Permanent Impairment Assessments under DRCA have specific technical and clinical definitions, and we explore those in this article
The requested report is necessary for DVA to determine the Permanent Impairment claim(s) in accordance with the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) and the Guide to the Assessment of the Degree of Permanent Impairment – Edition 2.1 (the Guide).
Preparing your report
The attached template(s) are designed to form the basis of your report and will help DVA to:
- confirm we have ongoing liability for the condition
- confirm there is an impairment
- assess the impairment of each injury under consideration (impairments from separate injuries are assessed separately)
- confirm whether the degree of impairment is at least 10%, or 5% for hearing (there is no threshold for the loss of taste, smell, fingers or toes).
Importantly, compensation is payable under DRCA when an impairment is permanent and stable.
‘Impairment‘ is defined as ‘the loss, loss of use, or the damage or malfunction of any part of the body or of any bodily system or function, or part of such system or function.’
‘Permanent’ means ‘likely to continue indefinitely.’
‘Stable’ means all reasonable treatment and rehabilitation has been undertaken and the condition is unlikely to improve in the foreseeable future. For example, a condition would not be considered stable where there has been a recent exacerbation of symptoms, a significant change in a treatment regime, or pending surgery.
The Guide presents descriptions of impairments in chapters and tables according to body system.
Methodology
The DRCA adopts an approach whereby impairment must be determined with respect to each injury. Where there are discrete injuries, including injuries arising from the original injury, they should be treated as separate injuries for assessment purposes: they are not combined and will need to meet the relevant threshold on their own to be compensable.
The impairment arising from each injury must be assessed separately and in isolation, even when using a table that assesses impairment on a functional basis. If the same functional table is used to assess the impairments arising from two or more separate injuries, a separate assessment must be conducted for each injury using that table, rather than assessing the injuries together.
Any impairment that results from a different injury or non-compensable condition must be isolated.
Multiple impairments
Impairment is system or function based. A single injury may give rise to multiple loss of function. When more than one table applies to a single injury separate scores should be allocated to each functional impairment. Where there is an initial injury which results in impairment, and a second injury which results in impairment to the same bodily system or function occurs, the pre-existing impairment must be disregarded when assessing the degree of impairment of the second injury. The second injury should be assessed by reference to the functional capacities of a normal healthy person. The final scores will be added together by DVA. Internet: www.dva.gov.au Phone: 1800 VETERAN (1800 838 372) GPO Box 9998, Brisbane QLD 4001 Page 6 of 36
Additional Diagnoses
Assessment of Impairment under DRCA requires each condition to be assessed in isolation and on the assumption that the veteran is otherwise normal and healthy. As best as you are able, please disregard the impact of any other medical conditions when making this assessment. If this is not possible, please list any additional diagnoses you have identified and apportion the overall impairment between them. Any significant aggravation of an accepted condition should be considered separately.
It is asked that you please keep the above aspects of the assessment methodology in mind when making your assessment.
You can find the Guide at: legislation.gov.au/Details/F2012C00537.
In the unlikely event that a client’s impairment is of a kind that cannot be assessed in accordance with the Guide, assessment be made under the provisions of the American Medical Association’s Guide to the Evaluation of Permanent Impairment, 5th edition, 2001.
Table 9.4 upper limbs & Table 9.5 lower limbs
Difficulty – an objective test
Difficulty with digital dexterity must be genuine and obvious to an observer, it is not sufficient for the claimant to state he/she believes they experience more difficulty with digital dexterity than before the injury. Similarly, it is not sufficient for the claimant to state he/she believes they experience more difficulty with grades, steps and distances than before the injury.
Pain versus difficulty
Table 9.4 & Table 9.5 are expressed in terms of difficulty. Pain and difficulty are not synonymous. Pain is not relevant to impairment for the purposes of assessment under the table and is catered for in the non-economic loss component. Pain on performance of activities such as grasping/ holding or climbing steps/grades is not an impairment nor is voluntary restriction of the use of a limb in order to avoid pain at the time or later an impairment. An inability to undertake a test due to pain is not to be assessed as an impairment of the limb. However, if difficulty occurs because of the actual, observable onset of pain, difficulty may exist for the purposes of Table 9.4 and Table 9.5 .
Note that difficulty with digital dexterity may occur because of problems in the wrist, elbow, upper arm or shoulder, it is not confined to cases where the injury or impairment is located in the hand or fingers. What is necessary is to look to the ease of use of the fingers and hand without undue restriction.
The degree of ‘difficulty’ required
The Full Federal Court in Comcare v Fiedler (2001) discussed the degree of ‘difficulty with digital dexterity’ which gives rise to a permanent impairment entitlement under Table 9.4: Something more than minimal problems with digital dexterity is required. But if a person, as a result of his injury, finds it troublesome or not easy to do tasks requiring digital dexterity, that will … justify a 10% impairment assessment under paragraph 1 of Table 9.4 (at 23).
Difficulty with distances
No specific distance has been prescribed under the Table. However, the Administrative Appeals Tribunal (AAT) decision Ivory v Comcare 2003 states that “although somewhat arbitrary, 600 metres is a distance that one would expect most people to be able to achieve comfortably and that is a reasonable distance for a clinical assessment”. Further AAT decisions in relation to the assessment of “difficulty with distances” seem inclined to take into consideration the circumstances of the individual’s case, and take into account what the claimant was able to do pre and post injury, and the distance of a person of similar age and fitness could walk.
It is important to note that having a 0% whole person impairment rating does not necessarily mean there is no impairment but rather may reflect that the next available rating descriptors have not been met at this time.
