Impairment Tables Regulations, 2007

L.N. 170 of 2007

SOCIAL SECURITY ACT

(CAP. 318)

Impairment Tables Regulations, 2007

IN exercise of the powers conferred by article 84(h) of the Social

Security Act, hereinafter referred to as “the Act”, the Minister for the

Family and Social Solidarity, with the concurrence of the Prime Minister

and Minister of Finance, has made the following regulations>

(1) The title of these regulations is the Impairment Tables Citation and

commencement.

Regulations, 2007.

(2) These regulations shall come into force on the 1st July,

2007.

(Regulation 2)

Impairment Tables Used To Assess Work-Related Impairments And Determine Eligibility

To A Pension In Respect Of Invalidity.

NOTE: In the Assessment of Work Related Impairments these Tables are to be used as

outlined in the official guide on Work Related Impairments issued by the Department of

Social Security.

TABLE 1 – LOSS OF CARDIOVASCULAR AND/OR RESPIRATORY

FUNCTION: EXERCISE TOLERANCE

Cardiovascular and Respiratory Function is measured by reference to

exercise tolerance. A rating is obtained from Table 1 by determining the

lowest MET band which causes restriction in activity from a cardiac or

respiratory condition. 1 MET is defined as average oxygen consumption at

rest which is 3.5mL O 2 /kg/min.

The clinical judgement of medical officers based on history and examination is

to be used but in cases where a reliable history is difficult to obtain despite

discussions with the treating doctor or the history of exercise tolerance is

inconsistent with clinical findings on examination, the results of an Exercise

ECG or Respiratory Function Test may be obtained.

The appropriate MET level is calculated using the lists in Table 1.2.

Peripheral Vascular Disease is assessed under the lower limb Table 4.

Varicose veins are assessed under either the Lower Limb or Skin Table.

Hypertension is assessed under Table 20. Where exercise intolerance is

caused by a combination of cardiac and respiratory conditions, Table 1 is to

be used and used only once. Episodic conditions such as cardiac arrhythmias

and episodic asthma should be assessed under Table 21 unless they are

exercise induced.

Assignment of Rating

Rating

Symptomatic Activity Level (METs)

NIL

7 – 8 or higher

FIVE

6 – 7

FIFTEEN

5 – 6

TWENTY

4 – 5

THIRTY

3 – 4

FORTY

2 – 3 or less

TABLE 1.2 - METABOLIC COST OF ACTIVITIES

Listed below is a more comprehensive set of activities, with their corresponding MET

level. One MET represents the energy level expenditure associated with the

consumption of 3.5ml O2/kg body weight/minute. Please use this list to assist you in

determining an appropriate symptomatic MET level for the claimant.

In determining the symptomatic activity level, greater reliance is placed on activities

which involve a steady expenditure of energy (e.g. walking steadily for 10 minutes) as

opposed to a sporadic expenditure of energy (e.g. playing one hole of golf). The

former activities are more reliable indicators of exercise tolerance. Less reliance is

placed on activities which can be completed in less than a few minutes, as symptoms

may take longer than this to occur.

Metabolic Cost of Activities

1-2 METs Energy expended at rest or minimal activity

lying down

sitting and drinking tea

using sewing machine (electric)

sitting down

sitting and talking on telephone

travelling in a car as passenger

strolling (slowly)

standing

typing

sitting and knitting

2-3 METs Energy expended to dress, wash and perform light household duties

walking 3.5km/hr (slowly)

playing piano/ violin/ organ

clerical work which involves

setting table

playing billiards

moving around

washing dishes

driving power boat

bench assembly work (sitting)

dressing

light sweeping

using self-propelled mower

light tidying, dusting

horseback riding at walk

polishing silver

driving a car

lawn bowls

making bed

cooking, preparing meals

3-4 METs Energy required for walking at average pace

walking 5km/hr (average

vacuuming

machine assembly

walking pace)

sedate cycling (10km/hr)

minor car repairs

light carpentry (chiselling,

shifting chairs

light gardening (weed/water)

hammering, sawing and planing

hanging out washing

playing golf (with power buggy)

with hand tools)

tidying house (includes

welding

carrying heavy objects)

4-5 METs Moderate activities: encompasses more active daily activities with the

exclusion of manual labour and vigorous exercise

stocking shelves with light objects

mopping floors

gentle swimming

golf (pulling buggy, carrying bag)

ballroom dancing

beating carpets

stacking firewood

painting outside of house

polishing furniture

cleaning windows

wallpapering

pushing light power mower over

walking 6.5 km/hr (sustained

hoeing (soft soil)

flat suburban lawn at slow, steady

brisk walk, discomfort talking at

showering

pace

the same time)

cleaning car (excludes vigorous

polishing)

5-6 METs Heavy exercise: manual labour or vigorous sports

shovelling dirt (12 throws/min.)

digging in garden

walking slowly but steadily up stairs

tennis doubles (social non-

scrubbing floors

pushing a full wheelbarrow (20kg)

competitive)

6-7 METs

loading truck with bricks

pace walking

carrying load upstairs (10kg)

7-8 METs Very heavy exercise

jogging (8km/hr)

sawing hardwood with hand tools

using pick & shovel to dig

trenches

tennis (singles, non-competitive)

swimming laps (non-competitive)

8-9 METs

running (9km/hr)

chopping hardwood

10 METs

running (9km/hr) non-competitive)

cycling quickly (25 km/hr)

carrying loads (10kg) up a gradient

TABLE 2 – LOSS OF RESPIRATORY FUNCTION: PHYSIOLOGICAL

MEASUREMENTS

Respiratory function is measured by reference to exercise tolerance in the

majority of cases and so Table 1 is used. Spirometry can be used where the

medical officer feels it is more appropriate for example, where a history of

exercise tolerance is difficult to obtain and assess or the history of exercise

tolerance is inconsistent with clinical findings on examination. A rating is then

obtained using Table 2.

Predictive nomograms for the forced expiratory volume over one second

(FEV1) and the forced vital capacity (FVC) are at Tables 2.2 and 2.3.

Measurements of Forced Expiratory Volume in one second and Forced Vital

Capacity should be performed with a vitalograph or equivalent instrument.

Ideally, three readings should be taken and the best of these used to calculate

a rating. Calculate the ratio of FEV1 and FVC against the predicted figures as

a percent. Testing pre- and post-bronchodilatation is unnecessary as the aim

of assessment under this Table is to assess people in their "normal" state.

Furthermore, this Table is only to be used for people with irreversible lung

disease. The FEV1 is usually selectively reduced in Chronic Airflow Limitation

and the FVC in Restrictive Lung Disorders. The FEV1 should be used in

preference to the FVC where there is a discrepancy between the two in

Chronic Airflow Limitation.

Assignment of a Rating

Rating

% Predicted FEVI or FVC

NIL

80 +

TEN

75 – 79

FIFTEEN

70 – 74

TWENTY

65 – 69

TWENTY – FIVE

60 – 64

THIRTY

50 – 59

FORTY

49 or less

TABLE 2.2

Prediction nomogram – males

NOTES

From Kamburoff, Petia L., and Woitowitz, H.J. & R.H. (1972)

Height

FVC

FEV1

Age

(cm)

(litre)

(litre)

(years)

TABLE 2.3

Prediction nomogram – females

NOTES

From Kamburoff, Petia L., and Woitowitz, H.J. & R.H. (1972)

Height

FVC

FEV1

Age

(cm)

(litre)

(litre)

(years)

TABLE 3 – UPPER LIMB FUNCTION

All upper limb problems are assessed under the upper limb Table (Table 3). Each

arm is assessed separately. Determination of upper limb impairments must be based

on a demonstrable loss of function.

Criteria

Can use dominant limb effectively; and/or

Demonstrable evidence of loss of strength, mobility, coordination,

dexterity and/or sensation of upper limb which causes mild interference

with hand function or manual handling.

Demonstrable evidence of loss of strength, mobility, coordination,

dexterity and/or sensation of non-dominant upper limb which causes

moderate interference with hand function or manual handling.

Demonstrable evidence of loss of strength, mobility, coordination,

dexterity and/or sensation of dominant upper limb which causes

moderate interference with hand function or manual handling.

Demonstrable evidence of major loss of strength, mobility, coordination,

dexterity and/or sensation of non-dominant upper limb which causes

significant interference with hand function or manual handling.

Demonstrable evidence of major loss of strength, mobility, coordination,

dexterity and/or sensation of dominant upper limb which causes

significant interference with hand function or manual handling; or

Unable to use non-dominant upper limb at all.

Unable to use dominant upper limb at all.

TABLE 4 – FUNCTION OF THE LOWER LIMBS

Table 4 is used to assess lower limb not spinal function (see Table 5). Assess both limbs

together. Determination of lower limb impairments must be based on a demonstrable loss of

Criteria

Walks without difficulty on a variety of different terrains and at varying

speeds for distances of more than 500m.

Demonstrable loss of strength, mobility, stability, balance, coordination

and/or sensation such as to cause moderate interference with walking

and one or more of the following: climbing, squatting, sitting or kneeling;

or

Pain or claudication restricts walking to 250-500m or less, at a slow to

moderate pace (4km/h). Can walk further after resting.

Demonstrable loss of strength, mobility, stability, balance, coordination

and/or sensation such as to cause major interference with walking and

one or more of the following: climbing, squatting, sitting or kneeling; or

Pain or claudication restricts walking (4km/h) to 50-250m or less at a time.

Can walk further after resting; or

Unable to walk or stand but independently mobile using a self-propelled

wheelchair.

Pain or claudication restricts walking (4km/h) to 50m or less at a time.

Can walk further after resting or restricted to walking in and around home

and

(a) requires quad stick, crutches or similar walking aid; or

(b) is unable to transfer without assistance.

Unable to walk or stand and mobile only in a motorised wheelchair or

wheelchair with an attendant.

TABLE 5 – SPINAL FUNCTION

Determination of spinal impairments must be based on a demonstrable loss of

TABLE 5.1 - CERVICAL SPINE

Criteria

Normal or nearly normal range of movement.

Loss of quarter of normal range of movement.

Loss of half of normal range of movement and frequent/constant neck

pain or loss of three quarters of normal range of movement with

infrequent neck pain.

Loss of three-quarters of normal range of movement and constant neck

pain.

Loss of almost all movement, or complete ankylosis in position of function.

Ankylosis in an unfavourable position, or unstable joint.

TABLE 5.2 - THORACO - LUMBAR-SACRAL SPINE

As spinal mobility is a composite movement, this Table measures overall mobility of

the trunk including hip movement and is not intended to measure mobility of

individual spinal segments.

Criteria

Normal or nearly normal range of movement.

Loss of one-quarter of normal range of movement.

Loss of one-quarter of normal range of movement as well as back pain or

Referred pain

(a) with many physical activities; and

(b) with standing for about 30 minutes; and

(c) with sitting or driving for about 60 minutes; or

(d) loss of half of normal range of movement.

Loss of half of normal range of movement as well as back pain or referred

pain

(a) with most physical activities; and

(b) with standing for about 15 minutes; and

(c) with sitting or driving for about 30 minutes; or

(d) loss of three-quarters of normal range of movement.

Ankylosis in an unfavourable position, or unstable joint.

TABLE 6 – PSYCHIATRIC IMPAIRMENT

It is important to record a detailed psychiatric history, a mental state examination,

and to distinguish between temporary and permanent psychiatric disorders. People

with established psychiatric disorders (e.g. Bipolar Disorder) may be highly variable

in their clinical presentation and this factor must be taken into account in the

assessment. The assessment of psychiatric impairment may benefit from

investigating; reports from mental health case managers, compliance with and the

effects of medication, support systems that people have in place, the degree of

insight present and the presence of psychotic illness. Where a person has a short

term problem, for example an adjustment disorder with depression following an

illness or marital breakdown, initially this should usually be considered to be of a

temporary nature. Table 6 is used for permanent psychiatric disorders only. If there is

insufficient clinical information available, a current or recent specialist report should

be obtained.

Criteria

Mild but regular symptoms which tend to cause subjective distress. On most

occasions able to distract themselves from this distress. Minimal

interference with function in everyday situations. Exacerbation of symptoms

may cause occasional days off work. (e.g. There may be some loss of

interest in activities previously enjoyed. There may be occasional friction

with family, colleagues or friends). Medical therapy or some supportive

treatment from treating doctor may be required.

Moderate and regular symptoms and generally functioning with some

difficulty. (e.g. noticeable reduction in social contacts or recreational

activities, or the beginnings of some interference with interpersonal or

workplace relationships). May have received psychiatric treatment which

has stabilised the condition. Minor effects on work attendance and/or ability

to work but the impairment would not prevent full-time work (e.g. short

periods of absence from work).

Psychiatric illness or disorder with either serious symptomatology or

impairment in functioning that requires treatment by a psychiatrist (e.g.

frequent suicidal ideation, severe obsessional rituals, frequent severe

anxiety attacks, serious anti-social behaviour, diagnosed psychotic illness

with continuing symptoms). There is significant interference with

interpersonal or workplace relationships with serious disruption of work

attendance or ability to work.

Serious psychiatric illness with major impairments in several areas, such as

work, interpersonal relations, judgement, thinking, or mood (e.g. depressed

person avoids friends, neglects family, unable to do housework), or some

impairment in reality testing or communication (e.g. speech is at times

obscure, illogical or irrelevant).

Major chronic psychiatric illness which results in an inability to function in

almost all areas, or behaviour is considerably influenced by either delusions

or hallucinations, or serious impairment in communication (e.g. sometimes

incoherent or unresponsive) or judgement (e.g. acts grossly

inappropriately).

TABLE 7 – ALCOHOL AND DRUG DEPENDENCE

Alcohol and drug dependence is assessed using Table 7. A rating other than NIL on

this Table should only be assigned where the person's medical and other reports,

history and presentation consistently indicate chronic entrenched drug and alcohol

dependence. It should also be causing a functional impairment; the use of drugs or

alcohol does not in itself constitute or necessarily indicate permanent impairment.

Any associated neurological functions or end organ damage should also be

assessed on the appropriate tables in addition to Table 7. The ratings are then added

together to obtain a total work-related impairment rating.

When applying this Table, consideration should be given to the known biological and

behavioural effects of particular substances.

Rating

Criteria

A pattern of alcohol or drug use with no or only minor effects on daily

NIL

functioning or work capacity.

A pattern of alcohol or drug use sufficient to cause intermittent or temporary

FIVE

absence from work.

Dependence on alcohol or other drugs, well established over time, which is

TWENTY

sufficient to cause prolonged absences from work. Reversible end organ

damage may be present.

Dependence on alcohol or other drugs, well entrenched over many years,

THIRTY

with minimal residual work capacity. Irreversible end organ damage may be

present.

Pattern of heavy alcohol or other drug use with severe functional disability

FORTY

and irreversible end organ damage.

TABLE 8 – NEUROLOGICAL FUNCTION: MEMORY, PROBLEM SOLVING,

DECISION MAKING ABILITIES AND COMPREHENSION

Table 8 is used to rate impairment of higher neurological functions of memory,

problem solving, decision making ability and comprehension. Loss of function within

this group is rated only once using this Table. If there are additional functional losses,

these are also assessed using other relevant Tables.

People with acquired brain injury may have associated problems with behaviour

and/or insight. These impairments may be rated using both Table 8 and Table 6.

If there is insufficient clinical information available on cognitive function, a current or

recent specialist report should be obtained (e.g. neurologist, specialist physician or

neuropsychologist). The report should address functions of comprehension, memory,

ability to concentrate, problem solving, loss of motivation, fatigue or any associated

behavioural abnormalities or disorders.

Criteria

Comprehension, reasoning and memory are comparable with peers or only

minor difficulties.

Can understand movies, radio programs or group discussions, but with some

difficulty. Comprehension is good in most situations, but understanding is

difficult in large groups, or when tired and upset. Has difficulty coping with

rapid changes of topic; or

Mild impairment of problem solving and ability to concentrate: appropriate

use is made of accumulated knowledge, and reasonable judgement is shown

in routine daily activities most of the time. Difficulties are apparent in new

circumstances; or

Mild impairment of memory. Can learn, although at a slower rate than

previously. Impairment has little impact on everyday activity because of

compensation through reliance on written notes, schedules, checklists and

colleagues.

Can understand speech face-to-face, but confusion or fatigue occurs rapidly

in any group. Is unable to cope with rapid change in topic, or with complex

topics and is unable to understand a series of work instructions from a

supervisor; or

Moderate impairment of memory: has frequent difficulty in recalling details of

recent experiences; frequently misplaces objects; fails to follow through with

intentions or obligations; tends to get lost more easily in unfamiliar areas.

Compensation through use of aids, e.g. lists or diaries is normally adequate.

If restricted to familiar schedules, activities, procedures and areas, is largely

independent; or

Moderate impairment of problem-solving ability and ability to concentrate

relies on accumulated knowledge. Suffers significant disadvantage in

circumstances requiring complex decision-making or non-routine activities,

i.e. when past decision-making is not directly relevant. Has reduced

initiative/spontaneity, reduced ability to concentrate and/or reduced capacity

for abstract thinking; or

Significant perceptual problems (visual, space or time) making learning and

complying with work tasks very difficult.

Can understand only simple sentences, and follow simple sentences from

context and gesture, although frequent repetition is needed.

Can understand only single words. Shows some understanding of slowly-

spoken simple sentences from context and gesture, although frequent

repetition is needed; or

Severe loss of problem solving ability. Is partially able to compensate, but

unable to function with complete independence.

TABLE 9 – COMMUNICATION FUNCTION – RECEPTIVE AND EXPRESSIVE

LANGUAGE COMPETENCY

This Table measures communication and language competency and addresses both

receptive (processing) and expressive language impairment. Hearing loss with

impaired language processing or expression should be scored using this Table and

Table 12. Hearing loss with normal language competency should only be scored on

Table 12. Where language impairment is an effect of cognitive loss, a single rating

should be assigned using Table 8 to reflect the combined loss of cognitive and

language function. Where language impairment is separate or additional to a

cognitive impairment, these losses may be rated using Table 8 and Table 9. The

following factors should be considered in determining an impairment rating

(a) the ability to independently and successfully use appropriate assistive devices,

aids or strategies to reduce the impact of the impairment;

(b) the ability to make use of environmental cues and resources (including sign

interpreters in the case of deaf people) to reduce the impact of the impairment;

(c) intactness of other channels of communication: reading, writing, non-verbal

language;

(d) the degree of effort required by the communication partner(s) in any particular

communication setting;

(e) appropriateness and degree of success of communicative interactions.

If there is insufficient clinical information available on communication skills, a current

or recent specialist report should be obtained (e.g. speech pathologist, neurologist or

neuropsychologist). The report should comment on functional communication status,

including the capacity to utilise compensatory strategies/aids to reduce the impact of

the impairment.

Rating

Criteria

NIL

Satisfactory or only minor difficulties with communication

FIFTEEN

Difficulty with unfamiliar, lengthy or complex verbal situations and unable to

adapt or manage interruption but competent communication in favourable

settings. Could work in a wide range of occupations but high public contact

and high communication content jobs may be too demanding.

TWENTY

Communication is effortful and limited. A communication partner is required

to assist in interpreting the information. Unable to cope with rapid change in

topic or complex/abstract information but can understand simple sentences &

follow information from context and gestures. Could work in open

employment in a limited range of occupations but could not manage jobs

which require high communication demands or public contact.

THIRTY

Communication is very limited. May be able to use context to convey

message and may be able to comprehend material if it is repeated,

rephrased or represented in another format. May convey information via a

YES/NO response. Unlikely to cope with open employment unless work

tasks had minimal communication requirements.

FORTY

There is little or no functional understanding of verbal language and

communication relies entirely on someone else to interpret meaning. May

have an augmentative/communication device or board but only able to use it

effectively in familiar settings. Unlikely to cope with any open employment.

TABLE 10 – INTELLECTUAL DISABILITY

This Table is only to be used for intellectual disability. Three key criteria are

assessed, IQ using the Weschler Adult Intelligence Scale (Revised WAIS-R) and two

areas of social functioning: adaptive behaviour and capacity for independent living.

The claimant is given a score for each and the three scores are then added. The

final figure is converted to a work-related impairment rating using the table below. A

score can only be assigned for the two social functioning criteria if a score has been

assigned for a low IQ. Where it is clear that the person is moderately to severely

intellectually impaired, formal psychometric testing may not be necessary but in

borderline and mild cases where no formal testing has been performed, this should

be arranged.

INTELLIGENCE (IQ)

SCORE

ADAPTIVE BEHAVIOUR

SCORE

No or only mild behavioural

Normal

problems

Moderate to severe behavioural

70 - 79

problems

50 - 69

30 - 49

Below 30

CAPACITY FOR INDEPENDENT LIVING

SCORE

Self-sufficient

Needs supervision of daily activities and routine financial

transactions e.g. needs to be reminded to perform routine

tasks/personal care

Needs regular help with daily activities and routine

financial

transactions

Needs major help with daily activities and routine financial

transactions

Totally dependent

(View following Conversion Table)

Table for Conversion to Work-Related Impairment Rating.

SCORE

RATING

TEN

TWENTY

TWENTY FIVE

THIRTY

THIRTY FIVE

9 or above

FORTY

TABLE 11.1 – GASTROINTESTINAL: STOMACH, DUODENUM, LIVER AND

BILIARY TRACT

Criteria

Peptic ulcer/oesophagitis /liver disease: mild symptoms despite optimal

treatment.

Nausea and vomiting: moderate symptoms despite optimal treatment

Peptic ulcer/oesophagitis: continuing frequent symptoms despite optimal

treatment

Past gastric surgery with moderate dyspepsia and dumping syndrome

Established chronic liver disease. Symptoms (e.g. fatigue, nausea) may

cause minor loss of efficiency in daily activities but rarely prevent

completion of any activity.

Constant dysphagia requiring regular dilatation

Vomiting: severe, not controlled despite optimal medication, and causing

significant weight loss

Peptic ulcer refractory to all treatment including surgery of with

complications e.g. bleeding or outlet obstruction

Established chronic liver disease. Symptoms (e.g. more persistent fatigue,

nausea, abdominal pain) may prevent or lead to avoidance of some daily

tasks and simple tasks will usually aggravate symptoms of fatigue. Most

daily activities can be completed but only with some difficulty.

Diet limited to liquid or to pureed food or long term total parenteral nutrition

Gastrostomy

Established chronic liver disease. Symptoms (e.g. ascites, bleeding

disorders, hepatic encephalopathy, more severe fatigue, nausea, vomiting)

may cause substantial difficulty with most daily tasks.

TABLE 11.2 – GASTROINTESTINAL: PANCREAS, SMALL AND LARGE BOWEL,

RECTUM AND ANUS

Criteria

Anal disorder: infrequent and minor symptoms, e.g. haemorrhoids, anal

fissures, controlled by medication

Bowel disorder, e.g., irritable bowel, diverticulosis: infrequent and minor

symptoms such as constipation or bowel disorder which respond to dietary

treatment alone.

Bowel disorder: frequent moderate symptoms despite optimal treatment

Occasional faecal soiling despite optimal treatment

Anal disorder: marked symptoms despite regular treatment

Colostomy, ileostomy - well controlled

Established chronic

pancreatic

disease

with

moderate

symptoms

(pain/steatorrhoea)

Large abdominal hernia not easily reduced and resulting in persistent

moderate symptoms.

Faecal soiling necessitating frequent changes of underwear and an

incontinence pad despite optimal treatment

Bowel disorder: marked symptoms, such as regular diarrhoea and frequent

abdominal pain, only partially controlled by optimal treatment

Colostomy, ileostomy - poorly controlled

Large abdominal hernia and/or repeated unsatisfactory hernia repairs

resulting in frequent and persistent severe symptoms

Established chronic

pancreatic

disease

with

moderate

symptoms

(pain/steatorrhoea)

Bowel disorder: diarrhoea and abdominal pain on most days, with poor

response to treatment and considerable interference with daily routine

Jejunostomy

Established chronic

pancreatic

disease

with

moderate

symptoms

(pain/steatorrhoea)

Complete faecal incontinence.

TABLE 12 – HEARING FUNCTION

Testing to be carried out without a hearing aid.

Assignment of Work-Related Impairment Rating

Percentage Loss of

Rating

Binaural Hearing

0 - 24.9

NIL

25 - 34.9

FIVE

35 - 44.9

TEN

45 - 54.9

FIFTEEN

55 - 64.9

TWENTY

65 - 74.9

TWENTY-FIVE

75 - 84.9

THIRTY

85 - 94.9

THIRTY-FIVE

95 – 100

FORTY

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 500Hz

HTL – BETTER EAR

0.6

1.0

1.4

1.4

2.0

2.8

1.8

2.5

3. 4

4. 5 2.2 3.0 3.9

5. 1

6. 4 2.6 3.4 4.3 5.5 6.8

8. 1 2.9 3.7 4.7 5.8 7.1 8.4

9. 7 3.2 4.0 5.0 6.1 7.3 8.6 9.9

11. 2 3.4 4.2 5.2 6.3 7.5 8.8 10.0 11.3

12. 6 3.5 4.4 5.4 6.5 7.7 8.9 10.2 11.5 12.7

14. 0 3.7 4.5 5.5 6.6 7.8 9.1 10.3 11.6 12.9 14.2

15. 5 3.8 4.7 5.7 6.8 8.0 9.2 10.5 11.8 13.1 14.5 15.7

16. 9 3.9 4.8 5.8 6.9 8.1 9.3 10.6 12.0 13.3 14.7 16.0

17. 2

18. 2 4.0 4.9 5.9 7.0 8.2 9.4 10.7 12.1 13.5 14.9 16.2 17.4 18.4

The guidelines in the Schedule to these regulations are being Prescription of

guidelines for

prescribed for the purposes of article 26 of the Act with regard to the claims under article

determination of the medical aspects for eligibility or otherwise of an 26 of the Act.

applicant for a claim in respect of a benefit, allowance or pension under

the Act.

2

3.2

4.0

4.9

5.9

7.0

8.2

9.4

10.7

12.1

13.5

14.9

16.2

17.4

18.4

3.4

4.1

5.0

6.0

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.3

17.6

18.5

3.4

4.2

5.1

6.1

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.4

17.6

18.6

TABELLA 12.3 - 1000 Hz

VALURI TA’ TELF PERĊENTWALI TA’ SMIGĦ LI JIKKORRISPONDU GĦAL LIVELLI

TA’ THRESHOLD TA’ SMIGĦ FIL-WIDNA T-TAJBA U FIL-WIDNA L-ĦAŻINA F’1000Hz

HTL – IL-WIDNA T-TAJBA

≤ 15

0.8

1.2

1.8

1.7

2.5

3.5

2.3

3.1

4.3

5.7

2.8

3.7

4.9

6.3

8.0

3.3

4.2

5.4

6.9

8.5

10.2

3.6

4.7

5.9

7.3

8.8

10.5

12.1

3.9

5.0

6.2

7.6

9.1

10.7

12.4

14.0

4.2

5.3

6.5

7.9

9.4

11.0

12.6

14.2

15.7

4.4

5.5

6.7

8.1

9.6

11.2

12.8

14.4

15.9

17.5

4.6

5.7

6.9

8.3

9.8

11.3

12.9

14.6

16.2

17.8

19. 4 4.7 5.8 7.1 8.5 10.0 11.5 13.1 14.8 16.4 18.1 19.7

21. 1 4.9 6.0 7.3 8.6 10.1 11.7 13.3 15.0 16.7 18.4 20.0 21.5

22. 7 5.0 6.2 7.4 8.8 10.3 11.8 13.4 15.1 16.9 18.6 20.3 21.7

1

4.1

5.0

6.0

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.3

17.6

18.5

19.2

4.2

5.1

6.1

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.4

17.6

18.6

19.3

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 1000Hz

HTL – BETTER EAR

≤ 15

0.0

0.5

0.8

0.8

1.2

1.8

1.2

1.7

2.5

3.5

1.7

2.3

3.1

4.3

5.7

2.1

2.8

3.7

4.9

6.3

8.0

2.5

3.3

4.2

5.4

6.9

8.5

10.2

2.8

3.6

4.7

5.9

7.3

8.8

10.5

12.1

3.1

3.9

5.0

6.2

7.6

9.1

10.7

12.4

14.0

3.3

4.2

5.3

6.5

7.9

9.4

11.0

12.6

14.2

15.7

3.5

4.4

5.5

6.7

8.1

9.6

11.2

12.8

14.4

15.9

17.5

3.7

4.6

5.7

6.9

8.3

9.8

11.3

12.9

14.6

16.2

17.8

19.4

3.8

4.7

5.8

7.1

8.5

10.0

11.5

13.1

14.8

16.4

18.1

19.7

21. 1 3.9 4.9 6.0 7.3 8.6 10.1 11.7 13.3 15.0 16.7 18.4 20.0 21.5

22. 7 4.1 5.0 6.2 7.4 8.8 10.3 11.8 13.4 15.1 16.9 18.6 20.3 21.7

0

4.2

5.2

6.3

7.5

8.9

10.3

11.9

13.5

15.2

17.0

18.7

20.4

21.9

23.2

4.3

5.3

6.4

7.6

8.9

10.3

11.9

13.5

15.2

17.0

18.7

20.5

22.0

23.3

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 1500Hz

HTL – BETTER EAR

0.6

1.0

1.4

1.4

2.0

2.8

1.8

2.5

3.4

4.5

2.2

3.0

3.9

5.1

6.4

2.6

3.4

4.3

5.5

6.8

8.1

2.9

3.7

4.7

5.8

7.1

8.4

9.7

3.2

4.0

5.0

6.1

7.3

8.6

9.9

11.2

3.4

4.2

5.2

6.3

7.5

8.8

10.0

11.3

12.6

3.5

4.4

5.4

6.5

7.7

8.9

10.2

11.5

12.7

14.0

3.7

4.5

5.5

6.6

7.8

9.1

10.3

11.6

12.9

14.2

15.5

3.8

4.7

5.7

6.8

8.0

9.2

10.5

11.8

13.1

14.5

15.7

16.9

3.9

4.8

5.8

6.9

8.1

9.3

10.6

12.0

13.3

14.7

16.0

17.2

18.2

4.0

4.9

5.9

7.0

8.2

9.4

10.7

12.1

13.5

14.9

16.2

17.4

18.4

19.1

4.1

5.0

6.0

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.3

17.6

18.5

19.2

4.2

5.1

6.1

7.1

8.1

9.5

10.8

12.2

13.6

15.0

16.4

17.6

18.6

19.3

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 2000Hz

HTL – BETTER EAR

0.5

0.7

1.1

1.0

1.5

2.1

1.4

1.9

2.5

3.4

1.7

2.2

2.9

3.8

4.8

1.9

2.5

3.3

4.1

5.1

6.1

2.2

2.8

3.5

4.4

5.3

6.3

7.3

2.4

3.0

3.7

4.6

5.5

6.4

7.4

8.4

2.5

3.1

3.9

4.7

5.6

6.6

7.5

8.5

9.4

2.6

3.3

4.0

4.9

5.7

6.7

7.6

8.6

9.6

10.5

2.7

3.4

4.1

5.0

5.9

6.8

7.8

8.7

9.7

10.7

11.6

2.8

3.5

4.3

5.1

6.0

6.9

7.9

8.9

9.9

10.8

11.8

12.7

2.9

3.6

4.4

5.2

6.1

7.0

8.0

9.0

10.0

11.0

12.0

12.9

13.6

3.0

3.7

4.4

5.3

6.1

7.1

8.1

9.1

10.1

11.1

12.1

13.0

13.8

14.3

3.1

3.8

4.5

5.3

6.2

7.1

8.1

9.1

10.2

11.2

12.2

13.2

13.9

14.4

3.2

3.8

4.6

5.4

6.2

7.1

8.1

9.1

10.2

11.3

12.3

13.2

14.0

14.5

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 3000Hz

HTL – BETTER EAR

0.3

0.5

0.7

0.7

1.0

1.4

0.9

1.2

1.7

2.3

1.1

1.5

2.0

2.5

3.2

1.3

1.7

2.2

2.7

3.4

4.1

1.4

1.9

2.3

2.9

3.5

4.2

4.8

1.6

2.0

2.5

3.0

3.6

4.3

4.9

5.6

1.7

2.1

2.6

3.1

3.7

4.4

5.0

5.6

6.3

1.8

2.2

2.7

3.2

3.8

4.4

5.1

5.7

6.4

7.0

1.8

2.3

2.8

3.3

3.9

4.5

5.2

5.8

6.5

7.1

7.7

1.9

2.3

2.8

3.4

4.0

4.6

5.2

5.9

6.6

7.2

7.8

8.4

2.0

2.4

2.9

3.4

4.0

4.7

5.3

6.0

6.6

7.3

8.0

8.6

9.1

2.0

2.5

3.0

3.5

4.1

4.7

5.4

6.0

6.7

7.4

8.1

8.7

9.2

9.5

2.1

2.5

3.0

3.5

4.1

4.7

5.4

6.1

6.8

7.5

8.2

8.8

9.2

9.6

2.1

2.6

3.0

3.6

4.1

4.7

5.4

6.1

6.8

7.5

8.2

8.8

9.3

9.6

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 4000Hz

HTL – BETTER EAR

≤20

0.0

0.2

0.3

0.3

0.5

0.8

0.5

0.7

1.0

1.5

0.6

0.9

1.3

1.8

2.5

0.8

1.1

1.5

2.1

2.7

3.5

0.9

1.3

1.7

2.3

2.9

3.6

4.4

1.0

1.4

1.9

2.4

3.1

3.8

4.5

5.2

1.2

1.5

2.0

2.6

3.2

3.9

4.6

5.3

6.0

1.2

1.6

2.1

2.7

3.3

3.9

4.6

5.3

6.0

6.7

1.3

1.7

2.2

2.7

3.4

4.0

4.7

5.4

6.1

6.8

7.5

1.4

1.8

2.3

2.8

3.4

4.1

4.8

5.5

6.2

6.9

7.6

8.2

1.4

1.9

2.3

2.9

3.5

4.2

4.9

5.6

6.3

7.0

7.7

8.4

8.9

1.5

1.9

2.4

3.0

3.6

4.2

4.9

5.7

6.4

7.1

7.8

8.5

9.0

9.5

1.6

2.0

2.5

3.0

3.6

4.3

5.0

5.7

6.5

7.2

7.9

8.6

9.1

9.5

1.6

2.0

2.5

3.1

3.7

4.3

5.0

5.7

6.5

7.2

8.0

8.7

9.2

9.6

TABLE 13 – VISUAL ACUITY IN THE BETTER EYE

Work-related impairment in relation to a loss of visual acuity is assessed by

measuring visual acuity. This refers to best corrected vision in the better eye

with spectacles or contact lenses (if applicable). Referral to an optometrist or

ophthalmologist may be required if there is doubt as to whether best corrected

vision has been achieved or with the accuracy of the Snellen's Chart

assessment. A person meets the criteria for permanent blindness if the

corrected visual acuity is less than 6/60 on the Snellen Scale in both eyes or

there is a combination of visual defects resulting in the same degree of

permanent visual loss.

Visual Acuity Rating

Cataract operation (unilateral and bilateral aphakia

not to receive a different rating)

Implant

Contact Lenses

Glasses

6/6

6/9

6/12

6/18

6/24 or worse

TABLE 14 – MISCELLANEOUS EYE CONDITIONS

Visual Disturbance

Squint (Heterophoria): Latent

Squint (Heterotropia): Without diplopia

Acquired Heterotropia (squint) with diplopia

one quadrant of upward gaze

all directions of upward gaze

one quadrant of downward gaze

one direction of sideways gaze

both directions of sideways gaze

all directions of gaze

all directions of downward gaz

all range of near vision

Constant irritation of eyes, photophobia, epiphora,

ectropion or entropion

Gaze defects (vertical and/or horizontal)

Glaucoma without visual loss

Longstanding Blepharospasm

Loss of stereoscopic vision in absence of squint

Permanent (e.g. blind in one eye)

Intermittent (e.g. ptosis or tarsorrhaphy)

Nystagmus without diplopia

Retinal Dystrophy with night blindness

TABLE 15 – VISUAL FIELDS

It is usually necessary to seek ophthalmological advice for an accurate

assessment under this Table. A person meets the criteria of a “visually

impaired person” under the Social Security Act if a person’s visual acuity is

certified by an ophthalmologist to be so low as to render such person unable

to perform any work for which eyesight is essential.

Type of Defect

Rating

Both eyes

Only one eye

affected (or there

affected

is only one eye

and it is affected)

Temporal Hemianopia

Nasal Hemianopia

Upper half loss

Lower half loss

Upper quadrant loss

Lower quadrant loss

Constriction outside 30 degrees of

fixation

Constriction to within 30 degrees of

fixation

Constriction to within 20 degrees of

fixation

Constriction to within 10 degrees of

permanent

fixation

blindness

TABLE 16 – LOWER URINARY TRACT

This Table is to be used for incontinence and other urethral and bladder outlet

Criteria

Minor stress incontinence. Bladder outlet or urethral obstruction with

mild symptoms.

Loss of voluntary control of bladder, but satisfactory emptying

achieved by triggering of reflex activity, suprapubic pressure or

Valsalva manoeuvre. No incontinence aid needed; or

Ileal or Sigmoid conduit; or

Chronic Urinary Obstruction needing regular catheterisation.

Loss of voluntary control of bladder with dribbling incontinence

needing frequent change of incontinence pads, or a collection device,

e.g. urodome catheter; or

Ureterosigmoidostomy.

TABLE 17 – RENAL FUNCTION

As renal disease has systemic effects, assessment of renal impairment as it

impacts on work capacity is based upon the loss of function resulting from

these systemic effects. For example, for persistent generalised symptoms

such as fatigue use Table 20, refractory anaemia is assessed using Table 20,

persistent gastrointestinal symptoms (e.g.. vomiting) despite optimal treatment

are assessed using Table 11 and persistent Central Nervous System

symptoms using Table 8. Renal transplants are assessed using Table 20.

Dialysis is rated as follows

Criteria

All types of dialysis (except outpatient haemodialysis) which are

functioning well. Some decreased ability to carry out everyday

activities but independence is retained.

Outpatient haemodialysis and all types of dialysis which are

functioning poorly. More severe symptoms with a decreased ability to

carry out many everyday activities. Most daily activities can be

completed with some difficulty. Symptoms may prevent or lead to

avoidance of some daily tasks and simple tasks will usually aggravate

symptoms of fatigue.

End stage renal disease with very severe symptoms which lead to

substantial difficulties with most daily tasks.

End stage renal disease leading to major restrictions in many

everyday activities. Capacity for self-care is restricted leading to

dependence on others.

TABLE 18 – SKIN DISORDERS

In the evaluation of work-related impairment resulting from a skin disorder, the

actual functional loss is the prime consideration. However, where there is

extensive cosmetic or cutaneous involvement, this should also be considered.

Criteria

Signs and symptoms of skin disorder present and with treatment

there is NO limitation in the performance of normal daily activities.

Signs and symptoms of skin disorder present despite optimal

treatment and results in some interference with normal daily activities.

Signs and symptoms of skin disorder present despite optimal

treatment and results in significant interference with normal daily

activities.

Very severe symptoms requiring continuous treatment which may

include periodic confinement to home or hospital and needs

considerable assistance with normal daily activities.

TABLE 19 – ENDOCRINE DISORDERS

The effects of endocrine disorders e.g. diabetes mellitus on other body

systems e.g. the vascular and visual systems should be assessed from the

appropriate tables and added together with values from this table.

Criteria

Thyroid disease, Acromegaly, Cushing's disease, Prolactinoma,

Diabetes Mellitus, Diabetes Insipidus, Parathyroid Disease, Paget's

disease, Osteoporosis, Addison's Disease adequately controlled with

hormone replacement and/or surgery and/or radiotherapy and/or

therapeutic agents.

Thyroid disease, Acromegaly, Cushing's disease, Prolactinoma,

Diabetes Insipidus, Parathyroid Disease, Paget's disease or

Osteoporosis which is incompletely controlled or treated e.g.

symptomatic Paget's disease, osteoporosis or other bone disease

with pain not completely controlled by continuous therapy.

Diabetes mellitus or Addison's Disease not satisfactorily controlled

despite vigorous therapy as indicated by for example frequent

hospital admissions, recurrent hypoglycaemic or hypotensive

episodes and/or progressive end organ damage.

TABLE 20 – MISCELLANEOUS – MALIGNANCY, HYPERTENSION, HIV

INFECTION, MORBID OBESITY (i.e. BMI >40), HEART / LIVER/ KIDNEY

TRANSPLANTS, MISCELLANEOUS EAR / NOSE / THROAT CONDITIONS &

CHRONIC FATIGUE OR PAIN

Table 20 can be used for miscellaneous conditions, for example, malignancy, HIV

infection, morbid obesity, transplants, miscellaneous ear/nose/throat conditions,

disorders with chronic fatigue (including Chronic Fatigue Syndrome) or pain and

hypertension. Where there is a separate loss of function, in addition to the loss

which can be rated using the system-specific Tables, Table 20 can be used. Double-

counting of a particular loss of function, by the use of more than one Table, must be

Criteria

Controlled hypertension

Malignancy in remission with a good to fair prognosis

Minor symptoms which are easily tolerated and have no appreciable effect

on ability to work.

Mild to moderate symptoms which are irritating or unpleasant but which

rarely prevent completion of any activity. Symptoms may cause loss of

efficiency in daily activities but minimal interference performing or persisting

with work-related tasks. There is minimal effect/impact on work attendance

Hypertension that is difficult to control despite intensive therapy but without

end-organ damage

Potentially life-threatening condition which is currently not interfering with

daily activities e.g. malignancy in remission with a poor prognosis

Heart/Liver/Kidney transplants - well controlled (well functioning) with only

mild systemic symptoms.

Moderate to severe symptoms which are more distressing but prevent few

everyday activities. Self-care is unaffected and independence is retained.

Symptoms may have mild to moderate impact on ability to perform or persist

with work-related tasks and/or attend work. Full-time work would still be

possible

Potentially life-threatening condition which is currently interfering with daily

activities but self-care is unaffected.

More severe symptoms with a decreased ability/efficiency to carry out many

everyday activities. Most daily activities can be completed with some

difficulty. Symptoms may prevent or lead to avoidance of some daily tasks

and simple tasks will usually aggravate symptoms of fatigue. Symptoms

cause significant interference with ability to perform or persist with work-

related tasks. Symptoms may cause prolonged absences from work.

Very severe symptoms which lead to substantial difficulty with most daily

tasks. Assistance with elements of self-care may be required. Symptoms

cause severe interference with ability to work or attend work (i.e. minimal

residual work capacity).

Heart/Liver/Kidney transplants - poorly controlled (poorly functioning) with

fairly severe symptoms which lead to substantial difficulty with most daily

tasks.

Malignant hypertension - severe, uncontrolled.

Inoperable, symptomatic and life-threatening aneurysm or malignancy. Very

poor prognosis with only a very limited lifespan.

Major restrictions in many everyday activities. Capacity for self-care is

restricted, leading to dependence on others. No residual work capacity.

TABLE 21 – INTERMITTENT CONDITIONS

Intermittent but continuing disorders that remain asymptomatic between

discrete episodes of impairment e.g. gout, epilepsy, Meniere's Disease,

vertigo & tinnitus (only to be scored in the presence of a diagnosed condition

causing these symptoms but if the symptoms are continuous Table 20 should

be used) are rated by reference to severity, duration and frequency of attacks

(a)

severity during an attack is defined in the descriptions below;

(b)

duration is defined in the descriptions below;

(c)

frequency is determined by the number of affected days in a year.

A rating using the above three factors is made by first coding severity and

duration into an intermittent grading. The code is then combined with

frequency, using Table 21.4, to give the rating.

Some intermittent disorders may be rated using system-specific tables. The

system-specific table is then used in preference e.g. severe asthma where

there is persistent airway limitation.

When episodes vary in severity, duration or frequency, an average for each

factor should be estimated. More than one rating may be given for the same

disorder. Thus for grand mal epilepsy one rating is given for the ictal phase

and a second rating for the post-ictal stage. The two are then added together.

For acute exacerbations of chronic disorders, where the acute relapses are

frequent and severe, the Intermittent Tables can be used in addition to the

primary score derived for the underlying medical condition e.g. frequent

attacks of acute bronchitis can be scored using Table 21 in addition to Table 1

or 2 for Chronic Airways Limitation and the scores added together.

TABLE 21.1 - INTERMITTENT ATTACK - SEVERITY LEVEL CRITERIA

Criteria

Minor symptoms which are easily tolerated.

Mild to moderate symptoms which are irritating or unpleasant but

which rarely prevent completion of any activity. Symptoms may cause

loss of efficiency in some activities.

More severe symptoms which are distressing, but prevent few

everyday activities. Loss of efficiency is discernible elsewhere. Self-

care is unaffected and independence is retained.

Loss of efficiency is discernible in many everyday activities. Some

elements of self-care are restricted but in most respects,

independence is retained. Bed-rest is often necessary during an

attack.

Major restrictions in many everyday activities. Capacity for self-care is

increasingly restricted, leading to partial dependence on others.

Most everyday activities are prevented. Dependent on others for

many kinds of self-care. Able to be maintained at home only with

considerable difficulty, or hospital admission is required.

Total incapacity. Unconscious or delirious. Self-care is impossible.

TABLE 21.2 - INTERMITTENT ATTACK - DURATION

Description

Duration

Transient

Lasting up to and including five minutes.

Lasting more than five minutes but less than 30 minutes.

Lasting from 30 minutes to four hours.

Prolonged

Lasting more than four hours.

TABLE 21.3 - SEVERITY -GRADING CODE DESCRIPTION SEVERITY

LEVEL

Description

Level

Transient

A

A

A

B

C

C

F

Short

A

A

C

C

D

E

H

Medium

A

B

C

D

E

H

I

Prolonged

A

C

D

F

G

I

J

A rating is obtained using Table 21.3 and Table 21.4

(a) determine the intermittent grading code appropriate to the estimated

severity and duration from Table 21.3; and

(b) make the rating appropriate to the intermittent grading code and

frequency from Table 21.4.

TABLE 21.4 - ASSIGNMENT OF A RATING

Frequency (Affected

days/year)

2+

5+

10+

20+

40+

100+

Intermittent

Rating

Grading Code

A

-

-

-

-

-

-

B

-

-

-

-

-

C

-

-

-

-

D

-

-

-

E

-

-

-

F

-

-

G

-

-

H

-

-

I

-

J

TABLE 22 – GYNAECOLOGICAL CONDITIONS

Gynaecological conditions such as pelvic inflammatory disease and

endometriosis should be assessed using Table 22. The Medical Officer

should only use this Table for significant diagnosed conditions affecting

normal daily functioning and which are likely to continue for the foreseeable

future. Malignancy should be scored using Table 20. Disability due to

mastectomy should only be scored where there is an associated loss of upper

limb function and Table 3 should then be used. Post-natal depression may be

scored using Table 6 if considered to be adversely affecting function for the

next year. For males, disorders of the genital system should be assessed

under Tables 16 or 17.

Criteria

Minor symptoms which are easily tolerated. Minimal effect on daily

functioning or work capacity.

Moderate and frequent symptoms present despite treatment due to a

condition which has been properly diagnosed. Some decreased ability

to carry out every day activities but independence is retained.

Moderate to severe symptoms frequently present despite optimal

treatment due to a condition which has been properly diagnosed.

Decreased ability to carry out everyday activities, requiring assistance

with elements of self-care.

More severe symptoms frequently present despite optimal treatment

due to a condition which has been properly diagnosed. This results in

substantial difficulties with most daily tasks.

Severe symptoms frequently present despite optimal treatment due to

a condition which has been properly diagnosed and needs

considerable assistance with many daily activities.