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SOP BULLETIN # 24

19 July 1999

RELEASE NOTES - CCPS VERSION 2.21

Version 2.21 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.  There is also a list of conditions that have had their existing rulebase removed to allow for work to be done on new rulebases.

New SOPs incorporated into CCPS

Impotence

Osteoporosis

Pruritus ani

Anal fissure

SOP amendments to be incorporated

Ischaemic heart disease

Non-melanotic malignant neoplasm of the skin

Varicose veins of the lower limb

Peptic ulcer disease

Soft tissue sarcoma

Depressive disorder

Pterygium

Inguinal hernia

Acute pancreatitis

PTSD and acute stress disorder

Enhancements to incorporated conditions

Malignant neoplasm of the renal pelvis and ureter

Malignant neoplasm of the lung

Acquired cataract

Miscellaneous changes

Claimant reports of psychiatric conditions

Alcohol consumption during eligible service

Malignant neoplasm of the stomach and non-Hodgkin's lymphoma

Changes to incorporated conditions to be included in the next MKB Release 2.22

(A)  New SOPs incorporated into CCPS

IMPOTENCE

Specified psychiatric condition

In the definition of a specified psychiatric condition, the RMA has listed a number of psychiatric conditions as being possible causes of impotence. However, the list is not exclusive. The RMA definition also includes any other psychiatric condition with features of anxiety or depression.

This SOP factor has been split into three contentions in CCPS. Mood disorder due to a general medical condition, and depressive disorder due to drugs are separate contentions in CCPS. This is because the rulebase needs to ask different questions to relate these conditions to service.

Other psychiatric conditions are covered by the CCPS contention specified psychiatric condition for impotence.  You will need to ICD encode the particular psychiatric condition applicable in your veteran's case.

Contention Management Screen commentary explains how the psychiatric conditions listed by the RMA are covered by the various psychiatric SOPs. To look at this commentary simply click on the Policy button on the bottom right hand side of the Contention Management Screen.

Note

Although bipolar disorder is listed as one of the specified psychiatric conditions in the Impotence SOP, the ICD codes assigned by the RMA exclude the following codes:

296.0 [manic disorder, single episode], 296.4 [bipolar affective disorder – manic] and 296.80 [manic depressive psychosis, unspecified].  But these are codes which are included in the Bipolar Disorder SOP.

Therefore you must be sure about the nature of the bipolar disorder at the time of the clinical onset of impotence. For example, a manic episode at the time of the clinical onset of impotence does not satisfy the definition of bipolar disorder contained in the SOP for Impotence. There is Commentary in CCPS to alert you to this requirement.

Aortic atherosclerotic disease

ICD codes in the RMA definition of this condition exclude aneurysms. Thus this SOP factor will be covered by the SOP for Non-Aneurysmal Aortic Atherosclerotic Disease. Because of this the Propagation Management Screen text, and the medical report text will be non-aneurysmal aortic atherosclerotic disease – in order to make sure aneurysms are excluded from consideration.

Disorders of the penis

This CCPS contention covers two SOP factors – priapism and Peyronie's disease

OSTEOPOROSIS

Many of the SOP factors have been grouped together based on timing requirements specified in the SOP:

List 1 conditions -chronic renal failure, rheumatoid arthritis, multiple myeloma, systemic mastocytosis and anorexia nervosa - need to have been present at the time of onset or worsening of osteoporosis

List 2 conditions –hypogonadism, hyperprolactinaemia, Cushing's syndrome, thyrotoxicosis and hyperparathyroidism - need to have been present for a continuous period of at last one year within the ten years before the onset or worsening of osteoporosis.

Being immobile

The claimant questionnaire for this contention asks about being immobile for a continuous period of at least 60 days.  This is the time requirement specified in the SOP for operational service cases.  If you have a case which has only eligible service, you may wish to edit the questionnaire to refer to 120 days instead of 60 days.

For information about this SOP see SOP Bulletin no 1 of 12/9/97

PRURITUS ANI

The factor “inability to maintain adequate anal hygiene” is the only above-line contention.  This inability can be due to environmental circumstances, physical incapacity such as obesity, or an anal condition such as haemorrhoids.  There is also a below line contention “a specified colorectal or anal condition”.  In cases where the anal hygiene has not been maintained because of a colorectal or anal condition, this below line contention should be investigated first because of its more generous time requirements.

The factor “systemic treatment with niclosamide, clioquinol or mineral oil” has been split into two contentions in CCPS to allow for a separate investigation into mineral oil which is a common over-the-counter preparation.

ANAL FISSURE

Although this condition is not commonly claimed, it has been incorporated into CCPS as part of a training exercise.

(B)  Amendments to incorporated conditions following changes to the SOPs

ISCHAEMIC HEART DISEASE

RMA instruments from December 1998 and May 1999 have been incorporated.

Investigative questionnaires such as the Claimant Report for Severe stressor should be edited to delete questions dealing with aggravation if aggravation is not a viable issue to the current claim (eg if the onset of ischaemic heart disease occurred after VEA service, aggravation paths must fail).

For information about this SOP see SOP Bulletins no 17 of 4/12/98, and 22 of 5/5/99.

NON MELANOTIC MALIGNANT NEOPLASM OF THE SKIN

RMA Instruments of July 98 have been incorporated.

A diagnostic questionnaire is available to obtain histology information if required.

For information about this SOP see SOP Bulletin no 14 of 2/7/98.

VARICOSE VEINS OF THE LOWER LIMB

Deep vein thrombosis (DVT) is the only above line factor.  However, DVT would also be covered by the factor “complete or partial obstruction of vein”.  Commentary in contention management suggests investigating the DVT factor first, because unlike all other factors which must occur at the time of clinical onset, DVT can occur any time before the clinical onset of varicose veins.

For information about this SOP see SOP Bulletin no 16 of 16/10/98.

PEPTIC ULCER DISEASE

The type of peptic ulcer – chronic gastric OR chronic duodenal ulcer – must be identified in order to investigate the aspirin factor.

The Helicobacter pylori factor has been amended by the RMA and no longer contains a definition of presumption of infection during service.  The issues of presumption of infection and relating infection to service life are currently under consideration by the policy area in National Office.  Pending the issue of an Advisory Note, existing CCPS commentary for this factor has been withdrawn.

For information about this SOP see SOP Bulletin no 20 of 2/3/99.

SOFT TISSUE SARCOMA

There are three preliminary questions in CCPS. This is because:

  • the lymphoedema factor only applies if the STS is an angiosarcoma, [previously this was a lymphangiosarcoma]
  • the gaseous vinyl chloride factor only applies if the STS is an hepatic angiosarcoma, and
  • the new chronic solar skin damage factor only applies if the STS is an atypical fibroxanthoma.

Therefore you will be asked if the veteran's soft tissue sarcoma is an angiosarcoma, an hepatic angiosarcoma or an atypical fibroxanthoma. CCPS will assume that if the STS is an hepatic angiosarcoma, it is an angiosarcoma. It will also assume that if the STS is not an angiosarcoma, then it is not an hepatic angiosarcoma.

For information about this SOP see SOP Bulletin no 14 of 2/7/98.

DEPRESSIVE DISORDER

The RMA Instruments of September 98 have now been incorporated into CCPS.

For information about this SOP see SOP Bulletin no 15 of 7/9/98.

PTERYGIUM

The RMA Instruments of September 98 have now been incorporated into CCPS.

When using the UV Risk Calculator computer program, if the clinical onset of the pterygium was during VEA service, then the evaluation date used in the program should be set to the date of onset of the pterygium.

  • For information about this SOP see SOP Bulletin no 15 of 7/9/98.

INGUINAL HERNIA

The RMA has provided a new definition of 'increased intra-abdominal pressure' and consequently this factor has been split into 3 CCPS contentions:

  • Increased intra-abdominal pressure due to chronic cough
  • Increased intra-abdominal pressure due to lifting heavy weights
  • Increased intra-abdominal pressure due to a medical condition.

If the veteran suffered increased intra-abdominal pressure due to a chronic cough associated with a medical condition (such as bronchitis), it should be processed under the “chronic cough” contention as the “medical conditions” specified in the SOP do not include respiratory conditions. The chronic cough contention also covers a chronic cough arising as a consequence of the environment of service eg working in an enclosed space with chemicals. There is a new medical questionnaire about increased intra-abdominal pressure.

Contention Management Screen commentary explains the contentions.  To look at this commentary simply click on the Policy button on the bottom right-hand side of the Contention Management Screen in CCPS.  Alternatively, if using the CCPS Research Library, access the condition Inguinal Hernia, click on Standard commentary and then click on Contention information.

For information about this SOP see SOP Bulletin no 16 of 16/10/98.

ACUTE PANCREATITIS

The RMA in October 98 amended the contents of the drugs Table 1.  The CCPS commentary has now been updated to reflect this amendment.

For information about this SOP see SOP Bulletin no 16 of 16/10/98.

PTSD and ACUTE STRESS DISORDER

In the RMA Instruments of January 99 and June 99, the SOP factor is now called severe stressor and has a new definition. These changes have been incorporated into CCPS commentary.

For information about these SOPs see SOP Bulletins no 19 of 18/1/99 and 23 of 28/6/99.

(C) Enhancements to Incorporated Conditions

MALIGNANT NEOPLASM OF THE RENAL PELVIS AND URETER

The SOP limits the smoking and phenacetin factors to carcinoma of the renal pelvis and ureter.  In CCPS this was interpreted to mean that carcinoma of the renal calyces was excluded from the smoking and phenacetin factors.

It is now recognised that the renal calyces are covered by the RMA definition of carcinoma of the renal pelvis and ureter.

In practical terms, all malignant neoplasms which fit the RMA definition of malignant neoplasm of the renal pelvis and ureter are carcinomas.  Therefore, if you are satisfied the neoplasm is not a soft tissue sarcoma, non-Hodgkin's lymphoma nor Hodgkin's disease, no further identification of histological type nor site is needed and all the SOP factors can be considered.

CCPS has been corrected to reflect this.

MALIGNANT NEOPLASM OF THE LUNG

The histological type of the lung cancer is relevant when dealing with the smoking and passive smoking contentions.  Commentary and the Diagnostic Protocol now include reference to non-small cell carcinoma, which is not an histological type but a term used to reflect a common treatment approach.  It usually covers squamous cell carcinoma, adenocarcinoma or large cell carcinoma.

(Thank you to Celia Perry from the Victorian State Office for bringing this to notice)

ACQUIRED CATARACT

The rulebase has been amended to reflect the SOP requirement that the required UV risk due to service has been achieved before the onset of the cataract.

When using the UV Risk Calculator computer program, if the clinical onset of the cataract was during VEA service, then the evaluation date used in the program should be set to the date of onset of the cataract.

(D) Miscellaneous

Claimant reports for psychiatric conditions

Claimant reports for alcohol dependence, depressive disorder and generalised anxiety disorder have been withdrawn.  This is because of concern that it may be inappropriate for mentally ill veterans to recall/relate stressful experiences in this way.

Alcohol consumption during eligible service

When calculating alcohol consumed during eligible service, CCPS Commentary previously directed claims assessors to exclude alcohol consumed while on leave or off duty.  Such alcohol should now be included when calculating the amount consumed during eligible service.  However, the causal relationship with service must still be addressed.

Commentary and reasons paragraphs have been amended to reflect this Policy adjustment.

Malignant neoplasm of the stomach and Non-Hodgkin's lymphoma

The issues of presumption of infection with Helicobacter pylori and relating the infection to service life are currently under consideration by the policy area in National Office, following the amendment of the Peptic Ulcer Disease Statement of Principles. These issues also affect the Helicobacter pylori commentary in malignant neoplasm of the stomach and Non-Hodgkin's lymphoma.  Therefore existing CCPS commentary for this factor has also been withdrawn for these two conditions.

Changes to incorporated conditions to be included in MKB release 2.22

Several conditions that are incorporated in CCPS have revocations or amendments that have not yet been incorporated into the rulebase.  To enable work to commence on these changes, which are to be included in the next MKB release of CCPS, the rulebase has been withdrawn for the following conditions:

  • Open angle glaucoma
  • Angle closure glaucoma
  • Malignant neoplasm of the bile duct (replacing Cholangiocarcinoma)
  • Malignant neoplasm of the gall bladder
  • Malignant neoplasm of the brain
  • Non-aneurysmal aortic atherosclerotic disease and Aortic aneurysm (replacing aortic atherosclerotic disease)

STOP PRESS:  Copies of SOP Bulletins are now available on the Title Page of CCPS Research Library, in chronological order.  Also, if you look at the RMA Instruments by year there is quick link to the relevant SOP Bulletin for each group of gazetted SOPs.

Remember, if you are having any problems with SOPs, including if you think a SOP needs to be changed, talk to us !