RELEASE NOTES - CCPS VERSION 2001/03

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			SOP Bulletin No.47

9 April 2001

Version 2001/03 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	Pulmonary thromboembolism
SOP amendments incorporated into CCPS	Deep vein thrombosis Diabetes mellitus Sensorineural hearing loss Tinnitus
Enhancements of CCPS rulebases and commentary	Anxiety disorder and Depressive disorder Cerebrovascular accident (CVA) Ischaemic heart disease (IHD) Leukaemias: - Acute lymphoid - Acute myeloid - Chronic lymphoid - Chronic myeloid Malignant neoplasm of the colon and polyps Malignant neoplasm of the prostate and dietary fat
Additional amendments - not noteworthy	NIL

New SOPs incorporated into CCPS

Pulmonary thromboembolism

• The smoking requirements for this SOP cannot be handled by the CCPS smoking module (the module cannot cope with a 90 day period).  Smoking is therefore dealt with by one rulebase contention called Smoking cigarettes or other tobacco products.  There are new questionnaires (one for veterans, one for widows) which seek information on the 3 types of smoking in the one form.

SOP amendments incorporated into CCPS

Deep vein thrombosis

• The old immobilisation factor has been amended so that the period of immobility has been reduced to four hours and there is no longer a requirement for the concurrent application of pressure to the vein.
• The time requirements for several factors have been changed eg suffering from a spinal cord injury within the 60 days before onset of DVT has changed to within the 90 days before the onset of DVT.
• For other information about the SOP see SOP Bulletin No. 44, 8 January 2001.

Diabetes mellitus

• The instruments that amended the factor dealing with work involving 2,3,7,8-TCDD contaminated herbicides required no change to the CCPS rulebase.  However, commentary has been updated to highlight the facts that are known about the involvement of Australian service personnel in such work.

The claimant report that can be used to investigate a contention of work with 2,3,7,8-TCDD (dioxin) contaminated herbicides during service, has also been amended.

Sensorineural Hearing Loss

• The instruments dated 22/2/2001 have been incorporated. The two new noise factors are the most noteworthy features.
• For information about the SOP see SOP Bulletin No. 45, 23 February 2001.

Tinnitus

• The instruments dated 3/1/2001 have been incorporated.. The two new noise factors are the most noteworthy features. In addition all factors now cater for aggravation as well as causation.
• For information about the SOP see SOP Bulletin No. 44, 8 January 2001.

Enhancements of CCPS rulebases and commentary

Anxiety Disorder and Depressive Disorder

• Commentary changes have been made to the "major illness/injury" factor and the "clinically significant psychiatric condition" factor for both these conditions.  These commentary changes have been made as a result of a case where the major illness/injury factor was rejected because the major illness was present for more than two years before the onset of depressive disorder – ie the assessor mistakenly interpreted the SOP to mean that the onset of the major illness had to be in the two years before the onset.
• It should be noted that there are many other examples of this sort of SOP factor ie where a medical condition must be present within a specified period of time before the onset of the SOP condition. In all such cases the condition need only be present within the specified period of time – it is not necessary for the onset of the condition to be within that period of time.

Cerebrovascular Accident (CVA)

Various CCPS changes recommended in SOP Monitoring Report No 2001-01 (CVA) have been implemented in this Release:

• The separate vertebrobasilar (VBI) rulebase has been withdrawn and the two additional VBI-specific factors have been incorporated within the cerebral ischaemia rulebase.  Access to these VBI factors requires evidence of cerebral ischaemia in the vertebral or basilar arteries.
• There has been an amendment to the hotword Cerebral ischaemia or intracerebral haemorrhage contained within the Diagnostic Protocol.  This reflects policy advice arising from the Federal Court decision in Cooke.  Where the type of CVA cannot be deduced after investigation, the question of diagnosis is to be decided on the balance of probabilities.  Therefore, any such case should be coded to 437.1 (cerebral ischaemia).
• The treatment with aspirin factor has been placed above line in CCPS to reflect its popular usage in intracerebral haemorrhage cases.
• The high cholesterol and severe stressor factors have been removed from above line in CCPS as both of these factors are rarely contended and unlikely to be successful. 
• New medical reports have been developed for the anticoagulant therapy and thrombolytic therapy factors.  These questionnaires include the relevant RMA definitions.
• The Hotword inability to undertake more than a mildly strenuous level of physical activity has been revised to provide additional information.

Ischaemic heart disease (IHD)

• The dyslipidaemia factor has been moved from above line to below line in CCPS as it is unlikely to succeed.

Leukaemias	- Acute lymphoid
	- Chronic lymphoid
	- Acute myeloid
	- Chronic myeloid

• The contention management screen for these leukaemia conditions has been revised to specifically refer to the Repatriation Commission Section 180A determinations re exposure to herbicides in Vietnam.  Although the RMA SOPs for these conditions do not include such a factor, the Repatriation Commission has made Section 180A determinations that where such exposure exists, it can be said that a reasonable hypothesis has been raised connecting the disease or death from the disease with the circumstances of that service.  The 'Exposure to herbicides in Vietnam' factor is above line in CCPS.

Malignant Neoplasm of the Colon and Polyps

• There has been a minor change to commentary arising from the recent monitoring report on this condition. The purpose of the change is to emphasise the fact that if a colorectal adenomatous polyp is only detected at the time of the diagnosis of the veteran's colon cancer, then it can be assumed that the polyp was present prior to the clinical onset of the colon cancer.

Malignant Neoplasm of the Prostate and Dietary Fat

• The rules for the dietary fat factor in cancer of the prostate have been changed to reflect the fact that in exceptional cases there may be a causal link between post-service fat consumption, and service. This has arisen as a consequence of several AAT decisions. Commentary has been provided by the Director Policy, Eligibility and Research, and you are urged to read both the questions and the commentary carefully when considering this factor. This change does not represent an acceptance by the Department of a "fat habituation" argument.
• The commentary contains links to two Advisory Notes, which are also available in CLIK. The first, AN 3/1999 Animal Fat Consumption, contains detailed information about the animal fat content of the military and civilian diet over the years, and includes the work of Dr Ruth English. The second, AN3/2001 Service and Dietary History deals with establishing the SOP requirements and relating animal fat consumption to service. A Dietary Survey Form has been made available, for use when appropriate.

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