Functional Impact Statement
Written by: You write this yourself. Family members can also write one about what they have observed.Related forms: D2582, D2051, D2020
This is a guide onlyWe do not collect or store anything you write. Have your statements reviewed by an advocate before submitting to DVA.
When you need thisWith most claims, but especially Permanent Impairment and Initial Liability claims. DVA uses this to understand how your condition affects you in practical terms.
A functional impact statement describes what you can and cannot do because of your condition. DVA assessors use this to understand how your condition affects your real life — not just the medical diagnosis.The key to a strong functional impact statement is being specific. "I have trouble walking" is vague. "I can only walk about 200 metres before the pain in my left knee forces me to stop and rest for 5 minutes" gives DVA a clear picture.
What DVA assessors generally look for
- DVA generally considers specific, measurable descriptions of limitations more useful than general statements.
- Assessors look for how the condition affects the full range of daily life — not just one area.
- Comparing what you could do before the condition with what you can do now helps assessors understand the change.
- Descriptions of how medication or treatment side effects affect your functioning are relevant.
Section-by-Section Guide
Work through each section. Answer each prompt in your own words.1
Daily activities affected
Why this section mattersDVA needs to understand how your condition affects the basic tasks of everyday life.
Questions to answer in this section- How does your condition affect your sleep? (Hours, quality, waking, needing medication to sleep.)
- Can you drive? Are there limits? (Distance, time of day, needing to stop frequently.)
- How does it affect household tasks? (Cooking, cleaning, laundry, yard work.)
- Can you look after yourself? (Showering, dressing, grooming — is anything harder?)
- Does it affect eating, appetite, or your ability to prepare meals?
- Can you manage everyday tasks like shopping, appointments, and using public transport?
Writing tipBe specific about limits. Instead of "I have trouble sleeping", describe: "I wake up 3-4 times a night due to pain. On a good night I get 4 hours of broken sleep. I take prescribed medication to help but it makes me groggy in the morning."
2
Work impact
Why this section mattersEmployment impact is a significant factor in many DVA assessments.
Questions to answer in this section- Are you currently working? Full-time, part-time, or not at all?
- If you have reduced your hours, by how much and why?
- Have you had to change jobs or modify your duties because of your condition?
- Have you lost a job because of your condition?
- What work tasks can you no longer perform?
- How many sick days do you take because of your condition? (Per week or month.)
- Does your condition affect your concentration, reliability, or ability to meet deadlines?
3
Social and relationship impact
Why this section mattersDVA assessors consider the broader impact on your life, not just physical limitations.
Questions to answer in this section- How has your condition affected your relationship with your partner or family?
- Have you withdrawn from social activities you used to enjoy?
- Do you avoid going out or being around people? If so, why?
- Have friendships changed because of your condition?
- Has it affected your ability to participate in community activities, sport, or hobbies?
4
Physical limitations
Why this section mattersSpecific physical limitations help DVA understand the severity of your condition.
Questions to answer in this section- How far can you walk before you need to stop? What stops you — pain, breathlessness, fatigue?
- Can you lift things? What is the maximum weight? (Use everyday examples: a shopping bag, a child, a toolbox.)
- Can you sit or stand for extended periods? How long before you need to change position?
- How much pain do you experience on a typical day? (Use a 0 to 10 scale if helpful.)
- What medication do you take? Does it have side effects that affect your functioning?
- Do you use any aids? (Walking stick, brace, wheelchair, hearing aid.)
5
Before versus now
Why this section mattersComparing your life before the condition with your life now shows DVA the real impact.
Questions to answer in this section- What activities could you do before that you cannot do now?
- What activities can you still do, but with difficulty or pain?
- How has your quality of life changed overall?
- If your condition has worsened over time, describe the progression.
Writing tipFrame it clearly: "Before my back injury, I could run 5km three times a week and play with my kids in the backyard. Now I cannot run at all, and I can only stand for about 10 minutes before the pain becomes too much."
Tips
- Be specific and use numbers where you can — distances, times, weights, hours of sleep.
- Describe a typical day with your condition. Walk DVA through what your morning, afternoon, and evening look like.
- Mention the bad days and the good days — DVA understands conditions fluctuate.
- Include the impact of medication side effects, not just the condition itself.
- Ask a family member to write their own functional impact statement about what they have observed — this adds another perspective.
- Take your time writing this. You do not have to do it in one sitting.
Common Mistakes to Avoid
- Being too vague — "I have pain" tells DVA very little. Describe what the pain stops you from doing.
- Only covering one area of life — DVA looks at the full picture: daily activities, work, social life, and physical capacity.
- Not mentioning medication side effects — these are part of the functional impact.
- Exaggerating or minimising — be honest about what you can and cannot do.
- Forgetting to compare before and after — this context helps DVA understand the change.
What to do next
This is a guide only. We do not collect or store any information. Always verify with DVA directly or with a qualified advocate.