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DSU Bulletins

Decision Support Unit

4 — th Floor AMP Place, 10 Eagle St Brisbane  3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

30 January, 2003

This bulletin is an update of SOP bulletin 27, issued in October 1999.

DIAGNOSTIC REQUIREMENTS IN SOPs

For most disability claims the diagnosis can be confirmed simply on the advice of a medical practitioner or from medical reports.

However, there are a number of conditions where, in order to be satisfied that the claimed condition meets the definition in the applicable Statement of Principles, or to have enough information to apply the SOP factors, it is necessary to obtain particular additional diagnostic evidence.

The circumstances where specific diagnostic information can be needed are:

1. Where the RMA has set specific diagnostic criteria and a particular piece of information is needed.  e.g.:

SOP

Information required
  •      Sensorineural hearing loss

- audiogram
  •      Osteoporosis

- bone densitometry, or X-ray evidence of osteoporotic fracture

2. Where the RMA has specified that clinical manifestations of a disease must be present.  e.g:

SOP

Information required
  •      Osteoarthrosis

- evidence of pain, impaired function, joint swelling and stiffness
  •      Spondylosis SOPs

- evidence of local pain and stiffness, or cord or nerve root compression


3. Where the SOP contains factors that apply only to certain sub-types or sites of the disease.  e.g:

SOP

Information required
  •      Diabetes mellitus

type – type 1 or type 2
  •      Peptic ulcer disease

site  – gastric or duodenal ulcer

For circumstances 1 and 2, where specific diagnostic requirements are stated in a SOP, it is essential that decision makers ensure that the veteran's condition satisfies the SOP definition before confirming the diagnosis.  Near enough is not good enough.

If a SOP has particular diagnostic requirements and/or type- or site-specific factors, these are highlighted in the diagnostic protocol for that condition on CCPS.  The diagnostic protocol for a condition appears when that condition is selected in the Encoder.  The protocols can also be easily accessed in the CCPS research library via the Statements of Principles folder on the title page.

A complete list of all the SOPs that contain particular diagnostic requirements and/or type- or site-specific factors, and the particular information required, is contained in the table on the following pages.

Note that for some SOPs with type- or site-specific factors, it will not always be necessary to obtain details of the type or site, as it may be possible to apply the SOP and determine the claim without that information.  See the relevant SOPs and the diagnostic protocols for details.

Contact Officers for this bulletin:

Maureen Anderson — 08 8290 0365

Dr Bev Grehan — 07 3223 8376

Dr Jon Kelley — 07 3223 8412

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

SOPs with specific diagnostic information requirements.  Underlining indicates that the information may not be necessary to process the claim.  For all other conditions the information is essential.  For full details see the diagnostic protocols and the SOPs themselves.

SOP

   Information required

All malignant neoplasm of an organ SOPs

Type – exclude non-Hodgkin's lymphoma,                                           Hodgkin's disease and soft tissue sarcoma

All psychiatric conditions

Psychiatric report (in accordance with Departmental guidelines) to establish that specific SOP (DSM IV derived) diagnostic criteria are satisfied.

Acute lymphoid leukaemia

Type – adult T-cell lymphoma-leukaemia,

ALL L3 subtype, or other

Angle-closure glaucoma

Type –acute, neovascular or other

Aortic stenosis

Type–rheumatic or not

Atherosclerotic peripheral vascular disease

Evidence of clinical manifestations

Cardiomyopathy

Type–primary or secondary
Cerebrovascular accident

Type –haemorrhagic or ischaemic +/-                                                        vertebrobasilar insufficiency or not

Cervical spondylosis
Evidence of local pain and stiffness, or cord or nerve root compression

Cholelithiasis

Type – pigment stones or cholesterol stones

Chronic bronchitis and emphysema

Spirometry results and/or cough/sputum history and/or specialist report

Chronic fatigue syndrome

Meets RMA criteria plus psychiatric report

Chronic gastritis

Histology report

Chronic lymphoid leukaemia
Type – adult T-cell chronic lymphoid leukaemia or not

Cluster headache syndrome
Evidence of recurrent unilateral headaches adjacent to the eye with accompanying eye, nasal or other symptoms as per the SOP definition

Conductive hearing loss

Audiogram with bone conduction
Contact dermatitis

Type – allergic or not
Deep venous thrombosis

Appropriate investigation performed –eg ultrasound, venography or MRI, or other convincing evidence.

Site  – exclude retinal, cerebral, pulmonary, hepatic,

renal, portal and mesenteric thrombosis,
Diabetes mellitus

Type – type 1 or type 2

Diverticular disease
Evidence of clinical manifestations

Goitre

Type – exclude congenital goitre and goitre due to malignant neoplasm of the thyroid, benign neoplasm of the thyroid, thyroiditis or Graves' disease.

Haemochromatosis

Type – exclude acquired haemosisderosis

Hepatitis B

Recent or non-recent infection (serology results)

Hiatus hernia
Type – sliding or paraoesophageal

Inflammatory bowel disease

Type – Crohn's disease or ulcerative colitis

Intervertebral disc prolapse
Evidence of local pain and stiffness +/- paraesthesia to limbs

Ischaemic heart disease
Evidence of cardiac disability, not just coronary atherosclerosis, eg: myocardial infarction (old or new); angina; arrhythmia with ECG evidence of myocardial ischaemia; or, cardiac failure.

Type – myocardial infarction or arrhythmia with                                           ECG evidence of myocardial ischaemia, or                             not

Lumbar spondylosis
Evidence of local pain and stiffness, or cord or nerve root compression
Macular degeneration

Type – age related or not

Malignant neoplasm of the -

Bladder
Type – squamous cell carcinoma or not

Cerebral meninges
Type – sarcoma or not

Colorectum
Site – colon or rectum

Eye

Site –   conjunctiva, cornea, retina, uveal tract and eye

ball are covered

lacrimal gland and duct, orbit, optic nerve and               the skin and connective tissue of the eyelid are               not

Liver

Type – hepatocellular carcinoma or not

Lung
Type – histological type

Nasopharynx
Type – carcinoma or not

Oesophagus

Type – squamous cell-, undifferentiated- or,                                           adeno- carcinoma, or other

Oral cavity and hypopharynx

Site – oral cavity or not

Ovary

Type – epithelial or not

Pancreas

Site – exocrine pancreas or not

Small Intestine

Type – adenocarcinoma or not

Stomach
Type – carcinoma or not and
Site – fundus, body, antrum or pylorus, or not

Thyroid

Type –papillary, follicular or anaplastic carcinoma                             or not

Mesangial IgA glomerulonephritis

Renal biopsy required

Myopia, hypermetropia and astigmatism

Type – myopia, hypermetropia or astigmatism

Neoplasm of the pituitary
Type – ACTH secreting pituitary adenoma or not

Non-aneurysmal aortic atherosclerotic disease
Evidence of clinical manifestations as specified in SOP

Type – aortic occlusive disease or not

Non-Hodgkin's lymphoma

Type –exclude Burkitt's lymphoma, hairy cell                                           leukaemia, plasma cell malignancy (myeloma)

Type and site –  whether B cell lymphoma of stomach or                             NHL of small intestine or adult T-cell                                           leukaemia-lymphoma

Non-melanotic malignant neoplasm of the skin
Type – BCC, SCC or other

Open angle glaucoma

Type –ghost cell, phacolytic, pigmentary,                                                         neovascular, or other

Osteoarthrosis
Evidence of pain, impaired function, joint swelling AND stiffness

Site – joint/s involved (unless a POW)

Osteoporosis

Bone densitometry results or osteoporotic fracture on    X-ray

Parkinson's disease

Type – excludes secondary Parkinsonism and                                           parkinsonism occuring as part of another disease

Peptic ulcer disease
Type – gastric or duodenal ulcer

Peripheral neuropathy
Type – polyneuropathy, mononeuritis multiplex,
brachial plexopathy, lumbosacral plexopathy or
not

Renal artery atherosclerotic disease
Evidence of at least 50% occlusion of a renal artery, plus: poorly controlled hypertension, or renal impairment, or acute pulmonary oedema

Secondary Parkinsonsim

Type –excludes primary Parkinson's disease and                                           parkinsonism occuring as part of another disease

Sensorineural hearing loss

Audiogram with bone conduction

Soft tissue sarcoma

Type – angiosarcoma, hepatic angiosarcoma, or                                           cutaneous atypical fibroxanthoma

Spondylolisthesis or spondylolysis
Type, site and subtype

Symptomatic Epstein-Barr virus

infection
Evidence of a compatible clinical illness + serology showing recent infection

Thoracic spondylosis
Evidence of local pain and stiffness, or cord or nerve root compression

Tension-type headaches
Frequency –  headaches on > 5days/month over a 6
month period (less = NIF)

Tinea

Type – Trichophyton rubrum or not
Tuberculosis

Type – Mycobacterium tuberculosis or not

         –primary or reactivated

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