Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
115Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.
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115 Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis.
2.4 Breathing disorders associated with sleep
116 Some disorders such as obstructive sleep apnoea, central sleep apnoea, and hypoventilation during sleep, can cause impairment which is not quantifiable by standard measurements of respiratory function such as spirometry, diffusing capacity, or response to exercise.
118 An overnight sleep study is used to define the severity of sleep-related disorders of breathing and can be used to define impairment after appropriate treatment has been implemented. During the overnight sleep study there is continuous monitoring of breathing pattern, respiratory effort, arterial oxygen saturation, electrocardiogram, and sleep state. Results of sleep studies cannot readily be expressed in terms of a percentage of predicted values. Consequently, impairment is rated by assigning scores to the degree of abnormality at sleep study (Figure 2-B: Calculating obstructive sleep apnoea score and Table 2.4: WPI derived from obstructive sleep apnoea score). These ratings are based on frequency of disordered breathing, frequency of sleep disturbance, degree of hypoxaemia and, as appropriate, hypercapnoea during sleep. In addition, degree of daytime sleepiness is assessed using the Epworth sleepiness scale (Johns, 1991).
119 Where vascular morbidity is present (for example, high blood pressure or myocardial infarction) and is attributable to sleep apnoea, impairment should be assessed using the relevant table in Chapter 1 – The cardiovascular system.
| Score | Epworth sleepiness score | Apnoeas + hypopnoeas/hr of sleep | Respiratory arousals* /hr of sleep | Cumulative sleep time, mins, with SaO2 <90% # |
| 0 | <5 | <5 | <5 | 0 |
| 1 | 5 to 10 | 5 to 15 | 5 to 15 | <15 |
| 2 | 11 to 17 | 16 to 30 | 16 to 30 | 15 to 45 |
| 3 | >17 | >30 | >30 | >45 |
Section 115 - Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 - Employees with mesothelioma are considered severely impaired and a WPI rating of 85% is awarded upon diagnosis. | Zoe
Notes to Figure 2-B
An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory effort related arousal, as defined by the American Academy of Sleep Medicine (1999).
2. # SaO2 = arterial oxygen saturation measured with a pulse oximeter.
Table 2.4: WPI derived from obstructive sleep apnoea score
121 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
122 The impairment resulting from an endocrine system condition (such as peripheral neuropathy, or peripheral vascular disease) must also be assessed under the relevant tables in other chapters, including tables in Chapter 10 – The urinary system.
123 In this circumstance, using the combined values chart (see Appendix 1), WPI ratings derived from the relevant tables in other chapters are combined with WPI ratings from tables in Chapter 3 – The endocrine system.
3.1 Thyroid and parathyroid glands
124 Hyperthyroidism is not considered to cause permanent impairment because the condition is usually amenable to treatment. Where visual and/or cosmetic effects resulting from exophthalmos persist following correction of the hyperthyroidism, a WPI rating may be derived from:
125 Hyperparathyroidism is usually amenable to correction by surgery. If surgery fails, or the employee cannot undergo surgery for sound medical reasons, long-term therapy may be needed. If so, permanent impairment can be assessed after stabilisation of the condition with medication, in accordance with the criteria in Table 3.1: Thyroid and parathyroid glands.
127 Permanent secondary impairment resulting from persistent hyperparathyroidism (such as renal calculi or renal failure) should be assessed under the relevant system (for example, Chapter 10 – The urinary system).
Table 3.1: Thyroid and parathyroid glands
See note to Table 3.1 for further information.
| 0 | Hyperparathyroidism – symptoms and signs readily controlled by medication or other treatment such as surgery.<br>or<br>Hypoparathyroidism – symptoms and signs readily controlled by medication.<br>or<br>Hypothyroidism adequately controlled by replacement therapy. |
| 10–15 | Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy.<br>or<br>Hyperparathyroidism – persisting mild hypercalcaemia, despite medication.<br>or<br>Hypoparathyroidism – symptoms and signs such as intermittent hyper or hypocalcaemia not readily controlled by medication. |
| 30 | Hyperparathyroidism – persisting severe hypercalcaemia with serum calcium above 3.0mmol/l, despite medication. |
Note to Table 3.1
Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
3.2 Adrenal cortex and medulla
128 Where Cushing’s syndrome is present, Table 3.2: Adrenal cortex and medulla should be used to evaluate impairment from the general effects of hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).
129 Using the combined values chart (see Appendix 1), WPI ratings derived from Table 3.2: Adrenal cortex and medulla may be combined with WPI ratings for specific associated secondary impairments (for example, fractures or diabetes mellitus).
Table 3.2: Adrenal cortex and medulla
| 0 | Cushing’s syndrome – surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion.<br>or<br>Phaeochromocytoma – benign tumour, surgically removed or removable where hypertension has not led to the development of permanent cardiovascular disease. |
| 5 | Hypoadrenalism – symptoms and signs readily controlled with replacement therapy.<br>or<br>Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15mg of prednisolone per day) where glucocorticoids will be required long-term. |
| 10 | Cushing’s syndrome – surgically corrected by removal of pituitary adenoma or adrenal carcinoma. |
| 15 | Cushing’s syndrome – due to:<br>bilateral adrenal hyperplasia treated by adrenalectomy; orlarge doses of glucocorticoids (for example, equivalent of at least 15mg of prednisolone per day) where glucocorticoids will be required long-term; orinadequate removal of source of ectopic ACTH secretion.<br>or<br>Phaeochromocytoma – malignant tumour where signs and symptoms of catecholamine excess can be controlled by blocking agents.<br>or<br>Hypoadrenalism – recurrent episodes of adrenal crisis during acute illness or in response to significant stress. |
| 70 | Phaeochromocytoma – metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be controlled by blocking agents or other treatment. |
3.3 Pancreas (diabetes mellitus)
130 Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6 – The visual system.
131 Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter10 – The urinary system.
133 Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20µg/minute. Where a 24 hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least two out of three consecutive urine specimens collected.
Table 3.3: Pancreas (diabetes mellitus)
See notes to Table 3.3 for further information.
| %WPI | Type | Therapy | Microvascular complications |
| 5 | Type 2 | Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. | Microangiopathy is not present. |
| 10 | Type 2 | Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. | Microangiopathy and/or significant neuropathy are present. |
| 15 | Type 1 | Dietary restrictions and insulin give satisfactory control. | Microangiopathy is not present. |
| 20 | Type 1<br>Type 2 | Dietary restrictions and insulin give satisfactory control.<br>Type 2 where dietary restrictions and insulin and/or oral hypoglycaemic agents give satisfactory control. | Microangiopathy and/or significant neuropathy are present. |
| 25 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is not present. |
| 30 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is present. |
| 40 | Type 1 | Dietary restrictions and insulin do not give satisfactory control and frequent episodes of severe hypoglycaemia requiring the assistance of another person have been documented. | Microangiopathy is present as well as significant neuropathy. |
| 50 | | Symptomatic hypoglycaemia due to metastatic tumour (usually insulinoma), uncontrolled by medication (such as diazoxide). | |
Notes to Table 3.3
For the purposes of Table 3.3, the degree of control is defined by reference to the glycated haemoglobin measurement (HbA1c) where:
(i) 4%-6% is the non-diabetic range; and
(ii) <8% is indicative of satisfactory control for the purposes of this table.
2. ‘Significant neuropathy’ means persistent symptoms of peripheral or autonomic neuropathy which interfere with quality of life to a considerable degree.
3. ‘Type 2’ means non-insulin dependent diabetes mellitus.
4. ‘Type 1’ means insulin dependent diabetes mellitus and other forms of diabetes requiring insulin, such as Cystic Fibrosis related diabetes and Type 3c diabetes.
3.4 Gonads and mammary glands
134 Impairments resulting from inability to reproduce, and other impairments associated with gonadal dysfunction, are assessed under Chapter 11 – The reproductive system.
| 0 | Diminished or absent level of gonadal hormones in either sex.<br>or<br>Abnormally high level of gonadal hormones in either sex. |
| 5 | Loss of one or both breasts in male.<br>or<br>Loss of whole or part of one breast in female.<br>or<br>Gynaecomastia in male where pain interferes with everyday activities – not controlled by medication. |
| 10 | Loss of whole or part of both breasts in female. |
CHAPTER 4 – DISFIGUREMENT AND SKIN DISORDERS
4.0 Introduction
136 In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.