5.3.4 All reasonable rehabilitative treatment

All reasonable rehabilitative treatment

Key points – determining claims under sections 68 and 71

To determine a claim under section 68 or 71, delegates must be reasonably satisfied (in this order) that:

• As a result of a service-caused condition, there is an impairment,
• The impairment is permanent (i.e. likely to continue indefinitely),
• The condition has stabilised, and
• The requisite degree of impairment, or increased degree of impairment, is met.

Reasonable rehabilitative treatment

When considering whether an impairment is likely to continue indefinitely (permanent), delegates should turn their mind to:

1. whether, based on appropriate medical opinion, there is reasonable rehabilitative treatment available for the impairment, and
2. whether the veteran has undertaken the reasonable rehabilitative treatment, or
3. whether the veteran has reasonably refused to undertake the rehabilitative treatment. 

Rehabilitative treatment means any treatment, including surgery, designed to restore a person, as far as it can be, to the person's former health (see Smiths J in Dragojlovic v Director-General of Social Security (1984) 1 FCR 307-308). 

An impairment being permanent is one of the very first considerations for a delegate, as it is the fundamental basis for the payment of permanent impairment compensation.

Note: The existence of a diagnosable condition is not sufficient for a delegate to determine that an impairment from that condition is permanent. Put simply, an impairment is not permanent just because it exists.

When an impairment cannot be determined permanent, permanent impairment compensation is not payable for the impairment. In this situation, the impairment can be excluded from the whole person assessment, and the delegate can continue to determine the compensation payable under sections 68 or 71, in respect of other impairment that is permanent.

For more information regarding unreasonable refusals to undertake medical treatment, please see Chapter 5.5.1 of the MRCA PI Manual.

              Determining an impairment is not permanent

If all reasonable rehabilitative treatment has been undertaken in respect of an impairment, this may indicate the impairment is permanent. 

However, if reasonable rehabilitative treatment exists for an impairment and the veteran is either:

1. currently engaged in the treatment, or
2. plans to commence the treatment soon, or
3. has unreasonable refused to undertake treatment, 

the delegate will likely be unable to determine the impairment is permanent. 

How claims should be determined when an impairment is not permanent

In cases where (a), (b) or (c) above applies, the delegate is unable to determine the impairment is permanent and the impairment can be excluded from the assessment. 

Due to the whole person assessment methodology under the MRCA, the delegate can continue to consider other accepted conditions where the impairment is permanent. Where the relevant thresholds are met, the claim can be accepted, and compensation paid, under sections 68 or 71 of the MRCA.

Example 1 – single accepted condition not permanent

If there is a single service-caused condition where the delegate is unable to determine the impairment is permanent because the veteran has not yet undergone reasonable medical treatment, the claim can be rejected under section 68 or 71 on that basis. 

Example 2 - more than one accepted condition, some impairment not permanent

If the delegate cannot determine an impairment is permanent, however other impairment is, then the delegate can accept the claim under section 68 or 71, if the requisite degree of impairment is satisfied in relation to the permanent impairment. The impairment that is not yet permanent can be excluded from the assessment of the claim.

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.

When an impairment is permanent but the condition causing the impairment is not yet stable, delegates should consider making an interim determination under section 75. For more information about interims, please see Chapter 5.8 of the MRCA PI Policy Manual.

However, when an impairment is not permanent because the veteran has not undergone all reasonable medical treatment for the impairment, the impairment is excluded from the assessment, and the claim is determined under sections 68 or 71. An interim under section 75 is not appropriate in this situation.

It is important to make the distinction that when an impairment is excluded from the assessment because the delegate cannot determine the impairment is permanent, the delegate is not assessing the impairment as zero under GARP M. This is because an assessment will not proceed to be undertaken under GARP M, until such time that the impairment is permanent.

Step by step delegate checklist

The following checklist will support delegates in ascertaining whether the claim should be determined under sections 68 and 71, or as an interim under section 75.