5.7.2 Investigation of NEL

How NEL scores are assessed

When assessing NEL compensation in relation to a specific injury or impairment, the delegate must assign a score against NEL tables B1 - B4 in the DRCA PI Guide.

NEL scores will usually be determined on basis of the information provided by the claimant in their NEL questionnaire and any relevant medical evidence before the delegate. The delegate should request further information from the claimant if they require clarification or further information about the specific losses suffered.

Often, the descriptions in the tables in the DRCA PI Guide will not precisely reflect the client's circumstances. In these circumstances, delegates will need to exercise their discretion when weighing up the evidence and determining an appropriate score.

Due to the subjective nature of NEL:

• there may be a variance in how each client reports the effects of their injury or impairment on their lifestyle and the loss they have suffered; and
• delegates have the ability to exercise discretion when determining the appropriate scores.

A delegate should ensure that they have sufficient evidence to satisfy themselves that the NEL suffered by the claimant was a result of the relevant injury.

It is important that the NEL scores in relation to one injury are not ‘offset’ against the scores determined for a separate injury.  If the delegate determines that the lifestyle effect was the result of a separate injury, including another service-related injury then consideration of the injury to which the current claim relates should focus on the lifestyle effects of this particular injury beyond that of the pre-existing condition.  It is important to remember that if the delegate intends to use a lower score than the self-assessed score that the delegate should give the veteran the opportunity to provide more detail on the impact of the injury.

General information about the assessment of NEL is also provided at Chapter 3.5.3.

For more detailed information about the NEL, ‘Part B’ Tables and Questionnaire, see Chapter 5.8. NEL Tables 1-5 and Questionnaire.

What should be considered when assessing the NEL scores

NEL scores are to be determined on the basis of the evidence available at the date of assessment. These scores form a part of the compensation payment that recognises the specific subjective NEL suffered by the veteran as a result of the injury or impairment.

NEL scores should not be based on speculation as to future NEL that has not yet manifested. Only lifestyle effects that are identified as being permanent should be taken into account when assigning a score for NEL.

Generally it would be reasonable for a delegate to accept the NEL scores as self-assessed by the veteran unless there is evidence that contradicts a certain finding. If the assessing doctor has provided responses on the NEL questionnaire, this may justify a certain score or provide clarification of any discrepancy in the scores on the questionnaire that will allow the delegate to consider if a score is appropriate. 

It is important that the scores given by the delegate are based on the evidence provided to them and are not simply based on the delegate’s own opinions as to the effect of the injury.

Justification of the NEL score

A delegate’s findings must be based on the evidence before them, including any medical evidence and the claimant’s NEL questionnaire. The delegate must carefully consider and weigh up this evidence before making a determination as to the appropriate NEL score in each of the tables.

If the veteran has not provided sufficient information to justify their self-assessed NEL score, the delegate must provide them with an opportunity to provide further information before making a determination, especially if the delegate intends to give an NEL score that is lower than the claimant’s self-assessed score.

A delegate must be able to justify the NEL score they have given against each of the tables. If the delegate decides to adjust a veteran’s self-assessed NEL score on the basis there is clear evidence that the impact on the lifestyle did not result from the injury (e.g. if it is found to have resulted from another injury) they will need to document the evidence and provide clear reasons for their finding.

Further information about documenting reasons for decision can be found in the DRCA Procedural Handbook - Compensation Payment and Determination Processes.

Example

A veteran lodges a PI claim for their accepted lumbar spine condition, and when completing the NEL questionnaire provides a score of 3 for pain with written justification explaining the basis for the score, including that the veteran takes regular anti-inflammatory medications and topical ointments for the pain.

In the majority of cases like this, it would be reasonable to award the NEL rating in the absence of contradictory evidence. Additionally where a rating provided by the client and their assessing medical practitioner is not at odds, there would be no justification for determining anything other than the score provided by the veteran.