CCPS_Bull031

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SOP BULLETIN #31

30th November 1999

RELEASE NOTES - CCPS VERSION 2.23

It is planned to release version 2.23 of the Medical Knowledge Base for CCPS into production tonight.  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	Acquired hallux valgus Adhesive capsulitis of the shoulder Animal envenomation Bronchiectasis Dengue fever Hiatus hernia Metatarsalgia Spondylolisthesis and spondylosis
SOP amendments incorporated into CCPS	Gastro-oesophageal reflux disease Diabetes mellitus Non-Hodgkin's lymphoma Migraine Tension-type headache
Enhancements of CCPS rulebases and commentary	Hepatitis B Osteoarthrosis

(A)New SOPs incorporated into CCPS

Acquired hallux valgus

•       The commentary for this condition includes a diagram which illustrates the deformity of hallux valgus. The diagram is contained in the "clinical onset" hotword. More graphics are being included in CCPS commentary to help visualise the anatomy of certain conditions.
•       For information about the SOP see SOP Bulletin no. 14, July 1998.

Adhesive capsulitis of the shoulder

•       One of the factors is “suffering quadriplegia or hemiplegia... or monoplegia involving the affected shoulder”.  The paralysis does not have to be permanent. It may be temporary, but must be more than transient; and must be within the 12 months before the clinical onset/worsening of adhesive capsulitis of the shoulder.
•       For information about the SOP see SOP Bulletin no. 19, January 1999.

Bronchiectasis

•       The SOP factor for pneumonia contains additional criteria (ongoing symptoms and evidence contrary to a causal link with the episode of pneumonia) for Balance of Probability cases.  A question dealing with these criteria is contained in the investigative medical questionnaire in CCPS.  Therefore:

• if you wish to use the questionnaire to investigate pneumonia

and

• you are dealing with a case that only has operational (or peacekeeping) service

you should delete Q2 from the questionnaire.

•       The SOP factor aspiration of gastric contents refers to 'evidence of pneumonia or bronchopneumonia' when addressing clinical worsening for reasonable hypothesis cases.  This is thought to be an error (the RMA definition of pneumonia includes bronchopneumonia) and has been referred to the RMA.  Meanwhile, the factor has been incorporated into CCPS using the words 'evidence of pneumonia or pneumonitis' which is the wording used in the factor for onset and worsening for balance of probability cases and for onset for reasonable hypothesis cases.

Dengue fever

•       If the veteran has a history of dengue fever and the condition is no longer present you should diagnose Dengue fever – resolved, or alternatively, diagnose No Incapacity Found

Hiatus hernia

•       If investigating the inability to obtain appropriate clinical management, CCPS will ask if the hiatal hernia is a paraoesphageal hiatal hernia, and if not, the claim must be rejected.
•       For information about the SOP see SOP Bulletin no. 23, June 1999.

Metatarsalgia

•       This is another condition which contains a diagram, this time of the metatarsal bones.

Metatarsalgia (S018) was revoked as a formal SOP condition on 30 March 2011 RMA determinations: On 30 March 2011 the RMA made a determination to revoke the Instruments 39 & 40 of 1996 regarding Metatarsalgia. By doing so, in effect the RMA have declared that Metatarsalgia is not a "disease" or "injury" as defined in subsection 5D(1) and so can not be covered by a Statement of Principle.

Refer Instruments 39 and 40 of 1996, which were reissued in March 2011 39 of 1996 (2011 version) Metatarsalgia (RH) 40 of 1996 (2011 version) Metatarsalgia (BOP) General Information: If metatarsalgia is claimed then the underlying cause must now be investigated and determined instead.

Spondylolisthesis and Spondylolysis

•       This is a complex SOP as the application of many of the factors depends on whether the condition is spondylolisthesis or spondylolysis or both, and also on what area of the spine is affected.
•       The trauma factor is particularly complicated as the required temporal link between the trauma and onset varies depending on the type of fracture/dislocation sustained as a result of the trauma. The aggravation requirements are also different from the onset requirements.
•       There are a number of multi - question screens in CCPS, to manage these requirements, and the commentary for these screens explains the purpose of the questions. The commentary for the Contention Management Screen [click on the policy button] also provides information about the application of factors.
•       The inability to obtain appropriate clinical management factor in this SOP is unusual because it only applies in the presence of acute traumatic spondylolisthesis or spondylolysis; neurological manifestations; or severe progressive symptoms warranting surgical intervention.

The following SOPs are incorporated in this release. However, there are no noteworthy CCPS features:

•       Animal Envenomation

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

Gastro-oesophageal reflux disease

The SOP requirements regarding smoking cannot be fully dealt with by the smoking module in CCPS.  Therefore, if the smoking history entered on CCPS satisfies the pack-year requirement specified in the SOP, a separate question will then be asked regarding the quantity that was smoked at the time of onset/worsening of gastro-oesophageal reflux disease.

Correction

In SOP Bulletin 26 when advising of the changes as a result of the new Instruments for this condition, we inadvertently made a mistake in regard the Zollinger-Ellison factor.  It should have read:

The Zolliinger-Ellison factor has been revised and where it was previously 'within 5 days' (RH) and 'within 24 hours' (BOP), it is now “at the time of” for both standards of proof.

•       For information about the SOP see SOP Bulletin no. 26, September 1999.

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

•       Diabetes mellitus
•       Non-Hodgkin's lymphoma
•       Migraine
•       Tension-type headache
•       For information about these SOPs see SOP Bulletin no. 28, November 1999

(C)Enhancements to Incorporated Conditions

Hepatitis B

The rulebase has been changed so that all contentions are consistent with more recently developed rule structures.  This has resulted in some changes to the questions, reasons and commentary in CCPS.

Osteoarthrosis

•       Following a review of the use of the RMA SOPs for osteoarthrosis two factors – continuous heavy physical activity and internal derangement of the knee – have been moved to below-line on the contention management screen.
•       Also as a result of the same review there have been some minor changes to the commentary on trauma to a joint.

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