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The Statements of Principles Monitoring, Aetiology and CCPS Commentary Unit

4th floor AMP Place, 10 Eagle St Brisbane Qld 4000.

Facsimile: 07 3223 8722.  email: smaccu@powerup.com.au

Bob Connolly

07 3223 8325  (Manager, Brisbane)

Dr Bev Grehan

07 3223 8376

Maureen Anderson

08 8290 0365  (Manager, Adelaide)

Dr Jon Kelley

07 3223 8412

Duncan Cape

07 3223 8757

Sue Lee

08 8290 0227

Gaynor Cavanagh

07 3223 8331

Vicki Saunders

07 3223 8513

SOP BULLETIN

No. 9

5 March 1998

Release notes - ccps version 2.17

Version 2.17 of the Medical Knowledge Base for CCPS is to be released into production on next Monday, 9th March 1998.

This Bulletin provides a summary of the new and amended SOPs that this new version of CCPS incorporates and also details the changes to some of the existing Rulebases and Commentary.

Refractive Error SOP now incorporated

Important points to note about this condition are:

  • Most refractive errors are present from childhood and are unaffected by life events.  Therefore, all of the SOP factors for this condition are 'below line'.
  • Different SOP factors apply to different types of refractive error.  In order to determine which of the SOP factors must be considered, you will need to identify the type of refractive error which is present.  This will not be set from the ICD code selected because more than one type of refractive error may exist in the one eye.

A Diagnostic Report is available for refractive error that will request the necessary diagnostic information.  The Diagnostic Protocol explains the various types of refractive error.

The diagnostic label or labels should be altered to reflect the actual type or types of refractive error which is/are present (i.e. hypermetropia, myopia, astigmatism etc. etc.)

The presence of the various types of refractive error will be asked by rulebase questions if you indicate on the Contention Management Screen that a contention is to be investigated.

  • Where the claim is for refractive error in both eyes, you should record a separate diagnosis for each eye if:
  • the type of refractive error in each eye is different;
  • or
  • the onset (or worsening) of refractive error occurred at different times in each eye;
  • or
  • there has been a contention made, or there is evidence, of any injury or disease involving either eye.

Amendments to incorporated SOPs

Asthma

The rulebase has been changed so that if you say on the Onset Screen the onset of asthma has occurred after the end of VEA service, not only will this disable (reject) all the aggravation contentions, now it will also reject the causal contention Exposure to occupational antigens ie when you move on to the Contention Management Screen all factors will be disabled (rejected).

This is because such a fact about the onset of asthma will now prove that the onset of asthma did not occur during operational (or eligible) service and consequently asthma could not be due to any antigen exposure during that service.

Malignant neoplasm of the bladder

The SOP amendment corrected the definition of 'aromatic amines' and this has been changed in commentary and the claimant questionnaire for this contention.

Ischaemic heart disease

The SOP amendment added a new causal factor Occupational exposure to, and handling of, products containing nitroglycerine and nitroglycol.  These products are used in some types of ammunition and in gelatinous explosives.

The SOP specifies however, that this new factor can only apply where the clinical onset of ischaemic heart disease occurred:

  • during, or within the two weeks immediately following, a period of operational service;

or

  • during, or within the week immediately following, a period of eligible service.

Cerebrovascular accident

This SOP amendment affects only the intracerebral haemorrhage type of CVA.  The Prolonged anti-platelet therapy factor has been replaced by Treatment with aspirin.

An important element of the new factor is the onset of the CVA must have occurred within 7 days (for operational service cases) or 48 hours (for eligible service cases) of the required amount of aspirin ingestion.

If needed, a questionnaire is available to obtain information about aspirin ingestion from the veteran's doctor.

Diverticular disease

The new Diagnostic Protocol makes it clear that asymptomatic diverticulosis is not covered by this SOP.  The clinical onset of diverticular disease is therefore limited to when the first symptoms were experienced.

This means that the presence of diverticulosis as an incidental finding does not constitute the clinical onset of the disease.

The SOP amendment to the Change to lower dietary fibre diet factor has specified the degree of dietary change required and has introduced a minimum period for the dietary change which must have occurred immediately before the clinical worsening of the diverticular disease.  This SOP factor applies only to operational service.

Gout

The main changes which have been implemented as a result of SOP amendment are:

  • Aspirin and nicotinic acid have been deleted from the list of drugs which may cause or aggravate gout.  Frusemide (used for hypertension, heart failure or kidney failure) and cyclosporine A (an immunosuppressive drug used for organ transplants) have been added to the list.  If needed, a specific questionnaire is available to obtain information about relevant drug treatment from the veteran's doctor.
  • New factors of Chemotherapy and Obesity have been added.

Non-Hodgkin's lymphoma

The causal factor Helicobacter pylori has been added for primary B-cell lymphoma of the stomach only.  For such cancers in operational service cases, the Helicobacter pylori factor may be the easiest way to accept the condition.

If the veteran has Vietnam service, you should investigate the Exposure to herbicides in Vietnam contention first as this may eliminate the need to identify the type and/or origin of the lymphoma.

Malignant neoplasm of the stomach

There have been many changes as a result of the SOP amendment.

  • It will be necessary to identify the type of malignant neoplasm because all the causal factors only apply if the neoplasm is a carcinoma - most are.
  • Smoking was previously limited to cigarettes.  Pipes and cigars have now been added and a 'cessation' aspect introduced.
  • Where the stomach carcinoma arose in the fundus, body, antrum, or pylorus there are new factors of Helicobacter pylori and Chronic atrophic gastritis. For such cancers in operational service cases, the Helicobacter pylori factor may be the easiest way to accept the condition.
  • The Therapeutic radiation factor has introduced a 'lag time'.
  • Working with asbestos has been deleted from the SOP.
  • Gastric resection is now known as Partial gastrectomy.  This factor is limited to carcinoma of the stomach which arose in the fundus, body, antrum, or pylorus.  A 'lag time' has been introduced.
  • With the exception of the Hiroshima/Nagasaki factor, all causal factors also apply to non-operational service cases (ie balance of probability cases) although the pack year requirements in the Smoking factor is different for each standard of proof.

the s.m.a.c.c unit will be happy to answer any questions about ANY OF THE ITEMS COVERED IN THIS BULLETIN AS WELL AS ABOUT ANY OTHER sop-related or ccps-related matter