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SOP BULLETIN

# 30

18 November 1999

RELEASE NOTES - CCPS VERSION 2.22

Version 2.22 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. This Bulletin also details changes to some existing rulebases and commentary.

New SOPs incorporated into CCPS

Sleep apnoea

SOP amendments incorporated into CCPS

Angle-closure glaucoma

Aortic aneurysm

Diabetes mellitus

Malignant neoplasm of the bile duct

Non-Hodgkin's lymphoma

Open-angle glaucoma

Enhancements of CCPS rulebases and commentary

Chronic bronchitis and emphysema

Conjunctivitis

Generalised anxiety disorder

Dietary fat – malignant neoplasms of the rectum, colon and prostate, colorectal adenomatous polyps

Additional amendments not noteworthy -

Subarachnoid haemorrhage

Seborrhoeic dermatitis

Non aneurysmal aortic atherosclerotic disease

Malignant neoplasm of the gallbladder

Cerebrovascular accident

Malignant neoplasm of the brain

New SOPs incorporated into CCPS

Sleep apnoea

The RMA definition of sleep apnoea requires that the episodes of sleep disordered breathing have led to certain clinical features. Therefore the clinical onset of a person's sleep apnoea was not when episodes of cessation and/or reduction in airflow at the nose and mouth during sleep were first noted, but when clinical features attributed to the syndrome were first experienced.

SOP amendments incorporated into CCPS

Angle-closure glaucoma

SOP factor (a) has been split into two contentions in CCPS. These are called Treatment with a drug causing mydriasis or miosis, and Treatment with a drug causing acute angle-closure glaucoma.
SOP factor (e) has been split into two contentions in CCPS. These are called Hereditary corneal dystrophies, (which covers posterior polymorphous dystrophy and Fuch's endothelial dystrophy), and Iridocorneal endothelial syndrome.
For information about the SOP see SOP Bulletin no. 19, 18/1/99.

Aortic aneurysm

SOP factors (d), (e), (f), (h), (m) and (n) which cover Marfan syndrome, Ehlers-Danlos type IV syndrome, cystic medial necrosis, infective aortitis, tertiary syphilis, Takayasu's syndrome, giant cell arteritis and coarctation of the aorta, have been combined into one CCPS contention called Specified conditions for aortic aneurysm.
For information about the SOP see SOP Bulletin no. 16, 16/10/98.

Diabetes mellitus

The serum 2,3,7,8-TCDD [dioxin] contention should only be investigated if the claim cannot succeed under another contention, and the veteran has Vietnam service that would support a causal association between that service and a level of serum dioxin.
The blood test required to investigate this factor is complex and expensive to perform.
The reasons paragraph that is produced when a claim fails fact 28287 (The veteran had a serum 2,3,7,8-TCDD level of at least 5 ppt at the time of the clinical onset of diabetes mellitus as a causal result of operational service) is necessarily generic because it has to cover all types of operational service, not just Vietnam service. Where a claimant has undergone the blood test for serum dioxin but still fails this contention, it would be more meaningful to the claimant if more specific reasons were added eg "A serum dioxin level of 2 parts per trillion was recorded on 15.9.99. This figure was used in a formula to calculate the serum dioxin level at the time of the clinical onset of diabetes mellitus (approx June 1987). The calculated level was 3.7 which is less than the level specified in the Statement of Principles."
One of the ways to identify relevant drugs in the contention Treatment with a drug reported to have caused hyperglycaemia is by accessing the Internet to establish if a drug has been “reported to have caused hyperglycaemia in the published peer-reviewed medical literature”. The Weblink and instructions on how to do this are contained within the hotword Internet Medline search for published peer-reviewed literature.

NB This Weblink will connect automatically if it is activated through the CCPS Research Library. However, if the hotword Internet Medline search for published peer-reviewed literature is opened via CCPS, the Weblink will not automatically open the Internet site and you will need to manually enter the Internet address on the Internet Browser.

For information about the SOP see SOP Bulletin no. 23, 28/6/99.

Malignant neoplasm of the bile duct

In the old cholangiocarcinoma SOP the chronic hepatobiliary infestation factor was split into two contentions in CCPS – clonorchiasis and opisthorchasis. In incorporating the new SOP these conditions have been re-combined into one contention called Chronic hepatobiliary infestation by liver flukes.
For information about the SOP see SOP Bulletin no. 22, 5/5/99.

Non-Hodgkin's lymphoma

For a veteran with service in Vietnam, you should first investigate the contention Being on land in Vietnam or at sea in Vietnamese waters. It is easier to investigate and to satisfy this contention than it is to investigate and to satisfy the herbicide contention (which requires that the veteran sprayed or decanted specified herbicides).
For information about the SOP see SOP Bulletin no. 23, 28/6/99.

Open-angle glaucoma

SOP factor (c), "suffering vitreal haemorrhage, hyphema or intraocular surgery" is covered by two CCPS contentions. Intraocular surgery is covered by the penetrating keratoplasty or other intraocular surgery contention. Vitreal haemorrhage and hyphema are covered by the intraocular haemorrhage contention.
For information about the SOP see SOP Bulletin no. 19, 18/1/99.

Enhancements of CCPS rulebases and commentary

Chronic bronchitis and emphysema

The rulebase for Exposure to an airborne irritant has been restructured so that if the onset/worsening of non-obstructive chronic bronchitis (ie chronic simple, chronic mucopurulent and asthmatic bronchitis) did NOT occur:

during operational service or within the year following operational service; or

during eligible service, or within the 30 days following eligible service

the contention is failed. This rule structure will save unnecessary CCPS processing for those cases which do not meet the timing requirements for this SOP factor.

An explanation about the application of the smoking factor to non-obstructive chronic bronchitis has been added to the Policy Window of the Contention Management screen. The SOP records a separate smoking factor for non-obstructive chronic bronchitis which includes a cessation clause. However, this cessation aspect is superfluous because factors (b) and (e) of the SOP (10/15 pack years without cessation) apply to all types of diseases covered by the CB&E SOP. Therefore there is no need to apply any cessation of smoking requirements to chronic simple, chronic mucopurulent, or asthmatic bronchitis.

Conjunctivitis

Sometimes it is necessary to represent SOP factors in a different form ie CCPS contentions don't always look like the SOP factors. This is the case with conjunctivitis. How this has been done, and why, is explained in the Policy Window attached to the Contention Management screen.
The list of SOP factors that is attached to the Decision Advice letter has been changed. Previously it listed the contentions as they appear in CCPS. Now it accurately reflects the SOP factors but also contains a note explaining how some of these factors relate to the headings used in the Decision Advice letter.

Generalised anxiety disorder

The RMA definition of a stressful event is very broad ie "an occurrence which evokes feelings of anxiety or stress". It was suggested that the examples that were included in commentary and reasons paragraphs implied a greater level of stress than the definition requires. Therefore, commentary and reasons paragraphs have been amended by deleting the examples of a stressful event.

Dietary fat factor for:

Malignant neoplasm of the prostate

Malignant neoplasm of the colon

Malignant neoplasm of the rectum

Colorectal adenomatous polyps

The commentary for these conditions now contains more detailed information about the level of animal fat in the civilian diet, and the service diet during World War 2. This information can be viewed by opening the hotwords called Increase in animal fat consumption and Alteration in dietary pattern [fat/fibre]. The information is derived from a scientific review of animal fat in the Australian diet including the armed services rations in World War 2, by Dr Ruth English.

Additional amendments

Amendments to the following incorporated conditions are included in this release. However, there are no noteworthy CCPS features: