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7.3 Treatment for Unidentifiable Conditions
Last amended: 6 September 2011
Treatment at departmental expense
Eligible veterans, who in extremely rare circumstances suffer from symptoms of an unidentifiable medical condition, may be able to receive treatment for those symptoms at departmental expense. Immediate treatment may be important in preventing deterioration of the condition.
Veterans with a Gold Card eligibility
Veterans who have a Repatriation Health Card - For All Conditions (Gold Card) can already obtain necessary treatments for all medical conditions at departmental expense. No determination under this special provision will be made.
Repatriation Health Card for all Conditions (Gold Card)
Who may be eligible for this special treatment entitlement?
A veteran, a member of the forces, or a peacekeeper who:
- has lodged a disability pension claim within 15 years of the end of their service in period:
- of operational service,
- of hazardous service,
- of peacekeeping service,
- of warlike service, or
- of non-warlike service,
- after investigation,
- where that claim has not been determined, and
- where the Repatriation Commission is of the opinion that the claimed symptoms do not satisfy diagnostic criteria in current evidence-based medicine (ie the symptoms are of an unidentifiable condition),
may be granted treatment for the symptoms of the claimed condition.
If the unidentifiable medical condition is later diagnosed and determined not to be war caused, or defence caused, then the veteran will no longer be eligible for treatment at the departmental expense unless another treatment entitlement exists.
Determining an unidentifiable condition
The Repatriation Commission can only form its opinion that a veteran's symptoms are from an unidentifiable condition after considering the informed advice of an appropriate person who will determine whether the veteran's condition satisfies the diagnostic criteria in current evidence-based medicine. At present the only 'appropriate person' nominated by the Repatriation Commission is the Senior Medical Adviser.
When a diagnosis of a disease is made
As soon as a diagnosis of claimed symptoms is made, the claim must be determined. Thereafter normal treatment entitlements will apply.
Treatment eligibility dates
The period in respect of which costs of treatment may be reimbursed under the Determination is three (3) months before the date on which the veteran made the claim for a pension, to and including the date on which the claim is determined.
White Card for veterans with war-caused conditions
Veterans who do not hold a Gold Card who are granted treatment for their unidentifiable condition and who have no other treatment entitlement will be issued with a Repatriation Health Card - For Specific Conditions (White Card). This entitles an eligible veteran to a wide range of public and private health care services for treatment provided under the Repatriation Health Care system at departmental expense for their specified condition.
If the condition is rejected as being war caused, and no other entitlement exists, the white card for the unidentifiable condition is withdrawn.
Repatriation Health Card - For Specific Conditions (White Card)
What treatment is available?
The type of treatment that a veteran can utilise includes:
- medical treatment,
- dental treatment,
- pharmaceutical benefits treatment,
- treatment generally from other health providers,
- treatment at hospitals and institutions,
- residential care treatment,
- treatment by rehabilitative appliance, and
- supplementary assistance treatment and respite care.
No application form is required
There is no application form for claiming treatment benefits where a claimed condition cannot be identified. Treatment benefits will be considered as part of normal disability pension claim processing actions. However, veterans may, on the claim, or later by letter, request that consideration be given to granting these special treatment benefits.
Entitlement to veterans supplement
A veteran who is granted treatment for an unidentifiable condition(s) may be entitled to payment of veterans supplement.
Appeals against unsuccessful claims
Claims for treatment that are refused may be appealed to the Federal Court (but not to the Administrative Appeals Tribunal). Alternatively, a veteran may ask the Commonwealth Ombudsman to investigate the circumstances of their claim.
Treatment for Unidentifiable Conditions
For the purposes of Part VI of the VEA, a reference to a veteran is taken to be a reference to:
- a veteran as defined in subsection 5C(1) of the VEA;
- a member of the Forces as defined in subsection 68(1) of the VEA; or
- a member of a Peacekeeping Force as defined in subsection 68(1) of the VEA.
For the purposes of Part VII of the VEA, according to subsection 5C(1), veteran means a person (including a deceased person):
- who is taken to have rendered eligible war service, or
- in respect of whom a pension is, or pensions are, payable under subsection 13(6) and
- in Part III and Part VIIC of the VEA includes a person who is:
- a Commonwealth veteran, or
- an allied veteran, or
- an allied mariner.
A condition that, in the opinion of the Repatriation Commission, is a medical condition that does not satisfy diagnostic criteria in current evidence-based medicine.
The Repatriation Health Card - For All Conditions is gold in colour and frequently referred to simply as the “Gold Card”. The card entitles its holder to obtain health care and related services for all the person's identified health care needs, whether they are war-caused or not.
A member of the forces is a person who served in the defence force for a continuous period that commenced after 7 December 1972 and has the type of service required in sections 69, 69A and 69B of the VEA.
Disability pension, for the purposes of service pension and income support supplement, means:
- a pension paid for incapacity from war caused conditions, or peacetime, peacekeeping or hazardous service caused conditions (other than a war widow's or orphan's pension); or
- temporary incapacity allowance; or
- any other payment in respect of incapacity or death resulting from war or war-like operations in which the Crown has been engaged [usually paid by another Commonwealth country].
Operational service is generally service performed:
- outside Australia,
- during war like operations in which Australian Defence Forces were involved, and
- in areas where the incurred level of risk is considered above that of normal peacetime conditions.
Refer to section 6 of the VEA through to 6F of the VEA for a full explanation of operational service.
According to subsection 120(7) of the VEA, Hazardous service is service in the Defence Force of a kind determined by the Minister for Defence to be hazardous service.
Hazardous service includes activity that exposes individuals or units to risks above the normal peacetime and training duties such as bomb and mine clearance, aid to civil power or protected evacuations.
According to subsection 68(1) of the VEA, peacekeeping service means service with a Peacekeeping Force outside Australia and includes:
- any period after a person's appointment to the Peacekeeping Force during which the person was travelling outside Australia for the purpose of joining the Peacekeeping Force, and
- any period (not exceeding 28 days) of authorised travel outside Australia after the person has ceased to serve with the Peacekeeping Force.
Non-warlike service is defined in Subsection 5C(1) to mean:
- service in the Defence Force of a kind determined in writing by the Minister for Defence to be non-warlike service.
Non-warlike service includes operations with a limited objective and casualties could occur but are not expected. The only force allowed is in self-defence.
The Repatriation Health Card - For Specific Conditions is white in colour and frequently referred to simply as the “White Card”. The card entitles its holder only to treatment for accepted service-related conditions, or where eligibility has been granted by DVA for treatment of pulmonary tuberculosis, malignant conditions (cancer) and post traumatic stress disorder.
Respite care is care provided for one member of a couple in a nursing home or hostel on a temporary basis so that their partner can have a break from providing care. For care to be recognised as respite care under the VEA, it must be Government subsidised care provided under the Aged Care Act 1997.
A pensioner receiving such care, and their partner (a respite care couple), are entitled to be paid the single rate of pension.
For the full definition of respite care, refer to subsection 5NC(8) of the VEA.
The veterans supplement was introduced on 20 September 2009 as part of the Government's Secure and Sustainable Pension Reform package. It is a fortnightly payment that replaces pharmaceutical allowance and/or telephone allowance for compensation recipients who are not in receipt of an income support supplement. There are two rates, the veterans supplement low rate and the veterans supplement high rate. The low rate replaces one of the allowances and the high rate replaces both. The low rate is indexed every January to the Consumer Price Index (CPI). The high rate is always twice the amount of the low rate.