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

 

 

 

 

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:

  1.     criteria by reference to which the degree of the permanent impairment of an   

              employee resulting from an injury must be determined;

  1.     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

  1.      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)).

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.
 

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.

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:

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.

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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

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

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

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

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

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 mammaryglands  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

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

Chapter 8 – The digestive system

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

Figure 8-B:   Body mass index criteria83

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/extension123

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

Chapter 10 – The urinary system

Table 10.1:   The upper urinary tract153

Chapter 11 – The reproductive system

Table 11.1.2: Male reproductive organs – Scrotum 159

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

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

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

 

 

 

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. 

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

 

 

 


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.

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.

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.


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.

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. 

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.

 


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.

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.

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.

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

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.

 

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. 

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:

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

 

 

 


Chapter 1 – The cardiovascular system

 Page no

1.0 Introduction................................................29

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

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).

 

 

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.

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

  1.                       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.

  1.                     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).

  1.                   Arrhythmias

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

+ one or two drugs

++ three or four drugs

+++  five or more drugs.

PTCA means percutaneous transluminal coronary angioplasty and/or stenting.

CABG means coronary artery bypass grafting.

Tx means heart transplant.

 

 

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.

 

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.

 

 

 

 

 

+ one drug

  ++ two drugs

+++ three or more drugs.

 

 

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.

 

 

 

 

 

Note to Table 1.2.2

 + one drug

 ++ two drugs

 +++three or more drugs.

 

 

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

 

 

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

‘PPM’ means permanent pacemaker.

‘Device’ means implanted defibrillator.

 

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

 

 

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.

 

 

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.

 

 

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.

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. 

2.1  Assessing impairment of respiratory function

The most commonly recommended measurements for determining respiratory impairment are:

However, the measurements used must be derived from either:

Other measurements commonly used to assess impairment include:

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

 

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

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:

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.

 


 

Note to Table 2.1

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

 

 

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:

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:

and either

or

and

 

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.

 

 

 

 

 

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

 

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.

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.

 

 

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

3.4   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:

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).


 

 

 

 

Notes to Table 3.1

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

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).

 

 

 

 

 

 

 

 

 

 

 

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:

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.

 

 

 

 

 

 


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:

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).

For the purposes of Table 4.1: Skin disorders:

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

 

 

 

 

 

 

 

 

 

 

 

 

 


Chapter 5 – Psychiatric Conditions

 Page no. 

 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.

 

 


5.1  Psychiatric Conditions

See note to Table 5.1, immediately after Table.

Despite the presence of one of the following employee is capable of performing activities of daily living without supervision or assistance:

  • reactions to stresses of daily living with minor loss of personal or social efficiency
  • lack of conscience directed behaviour without harm to community or self
  • minor distortions of thinking.

Despite the presence of more than one of the following employee is capable of performing activities of daily living without supervision or assistance:

  • reactions to stresses of daily living with minor loss of personal or social efficiency
  • lack of conscience directed behaviour without harm to community or self
  • minor distortions of thinking.

Any one of the following accompanied by a need for some supervision and direction in activities of daily living:

  • reactions to stresses of daily living which cause modification to daily living patterns
  • marked disturbances in thinking
  • definite disturbance in behaviour.

Any two of the following accompanied by a need for some supervision and direction in activities of daily living:

  • reactions to stresses of daily living which cause modification of daily living patterns
  • marked disturbance in thinking
  • definite disturbance in behaviour.

All of the following accompanied by a need for some supervision and direction in activities of daily living:

  • reactions to stresses of daily living which cause modification of daily living patterns
  • marked disturbances in thinking
  • definite disturbances in behaviour.

 


Table 5.1 (continued)

 

  •  

Any one of the following accompanied by a need for supervision and direction in activities of daily living:

  • hospital dischargees who require daily medication or regular therapy to avoid readmission
  • loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community.

More than one of the following accompanied by a need for supervision and direction in activities of daily living:

  • hospital dischargees who require daily medication or regular therapy to avoid readmission
  • loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or community.

One of the following:

  • severe disturbances of thinking and/or behaviour entailing potential or actual harm to self and/or others
  • need for supervision and direction in a confined environment.

Both of the following:

  • severe disturbances of thinking and/or behaviour which entail potential or actual harm to self and/or others
  • need for supervision and direction in a confined environment.

Very severe disturbance in all aspects of thinking and behaviour requiring constant supervision and care in a confined environment, and assistance with all activities of daily living

 

Notes to Table 5.1.

1. Table 5.1 includes psychoses, neuroses, personality disorders and other diagnosable conditions. The assessment should be made on optimum medication at a stage where the condition is reasonably stable.

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

3. Assistance means the provision of assistance to the employee in performing the activities of daily living by a suitable person, responsible in whole or in part for the care of the employee.

4. Direction means the provision of direction to the employee by a suitably qualified person, responsible in whole or in part for the care of the employee

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

6. Suitably qualified person means a person with the necessary qualifications, experience and skills to provide appropriate direction to the employee. Such persons include medical practitioners, nursing staff and clinical psychologists.


Chapter 6 – The Visual System

 Page no.

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

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

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

6.6 Visual impairment system for both eyes........................72

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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).

Chapter 6 provides a standard method for examining the visual system, and for calculating the extent of any visual impairment. Impairment is any loss or abnormality in the anatomy or function of the visual system. The visual system includes the eyes, the ocular adnexa, and the visual pathways.

All visual tests are standardised and impairment assessment follows a strict protocol in order to ensure that different ophthalmologists can closely reproduce results. Wherever possible, impairment assessment should be performed by an ophthalmologist.

Visual impairment exists when there is deviation from any of the normal functions of the eye.

Among the types of visual impairment listed below, the first three (6.1-6.3) contribute the most to the overall impairment (numbers correspond to sections in Chapter 6):

6.1 Central visual acuity for near and far objects

6.2 Monocular visual field

6.3 Ocular motility

6.4 Other ocular abnormalities

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

Impairments assessed under Chapter 6 include those caused by secondary conditions accompanying an endocrine system condition. An impairment assessed under Chapter 3 – The endocrine system should be combined with those resulting from the secondary conditions assessed under Chapter 6.

WPI ratings from Table 4.2: Facial disfigurement, cannot be combined with WPI ratings arising from either:

Facial nerve injury complicated by visual changes, such as occurs with corneal desiccation and scarring, rates as a significant impairment. Such an impairment is assessed under Chapter 6 and a resulting WPI rating may be combined with a WPI rating from Table 12.5.4: The facial nerve (VII).


Steps in determining whole person impairment.

 

 

 

 

 

 

 

 

 

 

A Snellen test chart is used to measure the distance of visual acuity. The test distance is six metres.

The near vision is measured using a LogMar reading card. If Near Snellen, Jaeger, Sloan or Roman reading cards are used the results need to be converted to LogMar (see Figure 6-B below). The distance in the near reading test is not fixed: the reading distance should be recorded by the ophthalmologist.

Central vision should be tested and recorded for distant and near objects. The employee should be refracted and tested with loose lenses, phoropter, or with his/her own glasses provided their correction is accurate.

If an employee wears contact lenses each day and wishes to wear them for the test, this is acceptable for measuring acuity. In certain ocular conditions (particularly in the presence of corneal abnormalities) contact lens-corrected vision may be better than that obtained with spectacle correction. However, if an employee does not already wear contact lenses, they should not be fitted for an impairment assessment.

 

 

 

Step 1

Measure the central acuity for distance and near, correcting for any refractive errors and presbyopia, and record the result.

Step 2

Consult Figure 6-C below to derive the overall loss, combining the values for corrected near and distance acuities.

Step 3

If monocular aphakia or pseudoaphakia is present then add 50% to the percentage loss of Central Vision obtained from Figure 6-C.

 

 

 

There are many ways of measuring the visual field. The most common are the manual Goldman Field and the Humphrey, Octopus and Medmont computerised field analysers. If using a computerised field it is necessary to test at least a 30-2 threshold.

An Esterman Binocular Field is suitable for the majority of visual field impairment assessments. The field is tested with the employee wearing spectacles and both eyes open. The binocular field result is determined by using the Esterman 120-unit binocular grid, and the dot count is multiplied by 5/6 to obtain the percentage of retained or lost field. Note that binocular field-testing is not recommended when diplopia is present.

If the automated 30-2 threshold field is normal, and the ocular history and examination do not suggest lesions that would affect the outer part of the field, it is then acceptable to conclude that the entire field is normal. Whatever technique is used to measure the visual field, the test should be performed by an ophthalmologist.

The normal visual field meridians in each of eight principal meridians are given in Figure 6-D below. The total, summed over 8 meridians is 500. 

 

 

The percentage of retained vision is calculated using the following steps.

 

These steps are based upon the following formulae:

 Total visual field = percentage of remaining visual field

 5

 100 - (percentage of remaining visual field) = percentage of visual field lost

Diplopia within the central 30 is measured by an ophthalmologist with a Tangent screen. Unless there is diplopia within 30 of the centre of fixation, the diplopia does not cause significant visual impairment. The exception is when looking downwards. Double vision within the central 20 signifies the maximum loss of ocular motility (that is, a 50% loss of ocular motility in one eye).

 

 

 

 

If an ocular adnexal disturbance or deformity interferes with visual function and is not reflected in diminished visual acuity, decreased visual fields, or ocular motility abnormalities with diplopia, then the significance of the disturbance or deformity should be evaluated by an examining ophthalmologist. In that situation, using the combined values chart (see Appendix 1), an ophthalmologist may combine up to an additional 10% impairment for each affected eye.

Problems in the visual system should also be taken into account where they result in symptoms such as epiphora, photophobia, metamorphopsia, and convergence insufficiency.

 


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

 

Using the combined values chart (see Appendix 1), an additional WPI of up to 10% may be combined with WPI ratings for conditions such as permanent deformities of the orbit, scars, and other cosmetic deformities that do not otherwise alter ocular function. 

Figure 6-F (from the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Chapter 8, page 219, 4th edition, 1995) is on the three following pages.

Figure 6-F was established using the equation:

3 x (impairment value of better eye) + (impairment value of worse eye)

4

= impairment of visual system

 

Percentages for the worse eye are read from the side of the table.

Percentages for the better eye are read from the bottom of the table. 

The impairment of the visual system is at the intersection of the column for the worse eye and the row for the better eye.

For example, for a 40 per cent impairment of one eye and 10 per cent impairment of the other eye, read down the table until you come to the large value (40 per cent). Follow across the row until it is intersected with the column designated by 10 per cent at the bottom of the page (18 per cent). Thus, the impairment to the visual system is 18 per cent.

% Impairment worse eye

0

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

0

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

1

1

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

1

2

2

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

1

2

3

3

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

1

2

3

4

4

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

2

2

3

4

5

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

2

3

3

4

5

6

6

7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

2

3

4

4

5

6

7

7

8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

2

3

4

5

5

6

7

8

8

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

3

3

4

5

6

6

7

8

9

9

10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11

3

4

4

5

6

7

7

8

9

10

10

11

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12

3

4

5

5

6

7

8

8

9

10

11

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13

3

4

5

6

6

7

8

9

9

10

11

12

12

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14

4

4

5

6

7

7

8

9

10

10

11

12

13

13

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15

4

5

5

6

7

8

8

9

10

11

11

12

13

14

14

15

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

4

5

6

6

7

8

9

9

10

11

12

12

13

14

15

15

16

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17

4

5

6

7

7

8

9

10

10

11

12

13

13

14

15

16

16

17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18

5

5

6

7

8

8

9

10

11

11

12

13

14

14

15

16

17

17

18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19

5

6

6

7

8

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20

5

6

7

7

8

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

5

6

7

8

8

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22

6

6

7

8

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23

6

7

7

8

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24

6

7

8

8

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25

6

7

8

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26

7

7

8

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27

7

8

8

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28

7

8

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29

7

8

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30

8

8

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31

8

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32

8

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

8

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34

9

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35

9

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

9

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

 

 

 

 

 

 

 

 

 

 

 

 

 

37

9

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

 

 

 

 

 

 

 

 

 

 

 

 

38

10

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

 

 

 

 

 

 

 

 

 

 

 

39

10

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

 

 

 

 

 

 

 

 

 

 

40

10

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

 

 

 

 

 

 

 

 

 

41

10

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

 

 

 

 

 

 

 

 

42

11

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

 

 

 

 

 

 

 

43

11

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

 

 

 

 

 

 

44

11

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

 

 

 

 

 

45

11

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

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29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

 

 

 

 

46

12

12

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

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33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

 

 

 

47

12

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

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33

34

34

35

36

37

37

38

39

40

40

41

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43

43

44

45

46

46

47

 

 

48

12

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

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27

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35

35

36

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40

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45

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48

 

49

12

13

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18

19

20

21

21

22

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35

36

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40

41

42

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44

45

45

46

47

48

48

49

 

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

% Impairment better eye


Figure 6-F: Calculation of Visual System Impairment for Both Eyes (Continued)

 % Impairment worse eye

 

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

13

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

51

13

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

52

13

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

53

13

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

54

14

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

55

14

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

56

14

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

57

14

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

58

15

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

59

15

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

60

15

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

61

15

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

62

16

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

63

16

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

64

16

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

65

16

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

66

17

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

67

17

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

68

17

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

69

17

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

70

18

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

71

18

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

72

18

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

73

18

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

74

19

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

75

19

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

76

19

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

77

19

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

78

20

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

79

20

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

80

20

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

81

20

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

82

21

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

83

21

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

84

21

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

85

21

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

86

22

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

58

87

22

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

59

88

22

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

59

89

22

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

58

59

90

23

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

59

59

91

23

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

59

60

92

23

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

58

59

60

93

23

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

59

59

60

94

24

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

59

60

60

95

24

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

58

59

60

61

96

24

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

59

59

60

61

97

24

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

59

60

60

61

98

25

25

26

27

28

28

29

30

31

31

32

33

34

34

35

36

37

37

38

39

40

40

41

42

43

43

44

45

46

46

47

48

49

49

50

51

52

52

53

54

55

55

56

57

58

58

59

60

61

61

99

25

26

26

27

28

29

29

30

31

32

32

33

34

35

35

36

37

38

38

39

40

41

41

42

43

44

44

45

46

47

47

48

49

50

50

51

52

53

53

54

55

56

56

57

58

59

59

60

61

62

100

25

26

27

27

28

29

30

30

31

32

33

33

34

35

36

36

37

38

39

39

40

41

42

42

43

44

45

45

46

47

48

48

49

50

51

51

52

53

54

54

55

56

57

57

58

59

60

60

61

62

 

 

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

% Impairment better eye

 

Figure 6-F: Calculation of Visual System Impairment for Both Eyes (Continued)

% Impairment worse eye

50

50

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

51

50

51

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

52

51

51

52

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53

51

52

52

53

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54

51

52

53

53

54

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55

51

52

53

54

54

55

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56

52

52

53

54

55

55

56

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

57

52

53

53

54

55

56

56

57

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58

52

53

54

54

55

56

57

57

58

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

59

52

53

54

55

55

56

57

58

58

59

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

60

53

53

54

55

56

56

57

58

59

59

60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61

53

54

54

55

56

57

57

58

59

60

60

61

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

62

53

54

55

55

56

57

58

58

59

60

61

61

62

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

63

53

54

55

56

56

57

58

59

59

60

61

62

62

63

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

64

54

54

55

56

57

57

58

59

60

60

61

62

63

63

64

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

65

54

55

55

56

57

58

58

59

60

61

61

62

63

64

64

65

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

66

54

55

56

56

57

58

59

59

60

61

62

62

63

64

65

65

66

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

67

54

55

56

57

57

58

59

60

60

61

62

63

63

64

65

66

66

67

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

68

55

55

56

57

58

58

59

60

61

61

62

63

64

64

65

66

67

67

68

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

69

55

56

56

57

58

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

70

55

56

57

57

58

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

71

55

56

57

58

58

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

72

56

56

57

58

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

73

56

57

57

58

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

74

56

57

58

58

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

75

56

57

58

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

76

57

57

58

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

77

57

58

58

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

78

57

58

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

79

57

58

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

80

58

58

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

81

58

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82

58

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

83

58

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

84

59

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

85

59

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

86

59

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

84

85

85

86

 

 

 

 

 

 

 

 

 

 

 

 

 

 

87

59

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

85

86

86

87

 

 

 

 

 

 

 

 

 

 

 

 

 

88

60

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

86

87

87

88

 

 

 

 

 

 

 

 

 

 

 

 

89

60

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

84

85

85

86

87

88

88

89

 

 

 

 

 

 

 

 

 

 

 

90

60

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

85

86

86

87

88

89

89

90

 

 

 

 

 

 

 

 

 

 

91

60

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

86

87

87

88

89

90

90

91

 

 

 

 

 

 

 

 

 

92

61

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

84

85

85

86

87

88

88

89

90

91

91

92

 

 

 

 

 

 

 

 

93

61

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

85

86

86

87

88

89

89

90

91

92

92

93

 

 

 

 

 

 

 

94

61

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

86

87

87

88

89

90

90

91

92

93

93

94

 

 

 

 

 

 

95

61

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

84

85

85

86

87

88

88

89

90

91

91

92

93

94

94

95

 

 

 

 

 

96

62

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

85

86

86

87

88

89

89

90

91

92

92

93

94

95

95

96

 

 

 

 

97

62

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

86

87

87

88

89

90

90

91

92

93

93

94

95

96

96

97

 

 

 

98

62

63

64

64

65

66

67

67

68

69

70

70

71

72

73

73

74

75

76

76

77

78

79

79

80

81

82

82

83

84

85

85

86

87

88

88

89

90

91

91

92

93

94

94

95

96

97

97

98

 

 

99

62

63

64

65

65

66

67

68

68

69

70

71

71

72

73

74

74

75

76

77

77

78

79

80

80

81

82

83

83

84

85

86

86

87

88

89

89

90

91

92

92

93

94

95

95

96

97

98

98

99

 

100

63

63

64

65

66

66

67

68

69

69

70

71

72

72

73

74

75

75

76

77

78

78

79

80

81

81

82

83

84

84

85

86

87

87

88

89

90

90

91

92

93

93

94

95

96

96

97

98

99

99

100

 

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

 

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

% Impairment better eye

Chapter 7 – Ear, nose and throat disorders

 Page no.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


7.0  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).

Table 12.5.5: The auditory nerve should be used to assess both Menière’s disease, and true vertigo consequent upon a disturbance of vestibular function.

Unless they cause interference with balance, speech, respiration or hearing, the following conditions attract a WPI rating of 0:

If interference with balance, speech, respiration or hearing is present, these conditions attract WPI ratings based on the degree of interference with balance, speech, respiration or hearing as described in the tables in Chapter 7.

Hearing defects are assessed in accordance with the current procedures from Australian Hearing.

Once the binaural percentage loss of hearing has been calculated, it is then converted to a WPI rating.

The calculation for converting the percentage loss of hearing to a WPI rating is:

 (Percentage loss of hearing)

 2

 

Table 7.2 is used to assess impairment arising as a result of tinnitus in the presence of unilateral or bilateral hearing loss.

 

 

 

Only complete loss of olfaction or taste attracts a WPI rating. If the employee is able to detect any odour or taste, even if unable to identify it, the WPI rating is 0.

WPI ratings from this table may not be combined with WPI ratings for the same condition from either Table 12.5.1: Olfactory nerve or Table 12.5.4: Facial nerve.

 

 

Table 7.4 below is used to assess impairment resulting from interference with speech from local lesions of the organs of speech.

For the purposes of Table 7.4, ‘speech’ means the capacity to produce vocal signals that can be heard, understood, and sustained over a useful period of time.

Table 7.4 must not be used to assess speech impairment resulting from a lesion of the central nervous system. In such cases, assessment should be made under Table 12.3.2: Production of speech and language symbols.

WPI ratings from Table 7.4 may not be combined with WPI ratings from Table 12.3.2: Production of speech and language symbols.

If there are two separate conditions (one local, and the other a central nervous system condition) interfering with speech production, speech production should be assessed under both Table 7.4 and Table 12.3.2. The greater value is the WPI rating due to speech impairment from all causes.

WPI ratings from within Table 7.4 may not be combined with each other.

If the major problem is one of audibility, intelligibility, or functional efficiency of speech, the criteria appropriate to the area should be used to assess impairment.

If there are problems in more than one area, each area (audibility, intelligibility, and functional efficiency) should be assessed, and the highest value selected as the WPI rating.

 


Table 7.4:  Speech

 

Table 7.5 assesses permanent impairment relating to defects of the air passages. Impairments of the lower airways and lung parenchyma, are dealt with in Chapter 2 – Respiratory system.

Permanent tracheostomy, or other respiratory stoma, attracts a permanent WPI rating of 25% which may be combined with other values derived from Table 7.5.

An employee is placed in an impairment category based on the criteria in Table 7.5.

Table 7.5 applies only to permanent partial obstruction of one or more of the following structures:

 


Table 7.5 does not apply to nasal obstruction. Nasal obstruction is assessed under Table 7.6: Nasal passage defects.

Prophylactic restriction of activity, such as sporting activity, does not attract the same WPI rating as dyspnoea on participation in the activity.

 

Table 7.5:  Air passage defects

% WPI

not applicable

not applicable

 

Table 7.6 applies only to nasal obstruction.

 

 

 


7.7  Chewing and swallowing

Table 7.7 below is used to assess impairment resulting from facial muscle damage or loss, dental and oral problems, and temporomandibular joint dysfunction.

WPI ratings derived from Table 7.7 may be combined with WPI ratings derived from Table 8.4: Surgically created stomas. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Chapter 8 – The Digestive System

 Page no.

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

 Calculation of Body Mass Index (BMI)............................83

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

  1.         Lower gastrointestinal tract: Colon and rectum.........................86
  2.         Lower gastrointestinal tract: Anus....................................89
  3.         Surgically created stomas...........................................90
  4.         Liver: Chronic hepatitis and parenchymal liver disease...................91
  5.         Biliary tract              ...............................................92
  6.         Hernias of the abdominal wall........................................93

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


8.0  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).

‘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 8, activities of daily living are those in Figure 8-A (see below).

 

Figure 8-A: Activities of daily living

 

Tables 8.1, 8.2 and 8.3 refer to primary and secondary criteria. All criteria from both categories (except where otherwise stipulated) must be met before a WPI rating can be assigned.

Where the condition being assessed interferes with chewing and/or swallowing, assessment is made under whichever of the following tables describes the impairment more specifically:

For the same condition, WPI ratings derived from Table 12.5.6 may not be combined with WPI ratings derived from Table 7.7.

Other complications of bleeding disorders assessed under Table 13.3: Haemorrhagic disorders and platelet disorders (see Chapter 13 – The haematopoietic system) may also be assessed under tables in Chapter 8, according to the site of the blood loss. The WPI rating so obtained should be combined with the WPI rating obtained from Table 13.3.

Where applicable, Body Mass Index (BMI) values are used as the objective assessment for weight. See Figure 8-B for calculation of BMI values.

 

Calculation of Body Mass Index (BMI)

BMI is calculated as follows:

Weight (kg)

Height2 (m)

The value obtained should be rounded to the nearest whole number. 

 

 

 

 

 

 


Notes to Table 8.1

1. Continuous drug treatment includes H2 receptor antagonists, proton pump inhibitors, corticosteroids, and pancreatic enzyme supplementation.

2. Continuous drug treatment does not include antacids, or mixed antacid and alginic acid preparations.

3. Modified diet does not include the avoidance of a few, or selected, food items. It refers to special diets devised to manage symptoms of the disease and maximise nutrition (for example, lactose-free diet, gluten-free diet).

 

 

 

 

 

 

 

 

 

 

 

 

 


Notes to Table 8.2

1. Medication does not include fibre supplements, vitamins or other nutritional supplements (unless there is a demonstrated vitamin deficiency), or over the counter preparations.

2. Modified diet does not include the avoidance of a few, or selected food items. It refers to special diets devised to manage the symptoms of the disease and maximise nutrition (for example, lactose free diet, gluten free diet).

 

 

Where the anal disorder is part of a colo-rectal disorder (for example, Crohn’s Disease), WPI ratings from Tables 8.2: Lower gastrointestinal tract: Colon and rectum and Table 8.3 may be combined using the combined values chart (see Appendix 1).

 

 

 

Using the combined values chart (see appendix 1), WPI ratings obtained from Table 8.4 may be combined with WPI ratings from other digestive system tables in Chapter 8, and with WPI ratings from Table 7.7: Chewing and Swallowing.

 

See note to Table 8.4 immediately following table.

 

1. Assessment for surgically created stomas is only allowed when the stoma is permanent and not a defunctioning or temporary stoma.

 

 

 

 

1. Signs of liver disease include: the stigmata of liver disease (spider angiomata, palma rerythema, and gynaecomastia); jaundice; palpably enlarged liver; evidence of abnormal liver size on ultrasound; evidence of intrahepatic lesions on ultrasound or positive antibodies to any of the viruses known to have the potential to cause chronic liver disease.

2. Jaundice does not include a mild elevation of plasma bilirubin with normal liver enzymes.

3. Liver function tests include estimates of total bilirubin, albumin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), and gamma glutamyl transferase (GGT).

4. All the criteria, both major and minor, must be present before a particular WPI rating can be allocated. However, liver biopsy is not mandatory and should not be undertaken solely for the purpose of permanent impairment assessment. Where liver biopsy has not been undertaken the histological criteria may be disregarded.

5. Where liver biopsy has not been undertaken the histological criteria may be disregarded.

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

 

 

 

1. Biliary tract dysfunction should only be assessed after cholecystectomy or other appropriate biliary tract surgery, except where there are sound medical reasons for not undertaking surgery.

 

 

See note to Table 8.7 immediately following table.

 

 


 Page no. 

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

 Part I The lower extremities:
feet and toes, ankles, knees and hips....................98

   Part I – Introduction......................................98

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

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

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

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

  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 The upper extremities:
hands and fingers, wrists, elbows and shoulders.........114

Part II – Introduction....................................114

9.8  Hands and fingers...................................115

9.8.1 Abnormal motion of digits.......................115

9.8.2  Sensory losses in the thumb and fingers...........119

9.9   Wrists............................................121

9.10  Elbows...........................................122

9.13  Neurological impairments affecting the upper extremities.129

9.13.1 Cervical nerve root impairment.................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 cord........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

 

 


9.0  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).

Chapter 9 is divided into three Parts:

Part I  –  The Lower Extremities (see page 98)

Part II   –  Upper Extremities (see page 114)

Part III  –  The Spine (see page 141)

 The range of motion to be measured is the range of active motion. The medical assessor should be satisfied that the claimant is making an appropriate effort to demonstrate the maximal range and that the measurements are consistent (that is, several repetitions).  The normal ranges of motion of individual joints in the musculoskeletal system are set out on the next page.

Peripheral vascular disease affecting lower and upper extremities is assessed under Table 1.4 and Table 1.5.

For the purposes of Chapter 9, activities of daily living are those in Figure 9-A (see below).

 

 

 

Table

Joint

Plane

ROM from

ROM through

ROM to

9.1

Hindfoot/Ankle (subtalar)

Frontal

Eversion 20°

0°

Inversion 30°

9.2

Ankle (talocrural)

Sagittal

Extension 20°

0°

Flexion 40°

9.3

Knee

Sagittal

Extension 0°

 

Flexion 150°

9.4

Hip

Rotation

External Rotation 50°

0°

Internal Rotation 40°

9.4

Hip

Frontal

Abduction 40°

0°

Adduction 20°

9.4

Hip

Sagittal

Extension 30°

0°

Flexion 100°

9.8.1.a

Thumb – IP joint

 

Extension 30°

0°

Flexion 80°

9.8.1.a

Thumb – MP joint

 

Extension 40°

0°

Flexion 60°

9.8.1.b

Thumb – Radial abduction/adduction

 

15°

(full radial adduction)

 

50°

(full radial abduction)

9.8.1.b

Thumb adduction

 

0 cm

 

8 cm

9.8.1.b

Thumb opposition

 

0 cm

 

8 cm

9.8.1.c

Index and middle fingers – DIP joint

 

Extension 30°

0°

Flexion 70°

9.8.1.c

Index and middle fingers – PIP joint

 

Extension 30°

0°

Flexion 100°

9.8.1.c

Index and middle fingers – MP joint

 

Extension 20°

0°

Flexion 90°

9.8.1.d

Ring and little fingers – DIP joint

 

Extension 30°

0°

Flexion 70°

9.8.1.d

Ring and little fingers – PIP joint

 

Extension 30°

0°

Flexion 100°

9.8.1.d

Ring and little fingers – MP joint

 

Extension 20°

0°

Flexion 90°

9.9.1.a

Wrist

Sagittal

Extension 60°

0°

Flexion 60°

9.9.1.b

Wrist

Frontal

Radial Deviation 20°

0°

Ulnar Deviation 30°

9.10.1.a

Elbow

Sagittal

Extension 0°

0°

Flexion 140°

9.10.1.b

Elbow (forearm)

Rotation

Supination 80°

0°

Pronation 80°

9.11.1.a

Shoulder

Sagittal

Extension 40°

0°

Flexion 180°

9.11.1.b

Shoulder

Rotation

External Rotation 90°

0°

Internal Rotation 90°

9.11.1.c

Shoulder

Frontal

Abduction 180°

0°

Adduction 50°

 

 

 

 

 

 

The impairments assessed for each region in the lower extremity are combined to obtain the overall impairment of the lower extremity for the individual extremity, subject to the notes accompanying the applicable tables, or any indication that combination is not permitted.

Where an arthroplasty procedure has been undertaken, refer to the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001. Combine the total WPI rating for abnormal motion with the relevant WPI rating for arthroplasty, obtained from the American Medical Association’s Guide.

A WPI rating for one lower extremity may be combined with a WPI rating for the other lower extremity, except in the case of WPI ratings under Table 9.7: Lower extremity function (see page 112), where the notes accompanying Table 9.7 are to be followed.

WPI ratings from Table 9.1: Feet and Toes, Table 9.2: Ankles, Table 9.3: Knees and Table 9.4: Hips must not be combined with a WPI rating under Table 9.7 if they assess the same condition in the same lower extremity.

Where a condition cannot be assessed under one of Tables 9.1, 9.2, 9.3 and 9.4, an assessment may be made under the provisions of the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

If the medical assessor considers that the impairment is not adequately assessed using one of Tables 9.1, 9.2, 9.3 and 9.4, and the condition does not cause a reduction in the range of motion of a joint but there is significant interference with gait, the medical assessor should consider the effect of the injury on gait and determine the WPI rating using Table 9.7. Table 9.7 cannot be used if the condition causes a reduction in the range of motion of a joint and an assessment can be made under any one or more of Table 9.1, 9.2, 9.3 or 9.4. 

If permanent, conditions such as sesamoiditis, plantar fasciitis, plantar tendonitis, and pes planus, should be assessed under Table 9.7.

All ankylosis assessments from Tables 9.1, 9.2, 9.3 and 9.4 are alternative assessments to those for abnormal motion of the individual joints.

The maximum WPI rating for a single lower extremity in Tables 9.1, 9.2, 9.3 and 9.4 is 40%, including combined WPI ratings.

Complex regional pain syndrome in the lower extremities should be assessed using the same methodology as for the upper extremity substituting lower extremity table where appropriate. The diagnostic requirements of Figure 9-E apply.


Steps in calculating lower extremity impairment

Step 1 

Add abnormal motion/ankylosis impairment values within an individual joint.

Step 2 

Combine abnormal motion/ankylosis impairment values for different joints in the toes.

Step 3 

Add impairment values obtained for each individual toe and combine this value with the impairment values for other joints in the foot to obtain the total abnormal motion/ankylosis impairment assessment for a foot.

Step 4

Combine with abnormal motion/ankylosis impairment assessments for different regions in the lower extremity (that is knee and hip).

Step 5

Combine with impairment values for peripheral nerve injuries.

Step 6

Combine with impairment values for amputation.

 

9.1  Feet and toes

Table 9.1 assesses impairments to range of motion of the feet and toes, including ankylosis of one or more joints. The maximum WPI rating under Table 9.1 is 2% for impairment of two or more of the 2nd, 3rd, 4th and 5th toes of one foot.

 

In the case of toes, the ankylosis referred to in Table 9.1 is that of the metatarso-phalangeal joint. 

 

Ankylosis of the interphalangeal joints of the 2nd, 3rd, 4th or 5th toe attracts a WPI rating of 0. The position of function is the neutral position.

 

Table 9.1: Feet and toes

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

Table 9.2 assesses impairments to range of motion and deformity of the ankle, as well as ankylosis. Ankle deformity with movement is assessed separately from ankylosis.

Ankylosis in the optimal position is equivalent to a WPI of 4%. The optimal position is the neutral position without flexion, extension, varus or valgus. This is the base level of ankylosis impairment in the ankle.

When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.2 for ankylosis in each direction. Then add the base figure of 4% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the ankle and hindfoot is 25% WPI. If the total WPI rating obtained by adding different WPI ratings is higher than 25% WPI, then the final WPI rating for the ankle is 25%.

 

Table 9.2: Ankles

 


 

 

 

 

 

 

 

 

 

9.3  Knees

Table 9.3 assesses impairments to range of motion and deformity of the knee, as well as ankylosis. Knee deformity with movement is assessed separately from ankylosis. ‘Deformity’ is measured by the femoral-tibial angle: 3-10 valgus is considered normal.

Ankylosis in the optimal position is equivalent to 27% WPI. The optimal position is 10-15 of flexion with good alignment. This is the base level of ankylosis impairment in the knee. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.3 for ankylosis in each direction. Then add the base figure of 27% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the knee is 40% WPI. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the knee is 40%.

 


Table 9.3: Knees

 

 

 

 

 

 

 

 

 

9.4  Hips

Table 9.4 assesses impairments of range of motion and deformity of the hip, as well as ankylosis. Hip deformity with movement is assessed separately from ankylosis.

Ankylosis in the optimal position is 20% WPI. The optimal position is 25-40 of flexion with neutral rotation, abduction and adduction. This is the base level of ankylosis impairment in the hip. When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.4 for ankylosis in each direction. Then add the base figure of 20% WPI for ankylosis in the optimal position.

The maximum WPI rating for multiple impairments of the hip is 40%. If the total WPI rating obtained by adding different WPI ratings is over 40%, then the final WPI rating for the hip is 40%.

 

Table 9.4: Hips

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 
 

9.5  Lower extremity amputations

Table 9.5 is the only table used to assess impairment arising from amputations in the lower extremity.

Table 9.7: Lower extremity function must not be used in cases involving amputations.

A WPI rating from Table 9.5 may be combined with other WPI ratings for lower extremity conditions above the amputation site.

 

Table 9.5: Lower extremity amputations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


9.6.1  Spinal nerve root impairment affecting the lower extremity

Table 9.6.1 is to be used where there is involvement of a single spinal nerve. Where there are multiple nerves involved, the respective WPI ratings for each involved nerve should be combined.

Values obtained for pain, discomfort and/or sensory loss should be combined with values obtained for loss of strength, using the combined values chart (see Appendix 1).

Where the same nerve root is assessed, Table 9.6.1 must not be used in conjunction with Table 9.17: Lumbar spine.

 

Table 9.6.1: Spinal nerve root impairment affecting the lower extremity

 
 
 
 
 
 

 

 

 

 
 
 
 
 
 

9.6.2  Peripheral nerve injuries affecting the lower extremities

WPI ratings obtained for sensory impairment should be combined with WPI ratings for dysaesthesia, and the total combined with WPI ratings for motor impairment, using the combined values chart (see Appendix 1).

Where the same nerve is assessed, Table 9.6.2a and Table 9.6.2b must not be used in conjunction with Table 9.17: Lumbar spine.

Use the grading system shown in Figure 9-C: Grading system.

 


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

grading

 

 


9.7  Lower extremity function

Table 9.7 (see following page) should only be used to assess impairment from objectively identified orthopaedic or neurological conditions arising in and affecting the lower extremities. It may not be used to assess impairment from conditions manifesting principally as pain with no clinically demonstrable lower extremity pathology.

A secondary dysfunction consequent to disuse is only assessable under Table 9.7 if this dysfunction is permanent (that is, not likely to improve as a result of surgery, medication or other rehabilitative treatment) and there are objective clinical findings that can be validly assessed using other tables in Chapter 9, Part 1 – The lower extremities.

If permanent, conditions such as sesamoiditis, plantar fasciitis, plantar tendonitis, and pes planus, should be assessed under Table 9.7.

Table 9.7 must not be used in cases involving amputations.

A single assessment only may be made under Table 9.7, regardless of whether one or two extremities are affected by the injury. The impairment assessed is of overall lower extremity function, rather than that of individual extremities.

Before using Table 9.7 the medical assessor should check the instructions (see Part I – Introduction, page 98) preceding the specific joint impairment tables (Tables 9.1–9.4) and use Table 9.7 strictly in accordance with those instructions. In particular, Table 9.7 cannot be used where the condition causes a reduction in the range of motion of a joint and an assessment can be made under any one or more of Table 9.1, 9.2, 9.3 or 9.4.

Where only one limb is affected, regardless of the number of impairments found in that limb, the limb should be assessed using the relevant Tables other than Table 9.7 and all impairments combined using the combined values table (see Appendix 1). The combined impairment rating should then be compared with the rating taken from the relevant row in Table 9.7 and the higher rating obtained from the two methods chosen.

Where both limbs are affected, each limb should be assessed using the relevant Tables other than Table 9.7 and all impairments in both limbs combined using the combined values table (see Appendix 1). The combined impairment rating should then be compared with the rating taken from the relevant row in Table 9.7 and the higher rating obtained from the two methods chosen.

Table 9.7 may be used to assess lower extremity impairment arising as a result of spinal cord damage. Observe the special procedure set out in the introduction to Part III of this Chapter.   However, Table 9.7 is not to be used to assess lower extremity impairment arising as a result of nerve root compression, or other neurological sequelae of other spinal conditions. These should be assessed under:

 

To fulfil the requirements of a WPI rating in Table 9.7, there must be one major criterion and at least two minor criteria present (where minor criteria are listed).

‘Manifest difficulty’ is difficulty (such as stumbling, or an altered gait) evident to the medical assessor. The difficulty must be tested clinically: history alone cannot be relied upon in the assessment.

 


Table 9.7: Lower extremity function

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part II – Introduction

The impairments assessed for each region in each upper extremity are combined (that is, hand, wrist, elbow, shoulder). The WPI rating for one upper extremity may be combined with a WPI rating for the other upper extremity, except in the case of assessments under Table 9.14, where the notes appearing prior to Table 9.14 are to be followed.

WPI ratings from the following tables must not be combined with a WPI rating under Table 9.14 if they assess the same condition in the same upper extremity:

If the medical assessor considers that the impairment is not adequately assessed using one of Tables 9.9, 9.10, and 9.11, and the condition involves radiographically demonstrated joint instability, radiographically demonstrated arthritis or where the employee has had an arthroplasty, the medical assessor may consider the effect of the injury on upper extremity function instead and determine the WPI rating using Table 9.14. Table 9.14 cannot be used unless the condition involves radiographically demonstrated joint instability or arthritis or the employee has had an arthroplasty.

Where a condition cannot be assessed under a specific table in the upper extremities group, an assessment may be made under the provisions of the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

All ankylosis assessments from tables in the upper extremities group are alternative assessments to those for abnormal motion of the individual joints.

The maximum WPI rating for a single upper extremity is 60%, including combined WPI ratings.

 

Steps in calculating upper extremity impairment

Note that sensory loss in the digit is assessed either as a digit impairment or as a peripheral nerve impairment as appropriate, but not both.

 

Step 1 

Add abnormal motion/ankylosis impairment values within an individual joint.

Step 2 

Add abnormal motion/ankylosis impairment values for different joints in the thumb.

Step 3 

Combine impairment values for different joints in the other four digits.

Step 4

Combine impairment values for each digit for sensory loss due to digital nerve injury and/or amputation.

Step 5 

Add impairment values for each digit to obtain the total hand assessment.

Step 6 

Combine with impairment values for different regions in the upper extremity.


9.8  Hands and fingers

Add the WPI ratings for each individual digit to obtain the total WPI rating for the hand.

WPI ratings for abnormal motion or ankylosis of digits are combined with those for sensory losses in the same digits.

 

9.8.1  Abnormal motion of digits

Table 9.8.1a, Table 9.8.1b, Table 9.8.1c and Table 9.8.1d assess impairments to range of motion of the digits of the hand, including ankylosis of one or more joints.

Impairment values for flexion and extension losses in each individual joint are added to obtain the total WPI rating for loss of range of motion of that joint.

Where there is abnormal motion or ankylosis of more than one joint of the same finger, the WPI ratings for abnormal motion or ankylosis are combined to obtain the WPI rating for that finger.

Where there is abnormal motion or ankylosis of more than one joint of the thumb, the WPI ratings for abnormal motion or ankylosis are added to obtain the WPI rating for the thumb.

 

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

See notes to Table 9.8.1a on page 118.

Direction

IP joint

MP joint

Direction

Extension/ hyperextension

Ankylosis

Loss of extension

Loss of flexion

Ankylosis

Loss of extension

Loss of flexion

Extension/ hyperextension

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

 

 

 

 

2

0

2

40

30

3

0

3

2

0

2

30

20

3

0

3

2

0

2

20

10

2

0

2

2

0

2

10

0

2

0

2

1

0

1

0

10

2

1

1

1

0

1

10

20

2

1

1

1

0

1

20

30

2

1

1

1

1

1

30

40

2

2

1

2

1

1

40

50

2

2

1

2

2

0

50

60

3

2

0

2

2

0

60

70

3

3

0

 

 

 

 

80

3

3

0

 

 

 

 

Flexion

 

 

 

 

 

 

Flexion

 


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

See notes to Table 9.8.1b on page 118.

 

 

 

 

 

 

 


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

See notes to Table 9.8.1c on page 118.

Direction

Index and middle fingers

Direction

Extension/ hyperextension

DIP joint

PIP joint

MP joint

Extension/ hyperextension

Ankylosis

Loss of extension

Loss of flexion

Ankylosis

Loss of extension

Loss of flexion

Ankylosis

Loss of extension

Loss of flexion

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

30

5

0

5

8

0

8

 

 

 

30

20

4

0

4

8

0

8

7

0

7

20

10

4

0

4

7

0

7

6

1

6

10

0

4

0

4

7

0

7

6

1

5

0

10

4

0

3

6

1

6

5

1

5

10

20

3

1

3

6

1

5

5

1

4

20

30

4

1

2

6

1

4

5

1

4

30

40

4

2

2

5

2

4

6

3

3

40

50

4

3

1

6

3

3

7

4

2

50

60

4

4

1

7

4

3

8

6

2

60

70

5

5

0

7

5

2

8

8

1

70

80

 

 

 

8

7

1

10

9

1

80

90

 

 

 

8

8

1

11

11

0

90

100

 

 

 

8

8

0

 

 

 

100

Flexion

 

 

 

 

 

 

 

 

 

Flexion

 

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

See notes to Table 9.8.1d on page 118.

Direction

Ring and little fingers

Direction

Extension/ hyperextension

DIP joint

PIP joint

MP joint

Extension/ hyperextension

Ankylosis

Loss of extension

Loss of flexion

Ankylosis

Loss of extension

Loss of flexion

Ankylosis

Loss of extension

Loss of flexion

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

%WPI

30

3

0

3

4

0

4

 

 

 

30

20

2

0

2

4

0

4

3

0

3

20

10

2

0

2

4

0

4

3

0

3

10

0

2

0

2

3

0

3

3

1

3

0

10

2

0

2

3

0

3

3

1

2

10

20

2

0

2

3

1

3

3

1

2

20

30

2

1

1

3

1

2

3

1

2

30

40

2

1

1

3

1

2

3

2

2

40

50

2

2

1

3

2

2

3

2

1

50

60

2

2

1

3

2

1

4

3

1

60

70

3

3

0

4

3

1

4

4

1

70

80

 

 

 

4

3

1

5

5

1

80

90

 

 

 

4

4

1

5

5

0

90

100

 

 

 

4

4

0

 

 

 

100

Flexion

 

 

 

 

 

 

 

 

 

Flexion

 

Notes to Tables 9.8.1a, 9.8.1b, 9.8.1c and 9.8.1d

1. Abbreviations.

IP = interphalangeal.

MP = metacarpo-phalangeal. 

CMC = carpometacarpal.

PIP = Proximal Interphalangeal. 

DIP = Distal Interphalangeal.

2. Thumb Adduction is the smallest possible distance from the flexor crease of the IP joint of the thumb to the distal palmar crease over the level of the MP joint of the little finger. The normal range of adduction of the thumb is from 8cm to 0cm.

 

3. Thumb Radial abduction is the largest angle of separation actively formed between the first and second metacarpals in the coronal plane. The normal angle of radial abduction is 50. The smallest angle of thumb radial adduction is 15.

 

4. Opposition of the thumb is measured as the largest achievable distance between the flexor crease of the IP joint of the thumb to the distal palmar crease directly over the third MP joint. The normal range of opposition of the thumb is from 0cm to 8cm. In the case of employees with small hands, compare the loss of opposition with the normal range of opposition in the unaffected hand.

 

5. Optimal positions of thumb and fingers:

 

Joint

Optimal Position

 

Joint

Optimal Position

Thumb IP

20 of flexion

 

Finger DIP

20 of flexion

Thumb MP

20 of flexion

 

Finger PIP

40 of flexion

Thumb CMC

30-35 of radial abduction

 

Finger MP

30 of flexion

 

9.8.2  Sensory losses in the thumb and fingers

Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table 9.8.2d assess sensory losses in the thumb and fingers due to digital nerve lesions only. 

Sensory losses due to peripheral nerve lesions are assessed under Tables 9.13.1, 9.13.2a and 9.13.2b (tables dealing with neurological impairments affecting the upper extremities, see pages 131-134).

The two-point discrimination test is used to determine sensory loss:

Total sensory loss   =  two-point discrimination of greater than 15mm;

Partial sensory loss  =  two-point discrimination of 7 to 15mm.

Two-point discrimination of less than 7mm is not treated as an impairment.

Transverse sensory loss involves both digital nerves (ulnar and radial). Longitudinal sensory loss involves a single digital nerve (ulnar or radial).

Determine the percentage of digit length involved using the method in the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001 and consult Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table 9.8.2d, using the corresponding WPI rating for the nerve or nerves involved. 

WPI ratings for transverse sensory loss must not be combined with WPI ratings for longitudinal sensory loss in the same digit. The conditions of transverse sensory loss and longitudinal sensory loss in an individual digit are mutually exclusive.

WPI ratings for sensory losses in digits are combined with those for abnormal motion or ankylosis in the same digits.

For the thumb and little finger, losses involving the ulnar digital nerve are rated higher than those of the radial digital nerve. For the other fingers, losses involving the radial digital nerve are rated higher than those of the ulner digital nerve.

If the little finger has been amputated, the ring finger is assessed as if it were the little finger.

 

Table 9.8.2a: Sensory losses       Table 9.8.2b: Sensory losses in the

in the thumb       index and middle fingers

 

 

 

 

 

10

 

20

 

30

 

40

 

50

 

60

 

70

 

80

 

90

 

100

 

 

 

Table 9.8.2c:  Sensory losses in the little Table 9.8.2d: Sensory losses in the ring finger              finger

 

 

 

 

 

10

 

20

 

30

 

40

 

50

 

60

 

70

 

80

 

90

 

100

 

 


9.9  Wrists

Table 9.9.1a and Table 9.9.1b assess impairments to range of motion of the wrists, including ankylosis.

Loss of range of motion in each functional plane is measured from the neutral position. The range of motion is expressed as the two achievable limits of active motion in each direction through the normal range of motion. It is possible that the only motion that can be achieved is between two points on one side of the neutral position.

The WPI rating for restriction of motion in one direction is determined according to the active motion than can be achieved in that direction. It is then added to the WPI rating for the active motion in the reverse direction.

Add the abnormal motion WPI ratings for each direction of motion for both wrist flexion/extension and radial/ulnar deviation. Where there is ankylosis, including after an arthrodesis procedure, the assessment should be made only under the ankylosis scale.

Where an arthroplasty procedure has been undertaken, refer to the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001. Combine the total WPI rating for abnormal motion with the relevant WPI rating for arthroplasty, obtained from the American Medical Association’s Guides.

For ankylosis, the optimal position for arthrodesis of the wrist is approximately 15-20 of dorsiflexion with slight ulnar deviation.

The maximum possible wrist impairment is 35% WPI.

For the same condition, a WPI rating from Table 9.9.1a or Table 9.9.1b may not be combined with a WPI rating from Table 9.14: upper extremity function.

 

Table 9.9.1a: Wrist flexion/extension

Direction

Ankylosis

Loss of extension

Loss of flexion

Direction

Extension

%WPI

%WPI

%WPI

Extension

60

25

0

25

60

50

22

1

22

50

40

17

2

15

40

30

16

3

13

30

20

14

4

10

20

10

13

5

8

10

0

13

7

6

0

10

13

8

5

10

20

15

11

4

20

30

17

14

3

30

40

20

18

2

40

50

23

22

1

50

60

25

25

0

60

Flexion

 

 

 

Flexion

 


Table 9.9.1b: Radial and ulnar deviation of wrist joint

Direction

Ankylosis

Loss of radial deviation

Loss of ulnar deviation

Direction

Radial deviation

%WPI

%WPI

%WPI

Radial deviation

20

11

0

11

20

15

10

1

9

15

10

8

1

7

10

5

7

2

5

5

0

5

2

3

0

5

5

3

2

5

10

5

3

2

10

15

7

5

2

15

20

8

7

1

20

25

10

9

1

25

30

11

11

0

30

Ulnar deviation

 

 

 

Ulnar deviation

 

9.10  Elbows

Table 9.10.1a and Table 9.10.1b assess impairments to range of motion of the elbows, including ankylosis.

Loss of range of motion in each functional plane is measured from the neutral position. The range of motion is expressed as the two achievable limits of active motion in each direction through the normal range of motion. It is possible that the only motion that can be achieved is between two points on one side of the neutral position.

The WPI rating for restriction of motion in one direction is determined according to the active motion than can be achieved in that direction. It is then added to the WPI rating for the active motion in the reverse direction.

Add the abnormal motion WPI rating for each direction of motion for both elbow flexion/extension and pronation/supination. Where there is ankylosis, including after an arthrodesis procedure, the assessment should be made only under the ankylosis scale.

Where an arthroplasty procedure has been undertaken, refer to the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001. Combine the total WPI rating for abnormal motion with the relevant WPI rating for arthroplasty, obtained from the American Medical Association’s Guides.

For ankylosis, the optimal or functional position is 80 of flexion and 20 of pronation.

The maximum possible elbow impairment is 40% WPI.

For the same condition, a WPI rating from Table 9.10.1a or Table 9.10.1b may not be combined with a WPI rating from Table 9.14: Upper extremity function.


Table 9.10.1a: Elbow flexion/extension

Direction

Ankylosis

Loss of extension

Loss of flexion

Direction

Flexion

%WPI

%WPI

%WPI

Flexion

140

25

25

0

140

130

23

22

1

130

120

20

19

1

120

110

19

16

2

110

100

16

13

4

100

90

15

10

5

90

80

13

7

6

80

70

14

5

9

70

60

15

4

11

60

50

17

3

14

50

40

19

2

16

40

30

20

2

19

30

20

22

1

20

20

10

23

1

22

10

0

25

0

25

0

Extension

 

 

 

Extension

 

 

Table 9.10.1b: Pronation and supination of forearm

Direction

Loss of pronation

Loss of supination

Direction

Supination

%WPI

%WPI

%WPI

Supination

80

17

17

0

80

70

16

16

0

70

60

16

15

1

60

50

15

14

1

50

40

14

13

1

40

30

14

13

1

30

20

13

11

2

20

10

11

9

2

10

0

9

7

2

0

10

7

5

2

10

20

5

2

2

20

30

5

2

4

30

40

7

2

5

40

50

9

1

8

50

60

11

1

11

60

70

14

1

13

70

80

17

0

17

80

Pronation

 

 

 

Pronation

 

9.11  Shoulders

Table 9.11.1a, Table 9.11.1b and Table 9.11.1c assess impairments to range of motion of the shoulders, including ankylosis.

Loss of range of motion in each functional plane is measured from the neutral position. The range of motion is expressed as the two achievable limits of active motion in each direction through the normal range of motion. It is possible that the only motion that can be achieved is between two points on one side of the neutral position. 

The WPI rating for restriction of motion in one direction is determined according to the active motion than can be achieved in that direction. It is then added to the WPI rating for the active motion in the reverse direction.

Add the abnormal motion WPI ratings for each direction of motion for shoulder flexion/extension, abduction/adduction and internal/external rotation. Where there is ankylosis, including after an arthrodesis procedure, the assessment should only be made under the ankylosis scale.

Where an arthroplasty procedure has been undertaken, refer to the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001. Combine the total WPI rating for abnormal motion with the relevant WPI rating for arthroplasty, obtained from the American Medical Association’s Guides.

For ankylosis, the optimal or functional position is 20-40 of flexion, 20-50 of abduction and 30-50 of internal rotation. Unless the shoulder has been arthrodesed, an assessment for ankylosis under this table would be rare.

The maximum possible shoulder impairment is 35% WPI.

For the same condition, a WPI rating from Table 9.11.1a, Table 9.11.1b or Table 9.11.1c may not be combined with a WPI rating from Table 9.14: Upper extremity function.

 


Table 9.11.1a: Shoulder flexion/extension

Direction

Ankylosis

Loss of extension

Loss of flexion

Direction

Flexion

%WPI

%WPI

%WPI

Flexion

180

18

18

0

180

170

18

17

1

170

160

17

17

1

160

150

17

16

1

150

140

17

16

2

140

130

17

15

2

130

120

17

14

2

120

110

17

14

3

110

100

16

13

3

100

90

16

13

4

90

80

15

11

4

80

70

13

9

4

70

60

12

7

5

60

50

10

5

5

50

40

9

3

6

40

30

9

3

6

30

20

9

2

7

20

10

11

2

10

10

0

14

2

13

0

10

15

1

14

10

20

16

1

14

20

30

16

1

16

30

40

17

1

17

40

50

18

0

18

50

Extension

 

 

 

Extension

 


Table 9.11.1b: Shoulder – internal/external rotation

Direction

Ankylosis

Loss of external rotation

Loss of internal rotation

Direction

External rotation

%WPI

%WPI

%WPI

External rotation

90

7

0

7

90

80

7

0

7

80

70

7

0

7

70

60

6

0

6

60

50

6

1

5

50

40

5

1

5

40

30

5

1

5

30

20

5

1

4

20

10

5

1

4

10

0

4

1

3

0

10

4

1

3

10

20

4

1

2

20

30

4

1

2

30

40

4

2

2

40

50

4

2

1

50

60

4

3

1

60

70

5

5

1

70

80

6

6

0

80

90

7

7

0

90

Internal Rotation

 

 

 

Internal Rotation

 


Table 9.11.1c: Abduction/adduction of shoulder

Direction

Ankylosis

Loss of adduction

Loss of abduction

Direction

Abduction

%WPI

%WPI

%WPI

Abduction

180

11

11

0

180

170

11

11

0

170

160

10

10

1

160

150

10

10

1

150

140

10

9

1

140

130

10

9

1

130

120

10

8

2

120

110

10

8

2

110

100

10

7

2

100

90

10

7

2

90

80

8

5

3

80

70

7

4

3

70

60

7

3

3

60

50

5

2

3

50

40

5

2

3

40

30

5

1

4

30

20

5

1

7

20

10

7

1

6

10

0

8

1

7

0

10

9

1

8

10

20

10

1

9

20

30

10

1

10

30

40

10

0

10

40

50

11

0

11

50

Adduction

 

 

 

Adduction

 

Total loss of hand function is equivalent to amputation of the whole hand and attracts a WPI rating of 54%.

Table 9.14: Upper extremity function must not be used for amputations.

 


Table 9.12.1: Upper extremity amputations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sensory impairments due to digital nerve lesions alone are assessed under Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table 9.8.2d (tables dealing with sensory losses in thumb and fingers, see pages 119-120).

Care must be taken to avoid duplicating impairment assessments for digital nerve sensory impairment with assessments for peripheral nerve sensory impairment. Assessments for digital nerve sensory impairment are assessed under Tables 9.8.2a, 9.8.2b, 9.8.2c, and 9.8.2d. Assessments for peripheral nerve sensory impairment are assessed under Tables 9.13.1, 9.13.2a, and 9.13.2b.

For sensory impairment in the same digit, WPI ratings obtained from Table 9.13.1, Table 9.13.2a, and Table 9.13.2b, must not be combined with WPI ratings from Tables 9.8.2a, 9.8.2b, 9.8.2c, and 9.8.2d.

The grading system set out in Figure 9-D: Grading system (see below) is to be used with Table 9.13.1, Table 9.13.2a, and Table 9.13.2b.

 

See note immediately following Figure 9-D.

 

 

 

 

 

 

 

 

 

 

 

Note to Figure 9-D

 

Use the appropriate section of Table 9.13.1, depending on whether there is involvement of a single spinal nerve, the brachial plexus, or combined nerve root impairment.

WPI ratings for sensory impairment should be combined with those for motor impairment, using the combined values chart (see Appendix 1).  Table 9.13.1 must not be used in conjunction with Table 9.15: Cervical spine where the same nerve is assessed under that table.

The maximum WPI rating for one upper extremity is 60%. A WPI of 60% may be awarded either:

but these cannot be combined to give a WPI rating greater than 60% for the one upper extremity.

 


Table 9.13.1: Cervical nerve root impairment

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

9.13.2  Specific nerve lesions affecting the upper extremities

Only employees with an objectively verifiable diagnosis qualify for a WPI rating under Table 9.13.2a and Table 9.13.2b. The diagnosis is made not only on credible and clinically logical symptoms but, more importantly, on the presence of positive clinical findings and loss of function. The diagnosis should be documented by electromyography as well as sensory and motor nerve conduction studies. As noted under the principles of assessment, the assessing medical practitioner should not order additional investigations solely for assessment purposes.

It is critical to understand that there is no correlation between the severity of conduction delay on nerve conduction velocity testing, and the severity of either symptoms or the WPI rating.

If available, surgical findings of evidence of nerve compression and reactive hyperaemia upon nerve release can be used to confirm the diagnosis.

Using the combined values chart (see Appendix 1), WPI ratings obtained for sensory impairment should be combined with WPI ratings for motor impairment.

A WPI rating under Tables 9.13.2a and 9.13.2b may be combined (except where the same nerve is assessed) with WPI ratings from Table 9.15: Cervical spine.

 

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

 

 

Nerve

 

 

 

 

 

 

 

 


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

 

 

Medial and lateral pectoral

Axillary

Dorsal scapular

Long thoracic

Median nerve (above mid forearm)

Median nerve (anterior interosseous branch)

Median nerve (below mid forearm)

Musculocutaneous

Radial (including loss of triceps function)

Radial (at elbow with sparing of triceps)

Subscapulars (upper and lower)

Suprascapular (upper and lower)

Thoracodorsal

Ulnar (above mid forearm)

Ulnar (below mid forearm)

 

Complex regional pain syndromes (CRPS) include reflex sympathetic dystrophy (CRPS I), and causalgia (CRPS II). The hallmark of these syndromes is a characteristic burning pain that is present without stimulation or movement, that occurs beyond the territory of a single peripheral nerve, and that is disproportionate to the inciting event. The pain is associated with specific clinical findings, including signs of vasomotor and sudomotor dysfunction and, later, trophic changes of all tissues from skin to bone.

Sympathetic nervous system dysfunction was thought to be involved in the generation of the symptoms and signs; hence, the term reflex sympathetic dystrophy (RSD). Causalgia was considered similar to RSD except, unlike RSD, it followed a lesion of a peripheral nerve, either of a major mixed nerve in the proximal extremity (major causalgia) or of a purely sensory branch more distally (minor causalgia). A recent reconsideration of these syndromes has generated new terminology and ideas concerning the underlying pathophysiology. The International Association for the Study of Pain has proposed the term complex regional pain syndromes, which has replaced the term RSD with CRPS I and causalgia with CRPS II. The most important difference from earlier opinions is that sympathetic dysfunction is not assumed to be the underlying basis for the symptoms and signs of CRPS. It is felt that sympathetically maintained pain is not an essential component of CRPS, as it may be present in a variety of painful conditions, including or independent of CRPS.

Contrary to previous suggestions, regional sympathetic blockade has no role in the diagnosis of CRPS. 

Since a subjective complaint of pain is the hallmark of these conditions, and many of the associated physical signs and radiographic findings can be the result of disuse, the differential diagnosis is extensive; it includes somatoform pain disorder, somatoform conversion disorder, factitious disorder, and malingering. Consequently, the approach to the diagnosis of these syndromes should be conservative and based on objective findings. 

The criteria listed in Figure 9-E predicate a diagnosis of CRPS upon a preponderance of objective findings that can be identified during a standard physical examination and demonstrated by radiographic techniques. At least eight of these findings must be present concurrently for a diagnosis of CRPS.   Signs are objective evidence of disease perceptible to the examiner, as opposed to symptoms, which are subjective sensations of the individual.

Use the methodology on page 136 to determine impairment. Use either Steps in CRPS I (RSD) Impairment Determination or Steps in CRPS II (causalgia) impairment determination as appropriate. Only one of the methodologies may be used and the impairment rating from one of the two methodologies may not be combined with a rating from the other methodology.

The impairment rating method described for sensory deficits due to lesions of digital nerves is not applied in CRPS.

 

Local clinical signs

Vasomotor changes:

  • Skin colour: mottled or cyanotic
  • Skin temperature: cool
  • Oedema

Sudomotor changes:

  • Skin dry or overly moist

Trophic changes:

  • Skin texture: smooth, nonelastic
  • Soft tissue atrophy: especially in fingertips
  • Joint stiffness and decreased passive motion
  • Nail changes: blemished, curved, talonlike
  • Hair growth changes: fall out, longer, finer

Radiographic signs

  • Radiographs: trophic bone changes, osteoporosis
  • Bone scan: findings consistent with CRPS

Interpretation:

≥ 8 Probable CRPS

< 8 No CRPS

 

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

 


Figure 9-F:  Impairment Grading for CRPS

CRPS I & II

Sensory deficits and pain

Grade (see Fig 9-D)

% of whole person impairment

5

0

4

1-15

3

16-36

2

37-48

1

49-59

0

60

 

In CRPS I, neither the initiating causative factor nor the symptoms involve a specific peripheral nerve structure or territory. If the diagnostic test in Figure 9-E is satisfied, the impairment assessment is derived as follows

 

Step 1 

Assess the WPI for the affected upper extremity resulting from loss of motion of each affected joint using Tables 9.8 to 9.11 as appropriate.

Step 2 

Assess the appropriate percentage impairment of the affected extremity resulting from sensory deficits and pain according to the grade that best describes the severity of interference with activities as described in Figure 9-D (page 129). Use clinical judgment to select the appropriate severity grade from Figure 9-D and the appropriate percentage from within the range for each grade shown in Figure 9-F and explain the reasons for that selection.

The maximum value is not automatically applied.

Step 3

Combine the impairment rating for sensory deficits and pain obtained from Step 2 with the rating obtained from Steps 1.

 

In contrast to CRPS II, impairment values for sensory and motor deficits of a specific nerve structure cannot be applied.

 

In CRPS II, a specific sensory or mixed nerve structure is involved.  If the diagnostic test in Figure 9-E is satisfied, the impairment assessment is derived as follows.

Step 1 

Assess the WPI for the affected upper extremity resulting from the loss of motion of each affected joint using Tables 9.8 to 9.11 as appropriate.

Step 2 

Assess the appropriate percentage impairment of the affected extremity resulting from sensory deficits and pain of the injured nerve(s) according to the grade that best describes the severity of interference with activities as described in Figure 9-D. Use clinical judgment to select the appropriate severity grade from Figure 9-D and determine the WPI % for the relevant nerve(s) from Table 9.13.2a.

The maximum value is not automatically applied.

Step 3

Assess the appropriate percentage impairment of the affected extremity resulting from motor deficits and loss of power of the injured nerve(s) according to the grade that best describes the severity of interference with as described in Figure 9-D. Use clinical judgment to select the appropriate severity grade from Figure 9-D determine the WPI% for the relevant nerve(s) from Table 9.13.2b. 

The maximum value is not automatically applied.

Step 4 

Combine the impairment ratings for sensory deficits and pain (Step 2), and for motor deficits and loss of power (Step 3), with the rating obtained from Step 1. The maximum WPI for the affected extremity is 60%.

 

9.14  Upper extremity function

Before using Table 9.14 the medical assessor should read the instructions (see Part II – Introduction, page 114) preceding the specific joint impairment tables (Tables 9.8–9.11). Table 9.14 is used strictly in accordance with those instructions.               In particular, Table 9.14 cannot be used where an assessment can be made under one or more Table 9.9, 9.10 or 9.11 and there is no radiologically demonstrated joint instability or arthritis or arthroplasty.

Table 9.14 is an alternative table, which may be used instead of the specific orthopaedic or neurological table or tables. It is important to note that Table 9.14 assesses the function of the entire upper extremity. Consequently, for the purposes of ascertaining the most beneficial WPI rating for the same upper extremity, any assessment under Table 9.14 for a single upper extremity may be compared only with the total or combined impairment obtained after using other tables in Chapter 9, Part II – The upper extremities.

For the purposes of ascertaining the most beneficial WPI rating, Table 9.14 may not be compared with single impairments under the other tables, unless there are no other impairments affecting the upper extremities.

At least one major criterion, and at least two minor criteria (where listed), must be satisfied for a WPI rating to be assigned under Table 9.14. Where possible, the major criteria should be assessed on the basis of neurological examination of motor strength, co-ordination and dexterity. Where possible, functional activities should be assessed by observation of the specified activities.

Table 9.14 should be used only to assess impairment from objectively identified orthopaedic or neurological conditions arising in, and affecting, the upper extremities.

While it is true that disuse secondary to pain may produce secondary dysfunction of the upper extremities, this must not be assessed using Table 9.14 unless this dysfunction is permanent (that is, not likely to improve as a result of surgery, medication or other rehabilitative treatment) and there are objective clinical findings that cannot be validly assessed using other tables in Chapter 9, Part II – The upper extremities..

Table 9.14 must not be used for assessment of amputations.

Where one limb only is affected, regardless of the number of impairments found in that limb, the limb should be assessed using the relevant tables other than 9.14 and all impairments combined using the combined values table (see Appendix 1). The combined impairment rating should then be compared with the rating taken from the relevant (non dominant or dominant) column in 9.14 and the higher rating obtained from the two methods used to determine WPI.

Where both limbs are affected, each limb should be assessed using the Tables other than 9.14 and all impairments in both limbs combined using the combined values table. The combined impairment rating should then be compared with the rating taken from the ‘both extremities’ column in Table 9.14 and the higher rating obtained from the two methods used to determine WPI.

Table 9.14 may be used to assess upper extremity impairment arising as a result of spinal cord damage. Use the special procedure set out in the introduction to Part III of this chapter. Table 9.14 is not to be used to assess upper extremity impairment arising as a result of nerve root compression, or other neurological sequelae of cervical spinal conditions. These should be assessed under Table 9.13.1, Table 9.13.2a and Table 9.13.2b (tables dealing with neurological impairments affecting the upper extremities, see pages 131-134).

 

Table 9.14  Upper extremity function

% WPI

% WPI

% WPI

Major criteria

(at least one required)

Minor criteria

(at least two required where listed)

Non-Dominant extremity

Dominant extremity

Both extremities

0

0

0

Normal digital dexterity.

 

No limitations in use of extremity for personal care.

Writes 2 A4 pages or more at one time.

 

Can lift more than 13 kilograms (males).

 

Can lift more than 9 kilograms (females).

 

Able to lace shoes easily.

 

Joins paper clips without difficulty.

3

5

10

Minor loss of digital dexterity.

 

Minor limitations in use of extremity for personal care.

Rests after writing an A4 page.

 

Cannot lift more than 13 kilograms (males).

 

Cannot lift more than 9 kilograms (females).

 

Finds it difficult to do up shoelaces.

 

Fumbles when joining paper clips.

10

10

20

Moderate loss of digital dexterity.

 

Moderate limitations in use of extremity for personal care.

Rests after writing half an A4 page.

 

Cannot lift more than 4.5 kilograms.

 

Cannot do up shoelaces.

 

Cannot join paperclips.

 

Dresses slowly unassisted.

15

20

35

Major loss of digital dexterity.

 

Major restrictions in personal care.

Rests after writing 50 words or less.

 

Cannot lift more than 1.5 kilograms.

 

Cannot put on a tie or belt.

 

Needs assistance to cut up food.

 

Needs some assistance to dress.

25

30

50

Little useful digital co-ordination.

 

Severely limited use of extremity for personal care.

Rests after writing 10 words or less.

 

Cannot lift more than 0.5 kilograms.

 

Constantly drops light objects (eg, cups).

 

Unable to cut up food.

 

Needs extensive assistance to dress.

30

40

60

No co-ordination of digits.

 

Severely limited use of extremity for personal care.

Unable to sign name.

 

Constantly needs a splint to write or eat.

 

Unable to lift light objects.

 

Needs food placed in mouth to eat.

 

Unable to dress without assistance.

40

50

70

Minimal extremity movement against gravity.

 

Cannot use extremity for personal care.

Cannot use extremity to eat.

 

Cannot bring a pen to paper.

 

Cannot raise extremity to assist dressing.

60

60

84

Unable to use upper extremity at all.

 

 

 

 

For the same condition, WPI ratings from Table 9.7: Lower extremity function (see page 112) and/or Table 9.14: Upper extremity function (see page 138), are not normally combined with WPI ratings from Table 9.15: Cervical spine, Table 9.16: Thoracic spine, or Table 9.17: Lumbar spine.  

However, the special procedure set out below applies where there is spinal cord injury with neurological sequelae (that is, corticospinal tract involvement).

 

Step 1

Assess (where applicable):

1.1. Lower limb impairment using Table 9.7;

1.2. Upper limb impairment using Table 9.14;

1.3. Bladder/urological dysfunction using Table 12.7:  Neurological impairment of the urinary system (Chapter 12 – The neurological system);

1.4. Anorectal dysfunction using Table 12.8:  Neurological impairment of the anorectal system (Chapter 12 – The neurological system);

1.5. Sexual dysfunction using Table 12.9:  Neurological impairment affecting sexual function (Chapter 12 – The neurological system);

1.6. Respiratory dysfunction (for example, with cervical spinal cord injuries) using Table 12.6: Neurological impairment of the respiratory system (Chapter 12 – The neurological system).

Step 2

Combine the relevant impairments from 1-6 in Step 1 above, as applicable.

Step 3

Then combine the WPI from the above procedure with the relevant WPI from Table 9.15, Table 9.16 or Table 9.17 (diagnosis-related estimates) to obtain the final WPI.

 

For injuries not involving spinal cord damage but resulting in nerve root involvement/radiculopathy, use Table 9.15, Table 9.16 or Table 9.17, but do not combine with WPI ratings from Tables 9.7 or 9.14.

Except where the same nerve is involved, WPI ratings from Table 9.15, Table 9.16 and Table 9.17 (where relevant) may be combined with WPI ratings under the following tables:

Where there is brachial plexus involvement, WPI ratings from Table 9.15: Cervical spine – diagnosis-related estimates may not be combined with WPI ratings under Table 9.13.1: Cervical nerve root impairment (see page 131).

Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment are used when assessing impairments of the spine under Table 9.15, Table 9.16 and Table 9.17.

 

Part III – Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment

These definitions are taken from the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.

Alteration of motion segment integrity - motion segment alteration can be either loss of motion segment integrity (increased translational or angular motion), or decreased motion secondary to developmental fusion, fracture healing, healed infection, or surgical arthrodesis.  An attempt at arthrodesis may not necessarily result in a solid fusion but may significantly limit motion at a motion segment. Motion of the individual spine segments cannot be determined by a physical examination but is evaluated with flexion and extension roentgenograms. When routine x-rays are normal and severe trauma is absent, motion segment alteration is rare, and flexion and extension roentgenograms are indicated only if motion segment alteration is suspected from the individual’s history or routine x-rays.

Asymmetry of spinal motion in one of the three principal planes is sometimes caused by muscle spasm or guarding. That is, if an individual attempts to flex the spine, he or she is unable to do so moving symmetrically: rather, the head or trunk leans to one side. To qualify as true asymmetric motion, the finding must be reproducible and consistent, and the examiner must be convinced that the individual is co-operative and giving full effort.

Atrophy is measured with a tape measure at identical levels on both limbs. For reasons of reproducibility, the difference in circumference should be 2cm or greater in the thigh, and 1cm or greater in the arm, forearm, or leg.

Cauda equina syndrome is manifested by bowel or bladder dysfunction, saddle anaesthesia and variable loss of motor and sensory function in the lower extremities. Individuals with cauda equina syndrome usually have loss of sphincter tone on rectal examination and diminished or absent bladder, bowel, and lower limb reflexes.

Electrodiagnostic verification of radiculopathy. Unequivocal electrodiagnostic evidence of acute nerve root pathology includes the presence of multiple positive sharp waves or fibrillation potentials in muscles innervated by one nerve root. However, the quality of the person performing and interpreting the study is critical. Electromyography should be performed only by a physician qualified through education, training, and experience in these procedures.  Electromyography does not detect all compressive radiculopathies and cannot determine the cause of the nerve root pathology. On the other hand, electromyography can detect noncompressive radiculopathies which are not identified by imaging studies.


Loss of motion segment integrity is defined as an anteroposterior motion of one vertebra over another that is greater than 3.5mm in the cervical spine, greater than 2.5mm in the thoracic spine, and greater than 4.5mm in the lumbar spine. Alternatively, it is defined as a difference in the angular motion of two adjacent motion segments greater than 15 at L1-2, L2-3 and L3-4, greater than 20 at L4-5 and greater than 25 at L5-S1. In the cervical spine, it is also defined as motion at one level that is more than 11 greater than at either adjacent level.

Muscle guarding is a contraction of muscle to minimise motion or agitation of the injured or diseased tissue. It is not true muscle spasm because the contraction can be relaxed. In the lumbar spine, the contraction frequently results in loss of the normal lumbar lordosis, and it may be associated with reproducible loss of spinal motion.

Muscle spasm is a sudden, involuntary contraction of a muscle or group of muscles.  Paravertebral muscle spasm is common after acute spinal injury but is rare in chronic back pain.  It is occasionally visible as a contracted paraspinal muscle but is more often diagnosed by palpation (a hard muscle).

To differentiate true muscle spasm from voluntary muscle contraction, the individual should not be able to relax the contractions. The spasm should be present standing, as well as in the supine position, and frequently causes a scoliosis. The physician can sometimes differentiate spasm from voluntary contraction by asking the individual to place all his or her weight first on one foot, and then the other, while the physician gently palpates the paraspinous muscles. With this manoeuvre, the individual normally relaxes the paraspinal muscles on the weight-bearing side. If the examiner witnesses this relaxation, it usually means that true muscle spasm is not present.

Nonverifiable radicular root pain is pain that is in the distribution of a nerve root but has no identifiable origin (that is, there are no objective physical, imaging, or electromyographic abnormal findings).

Radiculopathy is significant alteration in the function of a nerve root or nerve roots, and is usually caused by pressure on one or several nerve roots. The diagnosis requires a dermatomal distribution of pain, numbness, and/or paraesthesia. A root tension sign is usually positive. A diagnosis of herniated disc must be substantiated by an appropriate finding on an imaging study. The presence of findings on an imaging study is insufficient to make the diagnosis of radiculopathy. There must also be clinical evidence as described above.

Reflexes may be normal, increased, reduced, or absent. For reflex abnormalities to be considered valid, the involved and normal limb(s) should show marked asymmetry between arms or legs on repeated testing. Once lost because of previous radiculopathy, a reflex rarely returns. Abnormal reflexes such as babinski signs or clonus may be signs of corticospinal tract involvement.

Urodynamic tests. Cystometrograms are useful in individuals where a cauda equina syndrome is possible but not certain. A normal cystometrogram makes the presence of a nerve-related bladder dysfunction unlikely. Occasionally, more extensive urodynamic testing is necessary.

Weakness and loss of sensation. To be valid, the sensory findings must be in a strict anatomical distribution (that is, follow dermatomal patterns). Motor findings should also be consistent with the affected nerve structure(s). Significant, long-standing weakness is usually accompanied by atrophy.

 


Part III – Multi-level fractures involving the spinal canal

 

For multiple fractures involving the spinal canal on more than one level, as distinct from the spinous processes or facet joints, the assessment made under Tables 9.15, 9.16 or 9.17 is to be adjusted as follows:

The adjustment, by one or two levels, as applicable, may be made only once under each table.

The adjusted WPI assessment may not exceed the maximum WPI rating available in each individual table.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes to Table 9.15

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Notes to Table 9.16

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

A WPI rating from Table 9.18 may be combined with WPI ratings from Table 9.15: Cervical spine, Table 9.16: Thoracic spine and Table 9.17: Lumbar spine.

 

 

 

 

 

 

 

 

 Page no.

 


10.0  Introduction

 

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

 

Impairments assessed under Chapter 10 include those caused by secondary conditions accompanying an endocrine system condition. An impairment assessed under Chapter 3 – The endocrine system (see page 40) should be combined with those resulting from the secondary conditions assessed under Chapter 10.

 

10.1  Upper urinary tract

 

The upper urinary tract comprises the kidney and ureters.

Upper urinary tract dysfunction may be indicated by symptoms and signs including:

Especially in its early stages, renal disease may only become evident with laboratory findings.

Continuous medical treatment includes drug or dietary therapy.

Renal replacement therapy includes peritoneal or haemodialysis and renal transplantation.

 

 

 

 

 

 

 


10.2  Urinary diversion

 

Using the combined values chart (see Appendix 1), WPI ratings derived from Table 10.2 below may be combined with WPI ratings derived from Table 10.1 (on previous page).

 

 


10.3  Lower urinary tract

 

The lower urinary tract comprises the bladder and urethra.

Table 10.3: Lower urinary tract is on the following page.

Using the combined values chart (see Appendix 1), WPI ratings derived from Table 10.3 may be combined with WPI ratings from Table 10.1: The upper urinary tract (see page 153), and with WPI ratings from Table 10.2: Urinary diversion (see page 154).

Impairment in the lower urinary tract due to neurological causes, as opposed to local lower urinary tract pathology, should be assessed under Table 12.7: Neurological Impairment of the urinary system (see page 183).

If:

then:

 

Symptoms and signs of bladder disorder include:

 

Signs and symptoms of urethra function impairment include:

 

 

 

 

 

 

 Page no. 

 

 

 

 

 

 


11.0 Introduction

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

 

11.1 Male reproductive system

WPI ratings from Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4 may be combined, provided the total WPI rating for all conditions affecting ability to father children does not exceed 20%.

The WPI ratings in Tables 11.1.1, 11.1.2, 11.1.3 and 11.1.4 are applicable to 40–65 year old men.

Where the employee is outside this age group, the following calculation should be made:

For example, a 29 year old man with a combined maximum WPI of 20% of the male reproductive system would be rated as suffering a 30% WPI: 20% WPI + (0.5 x 20%WPI) = 30% WPI.

Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4 are not to be used with respect to sexual dysfunction arising as a result of neurological impairments rather than local reproductive pathology. Where sexual dysfunction is the result of spinal cord injury, use Table 9.6.1: Spinal nerve root impairment affecting the lower extremity (see page 109). Where sexual dysfunction is the result of neurological disorder other than spinal nerve root impairment, use Table 12.9: Neurological impairment affecting sexual function (see page 184).

Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4 are intended for use only to assess impairment resulting from neurological impairment, or local lesions of:

These tables can be used to assess impairment where obstruction of the vascular supply of the penis and other male organs occurs.

These tables are not intended for use where sexual function is impaired for any other reason (for example, pain or depression).

 

 


11.1.1  Male reproductive organs – penis

 

 

11.1.2  Male reproductive organs – scrotum

Skin disorders such as dermatitis, or tinea, affecting the scrotal skin are assessed under Table 4.1: Skin disorders (see page 57). Table 11.1.2 is not used to assess these conditions.

 

 

 


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

 

WPI ratings from Tables 11.2.1, 11.2.2 and 11.2.3 (see following pages) may be combined. However, the total WPI rating for all conditions affecting ability to conceive and be delivered of children may not exceed 30%.

 

Tables 11.2.1, 11.2.2, and 11.2.3 are not to be used with respect to sexual dysfunction arising as a result of neurological impairments rather than local reproductive pathology. Where sexual dysfunction is the result of spinal cord injury, use Table 9.6.1: Spinal nerve root impairment affecting the lower extremity (see page 109). Where sexual dysfunction is the result of neurological disorder other than spinal nerve root impairment, use Table 12.9: Neurological impairment affecting sexual function (see page 184).

 

 


11.2.1  Female reproductive organs – vulva and vagina

 

 

Notes to Table 11.2.1

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

 


11.2.2  Female reproductive organs – cervix and uterus

See notes to Table 11.2.2 immediately following the table.

 

 

 

 

 

1. Hormone replacement therapy is not considered continuous treatment for the purposes of Table 11.2.2.

2. Oral contraception may be considered continuous treatment if pregnancy is contraindicated because of the cervical or uterine lesion.


11.2.3  Female reproductive organs – fallopian tubes and ovaries

 

 

 Page no. 


12.0  Introduction

 

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

The four categories of cerebral impairment are:

WPI ratings from these four categories of cerebral impairment may not be combined with each other. The highest WPI rating from these four categories is to be used. Unless otherwise indicated, the highest WPI rating may then be combined with:

The following procedure should be used in assessing cerebral function.

Step 1

Determine whether disturbance is present in the level of consciousness or awareness (Table 12.1.1, Table 12.1.2 and Table 12.1.3). This may be a permanent alteration or an intermittent alteration in consciousness, awareness or arousal. Use the most applicable of Table 12.1.1, Table 12.1.2 or Table 12.1.3.

Step 2

Evaluate mental status and highest integrative functioning (Table 12.2).

Step 3

Identify any difficulty with comprehension and the use of language (Table 12.3). Use the higher of the WPI ratings from these two tables.

Step 4

Evaluate any emotional or behavioural disturbances, such as depression, that can modify cerebral function (Table 12.4).

Step 5

Identify the most severe cerebral impairment from steps 1 to 4 above. Combine the most severe WPI rating with WPI ratings from any tables in Chapter 12 including and following Table 12.5.1, or with WPI ratings from other chapters.

 

Activities of daily living are those 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.

For the purposes of Chapter 12, activities of daily living are those in Figure 12-A.

 

 

 

 

 

Station, gait and movement disorders:

 


12.1  Disturbances of levels of consciousness and awareness

Table 12.1.1 applies to stupor, coma, and permanent vegetative state. These conditions are assessed based on clinical findings on neurological examination and relevant ancillary testing such as CT scan, MRI, SPECT, EEG, evoked potentials and vestibular testing.

 

Notes to Table 12.1.1

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

 

12.1.2  Epilepsy, seizures and convulsive disorders

Table 12.1.2 is used for episodic neurological disorders of consciousness and awareness.

 


12.1.3  Sleep and arousal disorders

Arousal and sleep disorders include disorders related to:

 

See notes to Table 12.1.3 immediately following the table.

 

 

Notes to Table 12.1.3

1. Supervision 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.

 


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

WPI ratings in Table 12.2 reflect increasing levels of severity. To satisfy particular WPI rating requirements, the majority of criteria for each WPI rating should be present, as described in Figure 12-B.

The WPI ratings are incremental. In order to satisfy the criteria for a particular degree of impairment, the employee must have a greater degree of impairment than that described for the preceding levels.

The Clinical Dementia Rating (CDR) test for memory, abstract reasoning and problem solving (Figure 12-B) should be administered by a professional competent in the area.

The employee’s cognitive function for each category (memory, orientation, judgement and problem solving, community affairs, home and hobbies, personal care) is scored independently. For the purposes of assessing impairment, Memory is considered the primary category. The other categories are secondary.

The following rules apply to scoring:

Find the row in Table 12.2 that exactly matches the respective scores for CDR and memory. The WPI rating is shown in the first column of that row.

 

 

 


 

 

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


12.3  Communication impairments: dysphasia and aphasia

Communication involves comprehension, understanding, language, and effective interaction between and among individuals. Aphasia is a condition in which language function is defective or absent. It includes a lack of comprehension with deficits in vision, hearing, and language (both spoken and written), and also the inability to implement discernible and appropriate language symbols by voice, action, writing or pantomime. Dysphasia is a language impairment that is less severe than aphasia (which literally means “no speech”) but still is associated with a lesion in the dominant parietal lobe. It presents as a communication problem due to receptive or expressive dysphasia or a combination of the two. Inability to have a meaningful conversation because no nouns are used is an example of dysphasia. Other common errors include errors of grammatical structure, word-finding difficulties, and word substitution. Dysphasia and aphasia are different from dysarthria, which is imperfect articulation of speech due to disordered muscle control. Dysphonia is an impairment of sound production that causes difficulty speaking and understanding. Speech and communication impairments due to non neurological primary problems are discussed in Chapter 11 - Ear, nose, throat and related structures.

Dysphasia is the most common diagnosis, since most individuals usually retain some ability to communicate. An inability to understand language has a poorer prognosis than an inability to express language. Speech therapy is of little value in the absence of comprehension; therefore, compensatory techniques may not be learned when a receptive aphasia or dysphasia exists. Tests for dysphasia should be conducted after it is established how confused or disoriented the individual is and which side of the brain is dominant for speech. Cognition should also be evaluated after dysphasia mechanisms have been excluded.

Aphasia and dysphasia test batteries are frequently devised by the clinician and cover the following simple tasks: (1) listening to spontaneous speech or responses to simple questions; (2) pointing commands and questions that can be answered “yes” or “no” to test comprehension; (3) repeating words and phrases; (4) naming objects that have high-and-low frequency use; (5) reading comprehension and reading aloud (reading is related to educational achievement, which must be known before interpreting reading comprehension and reading aloud results); and (6) writing and spelling. If comprehension is relatively intact, the aphasia screening battery may be adequate to place an individual in class 1 or 2. However, individuals with dysphasia may score poorly on aphasia and dysphasia test batteries while they demonstrate communicative competency for activities of daily living. This communicative competency may be measured by means of the Communicative Abilities in Daily Living (CADL), in which non verbal communication is assessed. Table 12.3 describes the criteria for rating impairment due to aphasia or dysphasia.      

 


12.4  Emotional or behavioural impairments

Emotional or behavioural disorders resulting from verifiable neurological impairments (for example, stroke or head injury) are assessed under Table 12.4 below.

Psychiatric impairments without documented neurological origin are assessed under Chapter 5 – Psychiatric conditions. They are not assessed under Table 12.4.

Neurological conditions associated with changes in emotion and affect include:

The Neuropsychiatric Inventory (NPI) may be used to assess ‘no cognitive’ behavioural symptoms such as apathy, delusions, dysphoria, agitation/aggression, euphoria, hallucinations, irritability/lability, and aberrant motor behaviour (Cummings et al, 1994).

 

 

 

Notes to Table 12.4

1. Supervision 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.

 


12.5  Cranial nerves

Unless otherwise indicated, only the highest WPI rating from the preceding four categories (that is all tables in sections 12.1, 12.2, 12.3 and 12.4) may be combined with a WPI rating from one or more tables in the remainder of Chapter 12, and with WPI ratings from other Chapters. (For further information about deriving WPI ratings from an assessment of cerebral function, see Steps 1 to 5 in the Introduction to Chapter 12, page 167).

 

12.5.1  The olfactory nerve (I)

The WPI ratings in Table 12.5.1 reflect bilateral partial loss of function and total loss of function (anosmia).

A WPI rating made under Table 12.5.1 may not be combined with a WPI rating for the same condition made under Table 7.3: Olfaction and Taste (see page 77).

 

 

 

Dysfunction of these cranial nerves causes impairment of the visual system and is to be assessed under Chapter 6 – The visual system (see page 64).

 

 

This is a mixed nerve having sensory fibres to the face, cornea, anterior scalp, nasal and oral cavities, tongue and supratentorial dura mater. It also transmits motor impulses to the muscles of mastication.

Where sensory loss affects more than one division of the nerve with differing severity, the respective values for each affected division may be combined using the combined values chart (see Appendix 1).

If paralysis of the motor fibres of the nerve causes interference with speech, this impairment should be evaluated in accordance with the criteria in Chapter 7 – Ear, nose and throat disorders (see page 75).

Impairment due to chewing and swallowing difficulties is assessed under Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (see page 182). For the same condition, WPI ratings derived from Table 12.5.6 may not be combined with WPI ratings from Table 7.7: Chewing and swallowing (see page 80).

 

 

 

This is a mixed nerve. The motor part innervates the facial muscles of expression and the accessory muscles for chewing and swallowing. The sensory fibres carry tactile sensations from the ear, soft palate and adjacent pharynx, and transmit taste from the anterior two thirds of the tongue.

Impairment due to chewing and swallowing difficulties is assessed under Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (see page 182). For the same condition, WPI ratings derived from Table 12.5.6 may not be combined with WPI ratings from Table 7.7: Chewing and swallowing (see page 80).

Facial nerve injury, complicated by visual changes, such as occur with corneal desiccation and scarring, should rate as a significant impairment. This should be assessed under Chapter 6 – The visual system (see page 64), and may be combined with a WPI rating from Table 12.5.4.

For the same condition, a WPI rating from Table 12.5.4 may not be combined with a WPI rating from Table 7.3: Olfaction and taste (see page 77).

 

 

Notes to Table 12.5.4

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

The Auditory Nerve has two portions:

Impairment of hearing due to a lesion of the cochlear portion of the nerve should be evaluated under Chapter 7 – Ear, nose and throat disorders (see page 75). A WPI rating derived from Chapter 7 may be combined with a WPI rating from Table 12.5.5.

Lesions of the vestibular portion of the nerve result in vertigo with or without nausea and vomiting.

Table 12.5.5 is used where symptoms are continuous.

To obtain the final WPI rating in the case of episodic disturbances of equilibrium (such as Menière’s disease), apply the modifier from Figure 12-C (see below) to the WPI rating from Table 12.5.5.

 

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.

 

 

 

 

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.

 

 

 

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.

 

 

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.

 

 

Notes to Table 12.7

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

 

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.

 

 

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).

 

 

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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.

 

See note to Table 13.1 immediately following Table.

 

Note to Table 13.1.

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

 

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.

 

 

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.

 

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.

 

 

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.

 

 

 

 

 

 

 

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

 

 

 

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:

 

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.

 

 


‘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:

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.

 

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).

 

 

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.

 

 

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.

 

 

 

 

 

 

Table B2: Suffering

 

 

 

 

 

 

 

 

 

 

 

B3.3: Recreation and Leisure Activities

 

 

 

 

 

 

 

 

Table B5: Loss of Expectation of Life

 

 

 

 

 

 

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%.

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 = ____%

 

 

 

 

 

 

 

 

Division 3

 

Calculation of total entitlement under section 39 and section 41

 


Use the following Worksheet to derive the 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.

 

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:

$