Seafarers Rehabilitation and Compensation Act 1992

Section 42

INSTRUMENT OF APPROVAL

I, Christopher Evans, Minister for Tertiary Education, Skills, Jobs and Workplace Relations, under subsection 42(3) of the Seafarers Rehabilitation and Compensation Act 1992 (‘the Act’) approve, with effect on and from 1 December 2011:

(a) the revocation of the Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment (‘Edition 2 of the Guide’) prepared by the Chief Executive Officer of Comcare, acting under delegation from the Seafarers Safety, Rehabilitation and Compensation Authority (“the Authority”), under subsection 42(1) of the Act by instrument dated 30 January 2006 and approved by the Minister for Employment and Workplace Relations on 6 February 2006; and

NOTE:  Edition 2 of the Guide is registered on the Federal Register of Legislative Instruments as F2006L00534.

(b) the attached Guide to the Assessment of the Degree of Permanent Impairment (‘Edition 2.1 of the Guide’) prepared by the Authority under subsection 42(1) of the Act on 6 September 2011.

Dated:   2nd November 2011

[signed]

Christopher Evans

Minister for Tertiary Education, Skills, Jobs and Workplace Relations

Guide to the Assessment of the Degree of Permanent Impairment

Edition 2.1

Seafarers Safety, Rehabilitation

and Compensation Authority

Introduction to Edition 2.1 of the Guide

1. Authority.................................................................9

2. Structure of this guide...................................................10

3. Application of this guide..................................................11

4. Whole person impairment (WPI)..........................................11

5. Entitlements under the SRC Act...........................................11

6. Non-economic loss.......................................................11

7. Compensation Payable...................................................11

8. Interim and final assessments ...........................................12

9. Increase in degree of whole person impairment............................12

Contents..................................................................14

List of tables and figures....................................................15

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

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

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............................................24

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

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

1.0 Introduction.............................................................27

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

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

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

4.0 Introduction.............................................................56

4.1 Skin disorders...........................................................56

4.2 Facial disfigurement.....................................................58

4.3 Bodily disfigurement.....................................................59

5.0 Introduction.............................................................61

5.1 Psychiatric conditions....................................................62

6.0 Introduction.............................................................65

6.1 Central visual acuity.....................................................68

6.1.1 Determining the loss of central vision in one eye.........................69

6.2 Determining loss of monocular visual fields...............................70

6.3 Abnormal ocular motility and binocular diplopia............................71

6.4 Other ocular abnormalities...............................................71

6.5 Other conditions causing permanent deformities causing up to 10% impairment of the whole person.......72

6.6 Calculation of visual system impairment for both eyes......................72

7.0 Introduction...........................................................76

7.1 Hearing loss............................................................76

7.2 Tinnitus................................................................76

7.3 Olfaction and taste.....................................................77

7.4 Speech..................................................................77

7.5 Air passage defects......................................................78

7.6 Nasal passage defects..................................................79

7.7 Chewing and swallowing................................................80

8.0 Introduction...........................................................82

8.1 Upper digestive tract—oesophagus, stomach, duodenum, small intestine and pancreas.......84

8.2 Lower gastrointestinal tract—colon and rectum...........................86

8.3 Lower gastrointestinal tract—anus.......................................89

8.4 Surgically created stomas...............................................90

8.5 Liver—chronic hepatitis and parenchymal liver disease....................91

8.6 Biliary tract............................................................92

8.7 Hernias of the abdominal wall...........................................93

9.0 Introduction...........................................................96

Part I—Introduction........................................................98

9.1 Feet and toes...........................................................99

9.2 Ankles................................................................101

9.3 Knees................................................................102

9.4 Hips..................................................................104

9.5 Lower extremity amputations..........................................106

9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities.......108

9.6.1 Spinal nerve root impairment affecting the lower extremity.............109

9.6.2 Peripheral nerve injuries affecting the lower extremities..................109

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...........................................................124

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.....................................................141

Part III—Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment.......142

Part III—Multi-level fractures involving the spinal canal.....................144

9.15 Cervical spine—diagnosis-related estimates............................144

9.16 Thoracic spine—diagnosis-related estimates............................146

9.17 Lumbar spine—diagnosis-related estimates.............................148

9.18 Fractures of the pelvis................................................150

10.0 Introduction.........................................................152

10.1 The Upper Urinary Tract..............................................152

10.2 urinary diversion.....................................................154

10.3 lower urinary tract...................................................155

11.0 Introduction.........................................................158

11.1 Male reproductive system.............................................158

11.1.1 Male reproductive organs—penis.....................................159

11.1.2 Male reproductive organs—scrotum..................................159

11.1.3 Male reproductive organs—testes, epididymes and spermatic cords.....160

11.1.4 Male reproductive organs—prostate and seminal vesicles..............161

11.2 Female reproductive system..........................................162

11.2.1 Female reproductive organs—vulva and vagina.......................163

11.2.2 Female reproductive organs—cervix and uterus.......................164

11.2.3 Female reproductive organs—fallopian tubes and ovaries..............165

12.0 Introduction.........................................................167

12.1 Disturbances of levels of consciousness and awareness.................169

12.1.1 Permanent disturbances of levels of consciousness and awareness.....169

12.1.2 Epilepsy, seizures and convulsive disorders...........................169

12.1.3 Sleep and arousal disorders.........................................170

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

12.3 Communication impairments—dysphasia and aphasia...................174

12.4 Emotional or behavioural impairments.................................175

12.5 Cranial nerves.......................................................177

12.5.1 The olfactory nerve (I)..............................................177

12.5.2 The optic nerve, the oculomotor and trochlear nerves and the abducens (II, III, IV and VI).......177

12.5.3 The trigeminal nerve (V)............................................178

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

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

12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII).......181

12.6 Neurological impairment of the respiratory system......................182

12.7 Neurological impairment of the urinary system.........................183

12.8 Neurological impairment of the anorectal system.......................183

12.9 Neurological impairment affecting sexual function......................184

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

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

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

13.3 Haemorrhagic disorders and platelet disorders.........................189

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

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

Introduction..............................................................191

B1. Pain..................................................................192

B2. Suffering.............................................................193

B3. Loss of amenities......................................................194

B4. Other loss............................................................196

B5. Loss of expectation of life..............................................196

B6. Calculation of non-economic loss.......................................197

Division 3 Calculation of total entitlement under Section 24 and Section 27....198

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

Part 1 Appendix 1:  Combined Values Chart.................................201

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 Permanent 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 determinations made under sections 39, 40 or 41 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 was varied on 1 December 2011 by edition 2.1 of the Guide to the Assessment of the Degree of Permanent Impairment. 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 per cent 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 determinations made on and from 1 December 2011 under sections 39, 40 or 41 of the Seafarers Act in respect of claims under those sections received by the relevant authority after 28 February 2006.

Where a request by an employee (as defined in s4 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 after 1 December 2011 but relates to a claim under section 39 that was received by the employer on or before 28 February 2006, that request will 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 SRC Act (in respect of interim payment of permanent impairment compensation) is received by an employer after 1 December 2011 but relates to a claim under section 39 that was received by the authority between 28 February 2006 and 1 December 2011, that request will be determined under the provisions of the second edition of the guide.

Where a claim for compensation pursuant to subsections 40(4) of the Seafarers Act (in respect of a subsequent increase in the degree of permanent impairment) is received by the employer after 1 December 2011, that claim will be determined under the provisions of this guide, notwithstanding that the initial claim for compensation for permanent impairment may have been determined under the provisions of the previous editions of the 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 of non-economic loss shall not be less than the degree of permanent impairment or degree of non-economic loss determined under the provisions of the 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 function138

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, 4th edition, Chicago: American Medical Association.

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

American Thoracic Society Ad Hoc Committee on Impairment/Disability Criteria, 1986, ‘Evaluation of impairment/disability secondary to respiratory disorders’, 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

1.    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.

2.    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.

3.    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.

4.    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.

5.    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 5th 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. 

6.    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.

7.    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 PI.Guide@comcare.gov.au.

8.    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.

9.    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.

10. Calculating the assessment

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.

11. Ordering of additional investigations

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

12. Exceptions to use of this guide

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

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 5th 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.

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

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.

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 5th 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).

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 5th 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).

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

Table 1.3:  Arrhythmias

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

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

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

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.

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. 

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 PaO2 of <55 mm Hg and/or PaCO2 >50 mm Hg, despite optimal treatment, is evidence of severe impairment and attracts a WPI rating of 70%. 

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

2.1.2   Methods of measurement

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

• the Thoracic Society of Australia and New Zealand
• the Australian Sleep Society
• the Australian Council on Health Care Standards 

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

2.1.3  Impairment rating

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

Severity of impairment is rated as shown in Table 2.1. 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

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

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 (5th 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 FEV1.

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

treatment.

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

(or peak flow rate) x 0.85.

Table 2.2:  WPI derived from asthma impairment score

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.

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

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

Notes to Table 3.1

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

3.2  Adrenal cortex and medulla

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

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 g/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.

Notes to Table 3.3

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

• 4%-6% is the non-diabetic range
• <8% is indicative of satisfactory control for the purposes of this table.

2. ‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with quality of life to a considerable degree.

3. ‘NIDDM’ means non-insulin dependent diabetes mellitus.

4. ‘IDDM’ means insulin dependent diabetes mellitus.

3.4  Gonads and mammary glands

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

Loss of one or both breasts in females should also be assessed using Table 4.3: Bodily disfigurement (see Chapter 4 – Disfigurement and skin disorders). Using the combined values chart (see Appendix 1), a WPI rating derived from Table 4.3 may be combined with a WPI rating derived from Table 3.4 below.

Table 3.4:  Gonads and mammary glands

Chapter 4 –Disfigurement and Skin Disorders

 Page no.

4.0  Introduction................................................56

4.1   Skin disorders...............................................56

4.2   Facial disfigurement..........................................58

4.3   Bodily disfigurement.........................................59

4.0  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).

Impairments assessed under Chapter 4 include those caused by secondary conditions accompanying an endocrine system condition. A WPI rating from a table in Chapter 3 – The endocrine system should be combined with WPI ratings resulting from the secondary conditions assessed under Chapter 4.

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

• Table 3.4:  Gonads and mammary glands (see Chapter 3 – The endocrine system)
• Table 4.3:  Bodily disfigurement
• and the resulting WPI ratings combined.

In cases where two or three of Tables 4.1, 4.2 and 4.3 apply, WPI ratings from each table can be combined using the combined values chart (see Appendix 1).

WPI ratings awarded under Table 4.2 cannot be combined with WPI ratings arising under section 6.4 –Other ocular abnormalities, or section 6.5 – Other conditions causing permanent deformities causing up to 10% impairment of the whole person (see Chapter 6 – The visual system).

4.1  Skin disorders

For the purposes of Table 4.1: Skin disorders:

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

• ‘constant treatment’ means treatment that continues on a regular basis without interruption

• ‘complex treatment’ means treatment that requires regular and close supervision, usually by a dermatologist. Such supervision could involve regular blood tests and relevant regular physical examinations, such as blood pressure measurement. Complex treatments would be expected to have potential adverse side effects. Categories of drugs forming a part of, or the whole of, complex treatment would include high doses of systemic corticosteroids, or immunosuppressive medications such as azathioprine, methotrexate and cyclosporin. Phototherapy, photochemotherapy, or photophoresis, would also be considered complex treatments.

Column 4 in Table 4.1 is referenced to Figure 4-A: Activities of daily living, immediately below the table.

Table 4.1:  Skin disorders

Figure 4-A: Activities of daily living

4.2  Facial disfigurement

Table 4.2:  Facial disfigurement

4.3  Bodily disfigurement

Table 4.3:  Bodily disfigurement

Chapter 5 – Psychiatric Conditions

 Page no. 

 5.0  Introduction................................................61

 5.1 Psychiatric conditions.........................................62             

5.0  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)

For the purposes of Chapter 5, activities of daily living are those in Figure 5-A (see below). The examples provided below are not exhaustive and should not be seen as a substitute for assessor discretion when making decisions about impairment ratings.

Figure 5-A: Activities of daily living

5.1  Psychiatric Conditions

Table 5.1:  Psychiatric conditions

See note to Table 5.1, immediately after Table.