Seafarers Rehabilitation and Compensation Act 1992 Guide to the Assessment of the Degree of Permanent Impairment (Edition 2.1) (02/11/2011) (Cth)

SEAFARERS REHABILITATION AND COMPENSATION

ACT 1992 – GUIDE TO THE ASSESSMENT OF THE

DEGREE OF PERMANENT IMPAIRMENT –

EDITION 2.1 (CONSOLIDATION 1)

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

NOTES:

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

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

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

Guide to the Assessment of the Degree of Permanent Impairment

Edition 2.1

Introduction to Edition 2.1 of the Guide

1. AUTHORITY

2. STRUCTURE OF THIS GUIDE9

3. APPLICATION OF THIS GUIDE10

4. WHOLE PERSON IMPAIRMENT (WPI)11

5. ENTITLEMENTS UNDER THE SRC ACT11

6. NON-ECONOMIC LOSS11

7. COMPENSATION PAYABLE11

8. INTERIM AND FINAL ASSESSMENTS12

9. INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT12

CONTENTS14

LIST OF TABLES AND FIGURES15

LIST OF REFERENCES19

PRINCIPLES OF ASSESSMENT20

1. IMPAIRMENT AND NON-ECONOMIC LOSS1

2. EMPLOYABILITY AND INCAPACITY1

3. PERMANENT IMPAIRMENT1

4. PRE-EXISTING CONDITIONS AND AGGRAVATION22

5. THE IMPAIRMENT TABLES2

6. MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE2

7. PERCENTAGES OF IMPAIRMENT3

8. COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES23

9. COMBINED VALUES3

10. CALCULATING THE ASSESSMENT3

11. ORDERING OF ADDITIONAL INVESTIGATIONS4

12. EXCEPTIONS TO USE OF THIS GUIDE4

GLOSSARY5

DIVISION 1
ASSESSMENT OF THE DEGREE OF AN EMPLOYEE’S PERMANENT IMPAIRMENT RESULTING FROM AN INJURY7

1.0 INTRODUCTION7

1.1 CORONARY ARTERY DISEASE30

1.2 HYPERTENSION3

1.2.1 DIASTOLIC HYPERTENSION3

1.2.2 SYSTOLIC HYPERTENSION

1.3 ARRHYTHMIAS

1.4 PERIPHERAL VASCULAR DISEASE OF THE LOWER EXTREMITIES36

1.5 PERIPHERAL VASCULAR DISEASE OF THE UPPER EXTREMITIES37

1.6 RAYNAUD’S DISEASE38

2.0 INTRODUCTION41

2.1 ASSESSING IMPAIRMENT TO RESPIRATORY FUNCTION41

2.1.1 MEASUREMENTS41

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 INTRODUCTION49

3.1 THYROID AND PARATHYROID GLANDS

3.2 ADRENAL CORTEX AND MEDULLA50

3.3 PANCREAS (DIABETES MELLITUS)2

3.4 GONADS AND MAMMARY GLANDS4

4.0 INTRODUCTION6

4.1 SKIN DISORDERS6

4.2 FACIAL DISFIGUREMENT8

4.3 BODILY DISFIGUREMENT9

5.0 INTRODUCTION1

5.1 PSYCHIATRIC CONDITIONS2

6.0 INTRODUCTION5

6.1 CENTRAL VISUAL ACUITY8

6.1.1 DETERMINING THE LOSS OF CENTRAL VISION IN ONE EYE9

6.2 DETERMINING LOSS OF MONOCULAR VISUAL FIELDS70

6.3 ABNORMAL OCULAR MOTILITY AND BINOCULAR DIPLOPIA1

6.4 OTHER OCULAR ABNORMALITIES1

6.5 OTHER CONDITIONS CAUSING PERMANENT DEFORMITIES CAUSING UP TO 10% IMPAIRMENT OF THE WHOLE PERSON2

6.6 CALCULATION OF VISUAL SYSTEM IMPAIRMENT FOR BOTH EYES2

7.0 INTRODUCTION

7.1 HEARING LOSS

7.2 TINNITUS

7.3 OLFACTION AND TASTE

7.4 SPEECH7

7.5 AIR PASSAGE DEFECTS8

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 EXTREMITIES09

9.7 LOWER EXTREMITY FUNCTION.................................................................... 111

PART II—INTRODUCTION................................................................................. 114

9.8 HANDS AND FEET........................................................................................ 115

9.8.1 ABNORMAL MOTION OF DIGITS................................................................. 115

9.8.2 SENSORY LOSSES IN THE THUMB AND FINGER........................................... 119

9.9 WRISTS..................................................................................................... 121

9.10 ELBOWS................................................................................................... 122

9.11 SHOULDERS

9.12 UPPER EXTREMITY AMPUTATIONS............................................................. 127

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

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

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

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

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

PART III—INTRODUCTION

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

PART III—MULTI-LEVEL FRACTURES INVOLVING THE SPINAL CANAL

9.15 CERVICAL SPINE—DIAGNOSIS-RELATED ESTIMATES

9.16 THORACIC SPINE—DIAGNOSIS-RELATED ESTIMATES

9.17 LUMBAR SPINE—DIAGNOSIS-RELATED ESTIMATES

9.18 FRACTURES OF THE PELVIS

10.0 INTRODUCTION

10.1 THE UPPER URINARY TRACT

10.2 URINARY DIVERSION................................................................................ 154

10.3 LOWER URINARY TRACT............................................................................ 155

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 CHART200

PART 1 APPENDIX 1: COMBINED VALUES CHART

1. AUTHORITY

Division 4 of Part II (sections 39 to 42) of the Seafarers Rehabilitation and Compensation Act 1992 (the Seafarers Act) provides for payment of lump sum compensation for permanent impairment and non-economic loss resulting from a work related injury.

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

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

(a) the document, prepared by the Authority in accordance with section 42 under the title “Guide to the Assessment of the Degree of Permanent Impairment”, that has been approved by the Minister and is for the time being in force; and

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

Authority for this document rests therefore in subsections 42(1), 42(2) and 42(3) of the Seafarers Act, which provide that:

(1) The Authority may, from time to time, prepare a written document, to be called the “Guide to the Assessment of the Degree of Permanent Impairment”, setting out:

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

employee resulting from an injury must be determined;

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

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

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

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

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

This document is the new Guide to the Assessment of the Degree of Permanent Impairment. It may be referred to as ‘this guide’ or ‘edition 2.1 of the guide’. This guide is binding on employers and the Administrative Appeals Tribunal (subsection 42(4)).

2. Structure of this guide

This guide has three divisions:

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

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

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

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

3. Application of this guide

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

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

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

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

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

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

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

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

4. Whole Person Impairment (WPI)

Prior to 1993, the Seamen’s Compensation Act 1911 (the 1911 Act) (repealed with the coming into effect of the Seafarers Act) provided for the payment of lump sum compensation where a seafarer (employee) suffered the loss of, or loss of efficient use of, a part of the body or faculty, as specified in a table of maims. The range of conditions compensated was exclusive and did not reflect the broad range of work-related injuries and diseases.

This guide, like the previous editions, is for the purposes of expressing the degree of impairment as a percentage, based on the concept of ‘whole person impairment’. Subsection 39(5) of the Seafarers Act provides for the determination of the degree of permanent impairment of the employee resulting from an injury, that is, the employee as a whole person. The whole person impairment concept, therefore, provides for compensation for the permanent impairment of any body part, system or function to the extent to which it permanently impairs the employee as a whole person.

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

5. Entitlements under the Seafarers Act

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

Subsection 39(8) of the Seafarers Act excludes the operation of subsection 39(7) in relation to impairment resulting from the loss, or the loss of the use, of a finger or toe, or the loss of the sense of taste or smell.

6. Non-economic loss

Subsection 41(1) of the Seafarers Act provides that where there is liability to pay compensation in respect of a permanent impairment, additional compensation for non-economic loss is payable in accordance with section 41.

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

7. Compensation payable

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

8. Interim and final assessments

On the written request of the employee under subsection 40(1) of the Seafarers Act, an interim determination must be made of the degree of permanent impairment suffered and an assessment made of an amount of compensation payable to the employee, where:

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

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

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

When a final determination of the degree of permanent impairment is made, there is payable to the employee, under subsection 40(3) of the Seafarers Act, an amount equal to the difference, if any, between the final determination and the interim assessment.

9. Increase in degree of whole person impairment

Where a final assessment of the degree of permanent impairment has been made and the level of whole person permanent impairment subsequently increases by 10% or more in respect of the same injury, the employee may request, pursuant to subsection 40(4) of the Seafarers Act, another assessment for compensation for permanent impairment and non-economic loss. Additional compensation is payable for the increased level of impairment only.

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

CLAIMS FOR

PERMANENT IMPAIRMENT

Table of contents

List of tables and figures 15

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

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

Glossary............................................................................................ 25

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

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

Chapter 2 – The respiratory system..................................... 40

Chapter 3 – The endocrine system....................................... 48

Chapter 4 – Disfigurement and skin disorders........................ 55

Chapter 5 – Psychiatric conditions........................................ 60

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

Chapter 7 – Ear, nose and throat disorders........................... 75

Chapter 8 – The digestive system........................................ 81

Chapter 9 – The musculoskeletal system............................... 94

Chapter 10 – The urinary system......................................... 151

Chapter 11 – The reproductive system.................................. 157

Chapter 12 – The neurological system................................... 166

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

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

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

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

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

List of tables and figures

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

Chapter 1 – The cardiovascular system

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

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

Table 1.1: Coronary artery disease 31

Table 1.2.1: Diastolic hypertension .... 33

Table 1.2.2: Systolic hypertension ..... 34

Figure 1-C: Definitions of functional class 35

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

Table 1.4 Peripheral vascular disease of the lower extremities 36

Table 1.5: Peripheral vascular disease of the upper extremities 37

Figure 1-C: Definitions of functional class 38

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

Chapter 2 – The respiratory system

Table 2.1: Conversion of respiratory function values to impairment 43

Figure 2-A: . Calculating asthma impairment score 45

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

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

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

Chapter 3 – The endocrine system

Table 3.1 Thyroid and parathyroid glands 50

Table 3.2 Adrenal cortex and medulla 51

Table 3.3: Pancreas (diabetes mellitus) 52

Table 3.4: Gonads and mammary glands 54

Chapter 4 – Disfigurement and skin disorders

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

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

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

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

Chapter 5 – Psychiatric conditions

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

Table 5.1: Psychiatric conditions ..... 62

Chapter 6 – The visual system

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

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

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

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

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

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

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

List of tables and figures continues over page

List of tables and figures (continued)

Chapter 7 – Ear, nose and throat disorders

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

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

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

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

Table 7.6: Nasal passage defects.... 79

Table 7.7: Chewing and swallowing.. 80

Chapter 8 – The digestive system

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

Figure 8-B: Body mass index criteria. 83

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

Table 8.2: Lower gastrointestinal tract: Colon and rectum 86

Table 8.3: Lower gastrointestinal tract: Anus 89

Table 8.4: Surgically created stomas... 90

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

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

Table 8.7: Hernias of the abdominal wall 93

Chapter 9 – The musculoskeletal system

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

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

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

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

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

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

Table 9.5: Lower extremity amputations 106

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

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

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

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

Table 9.7: Lower extremity function... 112

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

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

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

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

Table 9.8.2a: Sensory losses in the thumb 119

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

Table 9.8.2c: Sensory losses in the little finger 120

Table 9.8.2d: Sensory losses in the ring finger 120

Table 9.9.1a: Wrist flexion/extension.. 121

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

Table 9.10.1a:Elbow flexion/extension. 123

Table 9.10.1b: Pronation and supination of forearm 123

Table 9.11.1a: Shoulder flexion/extension 125

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

List of Tables and Figures continues over page

List of tables and figures (continued)

Table 9.11.1c: Abduction/adduction of shoulder 127

Table 9.12.1: Upper extremity amputations 128

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

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

Table 9.13.1: Cervical nerve root impairment 131

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

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

Figure 9-E Diagnostic criteria for CRPS 135

Figure 9-F Impairment grading for CRPS 136

Table 9.14 Upper extremity function 138

Table 9.15: Cervical spine – Diagnosis-related estimates 144

Table 9.16: Thoracic spine – Diagnosis-related estimates 146

Table 9.17: Lumbar spine – Diagnosis-related estimates 148

Table 9.18: Fractures of the pelvis.. 150

Chapter 10 – The urinary system

Table 10.1: The upper urinary tract. 153

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

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

Chapter 11 – The reproductive system

Table 11.1.1: Male reproductive organs – Penis 159

Table 11.1.2: Male reproductive organs – Scrotum 159

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

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

Table 11.2.1: Female reproductive organs – Vulva and vagina 163

Table 11.2.2: Female reproductive organs – Cervix and uterus 164

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

Chapter 12 – The neurological system

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

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

Table 12.1.2: Epilepsy, seizures and convulsive disorders 169

Table 12.1.3: Sleep and arousal disorders 170

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

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

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

Table 12.4: Emotional or behavioural impairments 176

Table 12.5.1: The olfactory nerve (I). 177

Table 12.5.3: The trigeminal nerve (V) 178

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

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

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

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

List of Tables and Figures continues over page

List of tables and figures (continued)

Table 12.6: Neurological impairment of the respiratory system 182

Table 12.7: Neurological impairment of the urinary system 183

Table 12.8: Neurological impairment of the anorectal system 183

Table 12.9: Neurological impairment affecting sexual function 184

Chapter 13 – The haematopoietic system

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

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

Table 13.2: Leukocyte abnormalities or disease 188

Table 13.3: Haemorrhagic disorders and platelet disorders 189

Table 13.4: Thrombotic disorders.... 189

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

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

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

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

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

Table B3.3: Recreation and leisure activities 195

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

Table B5: Loss of expectation of life.. 196

B6: Worksheet
Calculation of non-economic loss 197

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

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

Appendices

Appendix 1 Combined values chart.. 201

List of references

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

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

American Medical Association, 1995, Guides to the Evaluation of Permanent Impairment, 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.

Principles of assessment

Page no.

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

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

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

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

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

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

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

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

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

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

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

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

Impairment and non-economic loss

Under section 3 of the Seafarers Act, impairment means ‘the loss, the loss of the use, or the damage or malfunction, of any part of the body or of the whole or part of any bodily system or function’. It relates to the health status of an individual and includes anatomical loss, anatomical abnormality, physiological abnormality, and psychological abnormality. The degree of impairment is assessed by reference to the impact of that loss by reference to the functional capacities of a normal healthy person.

Non-economic loss is assessed in accordance with Division 2 (page 190) of this guide, and deals with the effects of the impairment on the employee’s life. Under section 3 of the Seafarers Act, non economic loss, for an employee who has suffered an injury resulting in a permanent impairment, means:

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

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

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 section 3 of the Seafarers Act ‘permanent’ means ‘likely to continue indefinitely’. Subsection 39(2) of the Seafarers Act provides that for the purposes of determining whether an impairment is permanent, the following matters shall be considered:

(a) the duration of the impairment

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

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

(d) any other relevant matters.

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

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

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 this guide when assessing the degree of whole person impairment which results from an injury.

Where a table specifies a degree of impairment because of a surgical procedure, the same degree of impairment applies if the same loss of function has occurred due to a different medical procedure or treatment.

Malignancies and conditions resulting in major systemic failure

Conditions such as cancer, HIV infection, diabetes, asbestosis, mesothelioma and others, often with terminal consequences, may result in failure or impairment of multiple body parts or systems.

Assessments should be made of the impairment suffered in each of the affected body parts and systems and combined using the combined values chart in Appendix 1.

Percentages of impairment

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

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

For further information relating to the application of this guide, please contact the Comcare Permanent Impairment Guide Helpdesk on 1300 366 979 or email [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 Appendix 1) unless the notes in the relevant section specifically stipulate that the scores are to be added (For instance, see 9.8.1 at page 115).

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

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

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

Calculating the assessment10.

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

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

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

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

Ordering of additional investigations11.

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

Exceptions to use of this guide12.

In the event that an employee’s impairment is of a kind that cannot be assessed in accordance with the provisions of this guide, the assessment is to be made under the American Medical Association’s Guides to the Evaluation of Permanent Impairment 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 Chapter 9 – 9.13.3 Complex regional pain syndrome, see page 134).

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

Glossary

Definitions in italics are from section 3 of the Seafarers Act.

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

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

Disease means

(a) any ailment suffered by an employee; or
(b) the aggravation of any such ailment;
being an ailment or an aggravation that was contributed to in a material degree by the employee’s employment.

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

Injury means

(a) a disease suffered by an employee; or

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

but does not include anything suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment.

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

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

Glossary continues on following page

Glossary (continued)

Pain means physical pain.

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

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

Division 1

Assessment of the Degree of an Employee’s Permanent Impairment

Resulting from an Injury

Chapter 1 – The cardiovascular system

Page no
1.0.... Introduction.............................................................................. 29

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

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

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

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

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

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

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

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

1.0 Introduction

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

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

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

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

Figure 1-A: Activities of daily living

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

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

For post-thrombotic syndrome, assessments under Tables 1.4 and 1.5 are an alternative to Table 13.4: Thrombotic disorders. WPI ratings from Tables 1.4 and 1.5 must not be combined with a WPI rating from Table 13.4. Tables 1.4 and 1.5 should be used as the primary guide for assessing peripheral complications of thrombosis.

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

1.1 Coronary artery disease

Steps for assessment are as follows.

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

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

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

Age and gender	Symptomatic level of activity in METS
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

1. In Table 1.1, not applicable means the criterion is not applicable to the specified level of impairment.

2. Pathology – Column 3.

(i) Coronary artery disease:

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

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

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

(ii) Ischaemic left ventricular dysfunction:

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

++ LVEF 30-40%

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

(iii) Myocardial infarction (MI):

+ no previous MI

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

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

(iv) Arrhythmias

Assessed under Table 1.3 – Arrhythmias (see page 35).

3. Drug Therapy (continuous) – column 4.

+ one or two drugs

++ three or four drugs

+++ five or more drugs.

4. Intervention – Column 5.

PTCA means percutaneous transluminal coronary angioplasty and/or stenting.

CABG means coronary artery bypass grafting.

Tx means heart transplant.

1.2 Hypertension

Either diastolic hypertension (section 1.2.1 below) or systolic hypertension (section 1.2.2, on page 34) may be assessed, whichever provides the higher WPI rating.

1.2.1 Diastolic hypertension

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

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

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

Table 1.2.1: Diastolic hypertension

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

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

Note to Table 1.2.1

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

+ one drug

++ two drugs

+++ three or more drugs.

1.2.2 Systolic hypertension

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

Functional class (determined in accordance with Figure 1-B, see page 30) is the primary criterion for assessment. Level of systolic blood pressure (SBP) and therapy (see Table 1.2.2 below) are secondary criteria for assessment.

Table 1.2.2: Systolic hypertension

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

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

Note to Table 1.2.2

1. Drug therapy (continuous):

+ one drug

++ two drugs

+++three or more drugs.

1.3 Arrhythmias

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

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

Figure 1-C: Definitions of functional class

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

Table 1.3: Arrhythmias

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

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

Note to Table 1.3

1. Therapy – column 3:

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

‘PPM’ means permanent pacemaker.

‘Device’ means implanted defibrillator.

1.4 Peripheral vascular disease of the lower extremities

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

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

Table 1.4: Peripheral vascular disease of the lower extremities

% WPI	Signs and symptoms
0	The employee experiences neither intermittent claudication nor ischaemic pain at rest.
5	The employee has no difficulty with distances but experiences ischaemic pain on climbing either steps or gradients.
10	The employee experiences claudication on walking 200 metres or more at an average pace on level ground.
20	The employee experiences claudication on walking more than 100 but less than 200 metres at average pace on level ground.
30	The employee experiences claudication on walking more than 75 but less than 100 metres at average pace on level ground.
40	The employee experiences claudication on walking more than 50 but less than 75 metres at average pace on level ground.
50	The employee experiences claudication on walking more than 25 but less than 50 metres at average pace on level ground.
60	The employee experiences claudication on walking less than 25 metres at average pace on level ground.
70	The employee experiences ischaemic pain at rest.

1.5 Peripheral vascular disease of the upper extremities

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

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

Table 1.5 Peripheral vascular disease of the upper extremities

% WPI	Symptoms	Signs
5	Either no claudication or transient oedema.	Calcification of arteries on X-ray.
10	Either no claudication or persistent oedema controlled by support.	Dilatation of either arteries or veins.
15	As above.	Either loss of pulse or healed ulcer or surgery.
20	Either claudication on strenuous exercise or persistent oedema uncontrolled by support.	Either calcification of arteries on X-ray or dilatation of either arteries or veins.
30	As above.	Superficial ulcer.
40	As above.	Either deep or widespread ulcer or surgery.
45	Claudication on mild-moderate exertion.	Either calcification of arteries on X-ray or dilatation of either arteries or veins.
50	As above.	Superficial ulcer.
55	As above.	Either deep or widespread ulcer or surgery.
60	Rest pain/unable to exercise.	not applicable

1.6 Raynaud’s Disease

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

Figure 1-C: Definitions of functional class

See note immediately following Figure 1-C.

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

Note to Figure 1-C

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

Table 1.6: Raynaud’s Disease

See note immediately following Table 1.6.

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

Note to Table 1.6

1. Therapy – final column of Table 1.6:

Surgery includes sympathectomy and local debridement.

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

Chapter 2 – The respiratory system

Page no.

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

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

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

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

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

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

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

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

2.0 Introduction

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

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

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

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

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

2.1 Assessing impairment of respiratory function

2.1.1 Measurements

The most commonly recommended measurements for determining respiratory impairment are:

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

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

However, the measurements used must be derived from either:

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

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

Other measurements commonly used to assess impairment include:

the lung volumes

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

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

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

the elastic and flow resistive properties of the lungs

respiratory muscle strength

arterial blood gases

polysomnography (sleep studies)

echocardiography with estimation of pulmonary artery pressure

quantitative ventilation-perfusion scans of the lung.

Measurement of the partial pressures of oxygen and carbon dioxide in arterial blood (PaO₂ and PaCO₂ respectively) are not usually required to assign impairment ratings accurately. However, individual variation may result in severe impairment in gas exchange when other measures of function indicate only moderate impairment. Arterial PaO₂of <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.

Methods of measurement2.1.2

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

the Thoracic Society of Australia and New Zealand

the Australian Sleep Society

the Australian Council on Health Care Standards

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

2.1.3 Impairment rating

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

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

Table 2.1: Conversion of respiratory function values to impairment

See note immediately following Table 2.1

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

Note to Table 2.1

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

2.2 Asthma and other hyper-reactive airways diseases

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

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

the diagnosis and cause are established

exposure to the provoking factors is eliminated

appropriate treatment of asthma is implemented.

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

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

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

A score reflecting impairment from asthma is calculated by:

adding the points scored for reduction in FEV₁ %P

and either

change in FEV₁ with bronchodilator (reversibility)

or

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

and

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

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

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

Figure 2-A: Calculating Asthma Impairment Score

See notes immediately following Figure 2-A

Score	FEV₁, % P after bronchodilator	DFEV₁, % Change in 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

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

2. %P = percent predicted normal value.

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

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

treatment.

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

(or peak flow rate) x 0.85.

Table 2.2: WPI derived from asthma impairment score

% WPI	Asthma impairment score
0	0
10	1
20	2
30	3
40	4
45	5
50	6
55	7
60	8
65	9
70	10
75	11
80	12

2.3 Lung cancer and mesothelioma

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

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

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

2.4 Breathing disorders associated with sleep

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

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

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

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

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

Figure 2-B: Calculating obstructive sleep apnoea score

See notes immediately following Figure 2-B.

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

Notes to Figure 2-B

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

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

Table 2.4: WPI derived from obstructive sleep apnoea score

% WPI	Sleep apnoea score
0	0
10	1
20	2
30	3
40	4
45	5
50	6
55	7
60	8
65	9
70	10
75	11
80	12

Chapter 3 – The endocrine system

Page no.

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

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

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

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

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

3.0 Introduction

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

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

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

3.1 Thyroid and parathyroid glands

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

Chapter 4 – Disfigurement and skin disorders

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

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

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

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

Table 3.1 Thyroid and Parathyroid Glands

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

Notes to Table 3.1

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

3.2 Adrenal cortex and medulla

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

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

Table 3.2 Adrenal cortex and medulla

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

3.3 Pancreas (diabetes mellitus)

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

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

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

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

Table 3.3: Pancreas (diabetes mellitus)

See notes to Table 3.3 immediately following table.

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

Notes to Table 12.5.5

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

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

Figure 12-C: % WPI modifiers for episodic conditions

Signs and symptoms	Modifier
Absent.	0.0
Intermittent.	0.2
Present on a daily basis for periods aggregating 3 or more months per year but less than 6 months per year.	0.4
Present on a daily basis for periods aggregating 6 or more months per year but less than 8 months per year.	0.6
Present on a daily basis for periods aggregating 8 months or more per year but less than 10 months per year.	0.8
Present on a daily basis for period aggregating 10 months per year or more.	1.0

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

The spinal accessory nerve assists the vagus nerve in supplying some of the muscles of the larynx, and innervates the cervical portions of the sternocleidomastoid and trapezius muscles.

Disorders of these nerves affecting musculoskeletal function should be assessed in accordance with criteria contained in Chapter 9 – Musculoskeletal System (see page 94).

The glossopharyngeal nerve and the vagus nerve are mixed nerves supplying sensory fibres to the posterior third of the tongue, larynx and trachea. Sensory impairment may contribute to difficulties swallowing, breathing and speaking.

The hypoglossal nerve is a motor nerve that innervates the musculature of the tongue.

Dysarthia is a situation where the articulation of the voice mechanism is at fault. Pronunciation is unclear, although the linguistic content and meaning are normal.

Dysphagia is a condition in which the action of swallowing is difficult to perform, painful, or in which swallowed material is delayed in its passage to the stomach. Speech is slowed or slurred and may be completely unintelligible or non-functional. All other causes of difficulty with chewing or swallowing should be assessed using Table 7.7: Chewing and swallowing (see page 80). For the same condition, WPI ratings from Table 7.7 may not be combined with WPI ratings from Table 12.5.6.

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

% WPI	Criteria - ONE required (different conditions may be assessed separately)
10	Mild dysarthria (speech slow or slurred especially when tired). Dystonia (only neurological). Mild dysphagia (coughing on liquids or semi-solid foods). Diet limited to semi-solid or soft foods. Spasmodic torticollis (only neurological).
25	Moderately severe dysarthia (speech is laboured, imprecise, and often unintelligible). Speaker is required to repeat often and may need augmentative device to help convey message. Moderately severe dysphagia with nasal regurgitation and aspiration of liquids and semisolid foods. Diet limited to liquid foods.
50	Severe dysarthia – speech may be completely unintelligible or non-functional, or intelligible only to familiar people, and only with the aid of an augmentative communication device. Severe dysphagia (inability to swallow food, liquids or manage oral secretions). Regular suctioning required. Ingestion of food requires tube feeding or gastrotomy.

12.6 Neurological impairment of the respiratory system

Where the ability to breathe is impaired because of a neurological impairment, Table 12.6 below may be used. Impairments of the respiratory system not of documented neurological origin are assessed under Chapter 2 – The respiratory system (see page 40). They are not assessed under Table 12.6.

Table 12.6: Neurological impairment of the respiratory system

% WPI	Criteria
10	Able to breathe spontaneously but has difficulty performing Activities of Daily Living that require moderate exertion.
25	Able to breathe spontaneously but is restricted to sitting, standing or limited walking.
60	Able to breathe spontaneously but to such a limited degree that the employee is confined to bed.
90	No capacity for spontaneous respiration.

12.7 Neurological impairment of the urinary system

Where there is loss of bladder control due to a neurological impairment, Table 12.7 may be used.

Impairments of the urinary system not of documented neurological origin are assessed under Chapter 10 – Urinary system. They are not assessed under Table 12.7.

Documentation by cystometric and other relevant urologic tests may be necessary.

The status of the upper urinary tract must also be considered. Except for an impairment of bladder function, if several impairments of the urinary system are present, a WPI rating from Table 12.7 may be combined with a WPI rating from Chapter 10 – Urinary system.

Table 12.7: Neurological impairment of the urinary system

% WPI	Criteria
5	Some degree of voluntary control but impaired by urgency or intermittent incontinence.
10 - 15	Good bladder reflex activity, limited capacity, and intermittent emptying without voluntary control.
30	Poor bladder reflex activity, intermittent dribbling, and no voluntary control.
50	No reflex or voluntary control of the bladder.

Notes to Table 12.7

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

12.8 Neurological impairment of the anorectal system

Where there is loss of ability to control emptying because of a neurological impairment, Table 12.8 below may be used. Impairments of the anorectal system not of documented neurological origin are assessed under Chapter 8 – The digestive system (see page 81). They are not assessed under Table 12.8.

Table 12.8: Neurological impairment of the anorectal system

% WPI	Criteria
10	Reflex regulation but only limited voluntary control.
20	Reflex regulation but no voluntary control.
40	No reflex regulation or voluntary control.

12.9 Neurological impairment affecting sexual function

Where there is loss of awareness and the capability of having an orgasm because of a neurological impairment, Table 12.9 below may be used. Impairments of sexual function not of documented neurological origin are not assessed under Table 12.9. They are assessed under Chapter 11 – The reproductive system (see page 157).

The employee’s previous sexual functioning should be considered.

Impairment of the peripheral nervous system is assessed using the methodology for assessing the lower and upper extremities described in Chapter 9 – The musculoskeletal system (see pages 98 and 114).

Table 12.9: Neurological impairment affecting sexual function

% WPI	Criteria
10	Sexual functioning is possible, but with difficulty of erection or ejaculation in men, or lack of awareness, excitement or lubrication in either sex.
15	Reflex sexual functioning is possible, but there is no awareness.
20	No sexual functioning.

Chapter 13 – The haematopoietic system

Page no.

13.0 Introduction ............................................................................ 186

13.1 . Anaemia................................................................................. 186

13.2 . Leukocyte abnormalities or disease.............................................. 186

13.2... Haemorrhagic disorders and platelet disorders............................... 189

13.4 Thrombotic disorders................................................................. 189

13.0 Introduction

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

13.1 Anaemia

Iron deficiency anaemia and megaloblastic anaemia are generally manageable with proper treatment and should not cause permanent impairment. Some haemolytic anaemias are reversible with appropriate therapy, such as steroids or splenectomy, and also should result in negligible impairment.

The impairment resulting from persistent refractory anaemia, whether haemolytic or aplastic, is assessed using Table 13.1.

Table 13.1: Anaemia

See note to Table 13.1 immediately following Table.

% WPI	Haemoglobin level	Transfusion requirements
0	100-120g/L	None
10	80-100g/L	None
20	80-100g/L	2 Units every 6 weeks
40	<80g/L	2-3 Units every 4 to 6 weeks
60	<80g/L	2-3 Units every 2-3 weeks

Note to Table 13.1.

1. The haemoglobin level referred to in Table 13.1 are the levels prior to transfusion.

13.2 Leukocyte abnormalities or disease

Chronic low white cell counts (for example, neutropenia) are usually associated with substantially increased risk of infection. Impairment is measured in terms of the infection.

Neoplastic disorders of leukocytes include leukaemias, lymphomas, multiple myeloma, and macroglobulinaemia. Some of these disorders (chronic lymphatic leukaemia, hairy cell leukaemia, and some lymphomas) may cause no impairment for many years.

Similarly, multiple myeloma and macroglobulinaemia may be initially asymptomatic, and cause no gastrointestinal haemorrhage, bone pain, or need for chemotherapy or radiation.

The impairment should be assessed by reference to the appropriate chapters of this guide.

As the early stages of HIV infection are not likely to manifest in impaired organ systems, Table 13.2 alone should be used to assess any impairment. Where organ systems are impaired as the disease progresses, impairment should be assessed using those chapters of the guide which assess impairment of the principal organ systems affected by the disease: including, but not limited to, Chapter 2 – The respiratory system, Chapter 8 – The digestive system, Chapter 10 – The urinary system, and Chapter 12 – The neurological system. If several systems are involved, the WPI ratings derived for each system are combined using the combined values chart (see Appendix 1).

The combined impairment should then be compared with the WPI rating from Table 13.2 in order to ascertain the more beneficial WPI rating.

The contribution of side effects of drug treatment to overall impairment should also be considered.

The same principle applies to other conditions of the haematopoietic system where organ systems are impaired by the disease process and impairment can be assessed using other chapters of the guide.

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 Table 13.2: Leukocyte abnormalities or disease, activities of daily living are those in Figure 13-A below.

Figure 13-A: Activities of daily living

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

Table 13.2: Leukocyte abnormalities or disease

% WPI	Criteria (all required)
0	Signs of leukocyte abnormality but no symptoms. No or infrequent treatment needed. All the activities of daily living can be performed.
10	Signs and symptoms of leukocyte abnormality. Infrequent treatment needed. Almost all the activities of daily can be performed.
20	Signs and symptoms of leukocyte abnormality. Continuous or regular treatment needed. Most of the activities of daily can be performed.
30	Signs and symptoms of leukocyte abnormality. Continuous or regular treatment needed. Interference with the performance of the activities of daily to the extent that some assistance from others is required.
50	Signs and symptoms of leukocyte abnormality. Continuous or regular treatment needed. Interference with the performance of the activities of daily to the extent that considerable assistance from others is required.
70	Signs and symptoms of leukocyte abnormality. Continuous or regular treatment needed. Interference with the performance of the activities of daily to the extent that continuous assistance from others is required.
80	Signs and symptoms of leukocyte abnormality. Continuous or regular treatment needed. Totally dependent on others for performance of all activities of daily.

Notes to Table 13.2

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

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

13.3 Haemorrhagic disorders and platelet disorders

Thrombocytopenia does not constitute an impairment unless severe and not reversible by steroids, splenectomy, or other therapy.

A bleeding disorder that causes problems only after trauma or surgery does not constitute a permanent bleeding impairment.

Where an injury is made more severe by the presence of an underlying bleeding disorder, a combined WPI rating is allowed, incorporating values for bleeding sites or organ damage. A WPI rating obtained from tables in other chapters may be combined with a WPI rating obtained from Table 13.3.

Other complications of bleeding disorders, including gastrointestinal, mucosal or intramuscular haemorrhage, should also be assessed according to the site of the blood loss under other chapters of the guide, including Chapter 8 – The digestive system and/or Table 13.1: Anaemia.

A WPI rating obtained from other tables in this guide should be combined with a WPI rating obtained from Table 13.3 below.

Table 13.3: Haemorrhagic disorders and platelet disorders

% WPI	Criteria
0	Splenectomy; or easy bruising.
10	Continuous or regular medication is required.
25	Refractory thrombocytopenia <20,000/mL.

13.4: Thrombotic disorders

Long-term prophylaxis means prophylaxis continuing for at least 2 years.

Employees who have permanent respiratory or cardiac limitations, secondary to massive pulmonary embolism should be assessed as appropriate under Chapter 1 – The cardiovascular system, and Chapter 2 – The respiratory system.

For specific levels of impairment for post-thrombotic syndrome, use Table 1.4: Peripheral vascular disease of the lower extremities, or Table 1.6: Raynaud’s disease, Chapter 1 - The cardiovascular system. These Tables may be used as an alternative. WPI ratings from Tables 1.4 or 1.6, and Table 13.4, must not be combined.

Tables 1.5 and 1.6 should be used as the primary guide for assessing peripheral complications of thrombosis.

Table 13.4: Thrombotic disorders

% WPI	Criteria
0	Superficial thrombosis or thrombophlebitis.
10	Deep venous or other thrombosis requiring long-term prophylaxis with warfarin.
30	Post-phlebitic syndrome.

Division 2

Guide to the assessment of

non-economic loss

Introduction

The degree of non-economic loss is to be assessed in accordance with Division 2.

The compensation payable for non-economic loss is divided into two equal amounts.

The worksheet – calculation of non-economic loss (see section B6, page 197) uses the following formula to calculate the total payable in an individual case:

A + B = $Total

WHERE A = the percentage assessment of total permanent impairment,

multiplied by the first half of the maximum

AND B = a reasonable percentage of the second half of the maximum

having regard to the non-economic loss suffered

Listed below are the tables in Division 2 used to calculate a reasonable percentage.

Pain:

Table B1 – Pain (see page 192);

Suffering:

Table B2 – Suffering (see page 193).

Loss of Amenities:

Table B3.1 – Mobility (see page 194);

Table B3.2 – Social relationships (see page 195);

Table B3.3 – Recreation and leisure activities (see page 195).

Other Loss:

Table B4 – Other loss (see page 196).

Loss of expectation of life:

Table B5 – Loss of expectation of life (see page 196).

Scores derived from these tables are then transferred to the worksheet – calculation of non-economic loss (see section B6, page 197).
B1. Pain

Using Table B1, a score out of 5 is assessed for pain.

Using the worksheet – calculation of non-economic loss (see section B6), the score for pain is combined with the scores derived from Tables B2, B3.1, B3.2, B3.3, B4 and B5.

Pain means physical pain.

Only ongoing pain of a continuing or episodic nature is considered.

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

In Table B1, VAPS means ‘visual analogue pain scale’, with 0 being no pain, and 10 being the worst pain ever experienced.

Table B1: Pain

Score	Description of level of effect
0	No pain experienced. VAPS = 0
1	Intermittent attacks of pain of nuisance value only. Can be ignored when activity commences. VAPS = 1-2
2	Intermittent attacks of pain. Not easily tolerated, but short-lived. Pain responds fairly readily to treatment (for example, analgesics, anti-inflammatory medications). VAPS = 3-4
3	Episodes of pain more persistent. Not easily tolerated. Treatment, if available, of limited benefit. VAPS = 5-6
4	Pain occurring most of the time. Restrictions on activity. Resistant to treatment. VAPS = 7-8
5	Pain continuous and severe. Preventing activity. Uncontrolled by medication. VAPS = 9-10

B2. Suffering

Using Table B2, a score out of 5 is assessed for suffering.

Using the worksheet – calculation of non-economic loss (see section B6), the score for suffering is combined with the scores derived from Tables B1, B3.1, B3.2, B3.3, B4 and B5.

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

It includes emotional symptoms which are within the normal range of human responses to distressing events such as grief, anguish, fear, frustration, humiliation, embarrassment.

Only ongoing suffering of a continuing or episodic nature is considered.

Table B2 does not include:

temporary suffering

speculation about future suffering that has not yet manifested itself.

Table B2: Suffering

Score	Description of level of effect
0	No symptoms of mental distress experienced.
1	Symptoms of mental distress minimal or ill defined. Symptoms occur intermittently. No interference with activity.
2	Distinct symptoms of mental distress which are episodic in nature. Activities reduced during such episodes. Recovers quickly after episodes.
3	Symptoms of mental distress are distinct and varied. Episodes of mental distress occur regularly. Ability to cope or perform activity effectively reduced during episodes. Needs time to recover between episodes. Treatment – medication such as anti-depressants, counselling or other therapy by a psychologist or psychiatrist, or other supportive therapy – is of benefit in controlling or relieving symptoms.
4	Symptoms of mental distress are wide ranging and tend to dominate thinking. Rarely free of symptoms of mental distress. Difficulty coping or performing activity. Treatment necessary either to control or relieve symptoms.
5	Symptoms of mental distress arising from accepted condition interferes with normal thought processes. Activities severely restricted. Treatment of no real benefit in controlling or relieving symptoms.

B3. Loss of amenities

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

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

A score out of 5 is assessed for each of the following:

Mobility (using Table B3.1 – Mobility below). ‘Mobility’ refers to the employee’s ongoing ability to move around in his or her environment. This includes walking, driving, being a passenger, using public transport

Social relationships (using Table B3.2 – Social relationships, see following page). ‘Social relationships’ refers to the employee’s ongoing capacity to engage in usual social and personal relationships

Recreation and leisure activities (using Table B3.3 – Recreation and leisure activities, see following page). ‘Recreation and leisure activities’ refers to the employee’s ongoing ability to maintain customary recreational and leisure pursuits.

Using the worksheet – calculation of non-economic loss (see section B6), these scores are then combined with the scores derived from Tables B1, B1, B4 and B5.

Table B3.1: Mobility

Score	Description of level of effect
0	No or minimal restrictions on mobility.
1	Periodic effects on mobility, resulting in the need for some assistance; or Effects continuing but mild (such as slowing of pace or the need for a walking stick).
2	Mobility reduced, but remains independent of others both within and outside the home. Can travel but may require rest breaks, special seating, or other special treatment.
3	Mobility markedly reduced. Needs some assistance from others. Unable to use most forms of transport.
4	Restricted to home and vicinity. Can only travel outside home with door to door transport and the assistance of others.
5	Severely restricted mobility (for example, bed, chair, room). Dependent on others for assistance. Mechanical devices or appliances used for mobility within the home (for example, wheelchair, hoist).

Table B3.2: Social relationships

Score	Description of effect
0	Usual relationships unaffected.
1	Minor interference with personal relationships, causing some reduction in social activities and contacts.
2	Relationships confined to immediate and extended family and close friends, but unable to relate to casual acquaintances.
3	Difficulty in maintaining relationships with close friends and the extended family.
4	Social contacts confined to immediate family.
5	Difficulties relating socially to anyone.

Table B3.3: Recreation and leisure activities

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

B4. Other loss

Table B4 is used to assess losses of a non-economic nature that are not adequately covered by Tables B1, B2, B3.1, B3.2, B3.3, or B5.

A score out of 3 is assessed.

Using the worksheet – calculation of non-economic loss (see section B6) , this score is then combined with the scores derived from Tables B1, B2, B3.1, B3.2, B3.4, and B5.

Table B4: Other loss

Score	Description of effect
0	Nil or minimal disadvantages.
1	Moderate disadvantages. For example: dependence upon a specialised diet; detrimental effects of climatic features including temperature, humidity, ultra-violet rays, light, noise, dust.
2	Marked disadvantages. For example, requirement to move to specially modified premises.
3	Severe disadvantages. For example, dependence upon external life saving or supporting machines including aspirator, respirator, dialysis machine, or any form of electro-mechanical device for the sustenance or extension of activities.

B5. Loss of expectation of life

A score out of 3 is assessed.

Using the Worksheet – Calculation of non-economic loss (see section B6), this score is then combined with the scores derived from Tables B1, B1, B3.1, B3.2, B3.3, and B4.

Loss of expectation of life is restricted to a maximum of 3 points because of the value placed on it by the courts in damages cases.

Table B5: Loss of expectation of life

Score	Description of effect
0	Loss of life expectancy of less than 1 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 greater.

B6. Calculation of non-economic loss

This Worksheet allows for the calculation of the percentage of non-economic loss suffered by the employee for the purposes of section 41 of the Seafarers Act.

B6: Worksheet – Calculation of non-economic loss

STEP 1 – Calculation of Total Score from Division 2 Tables

Table	Score	Factor	Final score
Table B1: Pain	x 0.5 =
Table B2: Suffering	x 0.5 =
B3 – Amenities of Life B3.1: Mobility Score	x 0.6 =
B3.2: Social Relationships	x 0.6 =
B3.3: Recreation and Leisure Activities	x 0.6 =
Table B4: Other Loss	x 1.0 =
Table B5: Loss of Expectation of Life	x 1.0 =
Total of scores =

STEP 2 – Conversion of Total of Scores to a Percentage

Choose either Step 2.1 or Step 2.2

Step 2.1

If the Total of Scores from Step 1 above:

· equals 15; or

· is greater than 15

then the percentage non-economic loss suffered by the employee is 100%.

OR

Step 2.2

If the Total of Scores from Step 1 above is less than 15, insert in the grey shaded area below the Total of Scores from Step 1 above. Complete the calculation to find the percentage non-economic loss suffered by the employee:

__________ x 100 = ____%

15

Division 3

Calculation of total entitlement under section 39 and section 41

Use the following Worksheet to derive the total entitlement.

C1: Worksheet – calculation of total entitlement

Benefit levels are available from the Authority. They are indexed annually on 1 July in accordance with movements in the Consumer Price Index.

Calculate total whole person impairment entitlement
Step One	Calculate ss39(9) indexed amount for permanent impairment: WPI% x $	$
Step Two	Calculate ‘degree of permanent impairment’ of ss41(2) indexed amount for non-economic loss: WPI% x $	$
Step Three	Calculate ‘degree of non-economic loss’ of ss41(2) indexed amount for non-economic loss: _____ % Non-economic loss (from B6) x $	$
Step Four	Total permanent impairment entitlement:	$

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Citations

Seafarers Rehabilitation and Compensation Act 1992 - Guide to the Assessment of the Degree of Permanent Impairment (Edition 2.1) (02/11/2011) (Cth)

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