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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.
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 |
Bernadette McCabe |
07 3223 8393 |
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SOP BULLETIN #18 |
21 December 1998
RELEASE NOTES - CCPS VERSION 2.19
Version 2.19 of the Medical Knowledge Base for CCPS was released into production today.
This Bulletin provides a summary of the new and amended SOPs that this version of CCPS incorporates and also details changes to some existing rulebases and commentary.
These Release Notes are stored in the Research Library on the Title Page under Recent Releases of CCPS medical knowledge base. This is in a NEW CA-friendly format that allows details of changes regarding specific conditions to be easily located. Look at this as being an early Christmas present from Santa Softlaw.
(A) New SOPs incorporated into CCPS
CARPAL TUNNEL SYNDROME |
(a)In relation to the factors:
- Repetitive activities with the hand
- Activities where the hand or forearm is directly vibrated
the SOP requires that if the activities had ceased, the onset or worsening of carpal tunnel syndrome must have occurred within 30 days following the cessation of the activities. Therefore carpal tunnel syndrome can only be related to service activities if the onset or worsening of carpal tunnel syndrome occurred during service or within 30 days after service.
(b) Questions in the Claimant Report - Service Activities are based on the minimum time requirement (65 days) in the operational service SOP. If dealing with a case which has only eligible (ie non-operational) service, you should edit the questionnaire to reflect the 130 day minimum time requirement in the eligible service SOP ie wherever it says 65 days, change this to read 130 days.
CIRRHOSIS OF THE LIVER |
(a) Alcohol consumption is the only above line contention for this condition.
(b) In relation to the factors:
- Suffering from chronic hepatitis B
- Suffering from chronic hepatitis C
determining whether a hepatitis infection is chronic or acute is an essential part of investigation, but it may be a difficult task. You are encouraged to read the commentary carefully [including the hotwords], and to seek medical advice appropriately.
DEEP VEIN THROMBOSIS |
(a) Many of the SOP factors are systemic (affecting the body as a whole) therefore CCPS does not require the specific vein affected by the DVT to be identified unless it is relevant to the SOP factor being investigated. The effects of this are:
- It is not necessary to identify the side or site of the DVT when encoding the condition via the ICD encoder;
- It is necessary to edit the title of the diagnosis when diagnosing the claimed condition eg edit
"deep vein thrombosis" to read
"deep vein thrombosis left leg"
as appropriate;
- It may be necessary to find out in which vein the DVT has occurred eg if considering a trauma to the affected vein.
(b) Although there are many SOP factors for this condition, some of these are quite uncommon. Information about each factor is contained in the Policy window attached to the Contention Management Screen. The only above line contentions are Immobility/pressure to the vein, malignant neoplasm and surgery.
MALIGNANT NEOPLASM OF THE RENAL PELVIS AND URETER |
(a) The smoking and phenacetin factors only apply if the neoplasm is a carcinoma of the renal pelvis or ureter. In practical terms, all malignant neoplasms which fit the RMA definition of malignant neoplasm of the renal pelvis and ureter are carcinomas. Therefore, it is only necessary to identify the site of the malignant neoplasm to establish whether or not it is a carcinoma of the renal pelvis or ureter.
There is a special diagnostic report to enable this information to be requested if necessary.
(b) Phenacetin factor
Phenacetin was commonly used to treat pain and fever – in over the counter preparations such as APC, Vincent's and Bex.
It was also available on prescription in formulas such as Nembudeine, Pentalgin and Fiorinal.
By 1980 phenacetin had been removed from all Australian products and replaced with paracetamol.
Thus, the age of the veteran is an indication of whether or not he is likely to have taken phenacetin.
(c) Thorotrast factor
Thorotrast was used as an X-ray contrast medium, especially as an intravenous injection for examination of the liver, spleen and pelvic organs.
Its use as a diagnostic tool for veterans or members would have been unlikely after 1956, as by this time reports of malignancies caused by thorotrast were being published.
POLYMYALGIA RHEUMATICA |
This is a very uncommonly claimed condition. It has been included in this release only because it was used as a training exercise in the writing of commentary and decision advice paragraphs.
(B) SOP Amendments to incorporated conditions
CARDIOMYOPATHY |
(a) If the diagnosis is primary cardiomyopathy (this is the most common type of cardiomyopathy) and the onset was after the end of VEA service, all contentions on CCPS will be disabled. This is because:
- the SOP factors which apply to primary cardiomyopathy only deal with aggravation;
and
- aggravation can only be considered if the onset occurred before the end of VEA service.
To minimise the need for editorial changes in the decision advice in such a case, on the Contention Management Screen you could change the default setting for the below line contentions to 'Reject (No Evidence)'. This will prevent individual paragraphs being produced for each of the below line contentions.
A procedural note about this has been added to the commentary on the Onset screen.
(b) There is also a new factor included in the SOP - clinically apparent thiamine deficiency (beriberi). This disease may arise in POWs or, less commonly, through nutritional deficiencies associated with other conditions such as alcoholism. Being a POW (J) and drinking alcohol are factors which were already included in the SOP.
CEREBROVASCULAR ACCIDENT |
The factor acute stress causing a temporary aggravation of established hypertension has been replaced by a new factor acute severe stressor.
A new factor panic disorder has been added.
The factor bacterial meningitis has been replaced by a new factor meningitis, encephalitis or cerebral abscess. In CCPS this factor is called “Infection involving the brain”.
The factor carotid arterial disease has been replaced by a new factor disease of the precerebral artery .The pre-cerebral arteries are the carotid artery, the vertebral artery and the basilar artery.
There have been changes to the definition of potential source of cerebral emboli, and these have been incorporated into the hotword.
The wording of several factors has been changed from “immediately before” to “at the time of”. This change has no practical implications.
MALIGNANT NEOPLASM OF THE THYROID |
All factors, except “inability to obtain appropriate clinical management,” now apply for papillary, follicular, and anaplastic thyroid carcinomas only - medullary carcinoma is no longer included.
As papillary and follicular carcinomas account for 70% and 15% respectively of all primary thyroid cancers, this change should not have much of an impact.
OSTEOARTHROSIS |
(a) The terms generalised and localised osteoarthrosis have been omitted from the SOP. Therefore:
- A diagnosis of generalised osteoarthrosis should not now be made (except for POWs);
- Each joint affected by osteoarthrosis will need to be separately diagnosed and determined.
It is also worth noting that the RMA SOP definition of osteoarthrosis requires particular symptoms and signs. Xray evidence alone is insufficient for diagnosis.
(b) There are two new factors: septic arthritis and internal derangement of the knee.
(c) All causal factors (except being a POW) are also now worsening factors.
(d) The definition of trauma to a joint has been substantially changed:
- The trauma must be a single discrete event;
- An extraneous agent is no longer required;
- The reference to medical intervention has been omitted.
(e) The permanent ligamentous instability factor and definition no longer refer to trauma.
(f) The inflammatory joint disease definition now specifies which diseases are covered.
This new SOP arises in part out of a formal investigation by the RMA, particularly into microtrauma. Microtrauma is covered in the SOP by the factors for occupational continuous heavy physical activity and occupational use of pneumatic type tools. The RMA has determined that microtrauma is otherwise not a cause of osteoarthrosis.
PSORIASIS |
(a) The effect of the SOP amendment is to add four new CCPS contentions:
- Treatment with a specified drug
- Alcohol dependence or abuse
- Clinically significant anxiety disorder
- Clinically significant depressive disorder.
These contentions are aggravating factors only – they do not cause psoriasis.
(b) The SOP also amended the Treatment with beta-blockers factor so that only oral or parenteral (by injection) treatment is included. Topical treatment such as eye drops has been excluded by this change.
REITER'S SYNDROME |
The time limits for the factors Enteric bacterial infection and Sexually acquired infection of the urethra have been changed for onset and worsening:
- for reasonable hypothesis cases: previously 90 days, now 60 days
- for balance of probability cases: previously 28 days, now 30 days.
(C) Enhancements to incorporated conditions
Many of the following changes have resulted from feedback/requests by Compensation staff. So, if there is something in CCPS which you think should be changed or improved in some way, please let the SMACC Unit know and we will see what can be done.
TREATMENT OF FACTORS INVOLVING ALCOHOL CONSUMPTION |
For conditions where the SOP specifies consumption of alcohol as a factor, CCPS has previously enabled a causal link to be made between alcohol consumption and service, only through a diagnosis of psychoactive substance abuse involving alcohol.
Following discussions with ESO reps, the policy position re alcohol has changed. Consequently, the consumption of alcohol may be related to service in the following ways:
1. Alcohol consumed during, and as a result of, operational or eligible service.
For eligible service, alcohol consumed when off duty or on leave is not to be included under this 'on service' umbrella (- it could be picked up under 2-4 below).
2. As part of alcohol dependence or alcohol abuse.
3. As part of another psychiatric condition.
4. As "self medication" for a medical condition.
The SOPs that are affected by these changes are:
Cardiomyopathy |
Cerebrovascular accident |
Cirrhosis of the liver |
Colorectal adenomatous polyp |
Malignant neoplasm of the breast |
Malignant neoplasm of the colon |
Malignant neoplasm of the larynx |
Malignant neoplasm of the liver |
Malignant neoplasm of the oesophagus |
Malignant neoplasm of the rectum |
Acute pancreatitis |
Chronic pancreatitis |
Subarachnoid haemorrhage |
There are some SOPs such as hypertension, that have factors that specify psychoactive substance abuse involving alcohol, or alcohol dependence or alcohol abuse. The above changes do not apply to these SOPs and alcohol can only be service-related through the SOP Alcohol Dependence or Alcohol Abuse.
ISCHAEMIC HEART DISEASE |
Note – the following changes were done before the new instruments were signed on 1.12.98. Therefore the changed quantity and timing requirements of factors in the new SOP have not yet been incorporated into CCPS.
(a) The passive smoking contention 'Immersion in an atmosphere of visible smoke haze' has been shifted to 'below line'. The rule structure has also been altered so that those cases where the onset or worsening occurred more than 15 years after operational service (10 years for eligible service) will be eliminated at the beginning of the investigation.
(b) 'Cigar smoking' and 'Pipe smoking' have been made below line contentions (with 'Cigarette smoking' remaining above line) and you will not be asked any questions about smoking unless you elect to investigate one of the smoking contentions.
(c) 'Dyslipidaemia' remains an above line contention (a contention is made above line if it is likely to be claimed or likely to cause or worsen the condition. The likelihood of success of the factor is not a consideration when assigning it above or below line status). However, it will no longer be necessary to identify the type of dyslipidaemia and this contention will propagate to the non-SOP rulebase for dyslipidaemia.
(Thanks to Malcolm Smith in Qld and Andrew Fekete in NSW for their contribution here)
HYPERTENSION |
Commentary and reasons changes have been made to the 'Development secondary to medication' contention. Previously the commentary restricted a possible cause and effect relationship to those circumstances where the clinical onset of hypertension occurred within 4 weeks of starting any drug treatment. This limitation has been removed.
However, whether or not hypertension developed secondary to the taking of a particular drug is a matter which requires medical expertise. A finding that hypertension developed secondary to the taking of a particular drug must be based on medical evidence and should not be based purely on a temporal connection between the taking of a drug and the onset of hypertension.
ASTHMA |
(a) Commentary changes have been made to give more explanation of Clinical worsening of asthma. This term has been defined by the RMA and requires specific events to have occurred. It is quite a difficult test to satisfy.
(b) More information has been included on the Onset screen explaining the relationship between the onset of asthma and the SOP factors.
(c) The rulebase has been changed so that the question 'Has the veteran ever smoked' will only be asked if you elect to investigate the smoking contention.
(Thanks to Malcolm Smith in Qld for his questions and comments)
IRRITABLE BOWEL SYNDROME |
The SOP factor suffering a specified psychiatric condition has been split into two contentions.
The contention 'Specified psychiatric condition' deals with those psychiatric conditions that are specifically named by the RMA in its definition of specified psychiatric condition ie generalised anxiety disorder, panic disorder, adjustment disorder, post traumatic stress disorder and depressive disorders.
The contention 'Other psychiatric condition with features of anxiety or depression' should be used if the veteran has any other psychiatric condition which has features of anxiety or depression.
This change corrects the previous rule structure which limited the psychiatric conditions to those named by the RMA as examples.
(Thanks to Peter Kehoe in Vic for picking this up)
Haemorrhoids |
The CCPS rulebase incorrectly imposed a 24 hour time limit between an episode of straining of stool and the onset of haemorrhoids. This has been removed.
The RMA has been asked to consider inserting a minimum time requirement into this factor. However, until such an amendment is issued, the only time requirement is that an episode of straining at stool predated the onset of haemorrhoids.
Gastro-oesophageal reflux disease (GORD) |
The SOP factor smoking cigarettes or other tobacco products as an addiction had previously been translated on CCPS to smoking 10 pack years. This quantum leap in interpretation has been removed and the rulebase no longer interacts with the smoking module. Read all commentary carefully when investigating this smoking contention.
PEPTIC ULCER DISEASE |
The HW Stressful circumstances and the commentary for fact 6225 have been changed to make it clear that:
- stressful circumstances can arise from a medical condition such as a psychiatric condition
- all 6 month periods of experiencing stressful circumstances should be considered, not just those experienced on service.
GENERALISED ANXIETY DISORDER |
A questionnaire has been included to assist with obtaining details from the claimant about stressful events in the 2 years before onset/worsening of this condition. This questionnaire reflects the time requirements for operational service cases so if you are dealing with a case which has only eligible (ie non-operational) service, you should edit the questionnaire (as well as the medical questionnaire) to reflect the 1 year time requirement in the eligible service SOP ie wherever it says 2 years, change this to read 1 year.
(Thanks to Anne Robinson in NSW for letting us know of the need for this questionnaire)
CORTICOSTEROID HOTWORD |
This Hotword, which is used in several conditions, incorrectly stated that Becotide is not a corticosteroid. This error has been corrected.
(The spotter's fee goes to Wolf Seith and Viv Woolard in SA)
MALIGNANT NEOPLASM OF THE LIP |
Reference to methotrexate had inadvertently slipped into a couple of facts dealing with UV exposure.
(10 out of 10 to Malcolm Smith for detecting this glitch)
If you are having any problems with SOPs, including if you think a SOP needs to be changed, talk to us!