7.3 Treatment for Unidentifiable Conditions

Last amended: 12 August 2022

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.    

Who may be eligible for this special treatment entitlement?

A veteran, a member of the forces, or a peacekeeper who:

• has lodged a Disability Compensation Payment 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,

and

• 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 Veteran 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 not being war caused, and no other entitlement exists, the white card for the unidentifiable condition is withdrawn.    

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 Compensation Payment 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 Review Tribunal). Alternatively, a veteran may ask the Commonwealth Ombudsman to investigate the circumstances of their claim.    

See Also