Division 1 - Chapter 3
Division 1
Assessment of the Degree of an Employee's Permanent Impairment Resulting from an Injury
Chapter 3 - The Endocrine System
3.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
The degree of impairment caused by secondary conditions (such as peripheral neuropathy, or peripheral vascular disease) accompanying an endocrine system condition must also be assessed under the relevant tables in other Chapters, including tables in Chapter 10 - The Urinary System.
In this circumstance, using the Combined Values Chart (Appendix 1), WPI ratings derived from the relevant tables in other Chapters are combined with WPI ratings from tables in Chapter 3.
3.1 Thyroid and Parathyroid Glands
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:
- Chapter 4 - Disfigurement and Skin Disorders; and/or
- Chapter 6 - The Visual System (section 6.5 - Other Conditions Causing Permanent Deformities Causing up to 10% Impairment of the Whole Person).
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 medication, in accordance with the criteria in Table 3.1 below.
Where an employee has more than one of the conditions in Table 3.1 below, combine the WPI ratings using the Combined Values Chart (see Appendix 1).
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
|
% WPI |
Criteria |
|
0 |
Hyperparathyroidism ? symptoms and signs readily controlled by medication or other treatment such as surgery. Hypoparathyroidism ? symptoms and signs readily controlled by medication. Hypothyroidism adequately controlled by replacement therapy. |
|
15 |
Hypothyroidism where the presence of a disease in another body system prevents adequate replacement therapy. Hyperparathyroidism ? persisting mild hypercalcaemia, despite medication. 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. |
3.2 Adrenal Cortex and Medulla
Where Cushing?s syndrome is present, Table 3.2 should be used to evaluate impairment from the general effects of hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).
Using the Combined Values Chart (see Appendix 1), WPI ratings derived from Table 3.2 may be combined with WPI ratings for specific associated secondary impairments (for example, fractures or diabetes mellitus).
Table 3.2 Adrenal Cortex and Medulla
|
% WPI |
Criteria |
|
0 |
Cushing's syndrome - surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH secretion. Phaeochromocytoma - benign tumour, surgically removed or removable where the duration of hypertension has not led to the development of permanent cardiovascular disease. |
|
5 |
Hypoadrenalism ? symptoms and signs readily controlled with replacement therapy. Cushing?s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15 mg 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:
Phaeochromocytoma ? malignant tumour where signs and symptoms of catecholamine excess can be controlled with blocking agents. 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 with blocking agents or other treatment. |
3.3 Pancreas (Diabetes Mellitus)
Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6 - The Visual System.
Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter 10 - The Urinary System.
Using the Combined Values Chart (see Appendix 1), WPI ratings derived under Table 3.1 and Table 3.2 may be combined with WPI ratings from Table 3.3.
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 20mg/minute. Where a 24 hour specimen is taken, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least 2 out of 3 consecutive urine specimens.
Table 3.3: Pancreas (Diabetes Mellitus)
See notes to Table 3.3 immediately following Table.
|
% WPI |
Type |
Therapy |
Microvascular Complications |
|
5 |
Type 2 (NIDDM) |
Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. |
Microangiopathy is not present. |
|
10 |
Type 2 (NIDDM) |
Dietary restrictions with or without oral hypoglycaemic agents give satisfactory control. |
Microangiopathy and/or significant neuropathy are present. |
|
15 |
Type 1 (IDDM) |
Dietary restrictions and insulin give satisfactory control. |
Microangiopathy is not present. |
|
20 |
Type 1 (IDDM) Type 2 (NIDDM) |
Dietary restrictions and insulin give satisfactory control
Type 2 (NIDDM) where dietary restrictions & insulin &/or oral hypoglycaemic agents give satisfactory control. |
Microangiopathy and/or significant neuropathy are present. |
|
25 |
Type 1(IDDM) |
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 (IDDM) |
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 (IDDM) |
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
- 1. For the purposes of Table 3.3, the degree of control is defined
by reference to the glycated haemoglobin measurement (HbA1c) where:
- 4 is the non-diabetic range;
- <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. 'NIDDM' means non-insulin dependent diabetes mellitus.
- 4. 'IDDM' means insulin dependent diabetes mellitus.
3.4 Gonads and Mammary Glands
Impairments resulting from inability to reproduce, and other impairments associated with gonadal dysfunction, are assessed under Chapter 11 - The Reproductive System.
Loss of one or both breasts in females should also be assessed using Table 4.3: Bodily Disfigurement (Chapter 4 - Disfigurement and Skin Disorders). Using the Combined Values Chart (see Appendix 1), a WPI rating derived from Table 4.3 may be combined with a WPI rating derived from Table 3.4 below.
Table 3.4: Gonads and Mammary Glands
|
% WPI |
Criteria |
|
0 |
Diminished or absent gonadal hormones in either sex. Abnormally high level of gonadal hormones in either sex. |
|
5 |
Loss of one or both breasts in male. Loss of whole or part of one breast in female. Gynaecomastia in male where pain interferes with everyday activities - not controlled by medication. |
|
10 |
Loss of whole or part of both breasts in female. |
Acknowledgments | Introduction | Tables and Figures
| Principles of Assessment
Division 1 | 1 - The Cardiovascular System | 2 - The Respiratory System
3 - The Endocrine System | 4 - Disfigurement and Skin Disorders
5 - Psychiatric Conditions | 6 - The Visual System
7 - Ear, Nose and Throat Disorders | 8 - The Digestive System
9 - The Musculoskeletal System | 10 - The Urinary System
11 - The Reproductive System | 12 - The Neurological System
13 - The Haematopoietic System
Division 2 | Division 3 | Appendix