Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0
321The maximum WPI rating for one upper extremity is 60%. A WPI of 60% may be awarded either:
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323 It is critical to understand that there is no correlation between the severity of conduction delay on nerve conduction velocity testing, and the severity of either symptoms or the WPI rating.
324 If available, surgical findings of evidence of nerve compression and reactive hyperaemia upon nerve release can be used to confirm the diagnosis.
325 Using the combined values chart (see Appendix 1), WPI ratings obtained for sensory impairment may be combined with WPI ratings for motor impairment.
Radial (including loss of triceps function) 0 5 10 15 21 25
Radial (at elbow with sparing of triceps) 0 4 8 13 18 21
Subscapulars (upper and lower) 0 1 1 2 3 3
Suprascapular (upper and lower) 0 2 4 6 9 10
Thoracodorsal 0 1 2 4 5 6
Ulnar (above mid forearm) 0 6 11 17 24 28
Ulnar (below mid forearm) 0 4 8 13 18 21
9.13.3 Chronic pain conditions
327 This Section applies to the assessment of the degree of permanent impairment of an employee who suffers a chronic pain condition (however described) where no other diagnosis better explains the signs and symptoms of the condition and the condition is an injury.
328 A chronic pain condition affecting the upper extremities should be assessed using the methodology in this Section. A chronic pain condition affecting the lower extremities should be assessed using the same methodology as for the upper extremities substituting, where appropriate, the tables in Section 9.1 (Feet and toes), Section 9.2 (Ankles), Section 9.3 (Knees) and Section 9.4 (Hips).
329 If the chronic pain condition affects more than one extremity (whether upper or lower), only one WPI rating obtained under Table 9.13.3: Chronic pain conditions may be used to assess the degree of permanent impairment of the employee.
330 A chronic pain condition that does not affect the upper or lower extremities should be assessed in accordance with the applicable chapters in this Guide. If the condition cannot be assessed in accordance with any other chapters in this Guide (that is, where an assessment of 0% or more is not possible), the degree of permanent impairment of the employee resulting from that injury is 5%.
331 If the employee suffers an injury that results in chronic pain (other than migraine or tension headache) but is not a chronic pain condition, that injury should not be assessed using the methodology in this Section and should be assessed in accordance with the applicable chapters in this Guide.
332 If the employee suffers an injury that results in migraine or tension headache, the assessment of the degree of the permanent impairment of the employee resulting from that injury (to the extent the injury results in migraine or tension headache) is to be made in accordance with Chapter 18 of the AMA5.
Steps in assessing a chronic pain condition
| Step 1 | Assess whether there is objective evidence of impairment and subjective experience of pain in the affected upper extremity. |
| Step 2 | Assess the sensory deficits and pain in the affected upper extremity according to the grade that best describes the severity of interference with activities as described in Figure 9-D: Grading system. Use clinical judgment to select the appropriate severity grade from Figure 9-D and explain the reasons for that selection. The maximum value is not automatically applied. |
| Step 3 | Using the assessments obtained from Step 1 and Step 2, assess the WPI rating for the chronic pain condition using Table 9.13.3: Chronic pain conditions. Use clinical judgment to select the appropriate WPI rating from Table 9.13.3 and explain the reasons for that selection. |
| Step 4 | If the WPI rating obtained from Step 3 is greater than 5%, assess the WPI rating for the affected upper extremity resulting from loss of motion of each affected joint using the tables in Section 9.8.1 (Abnormal motion of digits), Section 9.9 (Wrists), Section 9.10 (Elbows) and Section 9.11 (Shoulders) as appropriate. (For lower extremity impairment, use the tables in Section 9.1 (Feet and toes), Section 9.2 (Ankles), Section 9.3 (Knees) and Section 9.4 (Hips) as appropriate.) |
| Step 5 | Combine the WPI rating obtained from Step 3 with the WPI rating obtained from Step 4 (if any). The maximum WPI rating for the affected extremity is 60%. |
Table 9.13.3: Chronic pain conditions
| %WPI | Criteria | Grade (see Figure 9-D) |
| 5 | Continuing pain that is disproportionate to any inciting event.<br>and<br>Evidence of at least one of the following:<br>Hyperaesthesiae and/or allodynia; andTemperature asymmetry and/or skin colour changes and/or skin colour asymmetry; and<br>Oedema and/or sweating increase or decrease and/or sweating asymmetry; andDecreased active joint range of motion and/or motor dysfunction (tremor, dystonia) and/or trophic changes (hair, nail, skin). | 5 |
| 10–15 | Continuing pain that is disproportionate to any inciting event.<br>and<br>Evidence of all of the following:<br>Hyperaesthesiae and/or allodynia; andTemperature asymmetry and/or skin colour changes and/or skin colour asymmetry; andOedema and/or sweating increase or decrease and/or sweating asymmetry; andDecreased active joint range of motion and/or motor dysfunction (tremor, dystonia) and/or trophic changes (hair, nail, skin). | 4 |
| 16–36 | Same as preceding criteria. | 3 |
| 37–48 | Same as preceding criteria. | 2 |
| 49–59 | Same as preceding criteria. | 1 |
| 60 | Same as preceding criteria. | 0 |
334 Table 9.14: Upper extremity function is an alternative table, which may be used instead of the specific orthopaedic or neurological table or tables. It is important to note that Table 9.14 assesses the function of the entire upper extremity. Consequently, for the purposes of ascertaining the most beneficial WPI rating for the same upper extremity, any assessment under Table 9.14 for a single upper extremity may be compared only with the total or combined impairment obtained after using other tables in Part II – The upper extremities (see Chapter 9 – The musculoskeletal system).
335 For the purposes of ascertaining the most beneficial WPI rating, Table 9.14: Upper extremity function may not be compared with single impairments under the other tables, unless there are no other impairments affecting the upper extremities.
336 At least one major criterion, and at least two minor criteria (where listed), must be satisfied for a WPI rating to be assigned under Table 9.14: Upper extremity function. Where possible, the major criteria should be assessed on the basis of neurological examination of motor strength, co-ordination and dexterity. Where possible, functional activities should be assessed by observation of the specified activities.
337 Table 9.14: Upper extremity function should be used only to assess impairment from objectively identified orthopaedic or neurological conditions arising in, and affecting, the upper extremities.
340 Where one limb only is affected by the injury, regardless of the number of impairments found in that limb, the limb should be assessed using the relevant tables other than Table 9.14: Upper extremity function and all impairments combined using the combined values table (see Appendix 1). The combined impairment rating should then be compared with the rating taken from the relevant (non-dominant or dominant) column in Table 9.14 and the higher rating obtained from the two methods used to assess WPI.
341 Where both limbs are affected by the injury, each limb should be assessed using the tables other than Table 9.14: Upper extremity function and all impairments in both limbs combined using the combined values table. The combined impairment rating should then be compared with the rating taken from the ‘both extremities’ column in Table 9.14 and the higher rating obtained from the two methods used to assess WPI.
342 Table 9.14: Upper extremity function may be used to assess upper extremity impairment arising as a result of spinal cord damage. Use the special procedure set out in the introduction to Part III of this Chapter (see Part III – Introduction). Table 9.14 is not to be used to assess upper extremity impairment arising as a result of nerve root compression, or other neurological sequelae of cervical spinal conditions. These should be assessed under Table 9.13.1, Table 9.13.2a and Table 9.13.2b (tables dealing with neurological impairments affecting the upper extremities).
Table 9.14: Upper extremity function
%WPI %WPI %WPI Major criteria(at least one required) Minor criteria(at least two required where listed)
Non-dominant extremity Dominant extremity Both extremities
0 0 0 Normal digital dexterity.No limitations in use of extremity for personal care. Writes 2 A4 pages or more at one time.Can lift more than 13 kilograms (males).Can lift more than 9 kilograms (females).Able to lace shoes easily.Joins paper clips without difficulty.
3 5 10 Minor loss of digital dexterity.Minor limitations in use of extremity for personal care. Rests after writing an A4 page.Cannot lift more than 13 kilograms (males).Cannot lift more than 9 kilograms (females).Finds it difficult to do up shoelaces.Fumbles when joining paper clips.
10 10 20 Moderate loss of digital dexterity.Moderate limitations in use of extremity for personal care. Rests after writing half an A4 page.Cannot lift more than 4.5 kilograms.Cannot do up shoelaces.Cannot join paperclips.Dresses slowly unassisted.
15 20 35 Major loss of digital dexterity.Major restrictions in personal care. Rests after writing 50 words or less.Cannot lift more than 1.5 kilograms.Cannot put on a tie or belt.Needs assistance to cut up food.Needs some assistance to dress.
25 30 50 Little useful digital co-ordination.Severely limited use of extremity for personal care. Rests after writing 10 words or less.Cannot lift more than 0.5 kilograms.Constantly drops light objects (for example, cups).Unable to cut up food.Needs extensive assistance to dress.
30 40 60 No co-ordination of digits.Severely limited use of extremity for personal care. Unable to sign name.Constantly needs a splint to write or eat.Unable to lift light objects.Needs food placed in mouth to eat.Unable to dress without assistance.
40 50 70 Minimal extremity movement against gravity.Cannot use extremity for personal care. Cannot use extremity to eat. Cannot bring a pen to paper.Cannot raise extremity to assist dressing.
60 60 84 Unable to use upper extremity at all.
PART III – THE SPINE
PART III – INTRODUCTION
Section 321 - Seafarers Rehabilitation and Compensation Act 1992 – Guide to the Assessment of the Degree of Permanent Impairment Edition 3.0 - The maximum WPI rating for one upper extremity is 60%. A WPI of 60% may be awarded either: | Zoe