IMPAIRMENT TABLES REGULATIONS

IMPAIRMENT TABLES

SUBSIDIARY LEGISLATION 318.21

IMPAIRMENT TABLES REGULATIONS

1st July, 2007

LEGAL NOTICE 170 of 2007.

The title of these regulations is the Impairment Tables

Regulations.

(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.

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 O 2 /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

travelling in a car as passenger

telephone

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

moving around

setting table

playing billiards

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

shifting chairs

light gardening (weed/

bench assembly work (sitting)

water)

hanging out washing

playing golf (with power

light carpentry (chiselling,

buggy)

hammering, sawing and planing

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

mopping floors

gentle swimming

stocking shelves with light objects

golf (pulling buggy,

ballroom dancing

carrying bag)

beating carpets

stacking firewood

painting outside of house

polishing furniture

cleaning windows

wallpapering

hoeing (soft soil)

pushing light power mower

walking 6.5 km/hr (sustained

over flat suburban lawn at

brisk walk, discomfort talking at

showering

slow, steady pace

the same time)

cleaning car (excludes

vigorous polishing)

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

shovelling dirt (12 throws/

digging in garden

walking slowly but steadily up

min.)

stairs

tennis doubles (social non-

scrubbing floors

pushing a full wheelbarrow

competitive)

(20kg)

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

using pick & shovel to dig

tools

trenches

IMPAIRMENT TABLES

tennis (singles, non-

swimming laps (non-

competitive)

competitive)

8-9 METs

running (9km/hr)

chopping hardwood

10 METs

running (9km/hr) (non-

cycling quickly (25 km/hr)

carrying loads (10kg) up a

competitive)

gradient

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)

IMPAIRMENT TABLES

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.

FIFTEEN D e m o n s t r a b l e e v i d e n c e o f m a j o r l o s s o f s t r e n g t h , m o b i l i t y,

coordination, dexterity and/or sensation of non-dominant upper limb

which causes significant interference with hand function or manual

handling.

TWENTY D e m o n s t r a b l e e v i d e n c e o f m a j o r l o s s o f s t r e n g t h , m o b i l i t y,

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.

THIRTY Unable to use dominant upper limb at all.

IMPAIRMENT TABLES

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 functions.

Criteria

Walks without difficulty on a variety of different terrains and at

varying speeds for distances of more than 500m.

D e m o n s t r a b l e l o s s o f s t r e n g t h , m o b i l i t y, s t a b i l i t y, b a l a n c e ,

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.

TWENTY D e m o n s t r a b l e l o s s o f s t r e n g t h , m o b i l i t y, s t a b i l i t y, b a l a n c e ,

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.

THIRTY 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.

FORTY 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

function.

TABLE 5.1 - CERVICAL SPINE

Rating

Criteria

NIL

Normal or nearly normal range of movement.

FIVE

Loss of quarter of normal range of movement.

TEN

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.

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

pain.

THIRTY Loss of almost all movement, or complete ankylosis in position of

function.

FORTY 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.

Rating

Criteria

NIL

Normal or nearly normal range of movement.

FIVE

Loss of one-quarter of normal range of movement.

TEN

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.

TWENTY 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.

FORTY Ankylosis in an unfavourable position, or unstable joint.

IMPAIRMENT TABLES

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).

TWENTY 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.

THIRTY 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).

FORTY 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

NIL

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

functioning or work capacity.

FIVE

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

temporary absence from work.

TWENTY Dependence on alcohol or other drugs, well established over time,

which is sufficient to cause prolonged absences from work. Reversible

end organ damage may be present.

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

years, with minimal residual work capacity. Irreversible end organ

damage may be present.

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

disability 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.

Rating

Criteria

NIL

Comprehension, reasoning and memory are comparable with peers or

only minor difficulties.

IMPAIRMENT TABLES

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.

TWENTY 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.

Criteria

Satisfactory or only minor difficulties with communication

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.

IMPAIRMENT TABLES

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

Normal

No or only mild behavioural problems

70 - 79

Moderate to severe behavioural

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.

TWENTY 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.

THIRTY 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.

IMPAIRMENT TABLES

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.

TWENTY 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)

THIRTY 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)

FORTY 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 Binaural Hearing

Rating

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

IMPAIRMENT TABLES

TABLE 12.2 - 500 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 15 20 25 30

35 40

< 95

WORSE EAR

0.0

0.4 0.6

0.6 1.0 1.4

1.0 1.4 2.0 2.8

1.3 1.8 2.5 3.4 4.5

1.7 2.2 3.0 3.9 5.1 6.4

2.0 2.6 3.4 4.3 5.5 6.8 8.1

2.3 2.9 3.7 4.7 5.8 7.1 8.4

The guidelines in the Schedule are being prescribed for the

purposes of article 26 of the Social Security Act with regard to the

determination of the medical aspects for eligibility or otherwise of

an applicant for a claim in respect of a benefit, allowance or

pension under the said Act.

IMPAIRMENT TABLES

7

2.5 3.2 4.0 5.0 6.1 7.3 8.6

9.9 11.2

2.7 3.4 4.2 5.2 6.3 7.5 8.8 10.0 11.3 12.6

2.8 3.5 4.4 5.4 6.5 7.7 8.9 10.2 11.5 12.7 14.0

2.9 3.7 4.5 5.5 6.6 7.8 9.1 10.3 11.6 12.9 14.2 15.5

3.0 3.8 4.7 5.7 6.8 8.0 9.2 10.5 11.8 13.1 14.5 15.7 16.9

3.1 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

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 19.1

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 19.2 19.7

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 19.3 19.7 20.0

TABLE 12.3 - 1000 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 15 20 25 30 35

< 95

WORSE EAR

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 23.0 23.9

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 24.1 24.6

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 24.2 24.7 25.0

TABLE 12.4 - 1500 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 15 20 25 30 35

< 95

HTL –

WORSE EAR

< 15

0.0

0.4 0.6

0.6 1.0 1.4

1.0 1.4 2.0 2.8

1.3 1.8 2.5 3.4 4.5

1.7 2.2 3.0 3.9 5.1 6.4

2.0 2.6 3.4 4.3 5.5 6.8

8.1

2.3 2.9 3.7 4.7 5.8 7.1

8.4

9.7

2.5 3.2 4.0 5.0 6.1 7.3

8.6

9.9 11.2

2.7 3.4 4.2 5.2 6.3 7.5

8.8 10.0 11.3 12.6

2.8 3.5 4.4 5.4 6.5 7.7

8.9 10.2 11.5 12.7 14.0

2.9 3.7 4.5 5.5 6.6 7.8

9.1 10.3 11.6 12.9 14.2 15.5

3.0 3.8 4.7 5.7 6.8 8.0

9.2 10.5 11.8 13.1 14.5 15.7 16.9

3.1 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

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 19.1

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 19.2 19.7

< 95

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 19.3 19.7 20.0

TABLE 12.5 - 2000 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 15 20 25 30 35

< 95

HTL –

WORSE EAR

< 15

0.0

0.3 0.5

0.5 0.7 1.1

0.7 1.0 1.5 2.1

1.0 1.4 1.9 2.5 3.4

1.3 1.7 2.2 2.9 3.8 4.8

1.5 1.9 2.5 3.3 4.1 5.1

6.1

1.7 2.2 2.8 3.5 4.4 5.3

6.3

7.3

1.9 2.4 3.0 3.7 4.6 5.5

6.4

7.4 8.4

2.0 2.5 3.1 3.9 4.7 5.6

6.6

7.5 8.5 9.4

2.1 2.6 3.3 4.0 4.9 5.7

6.7

7.6 8.6 9.6 10.5

2.2 2.7 3.4 4.1 5.0 5.9

6.8

7.8 8.7 9.7 10.7 11.6

2.3 2.8 3.5 4.3 5.1 6.0

6.9

7.9 8.9 9.9 10.8 11.8 12.7

2.4 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

2.4 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

2.5 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 14.8

< 95

2.6 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 14.8 15.0

IMPAIRMENT TABLES

TABLE 12.6 - 3000 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 15 20 25 30 35

< 95

HTL –

WORSE EAR

< 15

0.0

0.2 0.3

0.3 0.5 0.7

0.5 0.7 1.0 1.4

0.7 0.9 1.2 1.7 2.3

0.8 1.1 1.5 2.0 2.5 3.2

1.0 1.3 1.7 2.2 2.7 3.4

4.1

1.1 1.4 1.9 2.3 2.9 3.5

4.2

4.8

1.2 1.6 2.0 2.5 3.0 3.6

4.3

4.9 5.6

1.3 1.7 2.1 2.6 3.1 3.7

4.4

5.0 5.6 6.3

1.4 1.8 2.2 2.7 3.2 3.8

4.4

5.1 5.7 6.4

7.0

1.5 1.8 2.3 2.8 3.3 3.9

4.5

5.2 5.8 6.5

7.1

7.7

1.5 1.9 2.3 2.8 3.4 4.0

4.6

5.2 5.9 6.6

7.2

7.8

8.4

1.6 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

1.6 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

1.7 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

9.8

< 95

1.7 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

9.8 10.0

TABLE 12.7 - 4000 Hz

VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN

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

HTL - BETTER EAR

< 20

90 < 95

HTL –

WORSE 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

9.8

< 95

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

9.8 10.0

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

spe ctacles or contac t le nse s (if a ppli c a bl e ) . R e f e r r a l t o a n op t om e tr i s t o r

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

Rating

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 gaze

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

Rate as for visual

acuity

Retinal Dystrophy with night blindness

Rate as for visual

acuity and visual fields

IMPAIRMENT TABLES

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

Type of Defect

Rating

Only one eye

Both eyes

affected

affected (or

there 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 fixation

permanent

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.

TWENTY 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.

TWENTY O u tp a t ie n t h a e m o d i a l y s i s a n d a ll t y p e s o f d i a l y s i s w h i c h a r e

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.

THIRTY End stage renal disease with very severe symptoms which lead to

substantial difficulties with most daily tasks.

FORTY 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 sy mpt om s of skin di so rder p resent despit e op tim al

treatment and results in some interference with normal daily activities.

TWENTY Signs and sy mpt om s of skin di so rder p resent despit e op tim al

treatment and results in significant interference with normal daily

activities.

FORTY Very severe symptoms requiring continuous treatment which may

include periodic confinement to home or hospital and needs

considerable assistance with normal daily activities.

IMPAIRMENT TABLES

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,

D i a b e t e s I n s i p i d u s , P a r a t h y r o i d D i s e a s e , P a g e t ’s d i s e a s e o r

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.

TWENTY 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.

TWENTY 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 workrelated tasks. Symptoms may cause

prolonged absences from work.

THIRTY 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.

FORTY 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

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.

IMPAIRMENT TABLES

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.

Medium

Lasting from 30 minutes to four hours.

Prolonged

Lasting more than four hours.

TABLE 21.3 - SEVERITY -GRADING CODE DESCRIPTION SEVERITY

Description

Level

A

A

A

B

C

C

F

A

A

C

C

D

E

H

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 Grading Code

Rating

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.

TWENTY 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.

THIRTY 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.

FORTY Severe symptoms frequently present despite optimal treatment due to

a condition which has been properly diagnosed and needs considerable

assistance with many daily activities.