10.1b: Pronation and supination of forearm
Table 9.11.1a: Shoulder – flexion/extension
Table 9.11.1b: Shoulder – internal/external rotation
Table 9.11.1c: Shoulder – abduction/adduction
Table 9.12.1: Upper extremity amputations
Table 9.12.2: Amputation of digits
Table 9.13.1: Cervical nerve root impairment
Table 9.13.2a: Specific nerve lesions affecting the upper extremities – sensory impairment
Table 9.13.2b: Specific nerve lesions affecting the upper extremities – motor impairment
Table 9.13.3: Chronic pain conditions
Table 9.14: Upper extremity function
Table 9.15: Cervical spine – diagnosis-related estimates
Table 9.16: Thoracic spine – diagnosis-related estimates
Table 9.17: Lumbar spine – diagnosis-related estimates
Table 9.18: Fractures of the pelvis
Table 10.1: The upper urinary tract
Table 10.2: Urinary diversion
Table 10.3: Lower urinary tract
Table 11.1.1: Male reproductive organs – penis
Table 11.1.2: Male reproductive organs – scrotum
Table 11.1.3: Male reproductive organs – testes, epididymes and spermatic cords
Table 11.1.4: Male reproductive organs – prostate and seminal vesicles
Table 11.2.1: Female reproductive organs – vulva and vagina
Table 11.2.2: Female reproductive organs – cervix and uterus
Table 11.2.3: Female reproductive organs – fallopian tubes and ovaries
Table 12.1.1: Permanent disturbances of levels of consciousness and awareness
Table 12.1.2: Epilepsy, seizures and convulsive disorders
Table 12.1.3: Sleep and arousal disorders
Table 12.2: Impairment of memory, learning, abstract reasoning and problem solving ability
Table 12.3: Criteria for rating impairment due to aphasia or dysphasia
Table 12.4: Emotional or behavioural impairments
Table 12.5.1: The olfactory nerve (I)
Table 12.5.3: The trigeminal nerve (V)
Table 12.5.4: The facial nerve (VII)
Table 12.5.5: The auditory nerve (VIII)
Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)
Table 12.6: Neurological impairment of the respiratory system
Table 12.7: Neurological impairment of the urinary system
Table 12.8: Neurological impairment of the anorectal system
Table 12.9: Neurological impairment affecting sexual function
Table 13.1: Anaemia
Table 13.2: Leukocyte abnormalities or disease
Table 13.3: Haemorrhagic disorders and platelet disorders
Table 13.4: Thrombotic disorders
Table B1: Pain
Table B2: Suffering
Table B3.1: Mobility
Table B3.2: Social relationships
Table B3.3: Recreation and leisure activities
Table B4: Other loss
Table B5: Loss of expectation of life
Table B6: Worksheet – calculation of non-economic loss
LIST OF FIGURES
Figure 1-A: Activities of daily living
Figure 1-B: Symptomatic level of activity in METS according to age and gender
Figure 1-C: Definitions of functional class
Figure 1-C: Definitions of functional class
Figure 2-A: Calculating asthma impairment score
Figure 2-B: Calculating obstructive sleep apnoea score
Figure 4-A: Activities of daily living
Figure 5-A: Activities of daily living
Figure 6-A: Steps for calculating impairment of the visual system
Figure 6-B: Revised LogMar equivalent for different reading cards
Figure 6-C: Percentage loss of central vision in one eye
Figure 6-D: Normal extent of the visual field
Figure 6-E: Percentage loss of ocular motility of one eye in diplopia fields
Figure 6-F: Calculation of visual system impairment for both eyes
Figure 8-A: Activities of daily living
Figure 8-B: Body Mass Index criteria
Figure 9-A: Activities of daily living
Figure 9-B: Tables of normal ranges of motion of joints
Figure 9-C: Grading system
Figure 9-D: Grading system
Figure 12-A: Activities of daily living
Figure 12-B: Clinical dementia rating (CDR)
Figure 12-C: %WPI modifiers for episodic conditions
Figure 13-A: Activities of daily living
INTRODUCTION TO EDITION 3.0 OF THE GUIDE
STRUCTURE OF THIS GUIDE
1Division 1 is used to assess the degree of the permanent impairment of an employee resulting from an injury.
2Division 2 is used to assess the degree of non-economic loss suffered by an employee as a result of an injury or impairment.
3Division 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.
4Appendix 1 is used to obtain the combined value of multiple impairments resulting from a single injury where combination is required.
The Principles of Assessment and Glossary contain information relevant to the interpretation and application of Divisions 1 and 2.
APPLICATION OF THIS GUIDE
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.
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: PERSON IMPAIRMENT
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.
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.
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%.
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.
Whole person impairment is assessed under Division 1 of this Guide.
ENTITLEMENTS UNDER THE SRC ACT
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.
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.
For injuries suffered by employees after 1 October 2001, subsection 24(7A) of the SRC Act provides, in effect, that, if the injury results in a permanent impairment that is a hearing loss, the 10% threshold does not apply. In those cases:
a) subsection 24(7A) of the SRC Act provides that compensation is not payable to the employee under section 24 if the relevant authority determines the binaural hearing loss suffered by the employee to be less than 5%;
b) Section 7.1 (Hearing loss) of this Guide provides that the percentage of binaural hearing loss is converted to a WPI rating by dividing the percentage of binaural hearing loss by 2; and
c) consequently, the threshold for compensation under section 24 of the SRC Act for an injury resulting in a permanent impairment that is a hearing loss is 2.5% WPI under this Guide.
NON-ECONOMIC LOSS
Subsection 27(1) of the SRC Act provides that where there is liability to pay compensation in respect of a permanent impairment, additional compensation for non-economic loss is payable in accordance with section 27.
Non-economic loss is assessed under Division 2 of this Guide.
COMPENSATION PAYABLE
The maximum level of payment is prescribed in the legislation and indexed annually on 1 July in accordance with the Consumer Price Index. Compensation is calculated at the rate applicable at the time of the assessment. See Division 3 of this Guide for calculation of total entitlement to compensation for permanent impairment and non-economic loss.
INTERIM AND FINAL ASSESSMENTS
On the written request of the employee under subsection 25(1) of the SRC Act, an interim determination must be made 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.
When a final determination of the degree of permanent impairment is made by the relevant authority, there is payable to the employee, under subsection 25(3) of the SRC Act, an amount equal to the difference, if any, between the final determination and the interim assessment.
INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT
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.
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.
See Application of this Guide above as to assessments of the degree of permanent impairment made under the previous editions of the Guide.
SURVIVAL OF CLAIMS
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)).
In either case, if an amount of compensation is determined by the relevant authority to be payable under section 24 of the SRC Act in respect of the claim, subject to section 111, the amount is payable to the deceased employee’s estate (subsections 55(3) and 111(1)). No compensation under section 27 would be payable to the deceased employee’s estate for any non-economic loss (subsections 55(4)).
PRINCIPLES OF ASSESSMENT
IMPAIRMENT AND NON-ECONOMIC LOSS
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.
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.
Non-economic loss may be characterised as the ‘lifestyle effects’ of an injury or impairment. Lifestyle effects are a measure of an individual’s mobility and enjoyment of, and participation in, social relationships, and recreation and leisure activities. The employee must be aware of the losses suffered. While employees may have equal ratings of whole person impairment it would not be unusual for them to receive different ratings for non-economic loss because of their different lifestyles.
EMPLOYABILITY AND INCAPACITY
The concepts of ‘employability’ and ‘incapacity for work’ are not the tests for the assessment of impairment and non- economic loss. Incapacity for work is influenced by factors other than the degree of impairment and is compensated by weekly payments which are separate and independent to permanent impairment entitlements.
PERMANENT IMPAIRMENT
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)).
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.
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).
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.
Whatever the cause of death, the assessor must only assess the permanent impairment resulting from the injury. The assessor should, where possible, assess the degree of permanent impairment resulting from the injury by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment. For the purposes of the SRC Act and this Guide, death is not an impairment that is compensable under section 24 of the Act. Compensation for an injury resulting in death is dealt with separately in sections 17 and 18 of the Act.
PRE-EXISTING CONDITIONS AND AGGRAVATION
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.
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%.
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.
Where the pre-existing condition was previously symptomatic, the following method must be applied:
a) The assessor should, where possible, assess the degree of permanent impairment resulting from the pre-existing condition by reference to the available evidence (for example, clinical records, investigations, reported histories) and/or by using clinical judgment.
b) Where it is possible to assess the degree of permanent impairment resulting from the pre-existing condition, the assessor should, where possible, isolate the permanent impairment resulting from the injury (for example, by comparing the degree of permanent impairment resulting from the pre-existing condition with the degree of permanent impairment resulting from the injury to assess whether there has been an increase in the employee’s whole person impairment). Only the permanent impairment resulting from the injury is to be included in the assessment of the degree of permanent impairment of the employee.
c) Where it is not possible to assess the degree of permanent impairment resulting from the pre-existing condition, or it is not possible to isolate the permanent impairment resulting from the injury, the assessment of the degree of permanent impairment of the employee resulting from the injury is to be made by reference to the totality of effects of the pre-existing condition and the injury.
d) The percentage of permanent impairment suffered by an employee as a result of a particular injury ascertained by applying this method may be 0%.
PRE-EXISTING CONDITIONS AND INJURY OTHER THAN AGGRAVATION, TO SAME BODY PART, SYSTEM OR FUNCTION
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.
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%.
Where a pre-existing injury results in permanent impairment, and the employee subsequently suffers an injury which results in permanent impairment to the same body part, system or function (but the subsequent injury is not an aggravation of the pre-existing injury), the permanent impairment resulting from the pre-existing injury must be disregarded when assessing the degree of permanent impairment of the employee resulting from the subsequent injury. The subsequent injury should be assessed by reference to the functional capacities of a normal healthy person. The WPI rating for the pre-existing injury and the WPI rating for the subsequent injury may be added.
THE IMPAIRMENT TABLES
42Division 1 of this Guide is based on the concept of whole person impairment which is drawn from the AMA5.
43Division 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.
It may be necessary in some cases to have regard to a number of chapters within this Guide when assessing the degree of whole person impairment which results from an injury.
Where a table specifies a degree of impairment because of a surgical procedure, the same degree of impairment applies if the same loss of function has occurred due to a different medical procedure or treatment.
MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE
Conditions such as cancer, HIV infection, diabetes, asbestosis, mesothelioma and others, often with terminal consequences, may result in failure or impairment of multiple body parts or systems.
Assessments should be made of the impairment suffered in each of the affected body parts and systems and combined using the combined values chart in Appendix 1 to this Guide.
PERCENTAGES OF IMPAIRMENT
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%.
Where a table provides for impairment values within a range, consideration will need to be given to all criteria applicable to the condition, which includes performing activities of daily living and an estimate of the degree to which the medical impairment interferes with these activities. In some cases, additional information may be required to determine where to place an individual within the range. The assessor must provide written reason why they consider the selected point within the range as clinically justifiable.
COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES
Unless there are instructions in this Guide to the contrary, where two or more tables (or combinations of tables) are equally applicable to an impairment, the relevant authority will determine the degree of permanent impairment under the table or tables which yields or yield the most favourable result to the employee. The assessor (if not the relevant authority) should therefore provide assessments under all applicable tables to allow the relevant authority to make this determination.
COMBINED VALUES
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).)
It is important to note that whenever the notes in the relevant section in Division 1 refer to combined ratings, the combined values chart in Appendix 1 to this Guide must be used, even if no reference is made to the use of that chart.
CALCULATING THE ASSESSMENT
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.
There are some special circumstances where addition of scores rather than combination is required. These circumstances are specified in the relevant chapters in this Guide.
ORDERING OF ADDITIONAL INVESTIGATIONS
As a general principle, the assessor should not order additional radiographic or other investigations solely for impairment evaluation purposes, unless the investigations are specifically required in the relevant chapter of this Guide.
EXCEPTIONS TO USE OF THIS GUIDE
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.
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).
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.
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 [email protected].
LIST OF REFERENCES
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.
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.
American Medical Association, 1995, Guides to the Evaluation of Permanent Impairment, 4th edition, Chicago: American Medical Association.
American Medical Association, 2001, Guides to the Evaluation of Permanent Impairment, 5th edition, Chicago: American Medical Association.
American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/ disability secondary to respiratory disorders’, American Review of Respiratory Diseases, 133, 1205-09
American Thoracic Society, 1993, ‘Guidelines for the evaluation of impairment/disability in patients with asthma’, American Review of Respiratory Diseases, 147, 1056-61.
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.
Ensalada LH, ‘Complex regional pain syndrome’, in Brigham CR, ed, The Guides Casebook, Chicago, Ill: American Medical Association, 1999, 14.
Johns MW, 1991, ‘A new method for measuring daytime sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.
Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11), 2412-2414.
National Asthma Council, 2002, Asthma Management Handbook 2002, 5th edition, Melbourne: National Asthma Council of Australia.
GLOSSARY
In this Guide:
Activities of daily living means those activities that an employee needs to perform to function in a non-specific environment (that is, to live). Performance of activities of daily living is measured by reference to primary biological and psychosocial function.
Aggravation includes acceleration or recurrence (SRC Act, subsection 4(1)). See also the Principles of Assessment.
Ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development) (SRC Act, subsection 4(1)).
AMA4 means the Fourth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (1995) and any errata published prior to the commencement date.
AMA5 means the Fifth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (2001) and any errata published prior to the commencement date.
Assessor in relation to an employee means:
a) a legally qualified medical practitioner or audiologist, other than the employee, who is registered to practise a health profession with the Australian Health Practitioner Regulation Agency;
b) the relevant authority in relation to the employee;
c) a member within the meaning of section 3 of the Administrative Appeals Tribunal Act 1975.
Binaural hearing loss means hearing loss affecting both ears. For the purposes of this Guide, binaural hearing loss does not include tinnitus.
Commencement date has the meaning given in section 2 of the instrument titled Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0.
Disease has its ordinary meaning in Division 1 of this Guide.
Impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function (SRC Act, subsection 4(1)). See also the Principles of Assessment.
Injury in relation to an employee means an injury suffered by the employee in respect of which compensation is payable under the SRC Act (SRC Act, subsections 4(3) and 4(8), and sections 5A, 123A and 124).
Loss of amenities in relation to an employee means the effects on the employee’s mobility, social relationships and recreation and leisure activities. See also the Principles of Assessment.
Medical treatment has its ordinary meaning in Division 1 of this Guide.
Non-economic loss (NEL) in relation to an employee who has suffered an injury resulting in a permanent impairment, means loss or damage of a non-economic kind suffered by the employee (including pain and suffering, a loss of expectation of life or a loss of the amenities or enjoyment of life) as a result of that injury or impairment and of which the employee is aware (SRC Act, subsection 4(1)). See also the Principles of Assessment.
Pain means physical pain.
Permanent means ‘likely to continue indefinitely’ (SRC Act, subsection 4(1)). See also the Principles of Assessment.
SRC Act means the Safety, Rehabilitation and Compensation Act 1988.
Suffering means the mental distress resulting from the injury or impairment.
Whole person impairment (WPI) is the methodology used for expressing the degree of impairment of an employee, resulting from an injury, as a percentage. WPI is based on the AMA5. WPI is a medical quantification of the nature and extent of the effect of an injury on the employee’s functional capacity including activities of daily living. This Guide presents descriptions of impairments in chapters and tables according to body system. The extent of each impairment is expressed as a percentage value of the functional capacity of a normal healthy person. See also the Principles of Assessment.
DIVISION 1 – ASSESSMENT OF THE DEGREE OF THE PERMANENT IMPAIRMENT OF AN EMPLOYEE RESULTING FROM AN INJURY
CHAPTER 1 – THE CARDIOVASCULAR SYSTEM
1.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
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).
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.
74Chapter 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.
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.
Employees who have permanent cardiac limitation secondary to massive pulmonary embolism should be assessed under Chapter 1 – The cardiovascular system. A WPI rating assessed in these circumstances may not be combined with a rating from Table 13.4: Thrombotic disorders.
1.1 Coronary artery disease
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.
78Figure 1-B: Symptomatic level of activity in METS according to age and gender may be used for the assessment of symptomatic impairment caused by ischaemic heart disease, hypertension, cardiomyopathy, or rheumatic heart disease.
Figure 1-B: Symptomatic level of activity in METS according to age and gender
Age and gender Symptomatic level of activity in METS 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+ 18-30 M D D D C C B B B A A 18-30 F D D C C B B A A A 31-40 M D D D C C B B A A 31-40 F D D C B B B A 41-50 M D D C C B B A A 41-50 F D D C B B A A 51-60 M D D C B B A A A 51-60 F D D C B B A A 61-70 M D D C B B A A 61-70 F D D B B A A 70+ M D C B B A 70+ F D C B A A Table 1.1: Coronary artery disease
See notes to Table 1.1 for further details regarding abbreviations and symbols used in columns 3, 4 and 5.
Column 1
%WPI
Column 2
Level of activity in METS for age and gender
Column 3
Pathology
Column 4
Drug therapy
Column 5
Intervention
5 A Not applicable Not applicable Not applicable 10 A + + Not applicable 15 A ++ ++ PTCA 20 A +++ +++ CABG/Tx 25 B + + Not applicable 30 B ++ ++ PTCA 40 B +++ +++ CABG/Tx 50 C + + Not applicable 60 C ++ ++ PTCA 65 C +++ +++ CABG/Tx 75 D + + Not applicable 85 D ++ ++ PTCA 95 D +++ +++ CABG/Tx
Notes to Table 1.1
1. In Table 1.1, ‘not applicable’ means the criterion is not applicable to the specified level of impairment.
2. Pathology – column 3.
(i)Coronary artery disease:
+ either <50% stenosis in one or more coronary arteries, or single vessel disease >50% stenosis (except proximal left anterior descending (LAD) and left main coronary artery (LMCA)
++ either >50% stenosis in two vessels, or >50% stenosis in proximal LAD, or <50% stenosis in LMCA
+++ either >50% stenosis in 3 vessels, or LMCA >50% stenosis, or severe diffuse end organ disease.
(ii)Ischaemic left ventricular dysfunction:
+ left ventricular ejection fraction (LVEF) 40-50%
++ LVEF 30-40%
+++ either LVEF <30%, or LV aneurysm.
(iii)Myocardial infarction (MI):
+ no previous MI
++ previous possible MI (equivocal changes in ECG/cardiac enzymes)
+++ previous definite MI (unequivocal changes in ECG/cardiac enzymes: typical evolution of ST/T segments, or development of significant Q waves, or enzyme rise >3 times upper limit of normal).
(iv)Arrhythmias:
Assessed under Table 1.3: Arrhythmias.
3. Drug therapy (continuous) – column 4:
+ one or two drugs
++ three or four drugs
+++ five or more drugs.
4. Intervention – column 5:
‘PTCA’ means percutaneous transluminal coronary angioplasty and/or stenting.
‘CABG’ means coronary artery bypass grafting.
‘Tx’ means heart transplant.
1.2 Hypertension
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
Hypertensive cardiomyopathy can be assessed using the AMA5.
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.
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
Hypertensive cardiomyopathy can be assessed using the AMA5.
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
Underlying cardiac disease can be assessed using other tables in Chapter 1 – The cardiovascular system.
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
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).
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
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).
A WPI rating from Table 1.5: Peripheral vascular disease of the upper extremities may not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system).
Table 1.5: Peripheral vascular disease of the upper extremities
%WPI Symptoms Signs 5 Either no claudication or transient oedema. Calcification of arteries on X-ray. 10 Either no claudication or persistent oedema controlled by support. Dilatation of either arteries or veins. 15 As above. Either loss of pulse or healed ulcer or surgery. 20 Either claudication on strenuous exercise or persistent oedema uncontrolled by support. Either calcification of arteries on X-ray or dilatation of either arteries or veins. 30 As above. Superficial ulcer. 40 As above. Either deep or widespread ulcer or surgery. 45 Claudication on mild-moderate exertion. Either calcification of arteries on X-ray or dilatation of either arteries or veins. 50 As above. Superficial ulcer. 55 As above. Either deep or widespread ulcer or surgery. 60 Rest pain or unable to exercise. Not applicable
1.6 Raynaud’s disease
Functional class (assessed in accordance with Figure 1-C: Definitions of functional class) is the primary criterion for assessment. Signs of vasospastic disease and therapy (see Table 1.6: Raynaud’s disease) are secondary criteria for assessment.
Figure 1-C: Definitions of functional class
See note to Figure 1-C for further information.
Functional class Symptoms (all required) I No limitation of physical activity. II Slight limitation of physical activity.
Comfortable at rest and with ordinary, light activities of daily living.
Greater activity causes symptoms.
III Marked limitation of physical activity.
Comfortable at rest.
Ordinary activity causes symptoms.
IV Inability to carry out any physical activity without discomfort.
Note to Figure 1-C
1. Figure 1-C also appears in Section 1.3 (Arrhythmias). It is repeated here for ease of reference
Table 1.6: Raynaud’s disease
See note to Table 1.6 for further information.
%WPI Functional class Signs Therapy 5 I Nil. Nil. 10 I Nil. Drug(s). 15 I Nil. Surgery. 20 II Neither ulceration nor trophic changes. Drug(s). 25 II Either ulceration or trophic changes. Drug(s). 30 II Not applicable Surgery. 35 III Neither ulceration nor trophic changes. Drug(s). 40 III Either ulceration or trophic changes. Drug(s). 45 III Not applicable Surgery. 50 IV Not applicable Not applicable
Note to Table 1.6
1. Therapy – final column of Table 1.6:
‘Surgery’ includes sympathectomy and local debridement.
‘Drug(s)’ means continuous therapy with one or more drugs.
CHAPTER 2 – THE RESPIRATORY SYSTEM
2.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
The measure of impairment is the reduction in physiological function below that found in health.
Respiratory impairment is quantified by the degree to which measurements of respiratory function are changed by the compensable injury or injuries, relative to values obtained in a healthy reference population of similar individuals.
Conditions such as chronic obstructive airways disease and chronic bronchitis are to be assessed according to the methods used to measure loss of respiratory function.
Employees who have permanent respiratory limitation secondary to massive pulmonary embolism should be assessed under Chapter 2 – The respiratory system. Any WPI rating awarded in these circumstances may not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13 – The haematopoietic system).
2.1 Assessing impairment of respiratory function
2.1.1 Measurements
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.
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.
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.
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.
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%.
Measurements of arterial blood gases should be performed on two occasions, with the employee seated.
2.1.2 Methods of measurement
Measurements must be performed in a manner consistent with the methods used by a respiratory function laboratory accredited by one or more of the following bodies:
a) the Thoracic Society of Australia and New Zealand;
b) the Australasian Sleep Association; or
c) the Australian Council on Healthcare Standards.
Methods of measurement should conform to internationally recognised standards in relation to the equipment used, the procedure, and analysis of the data. Reference values (‘predicted’ normal values) should be representative of the healthy population and be appropriate for ethnicity where possible. Laboratories providing measurements used to assess impairment should state the method(s) of measurement used, and the source of the reference values used.
2.1.3 Impairment rating
Several professional groups have published criteria for rating the severity of impairment based on spirometry, gas transfer and 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.
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
Assessment of impairment due to asthma can be confounded by the natural history of occupational asthma, by variably severe airflow obstruction, and therefore variable FEV1, and by response to treatment.
For hyper-reactivity of airways due to occupational exposures, assessment of impairment is made after:
a) the diagnosis and cause are established;
b) exposure to the provoking factors is eliminated; and
c) appropriate treatment of asthma is implemented.
Appropriate treatment follows the guidelines in the Asthma Management Handbook 2002 (National Asthma Council, 2002, 5th edition, Melbourne: National Asthma Council of Australia), a later edition of those guidelines, or later guidelines widely accepted by the medical profession as representing best practice.
Permanent impairment should not be assessed until 2 years after cessation of exposure to provoking factors as severity may decrease during this period.
An impairment rating scale is set out in Figure 2-A: 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.
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.
The number of days on which any valid measurement of FEV1 or PF is less than 0.85 x the mean of the six highest values of FEV1 or PF during the monitoring period is to be expressed as a percentage of total days in the monitoring period.
The maximum impairment score from Figure 2-A: 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 bronchodilatorDFEV1, % change in FEV1
with bronchodilatorPD20 or µmol % of days lowest FEV1*
is ≤0.85 highest FEV10 >85 <10 >4.0 <6 1 76 to 85 10 to 19 0.26 to 4.0 6 to 24 2 66 to 75 20 to 29 0.063 to 0.25 25 to 34 3 56 to 65 ≥30 ≤ 0.062 35 to 44 4 ≤55 ≥45
Notes to Figure 2-A
1. Figure 2-A is based on scales proposed by: the American Thoracic Society (1993), as adapted in Tables 5-9 and 5-10 of the AMA5; and the Thoracic Society of Australia and New Zealand (Abramson, 1996).
2. %P = percent predicted normal value.
3. PD20 = cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV1.
4. * monitored twice daily before and after aerosol bronchodilator for at least 30 days during adequate treatment.
5. % of days = proportion of days any value of FEV1 (or of peak flow rate) is less than highest repeatable FEV1 (or peak flow rate) x 0.85.
Table 2.2: WPI derived from asthma impairment score
%WPI Asthma impairment score 0 0 10 1 20 2 30 3 40 4 45 5 50 6 55 7 60 8 65 9 70 10 75 11 80 12
2.3 Lung cancer and mesothelioma
Employees with lung cancers (other than mesothelioma) are considered severely impaired at the time of diagnosis and are given a WPI rating of 70%.
If there is evidence of tumour, or if tumour recurs one year after diagnosis is established, then the employee remains severely impaired and the WPI rating is increased to 80%.
Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.
2.4 Breathing disorders associated with sleep
Some disorders such as obstructive sleep apnoea, central sleep apnoea, and hypoventilation during sleep, can cause impairment which is not quantifiable by standard measurements of respiratory function such as spirometry, diffusing capacity, or response to exercise.
Obstructive sleep apnoea should be assessed using Table 2.4: 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).
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).
Where vascular morbidity is present (for example, high blood pressure or myocardial infarction) and is attributable to sleep apnoea, impairment should be assessed using the relevant table in Chapter 1 – The cardiovascular system.
The total score derived from Figure 2-B: 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 sleepRespiratory arousals*
/hr of sleepCumulative sleep time, mins, with SaO2 <90% # 0 <5 <5 <5 0 1 5 to 10 5 to 15 5 to 15 <15 2 11 to 17 16 to 30 16 to 30 15 to 45 3 >17 >30 >30 >45
Notes to Figure 2-B
1. * An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory effort related arousal, as defined by the American Academy of Sleep Medicine (1999).
2. # SaO2 = arterial oxygen saturation measured with a pulse oximeter.
Table 2.4: WPI derived from obstructive sleep apnoea score
%WPI Sleep apnoea score 0 0 10 1 20 2 30 3 40 4 45 5 50 6 55 7 60 8 65 9 70 10 75 11 80 12
CHAPTER 3 – THE ENDOCRINE SYSTEM
3.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
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.
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
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)).
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.
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).
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.
12.5.4The facial nerve (VII)
This is a mixed nerve. The motor part innervates the facial muscles of expression and the accessory muscles for chewing and swallowing. The sensory fibres carry tactile sensations from the ear, soft palate and adjacent pharynx, and transmit taste from the anterior two thirds of the tongue.
Impairment due to chewing and swallowing difficulties is assessed under Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII). For the same condition, WPI ratings derived from Table 12.5.6 may not be combined with WPI ratings from Table 7.7: Chewing and swallowing (see Chapter 7 – Ear, nose and throat disorders).
Facial nerve injury, complicated by visual changes, such as occur with corneal desiccation and scarring, should rate as a significant impairment. This should be assessed under Chapter 6 – The visual system, and may be combined with a WPI rating from Table 12.5.4: The facial nerve (VII).
For the same condition, a WPI rating from Table 12.5.4: The facial nerve (VII) may not be combined with a WPI rating from Table 7.3: Olfaction and taste (see Chapter 7 – Ear, nose and throat disorders).
Table 12.5.4: The facial nerve (VII)
See note to Table 12.5.4 for further information.
%WPI Criteria 3 Complete loss of taste over anterior two thirds of tongue.
or
Mild unilateral facial weakness.
10–12 Mild bilateral facial weakness.
or
Severe unilateral facial paralysis with 75% or greater facial involvement and inability to control eyelid closure.
30 Severe bilateral facial paralysis with 75% or greater facial involvement and inability to control eyelid closure.
Note to Table 12.5.4
1. Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
12.5.5The auditory nerve (VIII)
The auditory nerve has two portions:
a) the cochlear portion concerned with hearing; and
b) the vestibular portion concerned with balance and spatial orientation.
Impairment of hearing due to a lesion of the cochlear portion of the nerve should be evaluated under Chapter 7 – Ear, nose and throat disorders. A WPI rating derived from Chapter 7 may be combined with a WPI rating from Table 12.5.5: The auditory nerve (VIII).
Lesions of the vestibular portion of the nerve result in vertigo with or without nausea and vomiting.
435Table 12.5.5: The auditory nerve (VIII) is used where symptoms are continuous.
To obtain the final WPI rating in the case of episodic disturbances of equilibrium (such as Menière’s disease), apply the modifier from Figure 12-C: %WPI modifiers for episodic conditions to the WPI rating from Table 12.5.5: The auditory nerve (VIII).
Table 12.5.5: The auditory nerve (VIII)
See notes to Table 12.5.5 for further information.
%WPI Criteria 0 Symptoms of vestibular dysequilibrium present without supporting objective findings, and activities of daily living can be performed without assistance. 5 Symptoms of vestibular dysequilibrium present with supporting objective findings, and most activities of daily living can be performed without assistance. 10 Symptoms of vestibular dysequilibrium present with supporting objective findings, and most activities of daily living, except those of a complex nature (for example, riding a bicycle), or hazardous nature (for example, walking on a roof, girders or scaffolding), can be performed without assistance. 20 Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with most activities of daily living, except self care, walking, and riding in a motor vehicle as a passenger. 30 Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with all activities of daily living, except self care. 45 Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with all activities of daily living, including self care not requiring ambulation. 60 Symptoms of vestibular dysequilibrium present with supporting objective findings, and activities of daily living cannot be performed without assistance, including self care. 80 Symptoms of vestibular dysequilibrium present with supporting objective findings, and activities of daily living cannot be performed without assistance, including self care, and home confinement is necessary
Notes to Table 12.5.5
1. ‘Assistance’ means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
2. ‘Suitable person’ means a person capable of responsibly caring for the employee in an appropriate way.
Figure 12-C: %WPI modifiers for episodic conditions
Signs and symptoms Modifier Absent. 0.0 Intermittent. 0.2 Present on a daily basis for periods aggregating 3 or more months per year but less than 6 months per year. 0.4 Present on a daily basis for periods aggregating 6 or more months per year but less than 8 months per year. 0.6 Present on a daily basis for periods aggregating 8 months or more per year but less than 10 months per year. 0.8 Present on a daily basis for period aggregating 10 months per year or more. 1.0
12.5.6The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)
The spinal accessory nerve assists the vagus nerve in supplying some of the muscles of the larynx, and innervates the cervical portions of the sternocleidomastoid and trapezius muscles.
Disorders of these nerves affecting musculoskeletal function should be assessed in accordance with criteria contained in Chapter 9 – Musculoskeletal system.
The glossopharyngeal nerve and the vagus nerve are mixed nerves supplying sensory fibres to the posterior third of the tongue, larynx and trachea. Sensory impairment may contribute to difficulties swallowing, breathing and speaking.
The hypoglossal nerve is a motor nerve that innervates the musculature of the tongue.
Dysarthia is a situation where the articulation of the voice mechanism is at fault. Pronunciation is unclear, although the linguistic content and meaning are normal.
Dysphagia is a condition in which the action of swallowing is difficult to perform, painful, or in which swallowed material is delayed in its passage to the stomach. Speech is slowed or slurred and may be completely unintelligible or non- functional. All other causes of difficulty with chewing or swallowing should be assessed using Table 7.7: Chewing and swallowing (see Chapter 7 – Ear, nose and throat disorders). For the same condition, WPI ratings from Table 7.7 may not be combined with WPI ratings from Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII).
Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)
%WPI Criteria (one required – different conditions may be assessed separately) 10 Mild dysarthria (speech slow or slurred especially when tired).
Dystonia (only neurological).
Mild dysphagia (coughing on liquids or semi-solid foods).
Diet limited to semi-solid or soft foods.
Spasmodic torticollis (only neurological).
25 Moderately severe dysarthia (speech is laboured, imprecise, and often unintelligible).
Speaker is required to repeat often and may need augmentative device to help convey message. Moderately severe dysphagia with nasal regurgitation and aspiration of liquids and semisolid foods.
Diet limited to liquid foods.
50 Severe dysarthia – speech may be completely unintelligible or non-functional, or intelligible only to familiar people, and only with the aid of an augmentative communication device.
Severe dysphagia (inability to swallow food, liquids or manage oral secretions).
Regular suctioning required.
Ingestion of food requires tube feeding or gastrotomy.
12.6 Neurological impairment of the respiratory system
Where the ability to breathe is impaired because of a neurological impairment, Table 12.6: Neurological impairment of the respiratory system may be used. Impairments of the respiratory system not of documented neurological origin are assessed under Chapter 2 – The respiratory system. They are not assessed under Table 12.6.
Table 12.6: Neurological impairment of the respiratory system
%WPI Criteria 10 Able to breathe spontaneously but has difficulty performing activities of daily living that require moderate exertion. 25 Able to breathe spontaneously but is restricted to sitting, standing or limited walking. 60 Able to breathe spontaneously but to such a limited degree that the employee is confined to bed. 90 No capacity for spontaneous respiration.
12.7 Neurological impairment of the urinary system
Where there is loss of bladder control due to a neurological impairment, Table 12.7: Neurological impairment of the urinary system may be used.
Impairments of the urinary system not of documented neurological origin are assessed under Chapter 10 – Urinary system. They are not assessed under Table 12.7: Neurological impairment of the urinary system.
Documentation by cystometric and other relevant urologic tests may be necessary.
The status of the upper urinary tract must also be considered. Except for an impairment of bladder function, if several impairments of the urinary system are present, a WPI rating from Table 12.7: Neurological impairment of the urinary system may be combined with a WPI rating from Chapter 10 – Urinary system.
Table 12.7: Neurological impairment of the urinary system
See note to Table 12.7 for further information.
%WPI Criteria 5 Some degree of voluntary control but impaired by urgency or intermittent incontinence. 10–15 Good bladder reflex activity, limited capacity, and intermittent emptying without voluntary control. 30 Poor bladder reflex activity, intermittent dribbling, and no voluntary control. 50 No reflex or voluntary control of the bladder.
Note to Table 12.7
1. Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
12.8 Neurological impairment of the anorectal system
Where there is loss of ability to control emptying because of a neurological impairment, Table 12.8: Neurological impairment of the anorectal system may be used. Impairments of the anorectal system not of documented neurological origin are assessed under Chapter 8 – The digestive system. They are not assessed under Table 12.8.
Table 12.8: Neurological impairment of the anorectal system
%WPI Criteria 10 Reflex regulation but only limited voluntary control. 20 Reflex regulation but no voluntary control. 40 No reflex regulation or voluntary control.
12.9 Neurological impairment affecting sexual function
Where there is loss of awareness and the capability of having an orgasm because of a neurological impairment, Table 12.9: Neurological impairment affecting sexual function may be used. Impairments of sexual function not of documented neurological origin are not assessed under Table 12.9. They are assessed under Chapter 11 – The reproductive system.
The employee’s previous sexual functioning should be considered.
Impairment of the peripheral nervous system is assessed using the methodology for assessing the lower and upper extremities described in Chapter 9 – Musculoskeletal system.
Table 12.9: Neurological impairment affecting sexual function
%WPI Criteria 10 Sexual functioning is possible, but with difficulty of erection or ejaculation in men, or lack of awareness, excitement or lubrication in either sex. 15 Reflex sexual functioning is possible, but there is no awareness. 20 No sexual functioning.
CHAPTER 13 – THE HAEMATOPOIETIC SYSTEM
13.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
13.1 Anaemia
Iron deficiency anaemia and megaloblastic anaemia are generally manageable with proper treatment and should not cause permanent impairment. Some haemolytic anaemias are reversible with appropriate therapy, such as steroids or splenectomy, and also should result in negligible impairment.
The impairment resulting from persistent refractory anaemia, whether haemolytic or aplastic, is assessed using Table 13.1: Anaemia.
Table 13.1: Anaemia
See note to Table 13.1 for further information.
%WPI Haemoglobin level Transfusion requirements 0 100-120g/L None 10 80-100g/L None 20 80-100g/L 2 units every 6 weeks 40 <80g/L 2-3 units every 4 to 6 weeks 60 <80g/L 2-3 units every 2-3 weeks
Note to Table 13.1.
1. The haemoglobin levels referred to in Table 13.1 are the levels prior to transfusion.
13.2 Leukocyte abnormalities or disease
Chronic low white cell counts (for example, neutropenia) are usually associated with substantially increased risk of infection. Impairment is measured in terms of the infection.
Neoplastic disorders of leukocytes include leukaemias, lymphomas, multiple myeloma, and macroglobulinaemia. Some of these disorders (chronic lymphatic leukaemia, hairy cell leukaemia, and some lymphomas) may cause no impairment for many years.
Similarly, multiple myeloma and macroglobulinaemia may be initially asymptomatic, and cause no gastrointestinal haemorrhage, bone pain, or need for chemotherapy or radiation.
The impairment should be assessed by reference to the appropriate chapters of this guide.
As the early stages of HIV infection are not likely to manifest in impaired organ systems, Table 13.2: Leukocyte abnormalities or disease alone should be used to assess any impairment. Where organ systems are impaired as the disease progresses, impairment should be assessed using those chapters of the guide which assess impairment of the principal organ systems affected by the disease: including, but not limited to, Chapter 2 – The respiratory system, Chapter 8 – The digestive system, Chapter 10 – The urinary system, and Chapter 12 – The neurological system. If several systems are involved, the WPI ratings derived for each system are combined using the combined values chart (see Appendix 1).
The combined impairment should then be compared with the WPI rating from Table 13.2: Leukocyte abnormalities or disease in order to ascertain the more beneficial WPI rating.
The contribution of side effects of drug treatment to overall impairment should also be considered.
The same principle applies to other conditions of the haematopoietic system where organ systems are impaired by the disease process and impairment can be assessed using other chapters of the guide.
For the purposes of Table 13.2: Leukocyte abnormalities or disease, activities of daily living are those in Figure 13-A.
Figure 13-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 13.2: Leukocyte abnormalities or disease
See notes to Table 13.2 for further information.
%WPI Criteria (all required) 0 Signs of leukocyte abnormality but no symptoms.
No or infrequent treatment needed.
All the activities of daily living can be performed.
10 Signs and symptoms of leukocyte abnormality.
Infrequent treatment needed.
Almost all the activities of daily living can be performed.
20 Signs and symptoms of leukocyte abnormality.
Continuous or regular treatment needed.
Most of the activities of daily living can be performed.
30 Signs and symptoms of leukocyte abnormality.
Continuous or regular treatment needed.
Interference with the performance of the activities of daily living to the extent that some assistance from others is required.
50 Signs and symptoms of leukocyte abnormality.
Continuous or regular treatment needed.
Interference with the performance of the activities of daily living to the extent that considerable assistance from others is required.
70 Signs and symptoms of leukocyte abnormality.
Continuous or regular treatment needed.
Interference with the performance of the activities of daily living to the extent that continuous assistance from others is required.
80 Signs and symptoms of leukocyte abnormality.
Continuous or regular treatment needed.
Totally dependent on others for performance of all activities of daily living.
Notes to Table 13.2
1. ‘Assistance’ means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
2. ‘Suitable person’ means a person capable of responsibly caring for the employee in an appropriate way.
13.3 Haemorrhagic disorders and platelet disorders
Thrombocytopenia does not constitute an impairment unless severe and not reversible by steroids, splenectomy, or other therapy.
A bleeding disorder that causes problems only after trauma or surgery does not constitute a permanent bleeding impairment.
Where an injury is made more severe by the presence of an underlying bleeding disorder, a combined WPI rating is allowed, incorporating values for bleeding sites or organ damage. A WPI rating obtained from tables in other chapters may be combined with a WPI rating obtained from Table 13.3: Haemorrhagic disorders and platelet disorders.
Other complications of bleeding disorders, including gastrointestinal, mucosal or intramuscular haemorrhage, should also be assessed according to the site of the blood loss under other Chapters of the guide, including Chapter 8 – The digestive system and/or Table 13.1: Anaemia.
A WPI rating obtained from other tables in this Guide may be combined with a WPI rating obtained from Table 13.3: Haemorrhagic disorders and platelet disorders.
Table 13.3: Haemorrhagic disorders and platelet disorders
%WPI Criteria 0 Splenectomy.
or
Easy bruising.
10 Continuous or regular medication is required. 25 Refractory thrombocytopenia <20,000/µL.
13.4 Thrombotic disorders
Long-term prophylaxis means prophylaxis continuing for at least two years.
Employees who have permanent respiratory or cardiac limitations secondary to massive pulmonary embolism should be assessed as appropriate under Chapter 1 – The cardiovascular system and Chapter 2 – The respiratory system.
For specific levels of impairment for post-thrombotic syndrome, use Table 1.4: Peripheral vascular disease of the lower extremities or Table 1.5: Peripheral vascular disease of the upper extremities (see Chapter 1 – The cardiovascular system). These tables may be used as an alternative. WPI ratings from Tables 1.4 or 1.5, and Table 13.4: Thrombotic disorders, may not be combined.
472Table 1.4: Peripheral vascular disease of the lower extremities and Table 1.5: Peripheral vascular disease of the upper extremities should be used as the primary guide for assessing peripheral complications of thrombosis.
Table 13.4: Thrombotic disorders
%WPI Criteria 0 Superficial thrombosis or thrombophlebitis. 10 Deep venous or other thrombosis requiring long-term prophylaxis with warfarin. 30 Post-phlebitic syndrome.
DIVISION 2 – ASSESSMENT OF THE DEGREE OF NON-ECONOMIC LOSS SUFFERED BY AN EMPLOYEE AS A RESULT OF AN INJURY OR IMPAIRMENT
Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
The degree of non-economic loss is to be assessed in accordance with Division 2.
The compensation payable for non-economic loss is divided into two equal amounts.
476Table B6: Worksheet – calculation of non-economic loss uses the following formula to calculate the total payable in an individual case:
WHERE “A” = the percentage assessment of total permanent impairment, multiplied by the first half of the maximum
AND “B” = a reasonable percentage of the second half of the maximum having regard to the non-economic loss suffered.
Listed below are the tables in Division 2 used to calculate a reasonable percentage.
a) Pain:
i)Table B1: Pain.
b) Suffering:
i)Table B2: Suffering.
c) Loss of amenities:
i)Table B3.1: Mobility;
ii)Table B3.2: Social relationships; and
iii)Table B3.3: Recreation and leisure activities.
d) Other loss:
i)Table B4: Other loss.
e) Loss of expectation of life:
i)Table B5: Loss of expectation of life.
Scores derived from these tables are then transferred to Table B6: Worksheet – calculation of non-economic loss.
B1 Pain
Using Table B1: Pain, a score out of five is assessed for pain.
Using Table B6: Worksheet – calculation of non-economic loss, the score for pain is combined with the scores derived from Table B2: Suffering, Table B3.1: Mobility, Table B3.2: Social relationships, Table B3.3: Recreation and leisure activities, Table B4: Other loss and Table B5: Loss of expectation of life.
The term ‘pain’ is defined in the Glossary.
Only ongoing pain of a continuing or episodic nature is to be considered.
483Table B1: Pain does not include:
a) temporary pain; or
b) speculation of future pain that has not yet manifested itself.
In Table B1: Pain, VAPS means ‘visual analogue pain scale’, with 0 being no pain, and 10 being the worst pain ever experienced.
Table B1: Pain
Score Description of level of effect (all required) 0 No pain experienced.
VAPS = 0
1 Intermittent attacks of pain of nuisance value only.
Can be ignored when activity commences.
VAPS = 1-2
2 Intermittent attacks of pain.
Not easily tolerated, but short-lived.
Pain responds fairly readily to treatment (for example, analgesics, anti-inflammatory medications).
VAPS = 3-4
3 Episodes of pain more persistent.
Not easily tolerated.
Treatment, if available, of limited benefit.
VAPS = 5-6
4 Pain occurring most of the time.
Restrictions on activity.
Resistant to treatment.
VAPS = 7-8
5 Pain continuous and severe.
Preventing activity.
Uncontrolled by medication.
VAPS = 9-10
B2 Suffering
Using Table B2: Suffering, a score out of five is assessed for suffering.
Using Table B6: Worksheet – calculation of non-economic loss, the score for suffering is combined with the scores derived from Table B1: Pain, Table B3.1: Mobility, Table B3.2: Social relationships, Table B3.3: Recreation and leisure activities, Table B4: Other loss and Table B5: Loss of expectation of life.
The term ‘suffering’ is defined in the Glossary.
Suffering includes emotional symptoms which are within the normal range of human responses to distressing events such as grief, anguish, fear, frustration, humiliation, embarrassment.
Only ongoing suffering of a continuing or episodic nature is considered.
490Table B2: Suffering does not include:
a) temporary suffering; or
b) speculation about future suffering that has not yet manifested itself.
Table B2: Suffering
Score Description of level of effect (all required) 0 No symptoms of mental distress experienced. 1 Symptoms of mental distress minimal or ill defined.
Symptoms occur intermittently.
No interference with activity.
2 Distinct symptoms of mental distress which are episodic in nature.
Activities reduced during such episodes.
Recovers quickly after episodes.
3 Symptoms of mental distress are distinct and varied.
Episodes of mental distress occur regularly.
Ability to cope or perform activity effectively reduced during episodes.
Needs time to recover between episodes.
Treatment – medication such as anti-depressants, counselling or other therapy by a psychologist or
psychiatrist, or other supportive therapy – is of benefit in controlling or relieving symptoms.
4 Symptoms of mental distress are wide ranging and tend to dominate thinking.
Rarely free of symptoms of mental distress.
Difficulty coping or performing activity.
Treatment necessary either to control or relieve symptoms.
5 Symptoms of mental distress arising from accepted condition interferes with normal thought processes. Activities severely restricted.
Treatment of no real benefit in controlling or relieving symptoms.
B3 Loss of amenities
The term ‘loss of amenities’ is defined in the Glossary. Loss of amenities is also known as ‘loss of enjoyment of life’.
A score out of five is assessed for each of the following:
a) Mobility (using Table B3.1: Mobility). ‘Mobility’ refers to the employee’s ongoing ability to move around in their environment. This includes walking, driving, being a passenger, using public transport
b) Social relationships (using Table B3.2: Social relationships). ‘Social relationships’ refers to the employee’s ongoing capacity to engage in usual social and personal relationships
c) Recreation and leisure activities (using Table B3.3: Recreation and leisure activities). ‘Recreation and leisure activities’ refers to the employee’s ongoing ability to maintain customary recreational and leisure pursuits.
Using Table B6: Worksheet – calculation of non-economic loss, these scores are then combined with the scores derived from Table B1: Pain, Table B2: Suffering, Table B4: Other loss and Table B5: Loss of expectation of life.
Table B3.1: Mobility
Score Description of level of effect (all required) 0 No or minimal restrictions on mobility. 1 Periodic effects on mobility, resulting in the need for some assistance
or
effects continuing but mild (such as slowing of pace or the need for a walking stick).
2 Mobility reduced, but remains independent of others both within and outside the home.
Can travel but may require rest breaks, special seating, or other special treatment.
3 Mobility markedly reduced.
Needs some assistance from others.
Unable to use most forms of transport.
4 Restricted to home and vicinity.
Can only travel outside home with door to door transport and the assistance of others.
5 Severely restricted mobility (for example, bed, chair, room).
Dependent on others for assistance.
Mechanical devices or appliances used for mobility within the home (for example, wheelchair, hoist).
Table B3.2: Social relationships
Score Description of effect (all required) 0 Usual relationships unaffected. 1 Minor interference with personal relationships, causing some reduction in social activities and contacts. 2 Relationships confined to immediate and extended family and close friends, but unable to relate to casual acquaintances. 3 Difficulty in maintaining relationships with close friends and the extended family. 4 Social contacts confined to immediate family. 5 Difficulties relating socially to anyone.
Table B3.3: Recreation and leisure activities
Score Description of effect (all required) 0 Able to follow usual recreation and leisure activities 1 Intermittent interference with activities.
In between episodes able to pursue usual activities.
2 Interference to activities reduces frequency of activity, but is able to continue.
Is able to follow alternatives.
3 Unable to continue with pre-injury level of activity.
Alternative activity possible.
4 Range of pre-injury activities greatly reduced.
Needs some assistance to participate in pre-injury recreation and leisure activities.
5 Unable to undertake any pre-injury recreation and leisure activities.
B4 Other loss
494Table B4: Other loss is used to assess losses of a non-economic nature that are not adequately covered by Table B1: Pain, Table B2: Suffering, Table B3.1: Mobility, Table B3.2: Social relationships, Table B3.3: Recreation and leisure activities or Table B5: Loss of expectation of life.
A score out of three is assessed.
Using Table B6: Worksheet – calculation of non-economic loss, this score is then combined with the scores derived from Table B1: Pain, Table B2: Suffering, Table B3.1: Mobility, Table B3.2: Social relationships, Table B3.3: Recreation and leisure activities and Table B5: Loss of expectation of life.
Table B4: Other loss
Score Description of effect 0 Nil or minimal disadvantages. 1 Moderate disadvantages. For example, dependence upon a specialised diet; detrimental effects of climatic features including temperature, humidity, ultra-violet rays, light, noise, dust. 2 Marked disadvantages. For example, requirement to move to specially modified premises. 3 Severe disadvantages. For example, dependence upon external life saving or supporting machines including aspirator, respirator, dialysis machine, or any form of electro-mechanical device for the sustenance or extension of activities.
B5 Loss of expectation of life
A score out of three is assessed.
Using Table B6: Worksheet – calculation of non-economic loss, this score is then combined with the scores derived from Table B1: Pain, Table B2: Suffering, Table B3.1: Mobility, Table B3.2: Social relationships, Table B3.3: Recreation and leisure activities and Table B4: Other loss.
Loss of expectation of life is restricted to a maximum of three points because of the value placed on it by the courts in damages cases.
Table B5: Loss of expectation of life
Score Description of effect 0 Loss of life expectancy of less than one year. 1 Loss of life expectancy of one year to less than 10 years. 2 Loss of life expectancy of 10 years to less than 20 years. 3 Loss of life expectancy of 20 years or greater.
B6 Calculation of non-economic loss
500Table B6: Worksheet – calculation of non-economic loss allows for the calculation of the percentage of non-economic loss suffered by the employee for the purposes of section 27 of the SRC Act.
Table B6: Worksheet – calculation of non-economic loss
STEP 1 – Calculation of total score from Division 2 tables
Table Score Factor Final score Table B1: Pain x 0.5 = Table B2: Suffering x 0.5 = B3: Amenities of life B3.1: Mobility score x 0.6 = B3.2: Social relationships x 0.6 = B3.3: Recreation and leisure activities x 0.6 = Table B4: Other loss x 1.0 = Table B5: Loss of expectation of life x 1.0 = Total of scores =
STEP 2 – Conversion of total of scores to a percentage
Choose either Step 2.1 or Step 2.2 Step 2.1
If the total of scores from Step 1 above:
· equals 15; or
· is greater than 15
then the percentage of non-economic loss suffered by the employee is 100% (%NEL).
Or Step 2.2
If the total of scores from Step 1 above is less than 15, complete the following calculation to find the percentage non-economic loss suffered by the employee:
DIVISION 3 – CALCULATION OF THE TOTAL ENTITLEMENT TO COMPENSATION FOR PERMANENT IMPAIRMENT AND NON-ECONOMIC LOSS
Use Table C1: Worksheet – calculation of total entitlement to derive the total entitlement.
Table C1: Worksheet – calculation of total entitlement
Current statutory maximum amounts for permanent impairment and non-economic loss compensation are available on Comcare’s website: comcare.gov.au/claims/statutory-rates. They are indexed annually on 1 July in accordance with movements in the Consumer Price Index.
Calculate total whole person impairment entitlement Step 1 Obtain the current indexed maximum amount for permanent impairment under subsection 24(9) of the SRC Act (maximum s 24(9) amount) and complete the following calculation:
$ Step 2 Obtain the current indexed maximum amount for non-economic loss under subsection 27(2) “A” of the SRC Act (maximum s 27(2) “A” amount) and complete the following calculation:
$ Step 3 Obtain the current indexed maximum amount for non-economic loss under subsection 27(2) “B” of the SRC Act (maximum s 27(2) “B” amount) and complete the following calculation:
$ Step 4 Add the amounts calculated in Steps 1, 2 and 3 to calculate the total entitlement under sections 24 and 27 of the SRC Act: $
APPENDIX 1 – COMBINED VALUES CHART
The values are derived from the formula:
WHERE “A” and “B” are the decimal equivalents of the WPI ratings.
In the chart all values are expressed as percentages. To combine any two impairment values, locate the larger of the values on the side of the chart and read along that row until you come to the column indicated by the smaller value at the bottom of the chart. At the intersection of the row and the column is the combined value.
For example, to combine 35% and 20%, read down the side of the chart until you come to the larger value, 35%. Then read across the 35% row until you come to the column indicated by 20% at the bottom of the chart. At the intersection of the row and column is the number 48. Therefore, 35% combined with 20% is 48%. Because of the construction of this chart, the larger impairment value must be identified at the side of the chart.
If three or more impairment values are to be combined, sort the impairment values from highest to lowest, select the highest and find their combined values as above. The use that combined value and the third highest impairment value to locate the combined value of all.
This process can be repeated indefinitely, the final value in each instance being the combination of all the previous values. In each step of this process the larger impairment value must be identified at the side of the chart.
Combined values chart
Source: The AMA5 (pages 604-5).
Combined values chart (continued)
Combined values chart (continued)
0
0
0