Communication Disorders – Tables 12.2 and 12.3

The DRCA PI Guide includes the following introductory notes concerning the Communication Disorders tables (Tables 12.2 and 12.3):

These tables should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to the assessment of the consequences of neurological injury or disease.

Communication

Notes: Communication disorders may arise as a result of interference with comprehension and/or expression. They are the result of neurological damage arising for example from head injury or cerebro-vascular accident. Comprehension may be further divided into hearing and reading skills and expression into verbal and written skills. A report from a Speech Pathologist or Rehabilitation Specialist will generally be necessary to enable impairment of this function to be accurately assessed. In all cases the employee's abilities prior to the injury or disease must be taken into account. It would be inappropriate to assess an illiterate person with respect to reading and writing skills. Similarly where English is a second language, it may be more appropriate to base assessment on interference with ability to understand and speak the first language.

Hearing impairment must be distinguished from neurological impairment

Loss of neurological function under Table 12.2 (i.e. loss of the capacity to comprehend spoken language) must be distinguished from hearing impairment under Table 7.1. The latter concerns the ability to receive auditory signals while the former concerns the ability to interpret such signals. A Note at the end of Table 12.2 explains this distinction:

Note: Hearing refers to the ability to comprehend spoken language i.e. with the ability to interpret auditory signals not to receive such signals. It does not refer to hearing impairment which is assessed using Table 7.1.See also the separate discussion of hearing loss later in this Chapter.

If more than one rating is applied within either Table 12.2 Comprehension (Hearing & Reading) or Table 12.3 Expression (Verbal & Written) then both of the ratings should be combined.  For example, under Table 12.2, if a rating of 25 is applied for a hearing impairment, and a rating of 20 is applied for a reading impairment, then both of these ratings are combined.

Cognitive Function – Tables 12.4 and 12.5

The DRCA PI Guide includes the following introductory notes concerning the Cognitive Function tables (Tables 12.4 and 12.5):

These tables should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to the assessment of the consequences of neurological injury or disease.

Notes: Cognitive function has two components – memory and reasoning ability. These functions are affected where there is neurological damage e.g. from head injury, cerebro-vascular accident etc. Difficulties with memory or reasoning ability consequent to some other process e.g. psychiatric illness should not be assessed using these tables. Instead Table 5.1 [Psychiatric Conditions] should be used.

Treatment of multiple ratings under neurological function

The DRCA PI Guide provides no instruction on situations where the member's treating doctor has assigned ratings using more than one of the tables under the neurological function impairment. However, based on the instructions of the AMA Guided (which the DRCA PI Guide is based on), the practice is to combine these ratings rather than take the higher of the WPI ratings . Therefore, on this basis it would be appropriate to combine the ratings assigned under each of the neurological function tables.