3.4.5 Applying streamlining procedures
Policy is in place to allow a ‘decision-ready’ approach to processing claims for certain conditions.
There are two ‘decision ready’ pathways known as ‘streamlining’ and ‘straight-through processing’. Streamlining involves claims relating to certain identified conditions which, because of the known conditions of service and very high acceptance rates, can generally be accepted as having met a Statement of Principles factor without further investigation. Straight through processing involves claims relating to a number of service occupations which based on known levels of quantifiable physical activity, meet certain causal factors set out in the Statements of Principles for specific conditions, without requiring further investigation provided relevant types and timeframes of service are met.
Streamlining involves claims for certain conditions where it is considered that known conditions of service would lead to the development of the medical condition. Provided there is a diagnosis, these conditions can generally be accepted as service related without significant further investigation if there is evidence in the claim and/or service record that points to a relevant exposure or occurrence.
The conditions currently included in streamlining policy have been identified as conditions with very high acceptance rates and/or factors which relate to known conditions of service (such as exposure to impulsive noise or sunlight in relation to service in certain locations and timeframes) that will be experienced by members of the ADF or where there will be unambiguous evidence on a veteran’s file (such as having suffered a gunshot wound, or a particular type of injury) which means that further investigation is not required. Where the criteria for application of the policy are met there is usually no requirement for further additional information from the veteran.
Straight Through Processing is applied where an individual veteran’s profile and details of service can be used as evidence that certain causal factors, contained in the Statements of Principles (SOP), for a medical condition are met due to ADF service having led to a particular medical condition. The evidence and data available to DVA (for instance known occupational exposures or ADF role specific training programs) may demonstrate that in certain circumstances a person’s conditions of service, and type and length of time in service, would have led to a SoP factor being met. These generally relate to conditions that involve lifting or other quantifiable factors. Where members have a certain duration of service in particular roles (which depends on the condition and type of activities conducted), straight through processing may be applicable.
This policy therefore expedites the investigatory process and is less onerous on the claimant as they are not required to complete supplementary physical and/or service exposure questionnaires when a claimant meets the relevant timeframes in service or other relevant criteria.
The section below entitled ‘Investigation of claims by the MRCC’ sets out what information needs to be available to remove the requirement for further investigation prior to the acceptance of liability under this policy.
The conditions subject to streamlining and straight through processing policy are listed at the end of this section.
3.4.5.1 Statements of Principles
All of the identified conditions comprise diagnoses that are the subject of Statements of Principles (SoPs). The SoPs are legal instruments determined by the Repatriation Medical Authority (RMA) and are based on sound medical-scientific evidence. The SOPs detail the factors that must be met in order for a claim to be related to service. Each condition has two SoPs reflecting the different standards of proof: Reasonable Hypothesis (RH) which applies to warlike or non-warlike service; and Balance of Probabilities (BoP) which applies to peacetime service. Under s332 of the Military Rehabilitation and Compensation Act 2004 (MRCA) all claims for the MRCC-identified conditions must be determined using the relevant SoP.
3.4.5.2 Policy Rationale
The MRCC policy reflects the view that, on the balance of probabilities, most military personnel will meet the requirements of at least one of the SoP factors for each of the identified conditions due to the nature of military service. Service – regardless of type – needs only to have made a material contribution to the SoP factor requirements. The expectation, therefore, is that claims for the identified conditions will succeed, unless there are exceptional circumstances.
3.4.5.3 Acting under a Policy
Delegates of the MRCC who undertake investigations and make decisions on claims must exercise their own judgment and discretion, otherwise they risk making an error of law either in acting under direction or applying a policy without regard to the individual merits of a case. This does not mean that delegates are able to ignore a relevant policy put in place by the MRCC or the guidance of a more senior delegate. However, any such advice must be consistent with both the requirements of the MRCA and the relevant legislative instruments used or made under this Act (e.g. the SoPs). Delegates must therefore ensure that such advice is acknowledged in their reasons for decisions.
A decision by Justice Pincus in 1986 provides guidance /context for the overall application of policy. Policy guides decision makers it does not strictly control their decision. Justice Pincus held that where a statutory discretion exists, and where the legislation itself does not specify the way in which the discretion is to be exercised, a decision maker is entitled to formulate a policy in relation to the exercise of that decision. In this particular case, His Honour drew a distinction between a policy 'guiding' the making of a decision on the one hand and 'controlling' it on the other. The former was said to be lawful and the distinction is a question of degree and not of kind.
Accordingly, the policy outlined here is to be used by delegates as 'guiding' the investigation and decision making processes that are to be applied in handling claims for the above-mentioned conditions under the MRCA.
Any concerns about individual cases where the delegate believes the policy would result in an inappropriate decision (eg, where this policy would have resulted in the approval of the claim or application but there is other available evidence to indicate that this should not be the outcome) should be brought to the attention of their supervisor who will then report the matter to the Director of the Liability and Service Eligibility (L&SE) Policy section for consideration if appropriate.
3.4.5.4 Legal Responsibilities
While the MRCC supports the view that people with ADF service will almost invariably meet one of the SoP factors for the identified conditions, this does not negate a delegate's legal responsibilities. Under s336, the MRCC is 'not entitled to make certain presumptions' in relation to a claim for liability, and for this reason, it is essential that there is sufficient evidence available to make a legal determination. By the same token, however, it must be remembered that under s337 there is 'no onus of proof' on the person in relation to any matter that may be relevant to the determination of the claim.
3.4.5.5 Investigation of Claims by the MRCC
This policy clarifies that additional evidence beyond what is contained in the claim form and service records will not ordinarily be required for these conditions where the relevant profile is met. This is because the claim should contain the correct medical diagnosis as well as a contention in relation to the claimed condition.
If the profile is met the even if this contention is simply ‘service conditions’, it is sufficient to conclude with reference to the service documents that the claimed condition was caused by exposure to gunfire, exposure to sunlight, level of physical exertion, etc. due to the nature of military service. Therefore, there should be no need to investigate such claims further, for example, by seeking to obtain further medical opinion or assessment questionnaire.
Therefore, further investigation of the connection with service is not required, provided that:
there is evidence of relevant defence service;
the claim and/or service records contain information that points to at least one of the factors listed in the relevant SoP; and
the claim and/or service records contain medical opinions and/or medical reports from suitably qualified persons (eg, medical practitioners, audiologists, registered optometrists) that include a diagnosis that would enable a decision maker to be satisfied on the balance of probabilities that the client has a particular disease/condition. In such circumstances, no further opinion from a qualified person would be required.
One of the implications of the above is that investigative tools previously used (including the UV calculator, UV questionnaire or solar damage assessment form) will no longer be required for these conditions. This is expected to improve consistency in decision making and time taken to process claims for any of the specified conditions.
3.4.5.6 Exceptional Circumstances
Some cases, however, will demonstrate peculiarities that place them apart from the usual claim. These claims require careful consideration, including discussion with a team leader, before a decision can be made to reject. Each of the factors contained within the relevant SoP must be considered, and in a small number of cases, further investigation may be a necessary (but unusual) course of action. See “reject case example” below for further information.
3.4.5.7 Determination of Claims by Delegates of the Commission
Section 333 of the MRCA provides that after the investigation of a claim under section 324 is completed, the claim is to be referred to a delegate of the Commission who shall 'consider all matters that, in the Commission’s opinion, are relevant to the claim'. In this respect, the MRCC has determined that delegates are able to make decisions approving claims for liability under the MRCA for each of the conditions which are subject to streamlining or straight through processing policy, providing the above information is contained within the claim and service records.
Delegates investigating and determining claims for liability that involve one of the defined streamlined conditions are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the Director of the L&SE Policy section if deemed necessary.
3.4.5.8 Determining Claims
When determining claims it is important that an appropriate explanation and reasons for all decisions be provided to the client. Decisions to accept a claim should articulate the condition diagnosed, the contention, the evidence considered, standard of proof applicable and SOP factor met. Decisions to disallow a claim should contain similar information, but also acknowledge that all SoP factors have been considered and articulate the finding that service has not made a material contribution to the condition.
3.4.5.9 Accept case example
A decision to accept a claim for sensorineural hearing loss could be stated in the following (generic) manner, but suitably edited to reflect the circumstances of the case:
'The Statement of Principles which is relevant to your condition claimed states that exposure to an impulsive noise is a factor in the development of sensorineural hearing loss. I am satisfied such exposure (eg, in the form of gunfire) is commonplace during military service and I have accepted the claim on that basis.'
3.4.5.10 Reject case example
Again suitably edited, a decision to reject a claim for non-melanotic malignant neoplasm of the skin – following discussion with a Team Leader – could be explained in the following way:
“The Statement of Principles for your claimed condition contains two separate factors that relate to solar exposure, however neither applies in your particular case. The reason for this is because the basal cell carcinoma (BCC) which you have claimed compensation for is located on the underside of your foot which would not usually be exposed to the Sun (and therefore cannot be related to your Defence service). I have also considered the other factors contained in the Statement of Principles, none of which apply in this case. Therefore, having considered the relevant evidence I am reasonably satisfied that your BCC is not causally related to your Defence service.”
3.4.5.11 Accept case example – Sprain or strain
A decision to accept a claim for sprain or strain could advise in the following manner, suitably edited to reflect the circumstances of the case:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. Having considered your contention I am reasonably satisfied that you suffered a significant physical force through your ankle when you tripped whilst undertaking ADF physical training on duty. I am satisfied that physical training is a requirement of military service and I have accepted your claim on that basis.’
3.4.5.12 Reject case example – Sprain or strain
Again suitably edited, a decision to reject a claim for sprain or strain – following discussion with a Team Leader – could be explained in the following way:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. The diagnosis form submitted with your claim states that you sustained an ankle sprain when you tripped at your local supermarket. Having examined your medical records I can find no instances of a service-related ankle injury nor evidence of another medical condition which could have contributed to this injury. Therefore, having considered the relevant evidence I am reasonably satisfied that your ankle sprain is not causally related to your Defence service.’
3.4.5.13 Computer-based decisions
Decisions to accept liability in relation to a subset of streamlined and straight through processing conditions can be computer-based. These conditions can be automatically accepted within the MyService system where the condition occurred in or resulted from service while on duty, the veteran meets the relevant profile of service (such as having had a certain length of service in a relevant service arm), the condition has onset within the relevant timeframe after or during service and a diagnosis from a relevant practitioner is provided. Where these profiles (as adopted for streamlining/straight through processing are met the claim may be able to be accepted by the computer.
Claims cannot be rejected through a computer-based process.
Claims that do not meet the profile for automatic acceptance are manually assessed.
Computer-based decisions are reviewed following acceptance to confirm all relevant criteria have been met. The Acts permit a computer-based decision to be reviewed, adjusted, corrected or overturned if it is found that the computer-based decision has been accepted incorrectly, does not have sufficient specificity or requires further investigation to confirm the service-connection.
Computer-based decisions currently apply to 15 conditions:
1. Chondromalacia Patella
2. Dislocation
3. External bruise
4. Fracture
5. Iliotibial band syndrome
6. Joint Instability
7. Labral Tear
8. Plantar fasciitis
9. Rotator Cuff Syndrome
10. Sensorineural Hearing Loss
11. Shin splints (Medial Tibial Stress Syndrome)
12. Solar Keratosis
13. Sprain and Strain
14. Thoracolumbar Spondylosis (Lumbar and Thoracic spondylosis)
15. Tinnitus (automation only applies for claimants over the age of 40)
3.4.5.14 Conditions subject to streamlining policy
Conditions subject to streamlining policy under the MRCA and/or VEA, including the causal factors under which they are streamlined, are as follows:
| Condition | Act | SOP Type | SOP Factor |
| Achilles tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy | ||
| Acquired cataract | MRCA & VEA | BOP | Having sunlight exposure to the eye for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract |
| RH | Having sunlight exposure to the eye for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract | ||
| Acute articular cartilage tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected joint at the time of the clinical onset of acute articular cartilage tear |
| Acute meniscal tear of the knee | MRCA | BOP & RH | Having a significant physical force applied to or through the affected knee joint at the time of the clinical onset of acute meniscal tear of the knee |
| Benign neoplasm of the eye and adnexa (keratoachanthoma of the conjunctiva) – Reasonable Hypothesis only | MRCA | RH | For keratoacanthoma of the conjunctiva only, having sunlight exposure to the eye for a cumulative period of at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of benign neoplasm of the eye and adnexa |
| Chondromalacia patella | MRCA | BOP | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least six hours per week, for at least the four weeks before the clinical onset of chondromalacia patella |
| RH | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least four hours per week, for at least the four weeks before the clinical onset of chondromalacia patella | ||
| Cut, stab, abrasion or laceration | MRCA | BOP & RH | having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration |
| Dislocation of a joint and subluxation of a joint | MRCA | BOP & RH | Having physical trauma to the affected joint at the time of the clinical onset of dislocation |
| Explosive blast injury | MRCA | BOP & RH | being exposed to an explosive blast |
| Femoroacetabular impingement syndrome | MRCA | BOP | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least six hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome |
| RH | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least four hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome | ||
| Fracture | MRCA | BOP & RH | Having physical trauma to the affected bone at the time of the clinical onset of fracture |
| Gluteal tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, and for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy | ||
| Gunshot injury | MRCA | BOP & RH | experiencing a gunshot |
| Heat-induced burn | MRCA | BOP & RH | having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn |
| Iliotibial band syndrome (runner’s knee) | MRCA | BOP | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 6 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. |
| RH | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 4 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. | ||
| Internal derangement of the knee | MRCA | BOP & RH | having a sprain involving a ligament of the affected knee within the one year before the clinical onset of internal derangement of the knee |
| Joint instability | MRCA | BOP & RH | Having damage to a soft tissue structure as specified, at the time of the clinical onset of joint instability |
| Labral tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of the clinical onset of labral tear |
| Malignant melanoma of the skin | MRCA & VEA | BOP | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin |
| RH | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin | ||
| Malignant neoplasm of the eye | MRCA | BOP | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye |
| RH | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye | ||
| Medial tibial stress syndrome (shin splints) | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least six hours per week for the four weeks before the clinical onset of shin splints |
| RH | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least four hours per week for the four weeks before the clinical onset of shin splints | ||
| Merkel cell carcinoma | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Non-melanoma malignant neoplasm (NMMN) of the skin | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Otitic Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of otitic barotrauma |
| Patellar tendinopathy | MRCA | BOP | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 6 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. |
| RH | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 4 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. | ||
| Pinguecula (conjunctival degeneration) | MRCA | BOP | Having sunlight exposure to the unprotected eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula |
| RH | Having sunlight exposure to the unprotected eye for at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula | ||
| Plantar fasciitis | MRCA | BOP | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis |
| RH | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis | ||
| Pterygium | MRCA & VEA | BOP | Having sunlight exposure to the unprotected eye at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium |
| RH | Having sunlight exposure to the unprotected eye at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium | ||
| Retrocalcaneal heel bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of retrocalcaneal heel bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of retrocalcanceal heel bursitis | ||
| Sensorineural hearing loss | MRCA & VEA | BOP & RH | being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of sensorineural hearing loss |
| Sinus Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of sinus barotrauma |
| Solar keratosis | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis |
| RH | Having sunlight exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis | ||
| Sprain and strain | MRCA | BOP & RH | Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament |
| Tinea | MRCA & VEA | BOP & RH | having unprotected physical contact with: (a) a person infected with tinea; (b) an animal infected with tinea; (c) objects or surfaces contaminated with dermatophytes; (d) using communal showering or bathing facilities, swimming pool facilities or locker rooms; (e) soil contaminated with dermatophytes; or (f) a site of tinea on the same body; between 2 days and 3 weeks before the clinical onset or clinical worsening |
| Tinnitus | MRCA & VEA | BOP & RH | Being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of tinnitus |
| Traumatic contusion or haematoma | MRCA | BOP & RH | having trauma involving the affected site within the 24 hours before clinical onset |
| Trochanteric bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
* See 3.4.5.1 Limited streamlining approach for Barotrauma claims
There is an extension to streamlining policy for specific sequela conditions under MRCA and VEA. For a list of these conditions and information about the policy applicable to them, see 3.4.5.2 Sequelae Streamlining Policy.
3.4.5.14 Conditions subject to Straight Through Processing policy
Although this page relates primarily to streamlining policy, the following information on conditions to which the related straight through processing policy applies is provided for visibility. Claims under the relevant Act(s) in respect of the conditions listed below are subject to straight through processing policy in relation to the specified SoP factors.
| Condition | Act | SOP Type | SOP Factor |
| Adjustment disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 3 months before the clinical onset of adjustment disorder |
| Anxiety disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 5 years before the clinical onset of anxiety disorder |
| Osteoarthritis (of a joint of a lower limb) | MRCA | BOP | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint; and where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period. |
| RH | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 100 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint. | ||
| Posttraumatic Stress Disorder (Warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a period of at least 4 weeks before the clinical onset of posttraumatic stress disorder |
| Rotator cuff syndrome | MRCA | BOP | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 160 hours within a period of 210 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome |
| RH | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome | ||
| Thoracolumbar intervertebral disc prolapse | MRCA | BOP | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 300,000 within the 5 years before the clinical onset of thoracolumbar intervertebral disc prolapse |
| RH | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 150,000 within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse | ||
| Thoracolumbar spondylosis (also known as thoracic and lumbar spondylosis) | MRCA | BOP | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis; and where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period |
| RH | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 100,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis |
Notes:
- Conditions and factors correct as at 16/07/2024. Condition names and factors may be amended from time to time as SOPs are updated by the RMA. See the SOP Information pages in CLIK for the latest SOP factors. ISH is updated to reflect changes in conditions as these occur and consequently this policy is regularly updated to reflect changes.
- Although a condition may be subject to streamlining and straight-through-processing on the basis of a factor, other factors may be applicable to a claim and should be investigated if conditions for application of the policy are not met.
- Streamlining and STP does not apply if:
a. The relevant onset timeframe required is not met.
b. There is clear evidence available that the/a causal exposure was unrelated to service (for instance it occurred in an off duty incident unrelated to service or there is evidence on file of alternate causation) – note that the policy does not override the requirement for a claims assessor to be satisfied to the standard required by the legislation, nor does it permit them to disregard contrary evidence. If such evidence exists, it must be considered.
c. The relevant service duration/type for application of the policy has not occurred. These timeframes will vary according to the service, role and rank of the member, their length of service and the consequent timeframes and exposures.
d. The policy does not apply under DRCA as a) SOPs are not applicable and b) the requirement after 2007 for ‘significant’ contribution which requires assessment of non-service related exposure.
Note: some conditions are streamlined or STP for MRCA only given the confirmed evidence-base about cohort exposure relates only to more recent service.
Summary
Delegates investigating and determining claims for liability that involve one of the conditions mentioned in this policy are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the L&SE Policy section if deemed necessary.
Source URL: https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-3-liability/34-investigating-claim/345-applying-streamlining-procedures
3.4.5.2 Sequelae streamlining policy
Policy is in place to allow a ‘decision-ready’ approach to processing claims for certain conditions.
There are two ‘decision ready’ pathways known as ‘streamlining’ and ‘straight-through processing’. Streamlining involves claims relating to certain identified conditions which, because of the known conditions of service and very high acceptance rates, can generally be accepted as having met a Statement of Principles factor without further investigation. Straight through processing involves claims relating to a number of service occupations which based on known levels of quantifiable physical activity, meet certain causal factors set out in the Statements of Principles for specific conditions, without requiring further investigation provided relevant types and timeframes of service are met.
Streamlining involves claims for certain conditions where it is considered that known conditions of service would lead to the development of the medical condition. Provided there is a diagnosis, these conditions can generally be accepted as service related without significant further investigation if there is evidence in the claim and/or service record that points to a relevant exposure or occurrence.
The conditions currently included in streamlining policy have been identified as conditions with very high acceptance rates and/or factors which relate to known conditions of service (such as exposure to impulsive noise or sunlight in relation to service in certain locations and timeframes) that will be experienced by members of the ADF or where there will be unambiguous evidence on a veteran’s file (such as having suffered a gunshot wound, or a particular type of injury) which means that further investigation is not required. Where the criteria for application of the policy are met there is usually no requirement for further additional information from the veteran.
Straight Through Processing is applied where an individual veteran’s profile and details of service can be used as evidence that certain causal factors, contained in the Statements of Principles (SOP), for a medical condition are met due to ADF service having led to a particular medical condition. The evidence and data available to DVA (for instance known occupational exposures or ADF role specific training programs) may demonstrate that in certain circumstances a person’s conditions of service, and type and length of time in service, would have led to a SoP factor being met. These generally relate to conditions that involve lifting or other quantifiable factors. Where members have a certain duration of service in particular roles (which depends on the condition and type of activities conducted), straight through processing may be applicable.
This policy therefore expedites the investigatory process and is less onerous on the claimant as they are not required to complete supplementary physical and/or service exposure questionnaires when a claimant meets the relevant timeframes in service or other relevant criteria.
The section below entitled ‘Investigation of claims by the MRCC’ sets out what information needs to be available to remove the requirement for further investigation prior to the acceptance of liability under this policy.
The conditions subject to streamlining and straight through processing policy are listed at the end of this section.
3.4.5.1 Statements of Principles
All of the identified conditions comprise diagnoses that are the subject of Statements of Principles (SoPs). The SoPs are legal instruments determined by the Repatriation Medical Authority (RMA) and are based on sound medical-scientific evidence. The SOPs detail the factors that must be met in order for a claim to be related to service. Each condition has two SoPs reflecting the different standards of proof: Reasonable Hypothesis (RH) which applies to warlike or non-warlike service; and Balance of Probabilities (BoP) which applies to peacetime service. Under s332 of the Military Rehabilitation and Compensation Act 2004 (MRCA) all claims for the MRCC-identified conditions must be determined using the relevant SoP.
3.4.5.2 Policy Rationale
The MRCC policy reflects the view that, on the balance of probabilities, most military personnel will meet the requirements of at least one of the SoP factors for each of the identified conditions due to the nature of military service. Service – regardless of type – needs only to have made a material contribution to the SoP factor requirements. The expectation, therefore, is that claims for the identified conditions will succeed, unless there are exceptional circumstances.
3.4.5.3 Acting under a Policy
Delegates of the MRCC who undertake investigations and make decisions on claims must exercise their own judgment and discretion, otherwise they risk making an error of law either in acting under direction or applying a policy without regard to the individual merits of a case. This does not mean that delegates are able to ignore a relevant policy put in place by the MRCC or the guidance of a more senior delegate. However, any such advice must be consistent with both the requirements of the MRCA and the relevant legislative instruments used or made under this Act (e.g. the SoPs). Delegates must therefore ensure that such advice is acknowledged in their reasons for decisions.
A decision by Justice Pincus in 1986 provides guidance /context for the overall application of policy. Policy guides decision makers it does not strictly control their decision. Justice Pincus held that where a statutory discretion exists, and where the legislation itself does not specify the way in which the discretion is to be exercised, a decision maker is entitled to formulate a policy in relation to the exercise of that decision. In this particular case, His Honour drew a distinction between a policy 'guiding' the making of a decision on the one hand and 'controlling' it on the other. The former was said to be lawful and the distinction is a question of degree and not of kind.
Accordingly, the policy outlined here is to be used by delegates as 'guiding' the investigation and decision making processes that are to be applied in handling claims for the above-mentioned conditions under the MRCA.
Any concerns about individual cases where the delegate believes the policy would result in an inappropriate decision (eg, where this policy would have resulted in the approval of the claim or application but there is other available evidence to indicate that this should not be the outcome) should be brought to the attention of their supervisor who will then report the matter to the Director of the Liability and Service Eligibility (L&SE) Policy section for consideration if appropriate.
3.4.5.4 Legal Responsibilities
While the MRCC supports the view that people with ADF service will almost invariably meet one of the SoP factors for the identified conditions, this does not negate a delegate's legal responsibilities. Under s336, the MRCC is 'not entitled to make certain presumptions' in relation to a claim for liability, and for this reason, it is essential that there is sufficient evidence available to make a legal determination. By the same token, however, it must be remembered that under s337 there is 'no onus of proof' on the person in relation to any matter that may be relevant to the determination of the claim.
3.4.5.5 Investigation of Claims by the MRCC
This policy clarifies that additional evidence beyond what is contained in the claim form and service records will not ordinarily be required for these conditions where the relevant profile is met. This is because the claim should contain the correct medical diagnosis as well as a contention in relation to the claimed condition.
If the profile is met the even if this contention is simply ‘service conditions’, it is sufficient to conclude with reference to the service documents that the claimed condition was caused by exposure to gunfire, exposure to sunlight, level of physical exertion, etc. due to the nature of military service. Therefore, there should be no need to investigate such claims further, for example, by seeking to obtain further medical opinion or assessment questionnaire.
Therefore, further investigation of the connection with service is not required, provided that:
there is evidence of relevant defence service;
the claim and/or service records contain information that points to at least one of the factors listed in the relevant SoP; and
the claim and/or service records contain medical opinions and/or medical reports from suitably qualified persons (eg, medical practitioners, audiologists, registered optometrists) that include a diagnosis that would enable a decision maker to be satisfied on the balance of probabilities that the client has a particular disease/condition. In such circumstances, no further opinion from a qualified person would be required.
One of the implications of the above is that investigative tools previously used (including the UV calculator, UV questionnaire or solar damage assessment form) will no longer be required for these conditions. This is expected to improve consistency in decision making and time taken to process claims for any of the specified conditions.
3.4.5.6 Exceptional Circumstances
Some cases, however, will demonstrate peculiarities that place them apart from the usual claim. These claims require careful consideration, including discussion with a team leader, before a decision can be made to reject. Each of the factors contained within the relevant SoP must be considered, and in a small number of cases, further investigation may be a necessary (but unusual) course of action. See “reject case example” below for further information.
3.4.5.7 Determination of Claims by Delegates of the Commission
Section 333 of the MRCA provides that after the investigation of a claim under section 324 is completed, the claim is to be referred to a delegate of the Commission who shall 'consider all matters that, in the Commission’s opinion, are relevant to the claim'. In this respect, the MRCC has determined that delegates are able to make decisions approving claims for liability under the MRCA for each of the conditions which are subject to streamlining or straight through processing policy, providing the above information is contained within the claim and service records.
Delegates investigating and determining claims for liability that involve one of the defined streamlined conditions are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the Director of the L&SE Policy section if deemed necessary.
3.4.5.8 Determining Claims
When determining claims it is important that an appropriate explanation and reasons for all decisions be provided to the client. Decisions to accept a claim should articulate the condition diagnosed, the contention, the evidence considered, standard of proof applicable and SOP factor met. Decisions to disallow a claim should contain similar information, but also acknowledge that all SoP factors have been considered and articulate the finding that service has not made a material contribution to the condition.
3.4.5.9 Accept case example
A decision to accept a claim for sensorineural hearing loss could be stated in the following (generic) manner, but suitably edited to reflect the circumstances of the case:
'The Statement of Principles which is relevant to your condition claimed states that exposure to an impulsive noise is a factor in the development of sensorineural hearing loss. I am satisfied such exposure (eg, in the form of gunfire) is commonplace during military service and I have accepted the claim on that basis.'
3.4.5.10 Reject case example
Again suitably edited, a decision to reject a claim for non-melanotic malignant neoplasm of the skin – following discussion with a Team Leader – could be explained in the following way:
“The Statement of Principles for your claimed condition contains two separate factors that relate to solar exposure, however neither applies in your particular case. The reason for this is because the basal cell carcinoma (BCC) which you have claimed compensation for is located on the underside of your foot which would not usually be exposed to the Sun (and therefore cannot be related to your Defence service). I have also considered the other factors contained in the Statement of Principles, none of which apply in this case. Therefore, having considered the relevant evidence I am reasonably satisfied that your BCC is not causally related to your Defence service.”
3.4.5.11 Accept case example – Sprain or strain
A decision to accept a claim for sprain or strain could advise in the following manner, suitably edited to reflect the circumstances of the case:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. Having considered your contention I am reasonably satisfied that you suffered a significant physical force through your ankle when you tripped whilst undertaking ADF physical training on duty. I am satisfied that physical training is a requirement of military service and I have accepted your claim on that basis.’
3.4.5.12 Reject case example – Sprain or strain
Again suitably edited, a decision to reject a claim for sprain or strain – following discussion with a Team Leader – could be explained in the following way:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. The diagnosis form submitted with your claim states that you sustained an ankle sprain when you tripped at your local supermarket. Having examined your medical records I can find no instances of a service-related ankle injury nor evidence of another medical condition which could have contributed to this injury. Therefore, having considered the relevant evidence I am reasonably satisfied that your ankle sprain is not causally related to your Defence service.’
3.4.5.13 Computer-based decisions
Decisions to accept liability in relation to a subset of streamlined and straight through processing conditions can be computer-based. These conditions can be automatically accepted within the MyService system where the condition occurred in or resulted from service while on duty, the veteran meets the relevant profile of service (such as having had a certain length of service in a relevant service arm), the condition has onset within the relevant timeframe after or during service and a diagnosis from a relevant practitioner is provided. Where these profiles (as adopted for streamlining/straight through processing are met the claim may be able to be accepted by the computer.
Claims cannot be rejected through a computer-based process.
Claims that do not meet the profile for automatic acceptance are manually assessed.
Computer-based decisions are reviewed following acceptance to confirm all relevant criteria have been met. The Acts permit a computer-based decision to be reviewed, adjusted, corrected or overturned if it is found that the computer-based decision has been accepted incorrectly, does not have sufficient specificity or requires further investigation to confirm the service-connection.
Computer-based decisions currently apply to 15 conditions:
1. Chondromalacia Patella
2. Dislocation
3. External bruise
4. Fracture
5. Iliotibial band syndrome
6. Joint Instability
7. Labral Tear
8. Plantar fasciitis
9. Rotator Cuff Syndrome
10. Sensorineural Hearing Loss
11. Shin splints (Medial Tibial Stress Syndrome)
12. Solar Keratosis
13. Sprain and Strain
14. Thoracolumbar Spondylosis (Lumbar and Thoracic spondylosis)
15. Tinnitus (automation only applies for claimants over the age of 40)
3.4.5.14 Conditions subject to streamlining policy
Conditions subject to streamlining policy under the MRCA and/or VEA, including the causal factors under which they are streamlined, are as follows:
| Condition | Act | SOP Type | SOP Factor |
| Achilles tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy | ||
| Acquired cataract | MRCA & VEA | BOP | Having sunlight exposure to the eye for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract |
| RH | Having sunlight exposure to the eye for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract | ||
| Acute articular cartilage tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected joint at the time of the clinical onset of acute articular cartilage tear |
| Acute meniscal tear of the knee | MRCA | BOP & RH | Having a significant physical force applied to or through the affected knee joint at the time of the clinical onset of acute meniscal tear of the knee |
| Benign neoplasm of the eye and adnexa (keratoachanthoma of the conjunctiva) – Reasonable Hypothesis only | MRCA | RH | For keratoacanthoma of the conjunctiva only, having sunlight exposure to the eye for a cumulative period of at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of benign neoplasm of the eye and adnexa |
| Chondromalacia patella | MRCA | BOP | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least six hours per week, for at least the four weeks before the clinical onset of chondromalacia patella |
| RH | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least four hours per week, for at least the four weeks before the clinical onset of chondromalacia patella | ||
| Cut, stab, abrasion or laceration | MRCA | BOP & RH | having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration |
| Dislocation of a joint and subluxation of a joint | MRCA | BOP & RH | Having physical trauma to the affected joint at the time of the clinical onset of dislocation |
| Explosive blast injury | MRCA | BOP & RH | being exposed to an explosive blast |
| Femoroacetabular impingement syndrome | MRCA | BOP | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least six hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome |
| RH | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least four hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome | ||
| Fracture | MRCA | BOP & RH | Having physical trauma to the affected bone at the time of the clinical onset of fracture |
| Gluteal tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, and for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy | ||
| Gunshot injury | MRCA | BOP & RH | experiencing a gunshot |
| Heat-induced burn | MRCA | BOP & RH | having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn |
| Iliotibial band syndrome (runner’s knee) | MRCA | BOP | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 6 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. |
| RH | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 4 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. | ||
| Internal derangement of the knee | MRCA | BOP & RH | having a sprain involving a ligament of the affected knee within the one year before the clinical onset of internal derangement of the knee |
| Joint instability | MRCA | BOP & RH | Having damage to a soft tissue structure as specified, at the time of the clinical onset of joint instability |
| Labral tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of the clinical onset of labral tear |
| Malignant melanoma of the skin | MRCA & VEA | BOP | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin |
| RH | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin | ||
| Malignant neoplasm of the eye | MRCA | BOP | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye |
| RH | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye | ||
| Medial tibial stress syndrome (shin splints) | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least six hours per week for the four weeks before the clinical onset of shin splints |
| RH | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least four hours per week for the four weeks before the clinical onset of shin splints | ||
| Merkel cell carcinoma | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Non-melanoma malignant neoplasm (NMMN) of the skin | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Otitic Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of otitic barotrauma |
| Patellar tendinopathy | MRCA | BOP | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 6 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. |
| RH | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 4 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. | ||
| Pinguecula (conjunctival degeneration) | MRCA | BOP | Having sunlight exposure to the unprotected eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula |
| RH | Having sunlight exposure to the unprotected eye for at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula | ||
| Plantar fasciitis | MRCA | BOP | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis |
| RH | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis | ||
| Pterygium | MRCA & VEA | BOP | Having sunlight exposure to the unprotected eye at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium |
| RH | Having sunlight exposure to the unprotected eye at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium | ||
| Retrocalcaneal heel bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of retrocalcaneal heel bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of retrocalcanceal heel bursitis | ||
| Sensorineural hearing loss | MRCA & VEA | BOP & RH | being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of sensorineural hearing loss |
| Sinus Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of sinus barotrauma |
| Solar keratosis | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis |
| RH | Having sunlight exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis | ||
| Sprain and strain | MRCA | BOP & RH | Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament |
| Tinea | MRCA & VEA | BOP & RH | having unprotected physical contact with: (a) a person infected with tinea; (b) an animal infected with tinea; (c) objects or surfaces contaminated with dermatophytes; (d) using communal showering or bathing facilities, swimming pool facilities or locker rooms; (e) soil contaminated with dermatophytes; or (f) a site of tinea on the same body; between 2 days and 3 weeks before the clinical onset or clinical worsening |
| Tinnitus | MRCA & VEA | BOP & RH | Being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of tinnitus |
| Traumatic contusion or haematoma | MRCA | BOP & RH | having trauma involving the affected site within the 24 hours before clinical onset |
| Trochanteric bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
* See 3.4.5.1 Limited streamlining approach for Barotrauma claims
There is an extension to streamlining policy for specific sequela conditions under MRCA and VEA. For a list of these conditions and information about the policy applicable to them, see 3.4.5.2 Sequelae Streamlining Policy.
3.4.5.14 Conditions subject to Straight Through Processing policy
Although this page relates primarily to streamlining policy, the following information on conditions to which the related straight through processing policy applies is provided for visibility. Claims under the relevant Act(s) in respect of the conditions listed below are subject to straight through processing policy in relation to the specified SoP factors.
| Condition | Act | SOP Type | SOP Factor |
| Adjustment disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 3 months before the clinical onset of adjustment disorder |
| Anxiety disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 5 years before the clinical onset of anxiety disorder |
| Osteoarthritis (of a joint of a lower limb) | MRCA | BOP | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint; and where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period. |
| RH | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 100 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint. | ||
| Posttraumatic Stress Disorder (Warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a period of at least 4 weeks before the clinical onset of posttraumatic stress disorder |
| Rotator cuff syndrome | MRCA | BOP | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 160 hours within a period of 210 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome |
| RH | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome | ||
| Thoracolumbar intervertebral disc prolapse | MRCA | BOP | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 300,000 within the 5 years before the clinical onset of thoracolumbar intervertebral disc prolapse |
| RH | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 150,000 within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse | ||
| Thoracolumbar spondylosis (also known as thoracic and lumbar spondylosis) | MRCA | BOP | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis; and where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period |
| RH | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 100,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis |
Notes:
- Conditions and factors correct as at 16/07/2024. Condition names and factors may be amended from time to time as SOPs are updated by the RMA. See the SOP Information pages in CLIK for the latest SOP factors. ISH is updated to reflect changes in conditions as these occur and consequently this policy is regularly updated to reflect changes.
- Although a condition may be subject to streamlining and straight-through-processing on the basis of a factor, other factors may be applicable to a claim and should be investigated if conditions for application of the policy are not met.
- Streamlining and STP does not apply if:
a. The relevant onset timeframe required is not met.
b. There is clear evidence available that the/a causal exposure was unrelated to service (for instance it occurred in an off duty incident unrelated to service or there is evidence on file of alternate causation) – note that the policy does not override the requirement for a claims assessor to be satisfied to the standard required by the legislation, nor does it permit them to disregard contrary evidence. If such evidence exists, it must be considered.
c. The relevant service duration/type for application of the policy has not occurred. These timeframes will vary according to the service, role and rank of the member, their length of service and the consequent timeframes and exposures.
d. The policy does not apply under DRCA as a) SOPs are not applicable and b) the requirement after 2007 for ‘significant’ contribution which requires assessment of non-service related exposure.
Note: some conditions are streamlined or STP for MRCA only given the confirmed evidence-base about cohort exposure relates only to more recent service.
Summary
Delegates investigating and determining claims for liability that involve one of the conditions mentioned in this policy are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the L&SE Policy section if deemed necessary.
Source URL: https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-3-liability/34-investigating-claim/345-applying-streamlining-procedures/3452-sequelae-streamlining-policy
3.4.5.1 Limited streamlining approach for Barotrauma claims
Policy is in place to allow a ‘decision-ready’ approach to processing claims for certain conditions.
There are two ‘decision ready’ pathways known as ‘streamlining’ and ‘straight-through processing’. Streamlining involves claims relating to certain identified conditions which, because of the known conditions of service and very high acceptance rates, can generally be accepted as having met a Statement of Principles factor without further investigation. Straight through processing involves claims relating to a number of service occupations which based on known levels of quantifiable physical activity, meet certain causal factors set out in the Statements of Principles for specific conditions, without requiring further investigation provided relevant types and timeframes of service are met.
Streamlining involves claims for certain conditions where it is considered that known conditions of service would lead to the development of the medical condition. Provided there is a diagnosis, these conditions can generally be accepted as service related without significant further investigation if there is evidence in the claim and/or service record that points to a relevant exposure or occurrence.
The conditions currently included in streamlining policy have been identified as conditions with very high acceptance rates and/or factors which relate to known conditions of service (such as exposure to impulsive noise or sunlight in relation to service in certain locations and timeframes) that will be experienced by members of the ADF or where there will be unambiguous evidence on a veteran’s file (such as having suffered a gunshot wound, or a particular type of injury) which means that further investigation is not required. Where the criteria for application of the policy are met there is usually no requirement for further additional information from the veteran.
Straight Through Processing is applied where an individual veteran’s profile and details of service can be used as evidence that certain causal factors, contained in the Statements of Principles (SOP), for a medical condition are met due to ADF service having led to a particular medical condition. The evidence and data available to DVA (for instance known occupational exposures or ADF role specific training programs) may demonstrate that in certain circumstances a person’s conditions of service, and type and length of time in service, would have led to a SoP factor being met. These generally relate to conditions that involve lifting or other quantifiable factors. Where members have a certain duration of service in particular roles (which depends on the condition and type of activities conducted), straight through processing may be applicable.
This policy therefore expedites the investigatory process and is less onerous on the claimant as they are not required to complete supplementary physical and/or service exposure questionnaires when a claimant meets the relevant timeframes in service or other relevant criteria.
The section below entitled ‘Investigation of claims by the MRCC’ sets out what information needs to be available to remove the requirement for further investigation prior to the acceptance of liability under this policy.
The conditions subject to streamlining and straight through processing policy are listed at the end of this section.
3.4.5.1 Statements of Principles
All of the identified conditions comprise diagnoses that are the subject of Statements of Principles (SoPs). The SoPs are legal instruments determined by the Repatriation Medical Authority (RMA) and are based on sound medical-scientific evidence. The SOPs detail the factors that must be met in order for a claim to be related to service. Each condition has two SoPs reflecting the different standards of proof: Reasonable Hypothesis (RH) which applies to warlike or non-warlike service; and Balance of Probabilities (BoP) which applies to peacetime service. Under s332 of the Military Rehabilitation and Compensation Act 2004 (MRCA) all claims for the MRCC-identified conditions must be determined using the relevant SoP.
3.4.5.2 Policy Rationale
The MRCC policy reflects the view that, on the balance of probabilities, most military personnel will meet the requirements of at least one of the SoP factors for each of the identified conditions due to the nature of military service. Service – regardless of type – needs only to have made a material contribution to the SoP factor requirements. The expectation, therefore, is that claims for the identified conditions will succeed, unless there are exceptional circumstances.
3.4.5.3 Acting under a Policy
Delegates of the MRCC who undertake investigations and make decisions on claims must exercise their own judgment and discretion, otherwise they risk making an error of law either in acting under direction or applying a policy without regard to the individual merits of a case. This does not mean that delegates are able to ignore a relevant policy put in place by the MRCC or the guidance of a more senior delegate. However, any such advice must be consistent with both the requirements of the MRCA and the relevant legislative instruments used or made under this Act (e.g. the SoPs). Delegates must therefore ensure that such advice is acknowledged in their reasons for decisions.
A decision by Justice Pincus in 1986 provides guidance /context for the overall application of policy. Policy guides decision makers it does not strictly control their decision. Justice Pincus held that where a statutory discretion exists, and where the legislation itself does not specify the way in which the discretion is to be exercised, a decision maker is entitled to formulate a policy in relation to the exercise of that decision. In this particular case, His Honour drew a distinction between a policy 'guiding' the making of a decision on the one hand and 'controlling' it on the other. The former was said to be lawful and the distinction is a question of degree and not of kind.
Accordingly, the policy outlined here is to be used by delegates as 'guiding' the investigation and decision making processes that are to be applied in handling claims for the above-mentioned conditions under the MRCA.
Any concerns about individual cases where the delegate believes the policy would result in an inappropriate decision (eg, where this policy would have resulted in the approval of the claim or application but there is other available evidence to indicate that this should not be the outcome) should be brought to the attention of their supervisor who will then report the matter to the Director of the Liability and Service Eligibility (L&SE) Policy section for consideration if appropriate.
3.4.5.4 Legal Responsibilities
While the MRCC supports the view that people with ADF service will almost invariably meet one of the SoP factors for the identified conditions, this does not negate a delegate's legal responsibilities. Under s336, the MRCC is 'not entitled to make certain presumptions' in relation to a claim for liability, and for this reason, it is essential that there is sufficient evidence available to make a legal determination. By the same token, however, it must be remembered that under s337 there is 'no onus of proof' on the person in relation to any matter that may be relevant to the determination of the claim.
3.4.5.5 Investigation of Claims by the MRCC
This policy clarifies that additional evidence beyond what is contained in the claim form and service records will not ordinarily be required for these conditions where the relevant profile is met. This is because the claim should contain the correct medical diagnosis as well as a contention in relation to the claimed condition.
If the profile is met the even if this contention is simply ‘service conditions’, it is sufficient to conclude with reference to the service documents that the claimed condition was caused by exposure to gunfire, exposure to sunlight, level of physical exertion, etc. due to the nature of military service. Therefore, there should be no need to investigate such claims further, for example, by seeking to obtain further medical opinion or assessment questionnaire.
Therefore, further investigation of the connection with service is not required, provided that:
there is evidence of relevant defence service;
the claim and/or service records contain information that points to at least one of the factors listed in the relevant SoP; and
the claim and/or service records contain medical opinions and/or medical reports from suitably qualified persons (eg, medical practitioners, audiologists, registered optometrists) that include a diagnosis that would enable a decision maker to be satisfied on the balance of probabilities that the client has a particular disease/condition. In such circumstances, no further opinion from a qualified person would be required.
One of the implications of the above is that investigative tools previously used (including the UV calculator, UV questionnaire or solar damage assessment form) will no longer be required for these conditions. This is expected to improve consistency in decision making and time taken to process claims for any of the specified conditions.
3.4.5.6 Exceptional Circumstances
Some cases, however, will demonstrate peculiarities that place them apart from the usual claim. These claims require careful consideration, including discussion with a team leader, before a decision can be made to reject. Each of the factors contained within the relevant SoP must be considered, and in a small number of cases, further investigation may be a necessary (but unusual) course of action. See “reject case example” below for further information.
3.4.5.7 Determination of Claims by Delegates of the Commission
Section 333 of the MRCA provides that after the investigation of a claim under section 324 is completed, the claim is to be referred to a delegate of the Commission who shall 'consider all matters that, in the Commission’s opinion, are relevant to the claim'. In this respect, the MRCC has determined that delegates are able to make decisions approving claims for liability under the MRCA for each of the conditions which are subject to streamlining or straight through processing policy, providing the above information is contained within the claim and service records.
Delegates investigating and determining claims for liability that involve one of the defined streamlined conditions are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the Director of the L&SE Policy section if deemed necessary.
3.4.5.8 Determining Claims
When determining claims it is important that an appropriate explanation and reasons for all decisions be provided to the client. Decisions to accept a claim should articulate the condition diagnosed, the contention, the evidence considered, standard of proof applicable and SOP factor met. Decisions to disallow a claim should contain similar information, but also acknowledge that all SoP factors have been considered and articulate the finding that service has not made a material contribution to the condition.
3.4.5.9 Accept case example
A decision to accept a claim for sensorineural hearing loss could be stated in the following (generic) manner, but suitably edited to reflect the circumstances of the case:
'The Statement of Principles which is relevant to your condition claimed states that exposure to an impulsive noise is a factor in the development of sensorineural hearing loss. I am satisfied such exposure (eg, in the form of gunfire) is commonplace during military service and I have accepted the claim on that basis.'
3.4.5.10 Reject case example
Again suitably edited, a decision to reject a claim for non-melanotic malignant neoplasm of the skin – following discussion with a Team Leader – could be explained in the following way:
“The Statement of Principles for your claimed condition contains two separate factors that relate to solar exposure, however neither applies in your particular case. The reason for this is because the basal cell carcinoma (BCC) which you have claimed compensation for is located on the underside of your foot which would not usually be exposed to the Sun (and therefore cannot be related to your Defence service). I have also considered the other factors contained in the Statement of Principles, none of which apply in this case. Therefore, having considered the relevant evidence I am reasonably satisfied that your BCC is not causally related to your Defence service.”
3.4.5.11 Accept case example – Sprain or strain
A decision to accept a claim for sprain or strain could advise in the following manner, suitably edited to reflect the circumstances of the case:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. Having considered your contention I am reasonably satisfied that you suffered a significant physical force through your ankle when you tripped whilst undertaking ADF physical training on duty. I am satisfied that physical training is a requirement of military service and I have accepted your claim on that basis.’
3.4.5.12 Reject case example – Sprain or strain
Again suitably edited, a decision to reject a claim for sprain or strain – following discussion with a Team Leader – could be explained in the following way:
‘The Statement of Principles which is relevant to your diagnosed condition states that experiencing a significant physical force through the affected joint is a factor which can cause a sprain. The diagnosis form submitted with your claim states that you sustained an ankle sprain when you tripped at your local supermarket. Having examined your medical records I can find no instances of a service-related ankle injury nor evidence of another medical condition which could have contributed to this injury. Therefore, having considered the relevant evidence I am reasonably satisfied that your ankle sprain is not causally related to your Defence service.’
3.4.5.13 Computer-based decisions
Decisions to accept liability in relation to a subset of streamlined and straight through processing conditions can be computer-based. These conditions can be automatically accepted within the MyService system where the condition occurred in or resulted from service while on duty, the veteran meets the relevant profile of service (such as having had a certain length of service in a relevant service arm), the condition has onset within the relevant timeframe after or during service and a diagnosis from a relevant practitioner is provided. Where these profiles (as adopted for streamlining/straight through processing are met the claim may be able to be accepted by the computer.
Claims cannot be rejected through a computer-based process.
Claims that do not meet the profile for automatic acceptance are manually assessed.
Computer-based decisions are reviewed following acceptance to confirm all relevant criteria have been met. The Acts permit a computer-based decision to be reviewed, adjusted, corrected or overturned if it is found that the computer-based decision has been accepted incorrectly, does not have sufficient specificity or requires further investigation to confirm the service-connection.
Computer-based decisions currently apply to 15 conditions:
1. Chondromalacia Patella
2. Dislocation
3. External bruise
4. Fracture
5. Iliotibial band syndrome
6. Joint Instability
7. Labral Tear
8. Plantar fasciitis
9. Rotator Cuff Syndrome
10. Sensorineural Hearing Loss
11. Shin splints (Medial Tibial Stress Syndrome)
12. Solar Keratosis
13. Sprain and Strain
14. Thoracolumbar Spondylosis (Lumbar and Thoracic spondylosis)
15. Tinnitus (automation only applies for claimants over the age of 40)
3.4.5.14 Conditions subject to streamlining policy
Conditions subject to streamlining policy under the MRCA and/or VEA, including the causal factors under which they are streamlined, are as follows:
| Condition | Act | SOP Type | SOP Factor |
| Achilles tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of Achilles tendinopathy | ||
| Acquired cataract | MRCA & VEA | BOP | Having sunlight exposure to the eye for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract |
| RH | Having sunlight exposure to the eye for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Acquired Cataract | ||
| Acute articular cartilage tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected joint at the time of the clinical onset of acute articular cartilage tear |
| Acute meniscal tear of the knee | MRCA | BOP & RH | Having a significant physical force applied to or through the affected knee joint at the time of the clinical onset of acute meniscal tear of the knee |
| Benign neoplasm of the eye and adnexa (keratoachanthoma of the conjunctiva) – Reasonable Hypothesis only | MRCA | RH | For keratoacanthoma of the conjunctiva only, having sunlight exposure to the eye for a cumulative period of at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of benign neoplasm of the eye and adnexa |
| Chondromalacia patella | MRCA | BOP | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least six hours per week, for at least the four weeks before the clinical onset of chondromalacia patella |
| RH | undertaking weight bearing exercise involving forceful loading of the affected patellofemoral joint, at a minimum intensity of five METs for at least four hours per week, for at least the four weeks before the clinical onset of chondromalacia patella | ||
| Cut, stab, abrasion or laceration | MRCA | BOP & RH | having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration |
| Dislocation of a joint and subluxation of a joint | MRCA | BOP & RH | Having physical trauma to the affected joint at the time of the clinical onset of dislocation |
| Explosive blast injury | MRCA | BOP & RH | being exposed to an explosive blast |
| Femoroacetabular impingement syndrome | MRCA | BOP | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least six hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome |
| RH | Undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least four hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome | ||
| Fracture | MRCA | BOP & RH | Having physical trauma to the affected bone at the time of the clinical onset of fracture |
| Gluteal tendinopathy | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, and for at least the 4 weeks before the clinical onset or clinical worsening of gluteal tendinopathy | ||
| Gunshot injury | MRCA | BOP & RH | experiencing a gunshot |
| Heat-induced burn | MRCA | BOP & RH | having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn |
| Iliotibial band syndrome (runner’s knee) | MRCA | BOP | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 6 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. |
| RH | Undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a rate greater than 5 METs, for at least 4 hours per week for at least the 4 weeks before the clinical onset of iliotibial band syndrome. | ||
| Internal derangement of the knee | MRCA | BOP & RH | having a sprain involving a ligament of the affected knee within the one year before the clinical onset of internal derangement of the knee |
| Joint instability | MRCA | BOP & RH | Having damage to a soft tissue structure as specified, at the time of the clinical onset of joint instability |
| Labral tear | MRCA | BOP & RH | Having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of the clinical onset of labral tear |
| Malignant melanoma of the skin | MRCA & VEA | BOP | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin |
| RH | Having sunlight or ultraviolet light exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant melanoma of the skin | ||
| Malignant neoplasm of the eye | MRCA | BOP | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye |
| RH | having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Malignant neoplasm of the eye | ||
| Medial tibial stress syndrome (shin splints) | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least six hours per week for the four weeks before the clinical onset of shin splints |
| RH | undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side, at a minimum intensity of five METs, for at least four hours per week for the four weeks before the clinical onset of shin splints | ||
| Merkel cell carcinoma | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Non-melanoma malignant neoplasm (NMMN) of the skin | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin for a cumulative period of at least 4500 latitude equivalent hours, before clinical onset |
| RH | Having sunlight exposure to unprotected skin for a cumulative period of at least 2250 latitude equivalent hours, before clinical onset | ||
| Otitic Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of otitic barotrauma |
| Patellar tendinopathy | MRCA | BOP | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 6 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. |
| RH | Undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than 6 METs, for at least 4 hours per week for the 4 weeks before the clinical onset of patellar tendinopathy. | ||
| Pinguecula (conjunctival degeneration) | MRCA | BOP | Having sunlight exposure to the unprotected eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula |
| RH | Having sunlight exposure to the unprotected eye for at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pinguecula | ||
| Plantar fasciitis | MRCA | BOP | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis |
| RH | Undertaking exercise that involves repetitive weight bearing on the affected foot for, a) a minimum intensity of 5 METS, and b) for at least four hours per week for the 2 months before the clinical onset of plantar fasciitis | ||
| Pterygium | MRCA & VEA | BOP | Having sunlight exposure to the unprotected eye at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium |
| RH | Having sunlight exposure to the unprotected eye at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of Pterygium | ||
| Retrocalcaneal heel bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least six hours per week for at least the four weeks before the clinical onset of retrocalcaneal heel bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side, at a minimum intensity of five METs, for at least four hours per week for at least the four weeks before the clinical onset of retrocalcanceal heel bursitis | ||
| Sensorineural hearing loss | MRCA & VEA | BOP & RH | being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of sensorineural hearing loss |
| Sinus Barotrauma (limited cohorts only)* | MRCA & VEA | BOP & RH | experiencing a change in the ambient barometric pressure as specified within the 24 hours before the clinical onset of sinus barotrauma |
| Solar keratosis | MRCA & VEA | BOP | Having sunlight exposure to unprotected skin at the affected site for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis |
| RH | Having sunlight exposure to unprotected skin at the affected site for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis | ||
| Sprain and strain | MRCA | BOP & RH | Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament |
| Tinea | MRCA & VEA | BOP & RH | having unprotected physical contact with: (a) a person infected with tinea; (b) an animal infected with tinea; (c) objects or surfaces contaminated with dermatophytes; (d) using communal showering or bathing facilities, swimming pool facilities or locker rooms; (e) soil contaminated with dermatophytes; or (f) a site of tinea on the same body; between 2 days and 3 weeks before the clinical onset or clinical worsening |
| Tinnitus | MRCA & VEA | BOP & RH | Being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), before the clinical onset of tinnitus |
| Traumatic contusion or haematoma | MRCA | BOP & RH | having trauma involving the affected site within the 24 hours before clinical onset |
| Trochanteric bursitis | MRCA | BOP | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
| RH | undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 4 hours per week, for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis |
* See 3.4.5.1 Limited streamlining approach for Barotrauma claims
There is an extension to streamlining policy for specific sequela conditions under MRCA and VEA. For a list of these conditions and information about the policy applicable to them, see 3.4.5.2 Sequelae Streamlining Policy.
3.4.5.14 Conditions subject to Straight Through Processing policy
Although this page relates primarily to streamlining policy, the following information on conditions to which the related straight through processing policy applies is provided for visibility. Claims under the relevant Act(s) in respect of the conditions listed below are subject to straight through processing policy in relation to the specified SoP factors.
| Condition | Act | SOP Type | SOP Factor |
| Adjustment disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 3 months before the clinical onset of adjustment disorder |
| Anxiety disorder (warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 5 years before the clinical onset of anxiety disorder |
| Osteoarthritis (of a joint of a lower limb) | MRCA | BOP | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint; and where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period. |
| RH | Lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 100 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint. | ||
| Posttraumatic Stress Disorder (Warlike service only) | MRCA & VEA | RH | Living or working in a hostile or life-threatening environment for a period of at least 4 weeks before the clinical onset of posttraumatic stress disorder |
| Rotator cuff syndrome | MRCA | BOP | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 160 hours within a period of 210 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome |
| RH | Performing any combination of: (I) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (ii) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome | ||
| Thoracolumbar intervertebral disc prolapse | MRCA | BOP | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 300,000 within the 5 years before the clinical onset of thoracolumbar intervertebral disc prolapse |
| RH | physically carrying or lifting loads of at least 10 kilograms, to a cumulative total Load-Factor of at least 150,000 within the 10 years before the clinical onset of thoracolumbar intervertebral disc prolapse | ||
| Thoracolumbar spondylosis (also known as thoracic and lumbar spondylosis) | MRCA | BOP | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis; and where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period |
| RH | lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 100,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis |
Notes:
- Conditions and factors correct as at 16/07/2024. Condition names and factors may be amended from time to time as SOPs are updated by the RMA. See the SOP Information pages in CLIK for the latest SOP factors. ISH is updated to reflect changes in conditions as these occur and consequently this policy is regularly updated to reflect changes.
- Although a condition may be subject to streamlining and straight-through-processing on the basis of a factor, other factors may be applicable to a claim and should be investigated if conditions for application of the policy are not met.
- Streamlining and STP does not apply if:
a. The relevant onset timeframe required is not met.
b. There is clear evidence available that the/a causal exposure was unrelated to service (for instance it occurred in an off duty incident unrelated to service or there is evidence on file of alternate causation) – note that the policy does not override the requirement for a claims assessor to be satisfied to the standard required by the legislation, nor does it permit them to disregard contrary evidence. If such evidence exists, it must be considered.
c. The relevant service duration/type for application of the policy has not occurred. These timeframes will vary according to the service, role and rank of the member, their length of service and the consequent timeframes and exposures.
d. The policy does not apply under DRCA as a) SOPs are not applicable and b) the requirement after 2007 for ‘significant’ contribution which requires assessment of non-service related exposure.
Note: some conditions are streamlined or STP for MRCA only given the confirmed evidence-base about cohort exposure relates only to more recent service.
Summary
Delegates investigating and determining claims for liability that involve one of the conditions mentioned in this policy are now able to rely on the material lodged with the initial claim and/or contained in the service records. If that material is sufficient to satisfy the legal requirements of the MRCA (including the relevant SoP) then a decision to accept the claim can be made without the need for further circumstantial investigation. However, any decision to reject a claim for one of these conditions must first be discussed with a Team Leader who will report the case to the L&SE Policy section if deemed necessary.
Source URL: https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-3-liability/34-investigating-claim/345-applying-streamlining-procedures/3451-limited-streamlining-approach-barotrauma-claims