SOP Bulletin No. 80

Decision Support Unit

8 — th Floor, 259 Queen St, Brisbane — 3 — rd Floor Blackburn House, 199 Grenfell St, Adelaide

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

16 January 2003

RELEASE NOTES - CCPS VERSION 2003/12

It is anticipated that version 2003/12 of the Medical Knowledge Base for CCPS will be released into production on Monday 19 January 2004.  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	Morbid obesity
SOP amendments incorporated into CCPS	Hypertension Malignant neoplasm of the brain
Enhancements of CCPS rulebases and commentary	Asthma - the nonantigenic stimulus factor with regard to smoking Obesity as a factor - changes to 20 conditions Changes to several Hotwords
Additional amendments - not noteworthy	Chronic fatigue syndrome Chronic myeloid leukaemia Macular degeneration Non-Hodgkin's lymphoma Subarachnoid haemorrhage

New SOPs incorporated into CCPS

Morbid obesity

The SOP factor re excessive caloric intake requires that the caloric intake is excessive for energy needs and cannot be compensated by physical activity.  This means that if it were possible for the veteran to have increased physical activity to the extent necessary to counter caloric intake but he did not do so, the claim cannot succeed under this factor.  Where physical activity is restricted by one or more medical conditions, consider whether alternative activities would have been possible eg if osteoarthrosis of the knees prevented walking activities, what about swimming, bicycling or exercises using the upper body?

For information about the SOP see SOP Bulletin No. 76 of 18/08/03

SOP amendments incorporated into CCPS

Hypertension

The amended alcohol factor does not specify the period over which average alcohol intake is to be calculated.  Therefore, the average can be calculated over any reasonable period of time - presumably the one most favourable to the veteran's case.  This factor no longer requires alcohol consumption to be part of alcohol dependence or alcohol abuse but it does require the existence of some factor or factors that prevented the veteran from reducing average alcohol intake below the specified level at the time of the onset/worsening of hypertension.

For information about the SOP see SOP Bulletin No. 76 of 18/08/03

Malignant neoplasm of the brain

The new factor organ transplant from a donor with malignant neoplasm of the brain only applies in respect of operational, peacekeeping or hazardous service.  In addition, it is unlikely that a veteran had such a transplant as there were only 96 recipients of such organs in Australia and New Zealand from 1989-1996.

The new factor of atomic radiation exposure is also unlikely to apply – refer to SOP bulletin No. 106 - ATOMIC RADIATION

For information about the SOP see SOP Bulletin No. 73 of 6/06/03

Enhancements of CCPS rulebases and commentary

Asthma - the nonantigenic stimulus factor in relation to smoking

Previously the SOP factor Exposure to an antigenic or nonantigenic stimulus was split into two contentions in CCPS:  Exposure to an antigenic or nonantigenic stimulus and Service related smoking habit.  This was to enable consideration of exposure after service to smoke (a nonantigenic stimulus) from a personal smoking habit acquired as a result of service.  To avoid the suggestion that smoking is a SOP factor in its own right, it will no longer be treated as a separate contention but will be dealt with by specific questions under the Exposure to an antigenic or nonantigenic stimulus factor.

Obesity as a factor - changes to 20 conditions

Following the issue of a SOP for morbid obesity, the RMA's statement of 12.8.03 that obesity is not a "disease" and the RMA's amendment of the definition of "being obese" in several SOPs, the rulebase for the factor of obesity has been revised.  This has affected 20 conditions where rulebase support has previously been incorporated into CCPS.

We now have:

• 4 conditions where the definition of "being obese" states that it must be due to a cause specified in the Repatriation Medical Authority's Statement about the causes of “being obese” signed by the Chairman of the Authority on 16 August 1996.  These conditions are:

•           diabetes mellitus;
•           ischaemic heart disease;
•           malignant neoplasm of the breast; and
•           sleep apnoea.

It is anticipated that the definition of "being obese" will be amended when current investigations/redrafting of these SOPs is finalised  (stop press: new IHD instruments gazetted 19.11.03 - changes will be picked up in next MKB release)

• 15 conditions where, if the substantive requirements of the SOP are satisfied then the relationship of obesity to operational or eligible service must be ascertained as you would do so for any other factor that is a non-SOP condition.  This involves gathering evidence about the causes of obesity (one piece of evidence that addresses this is the RMA's Statement about the causes of being obese) and then evaluating the evidence in the case at hand.
  The conditions in this category are:

•           adenocarcinoma of the kidney•carpal tunnel syndrome
•           cervical spondylosis•colorectal adenoma
•           deep vein thrombosis•gout
•           gastro-oesophageal reflux disease•hypertension
•           lumbar spondylosis•malignant neoplasm of colorectum
•           thoracic spondylosis•osteoarthrosis
•           pes planus•plantar fasciitis
•           malignant neoplasm of endometrium

• The last condition, cholelithiasis, is similar to the category immediately above.  However, with this SOP the definition of "obesity" requires a BMI figure greater than 30.  The requirement for the 15 conditions above is "30 or greater".

Because the definitions of "obesity" and "being obese" encompass morbid obesity, if there is a history of obesity and the claim does not succeed via this factor, the rulebase will address the issue of morbid obesity, propagating to the morbid obesity SOP rulebase if appropriate.  No paragraphs in relation to morbid obesity will be produced for the 'Reasons for Decision' in these cases.

“Experiencing a severe stressor”

The text of this hotword has been enhanced to include a link to AN02/2003 which deals with the Federal Court decision in the case of Stoddart.  This case provides authority for the proposition that in assessing whether a particular event is a “severe stressor” as defined, it is necessary to consider both the objective nature of the event and the veteran's subjective knowledge about the event.  Experiencing a severe stressor

“Exposure to high noise levels” and “Adequate ear protection”

The text of these hotwords has been improved to provide more information about the SOP requirements and the level of protection provided by ear muffs and ear plugs.  Exposure to high noise levels and Adequate ear protection

“Flying in high performance aircraft”

The text of this hotword has been enhanced by expanding the list of high performance aircraft.  However, it should be noted that this is still not an exhaustive list.  Flying in high performance aircraft

Additional amendments

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

Chronic fatigue syndrome

For information about the SOP see SOP Bulletin No. 73 of 6/06/03

Chronic myeloid leukaemia

For information about the SOP see SOP Bulletin No. 73 of 6/06/03

Macular degeneration

For information about the SOP see SOP Bulletin No. 74 of 14/07/03

Non-Hodgkin's lymphoma

For information about the SOP see SOP Bulletin No. 76 of 18/08/03

Subarachnoid haemorrhage

For information about the SOP see SOP Bulletin No. 76 of 18/08/03

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