RELEASE NOTES - CCPS VERSION 2000/02

	Decision Support Unit
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		SOP Bulletin No. 33

28 — th February 2000

The February 2000 edition of the Medical Knowledge Base (MKB) for CCPS was released into production today.  Previous releases have been referred to by a sequential numbering system (this release would have been referred to as version 2.24), but new releases of the MKB will now be referred to by the year and month of their receipt by the Department.  Hence the February 2000 edition will be referred to as version 2000/02.

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	Chronic gastritis Drug dependence or drug abuse Malignant neoplasm of the oral cavity or hypopharynx Panic disorder Secondary parkinsonism Suicide or attempted suicide
SOP amendments incorporated into CCPS	Malignant neoplasm of the prostate Parkinson's disease
Enhancements of CCPS rulebases and commentary	Cholelithiasis Chronic bronchitis and emphysema Chronic pancreatitis Ischaemic heart disease Malignant neoplasm of the gallbladder Malignant neoplasm of the stomach Non-Hodgkin's lymphoma Osteoarthrosis Otitis externa Peptic ulcer disease
Additional amendments - not noteworthy	Myeloma

New SOPs incorporated into CCPS

Chronic gastritis

• Because chronic gastritis is asymptomatic, the SOP uses the term “before the diagnosis of chronic gastritis” instead of the term “before the clinical onset of chronic gastritis”.  The diagnosis is established by endoscopy alone or by endoscopy together with biopsy.
• There is only one causal factor for this condition - Helicobacter pylori infection.  When considering this contention, you should have regard to Advisory No 6/99 which deals with Helicobacter pylori.  This advisory can be accessed via the Hotword link in the CCPS commentary.
• For information about the SOP see SOP Bulletin No. 26, 2 September 1999.

Drug dependence or drug abuse

• Although this condition does not attract many claims, it has been incorporated into CCPS because it was previously covered by the SOP (now revoked) for Psychoactive substance abuse or dependence.
• For information about the SOP see SOP Bulletin No. 17, 4 December 1998.

Malignant neoplasm of the oral cavity or hypopharynx

• Cigarette smoking and alcohol consumption are the above line contentions for this neoplasm.
• The below line contention Oral use of smokeless tobacco and similar products only applies if the neoplasm was in the oral cavity (which includes the oropharynx) so there is a diagnostic report available to help you get this information if required.

Panic disorder

• This condition has no remarkable features.
• For information about the SOP see SOP Bulletin No. 19, 18 January 1999.

Secondary parkinsonism

• The Diagnostic Protocol (view this via CCPS Research) includes advice on action to take if it is not clear whether or not the veteran has Parkinson's disease or secondary parkinsonism.  If this is an issue in a particular case, remember to address this in the reasons for decision rather than leaving the advice letter to simply say 'the medical name for the claimed condition is secondary parkinsonism'.
• The SOP factor Lesion affecting the brain stem has been treated as two contentions in CCPS - Lesion affecting the brain stem which deals with lesions due to disease and Severe trauma to the head which deals with lesions due to trauma.  This latter contention is the only above line contention for this condition.
• For information about the SOP see SOP Bulletin No. 28, 4 November 1999.

Suicide or attempted suicide

• If an apparent attempt at suicide has been made, you should consider whether an underlying psychiatric condition is present and that should be diagnosed in answer to the claim.  You also need to consider whether any injury has resulted from this suicide attempt that should be diagnosed (and that should propagate to this SOP).
• When confirming the diagnosis (or cause of death) you should edit the diagnostic label to read either suicide or attempted suicide and not both.

SOP amendments incorporated into CCPS

Malignant neoplasm of the prostate

• The claimant report for the increased animal fat consumption factor refers to the RH requirement of 20 years duration.  If you have an eligible service only claim, you should edit this questionnaire to refer to 25 years duration to reflect the BOP requirement.
• For a veteran with Vietnam service, the contention Being on land in Vietnam or at sea in Vietnamese waters may be the easiest to satisfy, therefore it is suggested that this contention be tested first.

Parkinson's disease

• This is a primary condition of unknown cause and there are no causal factors in the SoP.  It can only be connected to service if it was aggravated by a service-related inability to obtain appropriate clinical management for Parkinson's disease.  The Diagnostic Protocol (view this via CCPS Research) includes advice on action to take if it is not clear whether or not the veteran has Parkinson's disease or secondary parkinsonism.
• For information about the SOP see SOP Bulletin No. 28, 4 November 1999.

Enhancements of CCPS rulebases and commentary

Chronic bronchitis and emphysema

• The contention Exposure to an airborne irritant has been moved to 'below line' because this SOP factor only applies to chronic simple, chronic mucopurulent, or asthmatic bronchitis.  Not many of our respiratory claims are in respect of these non-obstructive types of bronchitis.

Ischaemic heart disease

• The contention Experiencing a severe stressor has been moved to below line.  This is because it is not a common cause or aggravating factor of IHD (the 'immediately before' time requirement eliminates most claims), and the correct rule structure means answering several questions before addressing the timing element, at which point most claims would fail.

(Thanks to Adrian Crowe from the SA office for bringing this to our attention)

Malignant neoplasm of the stomach

and

Non-Hodgkin's lymphoma

and

Peptic ulcer disease

• Commentary previously withheld pending policy advice on Helicobacter pylori infection, has now been included.  When considering the Infection with Helicobacter pylori contention, you should have regard to Advisory No 6/99.  This advisory can be accessed via the Hotword link in the CCPS commentary.

Cholelithiasis and Malignant neoplasm of the gallbladder – the HW Cholesterol stones has been corrected.

Chronic pancreatitis - the Hotword Alcohol consumption for chronic pancreatitis has been corrected (acute  chronic).

Osteoarthrosis – reasons paragraphs for facts 26004 and 26005 have been changed to remove reference to 'microtraumata'.  This was in response to a request from the Qld SO.

Otitis externa – commentary relating to the contention Occupational requirement to swim or dive in water has been changed to reflect the intent that during operational service, any swimming or diving should be taken to be service related (invoking the "occurrence " provisions) while any swimming or diving during defence service needs to form part of service requirements (although not necessarily as an "occupation") in order to be service related.

The RMA has been asked to consider rewording this factor, in particular the use of the phrase 'being occupationally required', when it next reviews this SOP.

(Thanks to regular correspondent Celia Perry from the Vic office for raising this issue)

Additional amendments

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

Myeloma

• For information about the SOP see SOP Bulletin No. 28, 4 November 1999.

Miscellaneous changes

The RMA has issued a new SOP for Anxiety disorder.  This new SOP combines the SOPs for “Generalised Anxiety Disorder” and “Anxiety Due to a General Medical Condition”. The rulebases for these two conditions have been withdrawn to enable the new SOP to be incorporated in the next MKB release of CCPS.

Remember! If you are having any problems with SOPs, or SOPs in CCPS, talk to us!