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10.8 Provision of Alterations, Aids & Appliances and Services for Serving ADF Clients
The following table outlines the responsibilities for providing supports and services for serving members who have not been identified as ‘likely to separate from the Australian Defence Force (ADF) for medical reasons" or who have not reached the point of separation from the ADF. These responsibilities are supported by the Memorandum of Understanding (MOU) between DVA and Defence and the relevant legislation.
Australian Defence Force (ADF)
Aids and appliances for serving members
As the member's rehabilitation authority, Defence has the primary responsibility for providing aids and appliances for full time serving members, those members on Continuous Full Time Service (CFTS) and part-time Reservists. The ADFRP administers any full time or CFTS member requests for an aid, appliance or alteration, which will be considered through their ADFRP rehabilitation processes and provisions, after an assessment of the member's needs and circumstances is completed. Similarly, the Rehabilitation for Reservists program administers the part-time Reservist requests for an aid, appliance or alteration.
However, it is important to note that in some circumstances, DVA may be able to provide a wider range of aids and appliances to support a person's accepted conditions. There may therefore be occassions when an ADFRP or Rehabilitation for Reservists consultant approaches DVA to request assistance with the provision of aids and appliances for individuals who have not yet been identified for medical separation from the ADF.
A temporary transfer of rehabilitation authority is required for this support to be provided to full time and CFTS serving members. This approach is consistent with the MOU between Defence and DVA. It also ensures that the costs of aids, appliances and alterations can be met as a third party cost on a DVA rehabilitation plan.
For part-time Reservists with accepted DVA conditions who require assistance with aids, appliances and household alterations, these services and support can be considered in the following manner:
requests for aids and appliances will be initially referred to the Rehabilitation Appliances Program (RAP) for consideration of services through their DVA Health Card, via the ADF Rehabilitation Consultant;
requests for household alterations will be referred to the appropriate DVA rehabilitation team for consideration. A temporary transfer of rehabilitation authority through MRCA section 39(3)(aa) will be required before household alterations can be considered and provided.
Specific services and supports for serving members
It is important to note that household services, attendant care services and assistance under the Motor Vehicle Compensation Scheme are contained in the compensation provisions in chapter 4 of the MRCA. Likewise, household services and attendant care services are covered in the compensation provisions of Part II of the SRCA.
This means that there are no legislative barriers to DVA providing these services to serving ADF members while the Chief of the Defence Force remains their rehabilitation authority. However, Rehabilitation Coordinators need to be aware that the MOU between DVA and Defence specifies that an assessment of the client’s needs should be organised by Defence as the client’s rehabilitation authority prior to DVA involvement.
How DVA can assist ADF members
It is expected that, as a first step, Defence will have organised for an assessment of the client’s current needs and circumstances by an appropriately qualified health professional such as an Occupational Therapist. This report provides the basis for the ADFRP or the Rehabilitation for Reservists program to determine whether it needs to request that DVA provide specific aids, appliances or alterations where there are barriers to them being able to do so.
Section 55 of the MRCA provides that DVA can provide aids and appliances that are reasonably required by a person; repair or replacement of aids and appliances; and alterations to the person’s place of residence, education, work or service, where:
- a person has an impairment as a result of a service injury or disease; and
- DVA has accepted liability for the injury or disease; and
- the person is undertaking, or has completed an approved rehabilitation program, or has been assessed under MRCA section 44 as not having the capacity for rehabilitation.
An “approved rehabilitation program” is defined in section 41 of the MRCA as a rehabilitation program determined by the person’s rehabilitation authority. The provision does not specify that the MRCC must be the rehabilitation authority. However, practically, a rehabilitation plan can only be opened to provide the administrative mechanism to pay for the item, when DVA is the rehabilitation authority for the individual. A temporary transfer of rehabilitation authority for a limited period is therefore required. This enables the requested aid, appliance or alteration to be provided, and then for Defence to re-assume ongoing responsibility for the serving member’s rehabilitation needs.
It is important to note that in most cases, Defence will be able to meet the serving member’s needs for aids and appliances. Exceptions to this general rule include:
- IT equipment or software that is required in the serving member’s home environment;
- aids and appliances to assist with the management of symptoms of specific accepted conditions, such as tablets or mobile phones to assist with memory loss; or
- workplace aids and appliances for a part-time Reservist’s civilian employment, if the employer is refusing to supply this equipment as part of their responsibilities under the Work Health and Safety Act 2011.
Rehabilitation Coordinators are encouraged to contact the Rehabilitation Policy section via firstname.lastname@example.org for advice if they are concerned about the type of aids or appliances that ADFRP or Rehabilitation for Reservists Program consultants are requesting that DVA provide for serving ADF members.
Members who have been identified as likely to separate for medical reasons
Where a member has been identified as likely to separate from the ADF for medical reasons, then the MOU between Defence and DVA reinforces that DVA could accept a transfer of rehabilitation authority and take on the responsibility to consider provision of aids, appliances and home alterations that may be reasonably required for that individual, when requested to do so. This is because DVA will carry the ongoing responsibility for ensuring that the client’s needs are met.
What issues need to be considered
In determining whether an aid, appliance or alteration is reasonably required, section 58 of the MRCA specifies that the DVA delegate must consider the following issues:
- the likely period during which the alteration, aid or appliance will be required; and
- any difficulties faced by the person in gaining access to, or enjoying freedom of movement in, his or her place of residence, education, work or service; and
- whether arrangements can be made for hiring the article, aid or appliance concerned; and
- if the person has previously received compensation under this section in respect of an alteration of his or her place of residence and has later disposed of that place of residence – whether the value of that place of residence was increased as a result of the alteration; and
- if the person is a Permanent Forces member or a continuous full-time Reservist, the length of time that the person is likely to continue to serve as a Permanent Forces member or a continuous full-time Reservist, and whether the provision of an alteration, article, aid or appliance would increase that length of time.
The relevance of each of these issues must be considered, so that a decision can be made about whether “on balance” the alteration, aid or appliance is reasonably required. For example, if the serving member will be discharged from the ADF within the next few weeks, but they are likely to have an ongoing need for the aid or appliance, and the aid is likely to greatly assist the person to manage their accepted condition post separation from the ADF, then a delegate may determine that “on balance” the aid or appliance is reasonably required. As the client is so close to separating from the ADF, consideration of whether the aid is likely to increase the length of time that they serve as an ADF member can be given less weight than the other criteria.
After the decision is made, a determination letter must be provided to the client informing them of:
- the decision to approve or reject the request for the aid, appliance or alteration;
- the reasons for the decision; and
- their appeal rights.
This applies regardless of whether the client is a serving ADF member.
NOTE: References to Reservists are also taken to include Reservists on non-continuous full-time service (non CFTS), as it has been identified that this section was not amended when the legislative change specifying the CDF to be the rehabilitation authority for non CFTS Reservists was progressed.
Access to aids, appliances and alterations through the Rehabilitation Appliances Program
DVA Health cards are not generally issued to full time ADF members. This is because the ADF retains responsibility for a full time serving member’s medical treatment, regardless of whether they have submitted a claim to DVA for a service related injury or illness. This impacts on the serving member’s ability to access aids and appliances through the Rehabilitation Appliances Program (RAP). Therefore, where a serving member does not have a DVA Health card, any aids or appliances that DVA is requested to provide must be considered under section 56 of the MRCA or section 39 of the SRCA.
In contrast, part-time ADF reservists will, as a general rule, have been issued with a DVA Health Card. This is because DVA has the responsibility to provide medical treatment for conditions for which liability has been accepted. Part-time ADF reservists are therefore able to access the RAP. The policy principles outlined in the introduction to chapter 10 of the Rehabilitation Policy Guide therefore apply.
Where a serving member requires modifications to their privately rented or owner occupied property, a delegate is required to submit the request to email@example.com for advice. This helps to ensure consistency in decision making and to facilitate negotiations between RAP and the Rehabilitation Policy section, if required.
There are many advantages in DVA being informed as early as possible where a client with high or complex needs, who is starting to move toward separation from the ADF for medical reasons, requires aids and appliances to address their clinical needs. This helps to ensure that DVA is able to develop an understanding of the client’s current and ongoing needs, and is aware, in advance, of any issues that might need to be addressed.
Maintaining good communication with the ADFRP or the Rehabilitation for Reservists Program, and organising regular case conferences for clients with high or complex needs for treatment, aids and appliances and/or associated services who are identified as likely to separate from the ADF on medical grounds, will help to facilitate a client focused approach to service delivery.