C04/2005 CLAIMS ASSESSORS TO ADDRESS ALL CAUSES OF DEATH WHEN DECIDING A CLAIM FOR WAR WIDOW(ER)S PENSION

Contents

Part

Function

1

Gives the reason and background to this instruction

2

Clarifies the status of death certificates in deciding the causes of death.

3

States the need to investigate all possible causes of death, including the claimant's contention.

4

States the need to address the claimant's contention and all possible causes of death in reasons for decision.

5

Cases where the death of the Veteran is due to accepted disabilities

Purpose

The instruction states the requirement for Claims Assessors to address all causes of death contained on a death certificate, or contended by the claimant when deciding a claim for War Widow's pension.

The instruction also clarifies the circumstances by which the death of a veteran due to accepted disabilities can be taken to be war caused or defence caused.

This instruction replaces departmental instructions C10/97 and C03/98.

Issue raised

Legacy and other ex-service representatives continue to raise the lack of consistency in considering the causes of death.  Sometimes the investigation of the primary cause of death is rigidly linked to the primary cause in the first section of the death certificate.  On other occasions the death certificate is not used as the stated cause of death, and a separate medical opinion is obtained.

Death certificates are one piece of evidence

In the majority of cases the cause of death as shown on a death certificate is common ground and no further investigation is required to establish a cause.

However, this is not always the case.

Although the Australian Bureau of Statistics issues guidelines for Medical Officers to complete death certificates, our experience shows that the quality of the information recorded on death certificates varies considerably.

In some cases the certificate merely states the terminal event (eg pneumonia) without reference to the underlying disease process.  In the other extreme, the certificate may list all of a person's medical ailments without clearly indicating which ones were causal in the death.

In the final analysis the information contained on the death certificate constitutes no more than a medical opinion on the cause of death.  Consequently, death certificates can only be treated as one of the possible sources of evidence in deciding the causes of death for a particular claim.

'Rules' cannot apply to death certificates

Because of the variable quality of death certificates, Claims Assessors must not attempt to apply a set of rules in interpreting death certificates.  For instance, no rule can be made that for a cause to be accepted, the cause must appear in the first or second sections of the certificate.

Decide each case on its merits

Each case must be decided on its own merits and depends on the entirety of the evidence available.  Death certificates form part of this evidence on which the Claims Assessor decides the cause of death.

A claimant's contention about a cause of death cannot be disregarded simply on the basis that the contended cause is not included on the death certificate.

All causes to be investigated

Claims Assessors must investigate all causes of death that are shown on a death certificate before rejecting a claim.

The results of investigations must be clearly recorded on the claimant's file.

Claimant's contention to be investigated

In cases where the claimant has contended a cause of death that is not included on the death certificate, this contention must also be investigated and additional evidence sought to establish if it has a basis in fact.

In the first instance, claims assessors should seek guidance from a departmental medical officer (DMO) as to whether further investigation is required for the contended cause of death.  Preferably, the claimant's representative should be contacted to discuss the basis of the contention and be asked about the sources of evidence on which the contention is based.

The Claims Assessor may be required to investigate the matter further by obtaining clinical or hospital notes, autopsy reports, etc, depending on what evidence is available.

Care in accepting contributory causes

It is also important to note that all disabilities contained on a death certificate should not automatically be accepted as having causally contributed to the death.

Such a circumstance might arise where there is evidence that a major disability has caused the death (such as a cancer), but the death certificate also lists other unrelated or minor disabilities as contributory causes (such as hypertension which the medical history shows as controlled).

In this circumstance a medical opinion should be sought about the cause of death.  Before making a decision it may be necessary to obtain further details of the veteran's medical history and treatment in the time leading up to the death.  Again, each case needs to be considered on its merits.

Requirement for reject reasons

In preparing reasons for decisions when rejecting a claim for pension in respect of a veteran's death, Claims Assessors must:

• Show that they have considered all of the disabilities included on a death certificate.

• Show that they have considered the claimant's contention.

• State what they consider to be the causes of death.

• Refer to the evidence that leads to their conclusion.

System

Claims Assessors are required to clearly identify their findings on causes of death in their reasons for decision in the compensation claims processing system (CCPS).

Background

Prior to 1996 the Veterans' Entitlements Act 1986 (VEA) required that each claim for pension following the death of a veteran be determined having regard to the relationship between the death and the deceased's service.

Where the veteran died from an injury or disease that had already been determined by the Repatriation Commission to be war-caused, a claim for pension by the dependants needed to re-establish the service relationship.  Similar provisions applied to the dependants of members of the Defence Force, members of the Peacekeeping Force and members who rendered hazardous service.

The VEA was amended in 1996 to provide additional grounds upon which a pension may be granted to a dependant for claims lodged on or after 1 June 1994.  Section 8(1)(f) was introduced as part of these amendments.  This section provides for a death to be war-caused if the veteran died from an injury or disease that has been determined to be war-caused.  This means that the statement of principles as referred to in sections 120A and 120B, do not apply.

Assessment

Where a veteran has died from a condition, and;

• That condition is an accepted disability, then

The death is to be taken to have been war-caused or defence-caused, and

Section 8(1)(f) applies.  No further consideration is required under Sections 120A and 120B.

Where a veteran has died from a condition and;

•     The veteran has an accepted disability which is not the cause of death, and
•     The condition which caused death is a listed factor in the SOP for that accepted disability, then

Section 8(1)(f) cannot be applied, as the condition listed as a cause of death is not an accepted disability.  Section120A and 120B must be applied and the case is to be considered based on the substantial requirements of the SOP.  This is illustrated in the following examples.

.

Example 1:Ischaemic Heart Disease (IHD) is the sole cause of death.  Diabetes is the sole AD. Diabetes is a known cause of IHD however, as diabetes is not the direct cause of death, the case needs to be determined based on the substa — ntial requirements of the SOP, and needs to be related to eligible war service rendered by the veteran. Sections 120A and 120B apply.

Example 2:Ischaemic Heart Disease is the sole cause of death. IHD is an AD. The cause of death is due to an AD. As per section 8(1)(f), the death of the veteran is taken to be war caused.

Conclusion

In all cases where the veteran's death is not directly and solely related to an accepted disability then sections 120A and 120B apply. The cause of death and the relationship to service must be investigated using the appropriate SOP.

Contact

If you have any queries regarding the above information or procedures please contact Brian Eastman on (02) 6289 6348 or email brian.eastman@dva.gov.au