|
(Brisbane & Adelaide) (previously the SMACC 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 |
|
SOP BULLETIN #21 |
06 April 1999
Version 2.20 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.
New SOPs incorporated into CCPS |
Intervertebral disc prolapse |
Myopia, hypermetropia & astigmatism |
|
Alcohol dependence or alcohol abuse |
|
SOP amendments to incorporated conditions |
Hepatitis B |
CVA |
|
Cervical spondylosis |
|
Lumbar spondylosis |
|
Thoracic spondylosis |
|
Hypertension |
|
Osteoarthrosis |
|
Enhancements to incorporated conditions |
Conditions where consumption of alcohol is a SOP factor |
Gastro-oesophageal reflux disease |
(A) New SOPs incorporated into CCPS
Intervertebral disc prolapse |
To apply this SOP you need to identify the site of the prolapse when you are ICD encoding the condition. This requires 5 digit coding and there are 27 ICD codes, each one corresponding to a specific intervertebral disc. These are easily accessed using the Commonly Claimed list in the Encoder.
A Diagnostic Report is available for IVDP that will request the necessary diagnostic information.
Trauma or lifting?
The “lifting” factor in the SOP covers repeated heavy lifting over a prolonged period, occurring within a specified period before onset or worsening of disc prolapse.
The “trauma” factor includes a single episode of lifting, but only where this occurs immediately before onset or worsening, and defined symptoms arise immediately and last for a specified period
Thus if a veteran gives a history of lifting a heavy weight, followed immediately by the onset or worsening of IVDP, the factor to use is probably the “trauma” one. This covers a one-off lift of at least 10kg immediately before onset or worsening, provided the requirements re symptoms are met. The "lifting factor", on the other hand, requires prolonged heavy lifting within 5 or 10 years of onset or worsening.
The claimant report for "Repeated Lifting" has the more generous lifting requirements from the reasonable hypothesis SOP (ie 10kg at least 10 times a day). If you have a claim that has only eligible service, you may wish to change the requirements to reflect the balance of probabilities SOP (ie 10kg at least 25 times a day).
The SOP factor “suffering trauma to the relevant disc” is split into two contentions in CCPS- “trauma resulting from injury” and “trauma due to spinal manipulation”. Spinal manipulation forms part of the RMA definition of trauma. However, the rules for linking spinal manipulation to service are different to those linking a trauma due to injury with service.
The “penetrating injury to the relevant disc or adjacent vertebral body, or a fracture of the endplate of the adjacent vertebral body” SOP factor is treated as two contentions in CCPS – “penetrating injury to the relevant disc or adjacent vertebral body” and “fracture of the endplate of the adjacent vertebral body”.
Click on the Policy button on the Contention Management Screen or look in the Research Library [Standard Commentary/Contention Information] for information about all the contentions
For information about the SOP see SOP Bulletin no. 4, November 1997.
Myopia, hypermetropia and astigmatism |
To apply this SOP you need to know whether the veteran has myopia, hypermetropia or astigmatism, and whether the left, right, or both eyes are affected. This is because the SOP factors apply to specific types of refractive errors. For example, the nuclear cataract factor only applies if the veteran has myopia, and myopia in the left eye can only be caused by a nuclear cataract in the left eye.
A Diagnostic Report is available for this condition that will request the necessary diagnostic information
The contentions available for investigation in CCPS will now be determined by the ICD code/s you select. The Contention Management Screen will list only those contentions relevant to the condition you have coded. This is a change from the previous operation of Refractive Error.
CCPS will now allow you to code multiple types and sites of refractive errors. For example, if the veteran claims refractive error, and he has myopia in both eyes and astigmatism in the left eye, these two conditions can be coded as part of the same claim. Once again, this is an improvement on the previous operation of Refractive Error.
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'.
The SOP factor “undergoing surgery involving the cornea, or sclera or buckling procedures (for retinal detachment)” is treated as two contentions in CCPS – surgery involving the cornea or sclera, and undergoing buckling surgery for retinal detachment.
Click on the Policy button on the Contention Management Screen or look in the Research Library [Standard Commentary/Contention Information] for information about all the contentions
For information about the SOP see SOP Bulletins nos. 15 & 20, September 1998 & March 1999.
Alcohol dependence or alcohol abuse |
The "experiencing a stressful event" factor in the old SOP has been replaced with the "experiencing a severe stressor" factor in the new SOP. The definition of a severe stressor is far more detailed and precise than the definition of a stressful event, and also includes examples of events during service that would qualify as severe stressors.
The claimant and medical reports have the more generous time limit from the reasonable hypothesis SOP. If you have a claim that has only Eligible service, you may wish to change the time limit in the questions from 2 years to 1 year.
For information about the SOP see SOP Bulletin no. 17, December 1998.
(B) SOP Amendments to incorporated conditions
Hepatitis B |
A Diagnostic Report is now available for this condition that will request the necessary diagnostic information.
For information about the SOP see SOP Bulletin no. 19, January 1999.
CVA |
The factor "experiencing an acute severe stressor" has been changed to "experiencing a severe stressor" and this change has been incorporated into CCPS.
- For information about the SOP see SOP Bulletin no. 19, January 1999.
CERVICAL SPONDYLOSIS |
The SOP instruments from September 1998 and February 1999 have been incorporated.
The CCPS Hotword Clinical onset of cervical spondylosis now reflects the RMA definition of cervical spondylosis which requires the manifestation of clinical signs before it can be said the disease is present. This means incidental X-ray findings of degeneration in the cervical spine do not signify the clinical onset of cervical spondylosis.
For information about the SOP see SOP Bulletins nos. 15 & 20, September 1998 & March 1999.
LUMBAR SPONDYLOSIS and THORACIC SPONDYLOSIS |
The changes mirror those described above in Cervical Spondylosis except:
There is no factor for exposure to G forces.
A new factor Continuous heavy physical activity has been added. This requires such activity to have been undertaken as an occupation for at least 10 years.
Periods of operational service can be added to periods of eligible service to make up the 10 years. However, where it is necessary to add operational and eligible service, you must then apply the balance of probability SOP requirements ie the onset/worsening must be within the 25 years following the 10 years of heavy physical activity.
For information about the SOP see SOP Bulletins nos. 15 & 20, September 1998 & March 1999.
HYPERTENSION |
The SOP instruments from September 1998 and February 1999 have been incorporated.
The CCPS rulebase and commentary now reflect the RMA use of the term 'accurate determination of hypertension' rather than the clinical onset of hypertension. This means establishing the diagnosis of hypertension by the accurate measurement of blood pressure on a number of occasions.
This SOP is one of the few where the RMA has defined clinical worsening. It means clinically significant worsening of hypertension, which for example requires a change in medication to deal with the clinical worsening.
The factor psychoactive substance abuse involving daily consumption of alcohol has been replaced by the factor alcohol dependence or alcohol abuse which requires the consumption of a specified average amount of alcohol per week at the time of the accurate determination (or clinical worsening) of hypertension.
The SOP factor Injury to a kidney causing scarring of that kidney or injury to a renal artery causing stenosis of that artery is dealt with by two contentions in CCPS - Injury to the kidney and Renal artery stenosis. This latter contention also covers the SOP factor Renal artery stenosis. The SOP includes renal artery stenosis due to an injury as both a causal and an aggravating factor but renal artery stenosis due to disease can only be considered as a causal factor.
The Salt factor
This has been extended to eligible service cases and is now included for causation and aggravation of hypertension.
When looking at a causal relationship to service, it is only necessary to have regard to the salt consumed during operational or eligible service because of hot and/or humid conditions and/or the need to perform strenuous physical work. Salt added to food when cooking or eating should not be considered. This is because during preparation, service food was not salted more heavily than civilian food. The addition of salt to food when eating is a matter of personal taste established long before service life.
Consequently the accurate determination (or clinical worsening) of hypertension must occur during or immediately after operational or eligible service for it to be related to salt consumption during service.
For information about the SOPs see SOP Bulletins nos. 15,17 & 20, September 1998, December 1998 & March 1999.
OSTEOARTHROSIS |
The medical intervention aspect has been reintroduced into the definition of trauma.
A Claimant Report has been created for use with this contention if required.
For information about the SOP see SOP Bulletin no. 19, January 1999.
(C) Enhancements to Incorporated Conditions
Conditions where consumption of specific amounts of alcohol is a SOP factor |
The new rule structure implemented for these conditions in version 2.19 has not changed.
However, there have been some changes to the CCPS commentary, as a result of representations from ex-service organisations, and decisions by the policy area.
These changes include the following instructions:
- alcohol consumed during multiple periods of operational service [or multiple periods of eligible service] can be added together in order to make up the amount specified in the SOP, but only if all periods of consumption are causally related to service.
- an amount consumed on operational service can be added to an amount consumed on eligible service, to make up the amount specified in the SOP for eligible service. However, an amount consumed on eligible service cannot be added to an amount consumed on operational service to make up the amount specified in the SOP for operational service.
- alcohol consumed during service can be added to post-service alcohol consumed because of a medical/psychiatric condition, in order to make up the amount specified in the SOP, but only if both periods of consumption are causally related to service.
There is also additional emphasis on the fact that post service alcohol consumption is considered to be service related if it forms part of alcohol dependence or abuse, another psychiatric condition, or is "self-medication" for another medical condition.
Gastro-oesophageal reflux disease |
The text of the reasons paras for facts 26010 and 26011 in the Addiction to smoking contention has been changed. This should make it more apparent that we are talking about the veteran's case, rather than making a general statement. This change is in response to a request from staff in Qld.