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17. Diagnosis not confirmed -
For VEA claims if, after taking the various steps outlined above, including seeking a second opinion if required, the claims assessor is reasonably satisfied that the report fails to identify that the claimant is suffering from a psychiatric condition in accordance with the diagnostic criteria in DSM-IV or DSM-5 for that condition then, despite the opinion of the psychiatrist, the finding should be that there is no injury or disease found (NIF). The claim should not be rejected. The basis of a 'No Incapacity Found' (NIF) finding is contained in s 5D of the VEA which provides the definition of an Injury or Disease and s13(1)(b) which requires a level of incapacity for pension to be paid. The failure to establish a diagnosis leads to a finding that there is no incapacity from that injury or disease
For MRCA and SRCA claims if, after taking the various steps outlined above, the claims assessor is reasonably satisfied that the report fails to adequately address the diagnostic criteria contained in DSM-IV or DSM-5 for that condition then, despite the opinion of the psychiatrist, the claim should be rejected.
A correct decision must address the criteria from DSM-IV or DSM-5, rather than the SOP definition of disease alone.
A traumatic event discussed in DSM-IV/DSM-5 may not meet the SOP factor definition of a severe stressor. In this case a diagnosis can be established but the claim would be rejected as not meeting the relevant SOP factor. Of course all SOP factors must also be tested for a possible relationship to service.