S.L. 318.21 Art. 2Prescription of guidelines for claims under article 26 of the Social Security Act. Cap. 318. NOTE: In as outlined Department of TABLE 1 FUNCTION: tolerance. A which causes defined as The clinical be used but in with the clinical Function Test The Peripheral veins are assessed under cardiac and Episo

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.

SCHEDULE (Regulation 2)

Impairment Tables used to assess Work-Related Impairments and determine Eligibility to a Pension in respect of Invalidity.

the Assessment of Work Related Impairments these Tables are to be used in the official guide on Work Related Impairments issued by the Social Security. - LOSS OF CARDIOVASCULAR AND/OR RESPIRATORY EXERCISE TOLERANCE Cardiovascular and Respiratory Function is measured by reference to exercise rating is obtained from Table 1 by determining the lowest MET band restriction in activity from a cardiac or respiratory condition. 1 MET is average oxygen consumption at rest which is 3.5mL O /kg/min. 2 judgement of medical officers based on history and examination is to cases where a reliable history is difficult to obtain despite discussions treating doctor or the history of exercise tolerance is inconsistent with findings on examination, the results of an Exercise ECG or Respiratory may be obtained.

appropriate MET level is calculated using the lists in Table 1.2. Vascular Disease is assessed under the lower limb Table 4. Varicose assessed under either the Lower Limb or Skin Table. Hypertension is Table 20. Where exercise intolerance is caused by a combination of respiratory conditions, Table 1 is to be used and used only once. conditions such as cardiac arrhythmias and episodic asthma should be Table 21 unless they are exercise induced.

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

- METABOLIC COST OF ACTIVITIES

is a more comprehensive set of activities, with their corresponding One MET represents the energy level expenditure associated with the of 3.5ml O /kg body weight/minute. Please use this list to assist you in 2 appropriate symptomatic MET level for the claimant. determining the symptomatic activity level, greater reliance is placed on which involve a steady expenditure of energy (e.g. walking steadily for 10 opposed to a sporadic expenditure of energy (e.g. playing one hole of former activities are more reliable indicators of exercise tolerance. Less placed on activities which can be completed in less than a few minutes, as take longer than this to occur.

Cost of Activities 1-2 METs Energy expended at rest or minimal activity:

lying down sitting and drinking tea using sewing machine sitting down sitting and talking on travelling in a car telephone strolling (slowly) standing typing sitting and knitting 2-3 METs Energy expended to dress, wash and perform light household walking 3.5km/hr (slowly) playing piano/ violin/ organ clerical work which moving setting table playing billiards washing dishes driving power boat bench assembly dressing light sweeping using self-propelled light tidying, dusting horseback riding at walk polishing driving a car lawn bowls making 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 shifting chairs light gardening (weed/ bench assembly water) hanging out washing playing golf (with power light carpentry buggy) hammering, sawing with hand tidying house (includes welding carrying heavy objects) 4-5 METs Moderate activities: encompasses more active daily activities exclusion of manual labour and vigorous exercise:

mopping floors gentle swimming stocking shelves with golf (pulling buggy, ballroom dancing carrying bag) beating carpets stacking firewood painting outside polishing furniture cleaning windows wallpapering hoeing (soft soil) pushing light power mower walking 6.5 km/hr over flat suburban lawn at brisk walk, discomfort showering slow, steady pace the same cleaning car (excludes vigorous polishing) 5-6 METs Heavy exercise: manual labour or vigorous sports:

shovelling dirt (12 throws/ digging in garden walking slowly min.) stairs tennis doubles (social non- scrubbing floors pushing a full competitive) (20kg)

6-7 METs:

loading truck with bricks pace walking carrying load upstairs 7-8 METs Very heavy exercise:

jogging (8km/hr) sawing hardwood with hand using pick & shovel tools trenches (singles, non- swimming laps (non-competitive) competitive)

(9km/hr) chopping hardwood

(9km/hr) (non- cycling quickly (25 km/hr) carrying loads (10kg) up a competitive) gradient

- LOSS OF RESPIRATORY FUNCTION: PHYSIOLOGICAL MEASUREMENTS function is measured by reference to exercise tolerance in the majority so Table 1 is used. Spirometry can be used where the medical officer more appropriate for example, where a history of exercise tolerance is obtain and assess or the history of exercise tolerance is inconsistent with findings on examination. A rating is then obtained using Table 2. nomograms for the forced expiratory volume over one second (FEV1) vital capacity (FVC) are at Tables 2.2 and 2.3. Measurements of Expiratory Volume in one second and Forced Vital Capacity should be a vitalograph or equivalent instrument. Ideally, three readings should the best of these used to calculate a rating. Calculate the ratio of FEV1 against the predicted figures as a percent. Testing pre- and post-bronchodilatation is unnecessary as the aim of assessment under this Table is to in their "normal" state. Furthermore, this Table is only to be used for irreversible lung disease. The FEV1 is usually selectively reduced in Airflow Limitation and the FVC in Restrictive Lung Disorders. The FEV1 in preference to the FVC where there is a discrepancy between the Airflow Limitation. 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

(cm) (litre) (litre) 190

6 5

180

5 4

170

4 3

160

3 2

150

2

140 Prediction nomogram - females From Kamburoff, Petia L., and Woitowitz, H.J. & R.H. (1972)

FVC FEV1 Age (litre) (litre) (years) 20

4

3 30

40

3

2 50

60

2

70 TABLE 3 - UPPER LIMB FUNCTION All upper limb problems are assessed under the upper limb Table (Table arm is assessed separately. Determination of upper limb impairments on a demonstrable loss of function. Rating Criteria Can use dominant limb effectively; and/or NIL Demonstrable evidence of loss of strength, mobility, dexterity and/or sensation of upper limb which interference with hand function or manual handling. FIVE Demonstrable evidence of loss of strength, mobility, dexterity and/or sensation of non-dominant upper limb moderate interference with hand function or manual handling. TEN Demonstrable evidence of loss of strength, mobility, dexterity and/or sensation of dominant upper limb moderate interference with hand function or manual handling. FIFTEEN Demonstrable evidence of major loss of streng coordination, dexterity and/or sensation of non-dominant which causes significant interference with hand function handling. TWENTY Demonstrable evidence of major loss of streng coordination, dexterity and/or sensation of dominant upper causes significant interference with hand function or manual or Unable to use non-dominant upper limb at all. THIRTY Unable to use dominant upper limb at all. FUNCTION OF THE LOWER LIMBS used to assess lower limb not spinal function (see Table 5). Assess both together. Determination of lower limb impairments must be based on a loss of functions. 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 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 pain or loss of three quarters of normal range of movement infrequent neck pain. TWENTY Loss of three-quarters of normal range of movement and pain. THIRTY Loss of almost all movement, or complete ankylosis 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 of the trunk including hip movement and is not intended to measure 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 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 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. PSYCHIATRIC IMPAIRMENT important to record a detailed psychiatric history, a mental state examination, distinguish between temporary and permanent psychiatric disorders. People established psychiatric disorders (e.g. Bipolar Disorder) may be highly variable clinical presentation and this factor must be taken into account in the The assessment of psychiatric impairment may benefit from reports from mental health case managers, compliance with and the medication, support systems that people have in place, the degree of and the presence of psychotic illness. Where a person has a short for example an adjustment disorder with depression following an marital breakdown, initially this should usually be considered to be of a nature. Table 6 is used for permanent psychiatric disorders only. If there is clinical information available, a current or recent specialist report should

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 on this Table should only be assigned where the person's medical and history and presentation consistently indicate chronic entrenched drug dependence. It should also be causing a functional impairment; the alcohol does not in itself constitute or necessarily indicate permanent Any associated neurological functions or end organ damage should also on the appropriate tables in addition to Table 7. The ratings are then to obtain a total work-related impairment rating. When applying this Table, consideration should be given to the known and behavioural effects of particular substances.

Rating Criteria NIL A pattern of alcohol or drug use with no or only minor effects functioning or work capacity. FIVE A pattern of alcohol or drug use sufficient to cause intermittent temporary absence from work. TWENTY Dependence on alcohol or other drugs, well established which is sufficient to cause prolonged absences from work. end organ damage may be present. THIRTY Dependence on alcohol or other drugs, well entrenched years, with minimal residual work capacity. Irreversible damage may be present. FORTY Pattern of heavy alcohol or other drug use with severe disability and irreversible end organ damage.

TABLE 8 - NEUROLOGICAL FUNCTION: MEMORY, PROBLEM DECISION MAKING ABILITIES AND COMPREHENSION Table 8 is used to rate impairment of higher neurological functions problem solving, decision making ability and comprehension. Loss within this group is rated only once using this Table. If there functional losses, these are also assessed using other relevant Tables. People with acquired brain injury may have associated problems and/or insight. These impairments may be rated using both Table 8 and If there is insufficient clinical information available on cognitive current or recent specialist report should be obtained (e.g. neurologist, physician or neuropsychologist). The report should address comprehension, memory, ability to concentrate, problem solving, loss fatigue or any associated behavioural abnormalities or disorders.

Rating Criteria NIL Comprehension, reasoning and memory are comparable 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 LANGUAGE COMPETENCY This Table measures communication and language competency and receptive (processing) and expressive language impairment. Hearing impaired language processing or expression should be scored using Table 12. Hearing loss with normal language competency should only Table 12. Where language impairment is an effect of cognitive loss, should be assigned using Table 8 to reflect the combined loss of language function. Where language impairment is separate or additional cognitive impairment, these losses may be rated using Table 8 and following factors should be considered in determining an impairment

(a) the ability to independently and successfully use appropriate devices, aids or strategies to reduce the impact of the impairment;

(b) the ability to make use of environmental cues and resources sign interpreters in the case of deaf people) to reduce the impairment;

(c) intactness of other channels of communication: reading, verbal language;

(d) the degree of effort required by the communication partner(s) particular communication setting;

(e) appropriateness and degree of success of communicative If there is insufficient clinical information available on communication current or recent specialist report should be obtained (e.g. speech neurologist or neuropsychologist). The report should comment communication status, including the capacity to utilise compensatory 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 unable to adapt or manage interruption but competent communication in favourable settings. Could work in a wide range of occupations high public contact and high communication content jobs demanding. TWENTY Communication is effortful and limited. A communication required to assist in interpreting the information. Unable rapid change in topic or complex/abstract information understand simple sentences & follow information from gestures. Could work in open employment in a limited occupations but could not manage jobs which communication demands or public contact. THIRTY Communication is very limited. May be able to use context message and may be able to comprehend material if rephrased or represented in another format. May convey via a YES/NO response. Unlikely to cope with open unless work tasks had minimal communication requirements. 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.

- INTELLECTUAL DISABILITY

is only to be used for intellectual disability. Three key criteria are using the Weschler Adult Intelligence Scale (Revised WAIS-R) and two functioning: adaptive behaviour and capacity for independent living. is given a score for each and the three scores are then added. The final converted to a work-related impairment rating using the table below. A be assigned for the two social functioning criteria if a score has been a low IQ. Where it is clear that the person is moderately to severely impaired, formal psychometric testing may not be necessary but in mild cases where no formal testing has been performed, this should

INTELLIGENCE (IQ) SCORE ADAPTIVE BEHAVIOUR SCORE 0 No or only mild behavioural problems 0 79 3 Moderate to severe behavioural 3 problems 69 5 49 6 30 8

FOR INDEPENDENT LIVING

SCORE 0 supervision of daily activities and routine financial transactions 3 be reminded to perform routine tasks/personal care help with daily activities and routine financial transactions 4 help with daily activities and routine financial transactions 5 dependent 6

following Conversion Table) Conversion to Work-Related Impairment Rating.

SCORE RATING 3 TEN 5 TWENTY 6 TWENTY-FIVE 7 THIRTY 8 THIRTY-FIVE 9 or above FORTY TABLE 11.1 - GASTROINTESTINAL: STOMACH, DUODENUM, BILIARY TRACT Rating Criteria NIL Peptic ulcer/oesophagitis /liver disease: mild symptoms optimal treatment. TEN Nausea and vomiting: moderate symptoms despite optimal Peptic ulcer/oesophagitis: continuing frequent symptoms optimal treatment Past gastric surgery with moderate dyspepsia and dumping Established chronic liver disease. Symptoms (e.g. fatigue, may cause minor loss of efficiency in daily activities prevent completion of any activity. TWENTY Constant dysphagia requiring regular dilatation Vomiting: severe, not controlled despite optimal medication, causing significant weight loss Peptic ulcer refractory to all treatment including surgery complications e.g. bleeding or outlet obstruction Established chronic liver disease. Symptoms (e.g. more fatigue, nausea, abdominal pain) may prevent or lead to some daily tasks and simple tasks will usually aggravate fatigue. Most daily activities can be completed but only difficulty. THIRTY Diet limited to liquid or to pureed food or long term total nutrition Gastrostomy Established chronic liver disease. Symptoms (e.g. ascites, disorders, hepatic encephalopathy, more severe fatigue, vomiting) may cause substantial difficulty with most daily 11.2 - GASTROINTESTINAL: PANCREAS, SMALL AND LARGE 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 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 - 500 Hz OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 500Hz HTL - BETTER EAR

15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 < 95

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 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

- 1000 Hz OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 1000Hz HTL - BETTER EAR

15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 < 95

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 HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS HTL - BETTER EAR

< 15 20 25 30 35 40 45 50 55 60 65 70 75 80 HTL – WORSE EAR < 15 0.0 20 0.4 0.6 25 0.6 1.0 1.4 30 1.0 1.4 2.0 2.8 35 1.3 1.8 2.5 3.4 4.5 40 1.7 2.2 3.0 3.9 5.1 6.4 45 2.0 2.6 3.4 4.3 5.5 6.8 8.1 50 2.3 2.9 3.7 4.7 5.8 7.1 8.4 9.7 55 2.5 3.2 4.0 5.0 6.1 7.3 8.6 9.9 11.2 60 2.7 3.4 4.2 5.2 6.3 7.5 8.8 10.0 11.3 12.6 65 2.8 3.5 4.4 5.4 6.5 7.7 8.9 10.2 11.5 12.7 14.0 70 2.9 3.7 4.5 5.5 6.6 7.8 9.1 10.3 11.6 12.9 14.2 15.5 75 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 80 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 85 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 90 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 < 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

TABLE 12.5 - 2000 Hz VALUES OF PERCENTAGE LOSS OF HEARING CORRESPONDING HEARING THRESHOLD LEVELS IN THE BETTER AND WORSE EARS HTL - BETTER EAR

< 15 20 25 30 35 40 45 50 55 60 65 70 75 80 HTL – WORSE EAR < 15 0.0 20 0.3 0.5 25 0.5 0.7 1.1 30 0.7 1.0 1.5 2.1 35 1.0 1.4 1.9 2.5 3.4 40 1.3 1.7 2.2 2.9 3.8 4.8 45 1.5 1.9 2.5 3.3 4.1 5.1 6.1 50 1.7 2.2 2.8 3.5 4.4 5.3 6.3 7.3 55 1.9 2.4 3.0 3.7 4.6 5.5 6.4 7.4 8.4 60 2.0 2.5 3.1 3.9 4.7 5.6 6.6 7.5 8.5 9.4 65 2.1 2.6 3.3 4.0 4.9 5.7 6.7 7.6 8.6 9.6 10.5 70 2.2 2.7 3.4 4.1 5.0 5.9 6.8 7.8 8.7 9.7 10.7 11.6 75 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 80 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 85 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 90 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 < 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 - 3000 Hz OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 3000Hz HTL - BETTER EAR

15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 < 95

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 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

- 4000 Hz OF PERCENTAGE LOSS OF HEARING CORRESPONDING TO GIVEN THRESHOLD LEVELS IN THE BETTER AND WORSE EARS AT 4000Hz HTL - BETTER EAR

< 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 < 95

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 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 measuring visual acuity. This refers to best corrected vision in the spectacles or contact lenses (if applicable). Referral to an op ophthalmologist may be required if there is doubt as to whether best corrected has been achieved or with the accuracy of the Snellen&apos;s Chart assessment. meets the criteria for permanent blindness if the corrected visual acuity 6/60 on the Snellen Scale in both eyes or there is a combination of resulting in the same degree of permanent visual loss. Visual Acuity Rating

Cataract operation (unilateral and aphakia not to receive a different Implant Contact Lenses 6/6 0 0 0 6/9 0 0 10 6/12 5 10 20 6/18 10 20 40 6/24 or worse 20 40 40

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 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

Retinal Dystrophy with night blindness Rate acuity and - VISUAL FIELDS necessary to seek ophthalmological advice for an accurate assessment Table. A person meets the criteria of a “visually impaired person” under Security Act if a person’s visual acuity is certified by an ophthalmologist 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) Hemianopia 10 20 Hemianopia 10 20 loss 10 20 loss 20 20 quadrant loss 0 20 quadrant loss 0 20 outside 30 degrees of fixation 0 0 to within 30 degrees of fixation 10 10 to within 20 degrees of fixation 20 20 to within 10 degrees of fixation 20 permanent blindness

- LOWER URINARY TRACT

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 on work capacity is based upon the loss of function resulting from effects. For example, for persistent generalised symptoms such as fatigue 20, refractory anaemia is assessed using Table 20, persistent gastrointestinal symptoms (e.g.. vomiting) despite optimal treatment are assessed using persistent Central Nervous System symptoms using Table 8. Renal assessed using Table 20.

Dialysis is rated as follows: Rating Criteria FIFTEEN All types of dialysis (except outpatient haemodialysis) functioning well. Some decreased ability to carry activities but independence is retained. TWENTY Outpatient haemodialysis and all types of dialys functioning poorly. More severe symptoms with a decreased carry out many everyday activities. Most daily activities completed with some difficulty. Symptoms may prevent avoidance of some daily tasks and simple tasks will usually symptoms of fatigue. THIRTY End stage renal disease with very severe symptoms substantial difficulties with most daily tasks. FORTY End stage renal disease leading to major restrictions in many activities. Capacity for self-care is restricted leading to others.

TABLE 18 - SKIN DISORDERS In the evaluation of work-related impairment resulting from a skin actual functional loss is the prime consideration. However, where there cosmetic or cutaneous involvement, this should also be considered. Rating Criteria NIL Signs and symptoms of skin disorder present and with treatment is NO limitation in the performance of normal daily activities. TEN Signs and symptoms of skin disorder present despit treatment and results in some interference with normal daily TWENTY Signs and symptoms of skin disorder present despit treatment and results in significant interference with activities. FORTY Very severe symptoms requiring continuous treatment include periodic confinement to home or hospital considerable assistance with normal daily activities. - ENDOCRINE DISORDERS of endocrine disorders e.g. diabetes mellitus on other body systems vascular and visual systems should be assessed from the appropriate tables together with values from this table. Criteria Thyroid disease, Acromegaly, Cushing&apos;s disease, Prolactinoma, Diabetes Mellitus, Diabetes Insipidus, Parathyroid Disease, Paget’s disease, Osteoporosis, Addison&apos;s Disease adequately controlled with hormone replacement and/or surgery and/or radiotherapy and/or therapeutic agents. Thyroid disease, Acromegaly, Cushing&apos;s disease, Prolactinoma, Diabetes Insipidus, Parathyroid Disease, Paget’s disease or Osteoporosis which is incompletely controlled or treated e.g. symptomatic Paget&apos;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.

- MISCELLANEOUS – MALIGNANCY, HYPERTENSION, HIV MORBID OBESITY (i.e. BMI >40), HEART / LIVER/ KIDNEY TRANSPLANTS, MISCELLANEOUS EAR / NOSE / THROAT CONDITIONS & FATIGUE OR PAIN be used for miscellaneous conditions, for example, malignancy, HIV morbid obesity, transplants, miscellaneous ear/nose/throat conditions, chronic fatigue (including Chronic Fatigue Syndrome) or pain and Where there is a separate loss of function, in addition to the loss which using the system-specific Tables, Table 20 can be used. Double-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. FIFTEEN Moderate to severe symptoms which are more distressing few everyday activities. Self-care is unaffected and independence retained. Symptoms may have mild to moderate impact on ability persist with work-related tasks and/or attend work. Full-time would still be possible Potentially life-threatening condition which is currently with daily activities but self-care is unaffected. TWENTY More severe symptoms with a decreased ability/efficiency many everyday activities. Most daily activities can be completed some difficulty. Symptoms may prevent or lead to avoidance daily tasks and simple tasks will usually aggravate fatigue. Symptoms cause significant interference with perform or persist with workrelated tasks. Symptoms prolonged absences from work. THIRTY Very severe symptoms which lead to substantial difficulty daily tasks. Assistance with elements of self-care may Symptoms cause severe interference with ability to work work (i.e. minimal residual work capacity). Heart/Liver/Kidney transplants - poorly controlled functioning) with fairly severe symptoms which lead difficulty with most daily tasks. Malignant hypertension - severe, uncontrolled. Inoperable, symptomatic and life-threatening malignancy. Very poor prognosis with only a very limited FORTY Major restrictions in many everyday activities. Capacity is restricted, leading to dependence on others. No capacity.

TABLE 21 - INTERMITTENT CONDITIONS Intermittent but continuing disorders that remain asymptomatic between episodes of impairment e.g. gout, epilepsy, Meniere’s Disease, vertigo (only to be scored in the presence of a diagnosed condition causing these but if the symptoms are continuous Table 20 should be used) are rated 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 rating using the above three factors is made by first coding severity into an intermittent grading. The code is then combined with frequency, 21.4, to give the rating. Some intermittent disorders may be rated using system-specific system-specific table is then used in preference e.g. severe asthma persistent airway limitation.

When episodes vary in severity, duration or frequency, an average should be estimated. More than one rating may be given for the same for grand mal epilepsy one rating is given for the ictal phase and a second the post-ictal stage. The two are then added together. exacerbations of chronic disorders, where the acute relapses are frequent the Intermittent Tables can be used in addition to the primary score underlying medical condition e.g. frequent attacks of acute bronchitis using Table 21 in addition to Table 1 or 2 for Chronic Airways the scores added together. - 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.

- INTERMITTENT ATTACK - DURATION

Duration Lasting up to and including five minutes. Lasting more than five minutes but less than 30 minutes. Lasting from 30 minutes to four hours. Lasting more than four hours.

21.3 - SEVERITY -GRADING CODE DESCRIPTION SEVERITY

Description Level

0 1 2 3 4 5 6 A A A B C C F A A C C D E H A B C D E H I A C D F G I J

obtained using Table 21.3 and Table 21.4: determine the intermittent grading code appropriate to the estimated severity and duration from Table 21.3; and 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+ Intermittent Grading Code Rating A - - - -B - - - -C - - - -D - - - 5 10 E - - - 5 10 F - - 5 5 10 G - - 5 10 20 H - - 5 10 30 I - 5 10 30 40 J 5 10 20 40 40

TABLE 22 - GYNAECOLOGICAL CONDITIONS Gynaecological conditions such as pelvic inflammatory disease and should be assessed using Table 22. The Medical Officer should only for significant diagnosed conditions affecting normal daily functioning are likely to continue for the foreseeable future. Malignancy should be Table 20. Disability due to mastectomy should only be scored where associated loss of upper limb function and Table 3 should then be used. depression may be scored using Table 6 if considered to be adversely function for the next year. For males, disorders of the genital system assessed under Tables 16 or 17. Rating Criteria NIL Minor symptoms which are easily tolerated. Minimal functioning or work capacity. TEN Moderate and frequent symptoms present despite treatment condition which has been properly diagnosed. Some decreased to carry out every day activities but independence is retained. TWENTY Moderate to severe symptoms frequently present despite treatment due to a condition which has been properly Decreased ability to carry out everyday activities, requiring with elements of self-care. THIRTY More severe symptoms frequently present despite optimal due to a condition which has been properly diagnosed. substantial difficulties with most daily tasks. FORTY Severe symptoms frequently present despite optimal treatment a condition which has been properly diagnosed and needs assistance with many daily activities.