Safety, Rehabilitation and Compensation Act 1988 Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 (Cth)

SAFETY, REHABILITATION AND COMPENSATION ACT 1988 –

GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT
IMPAIRMENT EDITION 2.1 (CONSOLIDATION 1)

This consolidation incorporates the Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 (‘Edition 2.1’) as prepared by Comcare and approved by the Minister for Tertiary Education, Skills, Jobs and Workplace Relations on 2 November 2011 with effect from 1 December 2011 and as varied by the Safety, Rehabilitation and Compensation Act 1988 – Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 – Variation No.1 of 2011 (‘Variation 1 of 2011’) as approved by Comcare and approved by the Minister for Tertiary Education, Skills, Jobs and Workplace Relations on 29 November 2011 with effect from 1 December 2011.

NOTES:

1. Edition 2.1 and Variation 1 of 2011 were each prepared by Comcare under subsection 28(1) of the Safety, Rehabilitation and Compensation Act 1988 and approved by the Minister under subsection 28(3) of that Act.

2. Edition 2.1 was registered on the Federal Register of Legislative Instruments as F2011L02375 and Variation 1 of 2011 was registered as F2011L02519.

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

GUIDE TO THE ASSESSMENT OF THE DEGREE OF PERMANENT IMPAIRMENT

Edition 2.1

INTRODUCTION TO EDITION 2.1 OF THE GUIDE

1. AUTHORITY

2. STRUCTURE OF THIS GUIDE

3. APPLICATION OF THIS GUIDE

4. WHOLE PERSON IMPAIRMENT (WPI)

5. ENTITLEMENTS UNDER THE SRC ACT

6. NON-ECONOMIC LOSS

7. COMPENSATION PAYABLE

8. INTERIM AND FINAL ASSESSMENTS

9. INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT

CONTENTS

LIST OF TABLES AND FIGURES

LIST OF REFERENCES

PRINCIPLES OF ASSESSMENT

1. IMPAIRMENT AND NON-ECONOMIC LOSS

2. EMPLOYABILITY AND INCAPACITY

3. PERMANENT IMPAIRMENT

4. PRE-EXISTING CONDITIONS AND AGGRAVATION

5. THE IMPAIRMENT TABLES

6. MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE

7. PERCENTAGES OF IMPAIRMENT

8. COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES

9. COMBINED VALUES

10. CALCULATING THE ASSESSMENT

11. ORDERING OF ADDITIONAL INVESTIGATIONS

12. EXCEPTIONS TO USE OF PART 1 OF THIS GUIDE

GLOSSARY

DIVISION 1

ASSESSMENT OF THE DEGREE OF AN EMPLOYEE’S

PERMANENT IMPAIRMENT RESULTING FROM AN INJURY

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

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

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

4.0 INTRODUCTION

4.1 SKIN DISORDERS

4.2 FACIAL DISFIGUREMENT

4.3 BODILY DISFIGUREMENT

5.0 INTRODUCTION

5.1 PSYCHIATRIC CONDITIONS

6.3 ABNORMAL OCULAR MOTILITY AND BINOCULAR DIPLOPIA

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 INVOLVING PERMANENT DEFORMITIES CAUSING UP TO 10% IMPAIRMENT OF THE WHOLE PERSON

6.6 CALCULATION OF VISUAL SYSTEM IMPAIRMENT FOR BOTH EYES

FIGURE 6-F: CALCULATION OF VISUAL SYSTEM IMPAIRMENT FOR BOTH EYES

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

8.0 INTRODUCTION

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

9.0 INTRODUCTION

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

9.11 SHOULDERS

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

NOTES TO TABLE 9.17

9.18 FRACTURES OF THE PELVIS

10.0 INTRODUCTION

10.1 THE UPPER URINARY TRACT

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

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

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

GUIDE TO THE ASSESSMENT OF NON-ECONOMIC LOSS

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 TOTAL ENTITLEMENT UNDER SECTION 24 AND SECTION 27

APPENDIX 1

COMBINED VALUES CHART

PART 1 APPENDIX 1: COMBINED VALUES CHART

CONTENTS

LIST OF REFERENCES

LIST OF TABLES AND FIGURES

LIST OF REFERENCES

PRINCIPLES OF ASSESSMENT

1. IMPAIRMENT AND NON-ECONOMIC LOSS

2. EMPLOYABILITY AND INCAPACITY

3. PERMANENT

4. THE IMPAIRMENT TABLES

5. GRADATIONS OF IMPAIRMENT

6. COMBINED IMPAIRMENTS

7. DOUBLE ASSESSMENT

8. FINGERS AND TOES

9. INAPPLICABILITY OF PART 2 OF THIS GUIDE

10. INTERIM ASSESSMENTS

11. APPLICATION OF PART 2 OF THE GUIDE

12. LIKELIHOOD OF REDUCTION IN DEGREE OF IMPAIRMENT

13. AGGRAVATION

GLOSSARY

GLOSSARY (CONTINUED)

DIVISION 1—IMPAIRMENT

1. CARDIO-VASCULAR SYSTEM

2. RESPIRATORY SYSTEM

3. ENDOCRINE SYSTEM

4. SKIN DISORDERS

TABLE 4.2: FACIAL DISFIGUREMENT

5. PSYCHIATRIC CONDITIONS

6. VISUAL SYSTEM

7. EAR, NOSE AND THROAT DISORDERS

8. DIGESTIVE SYSTEM

9. MUSCULO-SKELETAL SYSTEM

10. URINARY SYSTEM

11. REPRODUCTIVE SYSTEM

12. NEUROLOGICAL FUNCTION

13. MISCELLANEOUS

APPENDIX 1

14. COMBINED VALUES CHART

PART 2—APPENDIX 1: COMBINED VALUES CHART

DIVISION 2—NON-ECONOMIC LOSS

1. Authority

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

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

‘approved guide’ is defined by section 4 of the SRC Act as meaning:

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

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

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

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

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

employee resulting from an injury shall be determined

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

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

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

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

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

This document is the new Guide to the Assessment of the Degree of Permanent Impairment. It may be referred to as ‘this guide’ or ‘Edition 2.1 of the guide’. This guide is binding on Comcare, licensed authorities and corporations, and the Administrative Appeals Tribunal (subsection 29(4) of the SRC Act).

2. Structure of this guide

This guide is divided into two parts:

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

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

Part 2—Defence-related claims for permanent impairment

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

The responsibility for development of any guide that applies to members of the Australian Defence Force in respect of injuries incurred after the commencement of the Military Rehabilitation and Compensation Act 2004 (MRC Act) will fall to the Military Rehabilitation and Compensation Commission (MRCC).

Part 1 of this guide has three divisions:

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

DIVISION 2—Division 2 is used to assess the degree of an employee’s non-economic loss resulting from impairment.

DIVISION 3—Division 3 is used to calculate the total entitlement based on the assessments completed in Divisions 1 and 2.

The Principles of Assessment and Glossary in Part 1 of this guide contain information relevant to the interpretation and application of Part 1, Divisions 1 and 2.

Part 2 of this guide has two divisions:

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

DIVISION 2—Division 2 is used to assess the degree of an employee’s non-economic loss resulting from impairment.

The Principles of Assessment and Glossary in Part 2 of this guide contain information relevant to the interpretation and application of Part 2, Divisions 1 and 2.

3. Application of this guide

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

The first edition of the guide was revoked and the second edition of the guide applied in relation to permanent impairment claims made under sections 24, 25 or 27 of the SRC Act on and from 1 March 2006. Claims under those sections received on or before 28 February 2006 continue to be determined under the provisions of the first edition of the guide.

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

Except as provided below, Part 1 of Edition 2.1 of the guide applies to permanent impairment claims under sections 24, 25 or 27 of the SRC Act received by the relevant authority on and from 1 December 2011.

Part 2 of this Guide applies to defence-related claims for permanent impairment under sections 24, 25 or 27 of the SRC Act received by the relevant authority on and from 1 December 2011 for injuries related to defence service rendered before 1 July 2004.

Where a request by an employee pursuant to subsection 25(1) of the SRC Act (in respect of interim payment of permanent impairment compensation) is received by the relevant authority on or after 1 December 2011, but relates to a claim under section 24 of the SRC Act that was received by the relevant authority on or before 28 February 2006, that request must be determined under the provisions of the first edition of the guide.

Where a request by an employee pursuant to subsection 25(1) of the SRC Act (in respect of interim payment of permanent impairment compensation) is received by the relevant authority on or after 1 December 2011, but relates to a claim under section 24 of the SRC Act that was received by the relevant authority on or after 1 March 2006 but before 1 December 2011, that request must be determined under the provisions of the second edition of the guide.

Where a claim for compensation pursuant to subsections 25(4) or 25(5) of the SRC Act (in respect of a subsequent increase in the degree of permanent impairment) is received by the relevant authority on or after 1 December 20112, that claim must be determined under the provisions of this edition of the guide, notwithstanding that the initial claim for compensation for permanent impairment may have been determined under the provisions of the previous editions of this guide.

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

In this guide, ‘relevant authority’ and ‘defence-related claims’ have the same meaning as defined in section 4 and Part XI of the SRC Act.

4. Whole person impairment (WPI)

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

This guide, like the 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.

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

5. Entitlements under the SRC Act

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

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

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

6. Non-economic loss

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

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

7. Compensation Payable

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

8. Interim and final assessments

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

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

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

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

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

9. Increase in degree of whole person impairment

Where a final assessment of the degree of permanent impairment has been made and the level of whole person permanent impairment subsequently increases by 10% or more 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 impairment only.

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

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

PART 1

CLAIMS FOR PERMANENT IMPAIRMENT

OTHER THAN DEFENCE-RELATED CLAIMS

PART 1

Contents

PART 1

List of tables and figures

List of references

Principles of assessment

Glossary

Division 1

Assessment of the degree

of an employee’s permanent impairment

resulting from an injury

Chapter 1—The cardiovascular system

Chapter 4—Disfigurement and skin disorders

Chapter 8—The digestive system

Chapter 9—The musculoskeletal system

Chapter 10—The urinary system

Chapter 11—The reproductive system

Chapter 12—The neurological system

Chapter 13—The haematopoietic system

Division 2

Guide to the assessment of

non-economic loss

Division 3

Calculation of total entitlement under

Appendix 1

Combined values chart

PART 1

List of tables and figures

Division 1—Assessment of degree and employee’s permanent impairment resulting from injury

Chapter 1—The cardiovascular system

Figure 1-A: Activities of daily living 31

Figure 1-B: Symptomatic level of activity in METS according to age and gender 32

Table 1.1: Coronary artery disease 33

Table 1.2.1: Diastolic hypertension 35

Table 1.2.2: Systolic hypertension 36

Figure 1-C: Definitions of functional class 37

Table 1.3: Arrhythmias 37

Table 1.4: Peripheral vascular disease of the lower extremities 38

Table 1.5: Peripheral vascular disease of the upper extremities 39

Figure 1-C: Definitions of functional class 40

Table 1.6: Raynaud’s disease 41

Chapter 2—The respiratory system

Table 2.1: Conversion of respiratory function values to impairment 45

Figure 2-A: Calculating asthma impairment score 47

Table 2.2: Whole person impairment derived from asthma impairment score 48

Figure 2-B: Calculating obstructive sleep apnoea score 49

Table 2.4: Whole person impairment derived from obstructive sleep apnoea score 50

Chapter 3—The endocrine system

Table 3.1: Thyroid and parathyroid glands 53

Table 3.2: Adrenal cortex and medulla 54

Table 3.3: Pancreas (diabetes mellitus) 56

Table 3.4: Gonads and mammary glands 57

Chapter 4—Disfigurement and skin disorders

Table 4.1: Skin disorders 60

Figure 4-A: Activities of daily living 61

Table 4.2: Facial disfigurement 62

Table 4.3: Bodily disfigurement 63

Chapter 5—Psychiatric conditions

Figure 5-A: Activities of daily living 65

Table 5.1: Psychiatric conditions 67

Chapter 6—The visual system

Figure 6-A: Steps for calculating impairment of the visual system 71

Table 6.1: Conversion of the visual system to whole person impairment rating 72

PART 1

List of tables and figures

(continued)

Figure 6-B: Revised LogMar equivalent for different reading cards 73

Figure 6-C: Percentage loss of central vision in one eye 74

Figure 6-D: Normal extent of the visual field 75

Figure 6-E: Percentage loss of ocular motility of one eye in diplopia fields 76

Figure 6-F: Calculation of visual system impairment for both eyes 78

Chapter 7—Ear, nose and throat disorders

Table 7.2: Tinnitus 82

Table 7.3: Olfaction and taste 83

Table 7.4: Speech 84

Table 7.5: Air passage defects 85

Table 7.6: Nasal passage defects 86

Table 7.7: Chewing and swallowing 86

Chapter 8—The digestive system

Figure 8-A: Activities of daily living 88

Figure 8-B: Body Mass Index criteria 89

Table 8.1: Upper digestive tract—oesophagus, stomach, duodenum, small intestine and pancreas 90-91

Table 8.2: Lower gastrointestinal tract—colon and rectum 92-94

Table 8.3: Lower gastrointestinal tract—anus 95

Table 8.4: Surgically created stomas 96

Table 8.5: Liver—chronic hepatitis and parenchymal liver disease 97-98

Table 8.6: Biliary tract 99

Table 8.7: Hernias of the abdominal wall 100

Chapter 9—The musculoskeletal system

Figure 9-A: Activities of daily living 103

Figure 9-B: Tables of normal ranges of motion of joints 104-105

Table 9.1: Feet and toes 108-109

Table 9.2: Ankles 110-111

Table 9.3: Knees 112-113

Table 9.4: Hips 114-115

Table 9.5: Lower extremity amputations 117

Figure 9-C: Grading system 118

Table 9.6.1: Spinal nerve root impairment affecting the lower extremity 119

Table 9.6.2a: Sensory impairment due to peripheral nerve injuries affecting the lower extremities 120

Table 9.6.2b: Motor impairment due to peripheral nerve injuries affecting the lower extremities 121

Table 9.7: Lower extremity function 123-124

PART 1

List of tables and figures

(continued)

Table 9.8.1a: Abnormal motion/ankylosis of the thumb—IP and MP joints 127

Table 9.8.1b: Radial abduction/adduction/ opposition of the thumb – abnormal motion/ankylosis 128

Table 9.8.1c: Abnormal motion/ankylosis of the fingers—index and middle fingers 129

Table 9.8.1d: Abnormal motion/ankylosis of the fingers—ring and little fingers 130

Table 9.8.2a: Sensory losses in the thumb 133

Table 9.8.2b: Sensory losses in the index and middle fingers 133

Table 9.8.2c: Sensory losses in the little finger 134

Table 9.8.2d: Sensory losses in the ring finger 134

Table 9.9.1a: Wrist flexion/extension 136

Table 9.9.1b: Radial and ulnar deviation of wrist joint 137

Table 9.10.1a: Elbow flexion/extension 139

Table 9.10.1b: Pronation and supination of forearm 140

Table 9.11.1a: Shoulder flexion/extension 142

Table 9.11.1b: Shoulder flexion/extension —internal/external rotation of shoulder 143

Table 9.11.1c: Abduction/adduction of shoulder 144

Table 9.12.1: Upper extremity amputations 145

Table 9.12.2: Amputation of digits 145

Figure 9-D: Grading system 147

Table 9.13.1: Cervical nerve root impairment 148-149

Table 9.13.2a: Specific nerve lesions affecting the upper extremities – sensory impairment 150

Table 9.13.2b: Specific nerve lesions affecting the upper extremities motor impairment 151

Figure 9-E: Diagnostic criteria for CRPS 153

Figure 9-F: Impairment grading for CRPS 154

Table 9.14: Upper extremity function 158-159

Table 9.15: Cervical spine—diagnosis-related estimates 164-165

Table 9.16: Thoracic spine—diagnosis-related estimates 167-168

Table 9.17: Lumbar spine—diagnosis-related estimates 170-171

Table 9.18: Fractures of the pelvis 172

Chapter 10—The urinary system

Table 10.1: The upper urinary tract 175

Table 10.2: Urinary diversion 176

Table 10.3: Lower urinary tract 178

Chapter 11—The reproductive system

Table 11.1.1: Male reproductive organs— penis 181

Table 11.1.2: Male reproductive organs— scrotum 181

PART 1

List of tables and figures

(continued)

Table 11.1.3: Male reproductive organs—

testes, epididymes and
spermatic cords 182

Table 11.1.4: Male reproductive organs —prostate and seminal vesicles 183

Table 11.2.1: Female reproductive organs—vulva and vagina 185

Table 11.2.2: Female reproductive organs—cervix and uterus 186

Table 11.2.3: Female reproductive organs—fallopian tubes and ovaries 187

Chapter 12—The neurological system

Figure 12-A: Activities of daily living 190

Table 12.1.1: Permanent disturbances of levels of consciousness and awareness 191

Table 12.1.2: Epilepsy, seizures and convulsive disorders 192

Table 12.1.3: Sleep and arousal disorders 193

Table 12.2: Impairment of memory, learning, abstract reasoning and problem solving ability 195

Figure 12-B: Clinical dementia rating (CDR) 196-197

Table 12.3: Criteria for rating impairment due to Aphasia and Dysphasia 199

Table 12.4: Emotional or behavioural impairments 201

Table 12.5.1: The olfactory nerve (I) 202

Table 12.5.3: The trigeminal nerve (V) 203

Table 12.5.4: The facial nerve (VII) 204

Table 12.5.5: The auditory nerve (VIII) 205

Figure 12-C: % WPI modifiers for episodic conditions 206

Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII) 208

Table 12.6: Neurological impairment of the respiratory system 208

Table 12.7: Neurological impairment of the urinary system 209

Table 12.8: Neurological impairment of the anorectal system 209

Table 12.9: Neurological impairment affecting sexual function 210

Chapter 13—The haematopoietic system

Table 13.1: Anaemia 212

Figure 13-A: Activities of daily living 214

Table 13.2: Leukocyte abnormalities or disease 215

Table 13.3: Haemorrhagic disorders and platelet disorders 216

Table 13.4: Thrombotic disorders 217

Division 2—Guide to the Assessment of Non-Economic Loss

Table B1: Pain 219

Table B2: Suffering 220

Table B3.1: Mobility 221

Table B3.2: Social relationships 223

Table B3.3: Recreation and leisure activities 223

Table B4: Other loss 224

Table B5: Loss of expectation of life 225

B6: Worksheet calculation of non-economic loss 226-227

Division 3—Final calculation of entitlements under Section 24 and Section 25

C1: Worksheet final calculation of entitlements 228

Appendices

Appendix 1: Combined values chart 230-232

PART 1

List of references

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

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

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

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

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

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

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

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

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

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

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

PART 1

Principles of assessment

1. Impairment and non-economic loss

2. Employability and incapacity

3. Permanent impairment

4. Pre-existing conditions and aggravation

5. The impairment tables

6. Malignancies and conditions resulting in major systemic failure

7. Percentages of impairment

8. Comparing assessments under alternative tables

9. Combined values

10. Calculating the assessment

11. Ordering of additional investigations

12. Exceptions to use of Part 1 of this guide

Impairment and non-economic loss

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

Non-economic loss is assessed in accordance with Part 1, Division 2 (see page 221) of this guide, and deals with the effects of the impairment on the employee’s life. Under subsection 4(1) of the SRC Act, for an employee who has suffered an injury resulting in a permanent impairment, it means:

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

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

Employability and incapacity

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

Permanent impairment

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

(a) the duration of the impairment

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

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

impairment

(d) any other relevant matters.

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

Pre-existing conditions and aggravation

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

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

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

The impairment tables

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

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

It may be necessary in some cases to have regard to a number of chapters within Part 1 of this guide when assessing the degree of whole person impairment which results from compensable 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 Part 1, Appendix 1.

Percentages of impairment

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

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

For further information relating to the application of this guide, please contact the Comcare Permanent Impairment Guide Helpdesk on 1300 366 979 or email [email protected].

Comparing assessments under alternative tables

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

Combined values

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

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

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

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

Calculating the assessment

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

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

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

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

Ordering of additional investigations

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

Exceptions to use of Part 1 of this guide

In the event that an employee’s impairment is of a kind that cannot be assessed in accordance with the provisions of Part 1 of this guide, the assessment is to be made under the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5^th edition 2001.

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

mental and behavioural impairments (psychiatric conditions)

impairments of the visual system

hearing impairment

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

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

Glossary

Definitions in italics are from subsection 4(1) and 5A(1) and 5B(1) of the SRC Act.

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

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

Disease means:

(a) an ailment suffered by an employee

(b) an aggravation of such an ailment

that was contributed to, to a significant degree, by the employee’s employment by the Commonwealth or a licensee.

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

Injury means:

(a) a disease suffered by an employee

(b) an injury (other than a disease) suffered by an employee, that is a physical or mental injury arising out of, or in the course of, the employee’s employment

(c) an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), that is an aggravation that arose out of, or in the course of, that employment

but does not include a disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employee’s employment.

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

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

Pain means physical pain.

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

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

PART 1

Division 1

Assessment of the degree of an employee’s

permanent impairment 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

1.0 Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 23-26) and the definitions contained in the glossary (see pages 27-28).

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

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

For the purposes of Chapter 1, activities of daily living are those in Figure 1-A (see below).

Figure 1-A: Activities of daily living

Activity	Examples
Self care, personal hygiene	Bathing, grooming, dressing, eating, eliminating.
Communication	Hearing, speaking, reading, writing, using keyboard.
Physical activity	Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising.
Sensory function	Tactile feeling.
Hand functions	Grasping, holding, pinching, percussive movements, sensory discrimination.
Travel	Driving or travelling as a passenger.
Sexual function	Participating in desired sexual activity.
Sleep	Having a restful sleep pattern.
Social and recreational	Participating in individual or group activities, sports activities, hobbies.

Chapter 1 does not cover impairments arising from cardiomyopathy, congenital heart disease, valvular heart disease, and pericardial heart disease. Where relevant, the degree of impairment arising from these conditions should be assessed in accordance with the appropriate table from the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5^th edition 2001.

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

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

1.1 Coronary artery disease

Steps for assessment are as follows.

Step 1	Using Figure 1-B (see below), determine the symptomatic level of activity in METS according to age and gender. Figure 1-B may be used to assess conditions affecting left ventricular function (LVF) (including ischaemic heart disease, rheumatic heart disease, and hypertension).
Step 2	Using Table 1.1 (see below), refer to any one of pathology (column 3), drug therapy (column 4), or intervention (column 5), to identify the degree of impairment within the range of impairments for that symptomatic level of activity.

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

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

Age and gender	Symptomatic level of activity in METS
Age and gender	1	1-2	2-3	3-4	4-5	5-6	6-7	7-8	8-9	10+
18-30 M	D	D	D	C	C	B	B	B	A	A
18-30 F	D	D	C	C	B	B	A	A	A
31-40 M	D	D	D	C	C	B	B	A	A
31-40 F	D	D	C	B	B	B	A
41-50 M	D	D	C	C	B	B	A	A
41-50 F	D	D	C	B	B	A	A
51-60 M	D	D	C	B	B	A	A	A
51-60 F	D	D	C	B	B	A	A
61-70 M	D	D	C	B	B	A	A
61-70 F	D	D	B	B	A	A
70+ M	D	C	B	B	A
70+ F	D	C	B	A	A

Table 1.1: Coronary artery disease

See notes immediately following Table 1.1 for further details regarding abbreviations and symbols used in columns 3, 4 and 5.

Column 1 % WPI	Column 2 Level of activity in METS for age and gender	Column 3 Pathology	Column 4 Drug therapy	Column 5 Intervention
5	A	Not applicable	Not applicable	Not applicable
10	A	+	+	Not applicable
15	A	++	++	PTCA
20	A	+++	+++	CABG/Tx
25	B	+	+	Not applicable
30	B	++	++	PTCA
40	B	+++	+++	CABG/Tx
50	C	+	+	Not applicable
60	C	++	++	PTCA
65	C	+++	+++	CABG/Tx
75	D	+	+	Not applicable
85	D	++	++	PTCA
95	D	+++	+++	CABG/Tx

Notes to Table 1.1

In Table 1.1, not applicable means the criterion is not applicable to the specified level of impairment.
Pathology—column 3.

(i)Coronary artery disease:

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

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

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

(ii)Ischaemic left ventricular dysfunction:

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

++ LVEF 30-40%

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

(iii) Myocardial infarction (MI):

+ no previous MI

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

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

(iv)Arrhythmias

Assessed under Table 1.3—Arrhythmias (see page 38).

Drug therapy (continuous) —Column 4.

+ one or two drugs

++ three or four drugs

+++ five or more drugs.

Intervention—column 5.

PTCA means percutaneous transluminal coronary angioplasty and/or stenting.

CABG means coronary artery bypass grafting.

Tx means heart transplant.

1.2 Hypertension

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

1.2.1 Diastolic hypertension

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

Functional class (determined in accordance with Figure 1-B, see page 32) is the primary criterion for assessment. Level of diastolic blood pressure (DBP) and therapy (see Table 1.2.1 below) are secondary criteria for assessment.

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

Table 1.2.1: Diastolic hypertension

See note immediately following Table 1.2.1 for explanation of symbols used in the final column (drug therapy).

% WPI	Level of activity in METS for age and gender	Usual DBP	Drug therapy
5	A	>90	+
10	A	>100	++
15	A	>110	+++
20	B	>90	+
25	B	>100	++
30	B	>110	+++
35	C	>90	+
40	C	>100	++
45	C	>110	+++
50	D	>90	+
55	D	>100	++
60	D	>110	+++

Note to Table 1.2.1

Drug therapy (continuous)—final column of Table 1.2.1:

+ one drug

++ two drugs

+++ three or more drugs.

1.2.2 Systolic hypertension

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

Functional class (determined in accordance with Figure 1-B, see page 32) is the primary criterion for assessment. Level of systolic blood pressure (SBP) and therapy (see Table 1.2.2 below) are secondary criteria for assessment.

Table 1.2.2: Systolic hypertension

See note immediately following Table 1.2.2 for explanation of symbols used in the final column (drug therapy).

% WPI	Symptomatic level of activity in METS for age and gender	Usual SBP	Drug therapy
5	A	>160	+
10	A	>160	++
15	A	>160	+++
20	B	>170	+
25	B	>170	++
30	B	>170	+++
35	C	>180	+
40	C	>180	++
45	C	>180	+++
50	D	>190	+
55	D	>190	++
60	D	>190	+++

Note to Table 1.2.2

Drug therapy (continuous):

+ one drug

++ two drugs

+++ three or more drugs.

1.3 Arrhythmias

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

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

Figure 1-C: Definitions of functional class

Functional class	Symptoms
I	No limitation of physical activity.
II	Slight limitation of physical activity. Comfortable at rest and with ordinary, light Activities of Daily Living. Greater activity causes symptoms.
III	Marked limitation of physical activity. Comfortable at rest. Ordinary activity causes symptoms.
IV	Inability to carry out any physical activity without discomfort.

Table 1.3: Arrhythmias

See note immediately following Table 1.3 for explanation of symbols used in the final column (therapy).

% WPI	Functional class	Therapy
5	I	Nil
10	I	Drug(s)
15	I	Surgery/cath/PPM/Device
20	II	Nil
30	II	Drug(s)
40	II	Surgery/cath/PPM/Device
45	III	Nil
50	III	Drug(s)
55	III	Surgery/cath/PPM/Device
60	IV	Not applicable

Note to Table 1.3

Therapy—column 3:

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

‘PPM’ means permanent pacemaker

‘Device’ means implanted defibrillator.

1.4 Peripheral vascular disease of the lower extremities

Amputatees should not be assessed under Table 1.4. They should be assessed under Table 9.5: Lower extremity amputations (see Chapter 9—The musculoskeletal system).

A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see 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 200 metres or more at an average pace on level ground.
20	The employee experiences claudication on walking more than 100 but less than 200 metres at average pace on level ground.
30	The employee experiences claudication on walking more than 75 but less than 100 metres at average pace on level ground.
40	The employee experiences claudication on walking more than 50 but less than 75 metres at average pace on level ground.
50	The employee experiences claudication on walking more than 25 but less than 50 metres at average pace on level ground.
60	The employee experiences claudication on walking less than 25 metres at average pace on level ground.
70	The employee experiences ischaemic pain at rest.

1.5 Peripheral vascular disease of the upper extremities

Amputees should not be assessed under Table 1.5. They should be assessed under Table 9.12.1: Upper extremity amputations, or Table 9.12.2: Amputation of digits (see Chapter 9—The musculoskeletal system).

A WPI rating from Table 1.5 must 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/unable to exercise.	Not applicable

1.6 Raynaud’s disease

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

Figure 1-C: Definitions of functional class

See note to immediately following Figure 1-C.

Functional Class	Symptoms
I	No limitation of physical activity.
II	Slight limitation of physical activity. Comfortable at rest and with ordinary, light activities of daily living. Greater activity causes symptoms.
III	Marked limitation of physical activity. Comfortable at rest. Ordinary activity causes symptoms.
IV	Inability to carry out any physical activity without discomfort.

Note to Figure 1-C

Figure 1-C also appears in Section 1.3—Arrhythmias, see page 37. It is repeated here for ease of reference

Table 1.6: Raynaud’s disease

See note immediately following Table 1.6.

% WPI	Functional class	Signs	Therapy
5	I	Nil.	Nil.
10	I	Nil.	Drug(s).
15	I	Nil.	Surgery.
20	II	Neither ulceration nor trophic changes.	Drug(s).
25	II	Either ulceration or trophic changes.	Drug(s).
30	II	not applicable	Surgery.
35	III	Neither ulceration nor trophic changes.	Drug(s).
40	III	Either ulceration or trophic changes.	Drug(s).
45	III	Not applicable	Surgery.
50	IV	Not applicable	Not applicable

Note to Table 1.6

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

2.1 Assessing impairment to 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

2.0 Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 23-26) and the definitions contained in the glossary (see pages 27-28).

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

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

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

Employees who have permanent respiratory limitation secondary to massive pulmonary embolism should be assessed under Chapter 2. Any WPI rating awarded in these circumstances must not be combined with a WPI rating from Table 13.4: Thrombotic disorders (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:

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

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

However, the measurements used must be derived from either:

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

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

Other measurements commonly used to assess impairment include:

the lung volumes

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

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

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

the elastic and flow resistive properties of the lungs

respiratory muscle strength

arterial blood gases

polysomnography (sleep studies)

echocardiography with estimation of pulmonary artery pressure

quantitative ventilation-perfusion scans of the lung.

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

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

2.1.2 Methods of measurement

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

the Thoracic Society of Australia and New Zealand

the Australian Sleep Society

the Australian Council on Health Care Standards.

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

2.1.3 Impairment rating

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

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

Table 2.1: Conversion of respiratory function values to impairment

See note immediately following Table 2.1.

% WPI	Respiratory function %P
0	>85
10	85 to 76
20	75 to 66
30	65 to 56
40	55 to 51
50	50 to 44
60	45 to 41
70	40 to 36
80	35

Note to Table 2.1

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

2.2 Asthma and other hyper-reactive airways diseases

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

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

the diagnosis and cause are established

exposure to the provoking factors is eliminated

appropriate treatment of asthma is implemented.

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

Permanent impairment should not be assessed until 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 and Table 2.2 (both on following page). The scale used in Figure 2-A and Table 2.2 is modified to account for frequency of increased impairment from asthma despite optimal treatment.

A score reflecting impairment from asthma is calculated by:

adding the points scored for reduction in FEV₁ %P

and either

change in FEV₁ with bronchodilator (reversibility)

or

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

and

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

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

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

Figure 2-A: Calculating asthma impairment score

See notes immediately following Figure 2-A.

Score	FEV₁, % P After bronchodilator	DFEV₁, % change in FEV₁with bronchodilator	PD₂₀ or mmol	*% of Days lowest FEV₁ is 0.85 highest FEV₁**
0	>85	<10	>4.0	<6
1	76 to 85	10 to 19	0.26 to 4.0	6 to 24
2	66 to 75	20 to 29	0.063 to 0.25	25 to 34
3	56 to 65	30	0.062	35 to 44
4	55	45

Notes to Figure 2-A

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

%P = percent predicted normal value.

PD₂₀= cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV_1.

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

% 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 below. 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 below and Table 2.4 on the following page). These ratings are based on frequency of disordered breathing, frequency of sleep disturbance, degree of hypoxaemia and, as appropriate, hypercapnoea during sleep. In addition, degree of daytime sleepiness is assessed using the Epworth sleepiness scale (Johns, 1991).

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

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

Figure 2-B: Calculating obstructive sleep apnoea score

See notes immediately following Figure 2-B.

Score	Epworth sleepiness score	Apnoeas + hypopnoeas/hr of sleep	*Respiratory arousals/hr of sleep**	Cumulative sleep time, mins, with SaO₂ <90% #
0	<5	<5	<5	0
1	5 to 10	5 to 15	5 to 15	<15
2	11 to 17	16 to 30	16 to 30	15 to 45
3	>17	>30	>30	>45

Notes to Figure 2-B

*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).

#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

3.1 Thyroid and parathyroid glands

3.2 Adrenal cortex and medulla

3.3 Pancreas (diabetes mellitus)

3.4 Gonads and mammary glands

3.0 Introduction

In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 23-26) and the definitions contained in the glossary (see pages 27-28).

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

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

3.1 Thyroid and parathyroid glands

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

Chapter 4—Disfigurement and skin disorders

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

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

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

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

Table 3.1 Thyroid and parathyroid glands

% WPI	Criteria
0	Hyperparathyroidism—symptoms and signs readily controlled by medication or other treatment such as surgery. Hyperparathyroidism—symptoms and signs readily controlled by medication. Hyperparathyroidism adequately controlled by replacement therapy.
10-15	Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy. Hyperparathyroidism—persisting mild hypocalcaemia, despite medication. Hyperparathyroidism—symptoms and signs such as intermittent hyper or hypocalcaemia not readily controlled by medication.
30	Hyperparathyroidism—persisting severe hypocalcaemia with serum calcium above 3.0mmol/l, despite medication.

Notes to Table 3.1

Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.

3.2 Adrenal cortex and medulla

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

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

Table 3.2 Adrenal cortex and medulla

% WPI	Criteria
0	Cushing’s syndrome—surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion. Phaeochromocytoma—benign tumour, surgically removed or removable where hypertension has not led to the development of permanent cardiovascular disease.
5	Hypoadrenalism—symptoms and signs readily controlled with replacement therapy. Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15mg of prednisolone per day) where glucocorticoids will be required long-term.
10	Cushing’s syndrome—surgically corrected by removal of pituitary adenoma or adrenal carcinoma.
15	Cushing’s syndrome—due to: · bilateral adrenal hyperplasia treated by adrenalectomy · large doses of glucocorticoids (for example, equivalent of at least 15 mg of prednisolone per day) where glucocorticoids will be required long-term · inadequate removal of source of ectopic ACTH secretion. Phaeochromocytoma—malignant tumour where signs and symptoms of catecholamine excess can be controlled by blocking agents. Hypoadrenalism—recurrent episodes of adrenal crisis during acute illness or in response to significant stress.
70	Phaeochromocytoma—metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be controlled by blocking agents or other treatment.

3.3 Pancreas (diabetes mellitus)

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

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

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

Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20 mg/minute. Where a 24 hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least two out of three consecutive urine specimens collected.
Table 3.3: Pancreas (diabetes mellitus)

See notes to Table 3.3 on the following page.

% WPI	Type	Therapy	Microvascular complications
5	Type 2 (NIDDM)	Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control.	Microangiopathy is not present.
10	Type 2 (NIDDM)	Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control.	Microangiopathy and/or significant neuropathy are present.
15	Type 1 (IDDM)	Dietary restrictions and insulin give satisfactory control.	Microangiopathy is not present.
20	Type 1 (IDDM) Type 2 (NIDDM)	Dietary restrictions and insulin give satisfactory control Type 2 (NIDDM) where dietary restrictions & insulin and/or oral hypoglycaemic agents give satisfactory control.	Microangiopathy and/or significant neuropathy are present.
25	Type 1 (IDDM)	Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.	Microangiopathy is not present.
30	Type 1 (IDDM)	Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.	Microangiopathy is present.
40	Type 1 (IDDM)	Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented.	Microangiopathy is present as well as significant neuropathy.
50	Symptomatic hypoglycaemia due to metastatic tumour (usually insulinoma), uncontrolled by medication (such as diazoxide).

Notes to Table 3.3

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

· 4%-6% is the non-diabetic range

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

‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with quality of life to a considerable degree.
‘NIDDM’ means non-insulin dependent diabetes mellitus.
‘IDDM’ means insulin dependent diabetes mellitus.

Notes:

Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.

Table 8.2: Disorders of the liver and biliary tract

(Percentage whole person impairment)

%	Description of level of impairment
0	Mildly abnormal liver function tests but adequate nutrition and strength with no other signs of disease.
5	Episodes of biliary colic twice a year or less frequently.
10	Stigmata of liver disease but no history of jaundice, ascites or bleeding oesophageal varices within the last five years. and Liver function tests normal or mildly abnormal.
15	Episodes of biliary colic three to five times a year.
20	Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices one to five years ago and liver function tests now normal or mildly abnormal.
25	Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices one to five years ago and liver function tests markedly abnormal.
40	Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices in the past year or objective signs of progressive liver disease.
50	Permanent irreparable biliary tract obstruction.
60	Objective signs of progressive liver disease with one of the following: persistent jaundice frequent, recurrent bleeding episodes central nervous system manifestations of hepatic insufficiency.
70	Objective signs of progressive liver disease with two of the following: persistent jaundice frequent, recurrent bleeding episodes central nervous system manifestations of hepatic insufficiency.
80	Objective signs of progressive liver disease with all of the following: persistent jaundice frequent, recurrent bleeding episodes central nervous system manifestations of hepatic insufficiency.
95	Hepatic coma.

Table 8.3: Fistulae and herniae

(Percentage whole person impairment)

%	Description of level of impairment
5	Any of the following: inguinal hernia (readily reducible) ventral hernia, well supported.
10	Any of the following: small recurrent inguinal hernia (operable but not readily reducible) colostomy.
15	Any of the following: large recurrent inguinal hernia (inoperable and not readily reducible) oesophagostomy gastrostomy ventral hernia, not well supported.
20	Any of the following: massive ventral hernia (inoperable, with severe diastasis of recti) jejunostomy ileostomy.

9. Musculo-skeletal system

(Percentage whole person impairment)

Introduction

These tables are intended to be used to assess impairment arising from specific joint lesions or amputations. Where the joints function normally but the use of a limb is restricted for other reasons, eg soft tissue injury, nerve injury or bony injury not involving joints, Tables 9.4 or 9.5 should be used. These Tables can be used to assess the impairment of overall limb function from any cause.

Note: either the musculo-skeletal table or Table 9.4 or 9.5 should be used—not both.

Assessment is in accordance with the range of joint movement. X-rays should not be taken solely for assessment purposes.

Table 9.1: Upper extremity

Values are for one joint only. Where more than one joint is affected, values should be combined using the combined values table (Appendix 1).

%	Description of level of impairment
0	X-ray changes but no loss of function of shoulder, elbow or wrist.
5	Any one of the following: x-ray changes with minimal loss of function of shoulder, elbow or wrist ankylosis of any joint of ring and / or small finger(s)
10	Any of the following: loss of less than half normal range of movement of shoulder or elbow loss of half normal range of movement of wrist ankylosis of any joints of index and / or middle finger(s).
15	Any of the following: loss of more than half normal range of movement of wrist ankylosis of any joint(s) of thumb.
20	Any of the following: loss of half normal range of movement of shoulder or elbow ankylosis of wrist.
30	Loss of more than half normal range of movement of shoulder or elbow.
40	Ankylosis of shoulder or elbow.

Table 9.2: Lower extremity

(Percentage whole person impairment)

Assessment is in accordance with the range of joint movement. X-rays should not be taken solely for assessment purposes.

Where a joint has been surgically replaced assessment is in accordance with its function.

Shortening of the lower extremity by 2.5cm or more is in impairment of 5%.

For conditions not covered (such as flail joints) the assessor should have regard to the loss of function (not exceeding the maximum allowed for amputation).

Values are for one joint only. Where more than one joint is affected, values should be combined using the combined values table (Appendix 1).

%	Description of level of impairment
0	X-ray changes but no loss of function of hip, knee or ankle or ankylosis or lesser changes in any toes except the hallux.
5	Loss of less than half normal range of movement of ankle.
10	Any of the following: loss of less than half normal range of movement of hip or knee loss of half normal range of movement of ankle ankylosis of hallux.
15	Loss of more than half normal range of movement of ankle.
20	Any of the following: Loss of half normal range of movement of hip or knee ankylosis of ankle.
30	Loss of more than half normal range of movement of hip or knee.
40	Ankylosis of hip or knee.

Table 9.3: Amputations and/or total loss of function

(Percentage whole person impairment)

Impairment relating to the loss of or injury to a finger or toe refers not only to amputation or total loss of efficient use of the whole digit, but also to partial loss of efficient use of a digit.

%	Description of level of impairment
5	Any of the following: amputation of little finger amputation of ring finger total loss of movement of any joint of thumb amputation of terminal segment of thumb involving one third of its flexor surface without loss of distal phalanx or interphalangeal joint amputation of two phalanges or joints of index, middle, ring or little finger amputation of distal phalanx or joint of forefinger amputation of distal phalanx or joint of hallux.
10	Any of the following: amputation of all toes amputation of great toe amputation of middle finger amputation of distal phalanx or joint of thumb.
15	Any of the following: mid-metatarsal amputation amputation of index finger.
20	Any of the following: partial amputation of the foot (Chopart) amputation of the thumb.
30	Any of the following: amputation below knee, with functional stump amputation at ankle amputation of all fingers, but not thumb.

%	Description of level of impairment
40	Any of the following: amputation above knee with functional stump disarticulation at knee Gritti Stokes amputation amputation below knee with short stump (7.5 cm or less below intercondylar notch) disarticulation at hip joint amputation above knee with short stump (7.5 cm or less below tuber ischii).
50	Any of the following: hemipelvectomy amputation of forearm distal to biceps tendon insertion disarticulation at wrist joint mid-carpal or mid-metacarpal amputation of hand.
60	Any of the following: amputation between deltoid insertion and elbow disarticulation at elbow amputation of forearm proximal to biceps tendon insertion disarticulation at shoulder amputation above deltoid insertion.
70	Forequarter (upper) amputation.

Table 9.4: Limb function—upper limb

(Percentage whole person impairment)

%	Description of level of impairment
10	Can use limb for self care and grasping and holding but has difficulty with digital dexterity.
20	Can use limb for self care but has no digital dexterity or has difficulties grasping and holding.
30	Retains some use of limb but has difficulty with self care.
40	Cannot use limb for self care.

Table 9.5: Limb function—lower limb

(Percentage whole person impairment)

Description of level of impairment
10	Can rise to standing position and walk but has difficulty with grades and steps.
20	Can rise to standing position and walk but has difficulty with grades, steps and distances.
30	Can rise to standing position and walk with difficulty but is limited to level surfaces.
50	Can rise to standing position and maintain it with difficulty but cannot walk.
65	Cannot stand or walk.

Table 9.6: Spine

(Percentage whole person impairment)

Lesions of the sacrum and coccyx should be assessed by using the table which most appropriately reflects the functional impairment. This will usually be Table 9.5.

Lesions of the spine are often accompanied by neurological consequences. These should be assessed using Table 9.4 or 9.5 and the results combined using the combined values table (Appendix 1).

%	Description of level of impairment
%	Cervical spine	Thoraco-lumbar spine
0	X-ray changes only.	X-ray changes only.
5	Minor restrictions of movement.	Minor restrictions of movement or crush fracture - compression of 25-50 percent.
10	Loss of half normal range of movement.	Loss of less than half normal range of movement or crush fracture—compression greater than 50 percent.
15	Loss of more than half normal range of movement.	Loss of half normal range of movement.
20	Complete loss of movement.	Loss of more than half normal range of movement.
30	Complete loss of movement.

10. Urinary system

Table 10.1: Upper urinary tract

(Percentage whole person impairment)

%	Description of level of impairment
0	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 90 litres/day or more and/or intermittent symptoms or signs of upper urinary tract dysfunction are present that do not require continuous treatment or surveillance.
10	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 75 to 89 litres/day and/or single kidney.
15	Creatinine clearance is 75 to 89 litres/day AND symptoms and signs of urinary tract dysfunction or disease necessitate continuous medical treatment.
30	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 60 to 74 litres/day.
40	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 50 to 59 litres/day.
45	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 50 to 59 litres/day and symptoms and signs of dysfunction or disease are incompletely controlled by surgical or continuous medical treatment.
60	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 40 to 49 litres/day.
65	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 40 to 49 litres/day and symptoms and signs of dysfunction or disease are incompletely controlled by surgical or continuous medical treatment.
70	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of less than 40 litres/day.
75	Diminution of upper urinary tract function is present as evidenced by creatinine clearance of less than 40 litres/day and symptoms and signs of dysfunction or disease are incompletely controlled by surgical or continuous medical treatment.
85	Deterioration of renal function requiring either peritoneal dialysis or haemodialysis.

Table 10.2: Lower urinary tract

(Percentage whole person impairment)

%	Description of level of impairment
0	Occasional intermittent disorder without interval problems.
10	Uretheral stricture or other disorder requiring intermittent therapy (for example, passage of sounds at intervals of greater than eight weeks).
15	Disorder requires continuous treatment or no voluntary bladder control but good reflex activity.
25	Urinary diversion with or without removal of the bladder or uretheral stricture or other disorder which cannot be effectively controlled, or recurs frequently, or requires more frequent passage of sounds (at intervals of less than four to eight weeks).
30	Intermittent dribbling incontinence.
45	Continuous dribbling incontinence.

11. Reproductive system

Table 11.1: Male

(Percentage whole person impairment)

This table is used to assess conditions affecting the testes, prostate, penis, seminal vesicles, spermatic cord, epididymis and scrotum

%

Description of the level of impairment

5

Any of the following:
or
all of the following:
or
all of the following:
or

only one testis present

symptoms and/or signs of scrotal loss or disease
scrotal malposition

symptoms and/or signs of testicular, epididymal and/or spermatic cord disease, WITH anatomical alteration
continuous treatment not required
no seminal or hormonal abnormalities

symptoms and/or signs of prostatic and/or seminal vesicular dysfunction or disease
anatomical alteration present
continuous treatment not required

impotence in a claimant aged 65 years or more with intact sexual organs.

10

Sexual function possible but varying degrees of difficulty with erection, ejaculation and/or sensation.

%

Description of the level of impairment

15

Any of the following:
or
all of the following:
or
all of the following:

sexual function possible in that there is sufficient erection but no ejaculation or sensation
testes implanted in other than scrotal position to preserve function and testicular pain or discomfort with activity
total loss of scrotum
impotence in a claimant aged between 40 and 64 years with intact sexual organs

symptoms and/or signs of testicular, epididymal and/or spermatic cord disease, with anatomical alteration
continuous or frequent treatment required
detectable seminal or hormonal abnormalities

frequent severe symptoms and/or signs of prostatic and/or seminal vesicular function or disease
anatomical alteration present
continuous treatment required.

20

No sexual function possible because of any of the following:
or

bilateral loss of testes
no detectable seminal or hormonal function of the testes, epididymis or spermatic cords
ablation of prostate and/or seminal vesicles

impotence in a claimant aged less than 40 years with intact sexual organs.

Table 11.2: Female

(Percentage whole person impairment)

%	Vulva and/or vagina	Cervix and/or uterus	Fallopian tubes and/or ovaries
10	Symptoms and/or signs of disease or deformity not requiring continuous treatment and sexual intercourse possible and vagina adequate for childbirth.	Symptoms and/or signs of disease or deformity not requiring continuous treatment or cervical stenosis not requiring treatment or anatomical loss in post menopausal years.	Symptoms and/or signs of disease or deformity not requiring continuous treatment or unilateral dysfunction or bilateral loss in post menopausal years.
25	Symptoms and/or signs of disease or deformity requiring continuous treatment and sexual intercourse possible with varying degrees of difficulty and vaginal delivery limited in pre-menopausal years.	Symptoms and/or signs of disease or deformity requiring continuous treatment or cervical stenosis requiring periodic treatment.	Symptoms and/or signs of disease or deformity requiring continuous treatment but tubes are patent and ovulation is possible.
35	Symptoms and/or signs of disease or deformity not controlled by continuous treatment and sexual intercourse not possible and vaginal delivery not possible in the pre-menopausal years.	Symptoms and/or signs of disease or deformity not controlled by continuous treatment or cervical stenosis complete or anatomical or complete functional loss in the pre-menopausal years.	Symptoms and/or signs of disease or deformity not controlled by continuous treatment and total loss of tubular patency, or total failure to produce ova, in the pre-menopausal years.

Table 11.3: Mammary glands

(Percentage whole person impairment)

%

Description of level of impairment

10

Any of the following.

female of childbearing age with absence of the breasts
male with painful gynaecomastia that interferes with daily activities
galactorrhoea sufficient to require the use of absorbent pads.

12. Neurological function

Neurological function is divided into three sub-groups—cranial nerves (Table 12.1), communication (Tables 12.2 & 12.3) and cognitive function (Tables 12.4 & 12.5).

Communication and cognitive function are each divided into two sub-sections—the sub-sections of communication are comprehension (Table 12.2) and expression (Table 12.3); the sub-sections of cognitive function are memory (Table 12.4) and reasoning (Table 12.5).

Cranial nerves

(Percentage whole person impairment)

Please note that assessments for sight, smell and taste can be made under other tables. They have been included here as well so that this table is complete. Do not make two separate assessments and combine them. Use one or the other. The other relevant tables are Table 6.1 ‘Visual system’, and Table 7.2 ‘Ear, nose and throat disorders—Miscellaneous’.

Table 12.1

%	Criteria
%	Unilateral loss or paralysis	Bilateral loss or paralysis	Other
0	I XII	I
5	V (motor)	VII (complete loss of taste).
10	V (sensory)	XII (swallowing impairment, with diet restricted to semi-solids).	Swallowing impairment due to one or two combinations of IX, X and XI, with diet restricted to semi-solids.
15	VII
20	VII Atypical facial neuralgia.
25	II or III, IV, VI alone or in combination (diplopia corrected by covering one eye.
30	XII (swallowing impairment, with diet restricted to liquids).	Swallowing impairment due to one or two combinations of IX, X and XI, with diet restricted to liquids.
35	V (sensory)
45	V (motor)
50	V Intractable typical trigeminal neuralgia or tic douloureux.
60	XII (swallowing impairment, with diet by tube feeding or gastrostomy.	Swallowing impairment due to one or two combinations of IX, X & XI, and resulting in diet by tube feeding or gastrostomy.
85	II

Tables 12.2 to 12.5 should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to the assessment of the consequences of neurological injury or disease.

Communication

Notes:

Communication disorders may arise as a result of interference with comprehension and/or expression. They are the result of neurological damage arising for example from head injury or cerebro-vascular accident. Comprehension may be further divided into hearing and reading skills and expression into verbal and written skills. A report from a Speech Pathologist or Rehabilitation Specialist will generally be necessary to enable impairment of this function to be accurately assessed. In all cases the employee’s abilities prior to the injury or disease must be taken into account. It would be inappropriate to assess an illiterate person with respect to reading and writing skills. Similarly where English is an employee’s second language, it may be more appropriate to base assessment on interference with ability to understand and speak the employee’s first language.

Table 12.2: Comprehension

(Percentage whole person impairment)

%	Criteria
Hearing*	Reading
5	Understands speech in most situations, but has difficulties in groups or when fatigued.	Reads books and magazine articles, but does not understand details.
10	Understands speech in one to one situations, but cannot cope in group situations.	Can get the gist of simple articles, for example in newspapers, but has great difficulty with details.
20	Understands only simple sentences.
25	Understands simple sentences although repetition is sometimes needed.
30	Able to read only single words.
35	Unable to read at all.
40	Able to understand only single words.
50	Unable to understand any language.

Notes:

*Hearing refers to the ability to comprehend spoken language—i.e. with the ability to interpret auditory signals, not to receive such signals. It does not refer to hearing impairment which is assessed using Table 8.1

Table 12.3: Expression

(Percentage whole person impairment)

%	Criteria
%	Verbal	Written
5	Can sustain conversation, but has minor word retrieval problems and/or hesitancy.	Can write simple letters, but cannot write complex documents.
10	Can converse in simple sentences only and may have difficulty with word finding and expressing complex ideas.	Can write postcards and letters of about five lines (spelling and grammatical errors may be apparent), but cannot write longer documents.
15	Can write only short, simple sentences (spelling errors may be evident).
20	Only able to respond in short sentences or phrases.	Cannot write sentences, but can write single words.
25	Able to write or copy only a familiar sequence of letters, for example own name or unable to write at all.
30	Limited to use of single words and/or social or stereotyped phrases.
35	No useful speech (includes unintelligible speech and speech limited to swearing).

Table 12.4: Memory

(Percentage whole person impairment)

%	Criteria
0	No appreciable effect. Reliance on notes, lists etc is comparable to others of same age, education and lifestyle.
10	Difficulties with names and appointments and tends to misplace objects. There may be partial compensation by reliance on notes, lists, diaries or other people.
25	Failure to keep appointments or fulfil other obligations despite use of memory aids and difficulties recalling details of recent events AND tendency to get lost in unfamiliar surroundings.
40	Failure to keep appointments or fulfil other obligations despite use of memory aids, to a more pronounced extent and some supervision by another necessary.
60	Unable to recall recent events or experiences and constant supervision necessary to avoid harm, resulting in inability to live independently.
70	Unable to recall recent events or experiences, to a more pronounced extent and disorientation in familiar surroundings and inability to recognise familiar faces or objects.

Notes:

Cognitive function has two components—memory and reasoning ability. These functions are affected where there is neurological damage eg, from head injury, cerebro-vascular accident etc. Difficulties with memory or reasoning ability due to some other process eg, psychiatric illness should not be assessed using these tables. Instead Table 6.1 should be used.

Assessment should be carried out by a neurologist or clinical psychologist.

Table 12.5: Reasoning

(Percentage whole person impairment)

%	Criteria
0	Abilities intact.
10	Able to cope with routine activities and situations but experiences minor difficulties in new situations.
25	Still able to cope with routine activities but has moderate difficulties in new situations and Complex decision making and abstract thinking are affected.
40	Major difficulties in new situations and difficulties with routine activities and problems becoming manifest and complex decision making and abstract thinking seriously affected.
60	Major difficulties in carrying out routine daily activities. Perseverative thinking may be evident.
70	Needs prompting and assistance with even the simplest activities.

Notes:

Assessment is carried out by examining the degree of interference with the ability to plan and carry out tasks involving a number of steps, ability to solve problems and make decisions which involve the examination of new and old material, ability to think in abstract terms eg, interpret proverbs. Generally complex tasks and decisions will be first affected as will decisions involving unfamiliar factors.

Assessment should be carried out by a neurologist or clinical psychologist.

13. Miscellaneous

Table 13.1: Intermittent conditions

(Percentage whole person impairment)

For use in the assessment of disorders of the haemopoietic system such as anaemia, polycythaemia, leucocyte and platelet disorders and intermittent disorders such as asthma, migraine, tension headache, epilepsy etc.

Principles:

Determine the frequency, duration and severity of attacks with reference to the degree of interference with activities of daily living.

%	Description of level of impairment
0	Episodes may be of any frequency but do not interfere with activities of daily living or are readily prevented or reversed by appropriate medication or treatment.
10	Episodes occur 12 or more times a year and cause minor interference with activities of daily living or episodes occur less frequently and cause interference with all activities of daily living other than self care.
20	Episodes occur up to 25 percent of the time and cause significant interference with most activities of daily living other than self care.
30	Episodes occur up to 30 percent of the time and cause significant interference with most activities of daily living other than self care.
40	Episodes occur up to 40 percent of the time and cause significant interference with most activities of daily living other than self care.
50	Episodes occurup to 50 percent of the time and cause significant interference with most activities of daily living other than self care.
60	Episodes occur up to 60 percent of the time and cause significant interference with most activities of daily living other than self care.
70	Episodes occur up to 70 percent of the time and cause significant interference with most activities of daily living other than self care.
75-95	Episodes occur 75 to 100 percent of the time and needs assistance with most or all activities of daily living including self care (confinement to a residential care facility is required for assessed impairment levels of more than 80 percent).

Notes:

Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.

Table 13.2: Malignancies

(Percentage whole person impairment)

%	Description of level of impairment
0	No symptoms or evidence of disease and able to undertake normal activities with no special care needed.
10-15	Some signs or symptoms of disease and normal activities can be undertaken with moderate effort.
35	Does not require institutional care but needs assistance with activities of daily living other than self care.
50	Can still be maintained at home but with considerable assistance and frequent medical care.
65	Requires institutional care and considerable assistance with activities of daily living other than self care.
75	Requires institutional care and considerable assistance with activities of daily living including self care.
85	Intensive support and/or treatment needed (disease may be progressing rapidly).

Notes:

Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.

PART 2

Appendix 1

14. Combined values chart

The values are derived from the formula:

A + B(1-A) = combined value of A and B

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 second highest, then find their combined values as above. Then use that combined value and the third highest impairment value to locate the combined value of all impairments.

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.

Part 2—Appendix 1: Combined values chart

Source: American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5^th edition, pages 604-5.
Part 2—Combined values chart (continued)

Part 2—Combined values chart (continued)

PART 2

Division 2—Non-economic loss

Introduction

The degree of non-economic loss is to be assessed in accordance with this part.

The compensation payable for non-economic loss is divided into two equal amounts. The formula to calculate the total payable in an individual case is:

$ Total = A + B

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.

To calculate B, the following tables in this part are used:

Table 1: Pain and suffering

Table 2: Loss of amenities

Table 3: Other loss

Table 4: Loss of expectation of life

Table 5: Combined value calculation

Table 6: Final calculation.

Table 1: pain and suffering

Only permanent pain and suffering is considered. Suffering is the mental distress as a result of the accepted conditions (it includes emotional symptoms such as grief, anguish, fear, frustration, humiliation, embarrassment etc).

This table does not include temporary pain and suffering. Nor does it include speculation of future pain and suffering that has not yet manifested itself.

A score out of five is assessed for both pain and for suffering. These two scores are then combined with the scores derived from Tables 2, 3 and 4 using the combined value calculation (Table 5).

Pain
Score	Description of level of effect
0	No pain experienced.
1	Intermittent attacks of pain of nuisance value only. Can be ignored when activity commences.
2	Intermittent attacks of pain. Not easily tolerated, but short lived. Responding fairly readily to treatment.
3	Episodes of pain more persistent. Not easily tolerated. Treatment, if available, of limited benefit.
4	Pain occurring most of the time. Restrictions on activity. Resistant to treatment.
5	Pain continuous and severe preventing activity. Not controlled by medication.

Suffering
Score	Description of effect
0	No symptoms experienced.
1	Symptoms minimal or ill defined. Occur intermittently. No interference with activity.
2	Distinct symptoms. Episodic in nature. Activities reduced during such episodes. Recovers quickly after episodes.
3	Symptoms distinct and varied. Episodes occur regularly. Ability to cope or perform activity effectively reduced during episodes. Needs time to recover between episodes. Treatment of benefit.
4	Symptoms wide ranging. Tend to dominate thinking. Little time when free of symptoms. Difficulty coping or performing activity. Treatment necessary.
5	Constantly focussed on condition. Ruled by emotions. Symptoms interfere with normal thought processes. Unable to cope. Activities severely restricted. Treatment of no real help.

Table 2: loss of amenities

Loss of amenities is also known as loss of enjoyment of life.

A score out of five is assessed for each of the following:

mobility
social relationships
recreation and leisure activities.

These are then combined with the scores from Tables 1, 3 and 4 using the combined value calculation (Table 5).

Mobility

Concerns the employee’s ability to move around in his or her environment

Score	Description of effect
0	No or minimal restrictions on mobility.
1	Effects on mobility periodic or intermittent—in between episodes no restrictions. Effects continuing but mild (eg slowing of pace, need for a walking stick) (can do everything, but at a slower pace).
2	Mobility reduced, but remains independent of others both within and outside the home. Can travel but may need to have 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 with door to door transport. Needs assistance of others.
5	Severely restricted mobility (eg bed, chair, room). Dependent on others for assistance. Mechanical devices or appliances used (eg wheelchair, hoist).

Social relationships

Concerns the employee’s capacity to engage in usual social and personal relationships.

Score	Description of effect
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	Difficulty relating socially to anyone.

Recreation and leisure activities

Concerns the employee’s ability to maintain customary recreational and leisure pursuits

Score	Description of effect
0	Able to follow usual recreation and leisure activities.
1	Intermittent interference with activities. In between episodes able to pursue usual activities.
2	Interference with activities reduces frequency of activity, but is able to continue. Is able to enjoy alternatives.
3	Unable to continue activity. Alternative less satisfying activity possible.
4	Range of activities greatly reduced. Needs some assistance to participate.
5	Unable to undertake any satisfying or rewarding activities.

Table 3: Other loss

This table is used to assess losses of a non-economic nature that are not adequately covered by Table 1, 2 or 4.

A score out of 3 is assessed. This is then combined with the scores derived from Tables 1, 2 and 4. using the combined value calculation (Table 5).

The factors to be considered include:

dependence upon external life saving or supporting machine (for example, aspirator, respirator, dialysis machine, or any form of electro-mechanical device for the sustenance or extension of activities)
dependence upon a specialised diet
detrimental effects of climatic features (for example, temperature, humidity, ultra-violet rays, light, noise, dust)
move to specially modified premises.

Score	Description of effect
0	Nil or minimal disadvantages
1	Slight disadvantages
2	Moderate disadvantages
3	Marked disadvantages

Table 4: Loss of expectation of life

A score out of three is assessed. This is then combined with the scores derived from Tables 1, 2 and 3. using the combined value calculation (Table 5). 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.

Score	Description of effect of effect
0	Loss of life expectancy of less than one year.
1	Loss of life expectancy of 1 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 more.

Table 5: Combined value calculation

This table converts the total of the scores (assessed in Tables 1, 2, 3 and 4) to a percentage of the second half of the maximum lump sum payable for non-economic loss.

Calculation of total of scores

Table 1: Pain and suffering

(Pain score ____) x 0.5 = ____

(Suffering score ____) x 0.5 = ____

Table 2: Amenities of life

(Mobility score ____) x 0.6 = ____

Social relationships score ____) x 0.6 = ____

(Recreation and leisure activities score ____) x 0.6 = ____

Table 3: Other loss

(Score ____) x 1.0 = ____

Table 4: Loss of expectation of life

(Score ____) x 1.0 = ____

Total of scores = ____

Conversion of total of scores to a percentage

A. If the combined total of scores from Tables 1, 2, 3 and 4 equals or is greater than 15, then 100 percent of the second half of the maximum is payable

or

B. If the combined total of scores from Tables 1, 2, 3 and 4 is less than 15, then the percentage of the second half of the maximum that is payable is calculated using the following formula:

(total of scores)	x 100
15

Table 6: Final calculation

(benefit levels as from 1 July 2011)*

(1)	Whole person impairment (as per Permanent impairment questionnaire)
____ % x $163,535.42	$__________
(2)	First half of $30,662.91	____ % x $30,662.91	$__________
(3)	Second half of $30,662.91 (as per non-economic loss questionnaire)
Table 1: Pain and suffering
Pain score	____
Suffering score	____
Subtotal of scores	____ x 0.5 = ____
Table 2: Amenities of life
Mobility score	____
Social relationships score	____
Recreation and leisure Activities score	____
Subtotal of scores	____ x 0.6 = ____
Table 3: Other loss
Other loss score	____ x 1.0 = ____
Table 4: Loss of expectation of life
Loss of expectation score	____ x 1.0 = ____

Total of scores

If Score > 15: pay maximum $30,662.91
If Score < 15: calculate % of $30,662.91
using following formula:

(total of scores)	x 100
15

$__________

Total

$__________

*These are indexed annually on 1 July in accordance with CPI. Check with Comcare for the latest rates if unsure.

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Citations

Safety, Rehabilitation and Compensation Act 1988 - Guide to the Assessment of the Degree of Permanent Impairment Edition 2.1 (Cth)

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