Table 4.1 Functional loss
In the evaluation of impairment resulting from a skin disorder the actual functional loss is the prime consideration, rather than the extent of cutaneous involvement.
For a rating of 10% whole person impairment (WPI), or higher, decision makers need to consider how the loss of function caused by the skin condition interferes with activities of daily living (ADL).
ADL are defined in the glossary of the Safety, Rehabilitation and Compensation (Defence-related Claims)—Guide to the Assessment of the Degree of Permanent Impairment 2023 (the DRCA Guide).
Example 1
A veteran with a service-related psoriasis condition, when present, causes interference with bathing, dressing, shaving and walking, due to the condition being under the arms, on the neck, legs and chest. For periods in aggregate of up to three months per year the veteran requires steroid injections and steroid creams for the treatment of psoriasis. It is open to the delegate in this case to determine the degree of WPI is 20% under Table 4.1 and that compensation may be payable under DRCA.
Example 2
A veteran with a service-related BCC condition is absent on examination, however the medical evidence shows multiple incidences of freezing and excision of lesions and the medical practitioner provides it is likely further BCCs will emerge over time, requiring further treatment. The medical evidence also shows that when BCCs are present, the veteran avoids sunlight, swimming and other recreational activities, however ADL are not affected. It is open to the delegate in this case to determine the degree of WPI is 5% and that compensation is not payable under the DRCA.
Table 4.2 Facial Disfigurement
Where a client has a facial disfigurement, they should be assessed with a rating under both Table 4.1 and 4.2. These ratings should then be combined using the combined values chart.
In most cases, multiple instances of skin damage caused by solar exposure are most appropriately assessed as part of the same injury. For example, a BCC or SCC condition causing distortion of the nose and deformity of the external ear would attract two 5% WPI ratings under Table 4.2. In this situation, each incidence of scarring should be given its own rating under 4.2, those ratings should then be combined to produce a Table 4.2 score, before then combining again with the Table 4.1 score, to find the final combined WPI rating.
In cases where decision makers have medical evidence confirming more than one skin injury, compensation may be payable separately under section 24 and 27 for each injury, provided each injury in isolation causes a distinct permanent impairment of at least 10% WPI.
Note: For more information about the definition of injury, please see Chapter 3.1 of the DRCA PI Policy Manual.
Note: For a copy of suggested sample medical questions to assist with this, please see Chapter 5.3.5 of the DRCA PI Policy Manual.
Note: Where delegates require additional support, please contact Benefits & Payments Policy via the Delegate Support Framework.