5.4 When is an Impairment Stable?

5.4 When is a condition stable

Key points

• Where a condition is not stable, section 75 of the MRCA provides for payment of interim permanent impairment compensation.

• Stable means the condition is unlikely to improve to any major degree.

• A condition’s stability status must not be confused with whether an impairment is permanent. 

• An impairment must still be permanent before interim compensation can be considered under section 75.

• Stability in the MRCA context has no nexus with whether reasonable medical treatment has been undertaken.

Section 75

In accordance with section 75 of the MRCA, interim compensation may be paid to a veteran when the delegate is satisfied:

• the impairment is permanent, however
• the final degree of impairment cannot be determined due to one or more conditions not being stable, and
• the degree of impairment will constitute at least the number of impairment points required for compensation to be payable under sections 68 or 71.

When a condition is stable

It will be a matter of medical evidence when a condition is unlikely to improve to any major degree and becomes stable. A common scenario for when a condition might not yet be stable, is when all reasonable medical treatment has been undertaken for the impairment (and the impairment is permanent), but the condition requires a further period of convalescence before it reaches a point where the medical practitioner states the condition is unlikely to improve to any major degree.

Note: If medical evidence indicates a condition might worsen over time, this is not an indication that the condition is unstable. Remember that stable means the condition is unlikely to improve to any major degree

Permanency versus stability

The relevant considerations for when an impairment is permanent under section 73 of the MRCA are different to that of a condition’s stability status under section 75. For more information about the distinct differences, please refer to Chapter 5.3.4 of the MRCA PI Policy Manual.

              Example – condition is not stable

A veteran has a degenerative osteoarthritis of the knee and has undergone a total knee replacement to improve the impairment and quality of life but will not resolve the impairment completely. The medical evidence indicates the treatment was successful, but further improvement of the condition will occur naturally due of the normal healing process over a six-month period. The medical evidence also indicates there is no further reasonable medical treatment required. In this example it would be open to the delegate to consider the impairment is permanent because all reasonable medical treatment has been undertaken and the underlying impairment is likely to continue indefinitely. Because the condition will improve naturally over the next 6 months, it is not stable. The delegate can consider an interim under section 75. 

Considering the date a condition became stable

A medical practitioner should be able to advise delegates of the date a condition becomes stable. If more information is required to determine an exact date, the delegate may wish to ask the medical practitioner:

“Based on the available evidence and the plausible natural history of the condition(s), when was the current, stabilised level of impairment reached?”

Use of internal medical advisors

In cases where the stability of an impairment or the date of stability is unclear, a veteran’s medical practitioner should always be the first point of call. If this is unsuccessful, the delegate may consult an internal medical advisor for medical input.

The medical advisor should not provide the date a condition became stable, rather should provide an opinion on whether the relevant medical evidence supports the date the delegate is considering for their determination. 

                 Example – condition is stable 

A veteran has tinnitus and has undergone cognitive behavioural therapy and other recommended specialist treatment to improve the impairment and quality of life. Whilst the impairment has been improved by the treatment, it has not completely resolved. The medical evidence indicates there is no further period of convalescence required for the condition; it reached a stable status and was unlikely to improve to any major degree, very shortly after the treatment regime was finished. In this example, it would be open to the delegate to consider the impairment is permanent because all reasonable medical treatment has been undertaken and the underlying impairment is likely to continue indefinitely. Because the condition is not likely to improve any further over time, the condition is stable and the delegate does not need to consider an interim under section 75. The delegate can determine the claim under sections 68 or 71.