SOP Bulletin No. 88

Decision Support Unit

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

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

13 December 2004

RELEASE NOTES - CCPS VERSION 2004/11

Version 2004/11 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	Nil
SOP amendments incorporated into CCPS	Osteoporosis
Enhancements of CCPS rulebases and commentary	Atherosclerotic peripheral vascular disease Atrial fibrillation Cerebrovascular accident Depressive disorder Diabetes mellitus Gastro-oesophageal reflux disease Ischaemic heart disease Macular degeneration Malignant neoplasm of the colorectum Malignant neoplasm of the prostate Morbid obesity Osteoarthrosis Peptic ulcer disease Rotator cuff syndrome Psoriasis Physical injury due to munitions discharge & Cuts, stabs, abrasions or lacerations

New SOPs incorporated into CCPS

Nil

SOP amendments incorporated into CCPS

Osteoporosis

As there are 2 definitions for osteoporosis where the diagnosis is based on bone mineral density – one for RH and one for BOP – it has been necessary to introduce into CCPS questions to establish if one or both have been met.  Confirmation of the diagnosis in the CCPS Encoder will not establish if one or both definitions are met in cases where a veteran has both operational and eligible service.  In the Commonly Claimed Conditions list in the Encoder there are 2 entries for osteoporosis: osteoporosis - diagnosed by bone densitometry and osteoporosis - diagnosed by fracture.  If the diagnosis of osteoporosis - diagnosed by bone densitometry is selected then a preliminary question will ask if the diagnosis meets the relevant definition of osteoporosis.  If 'yes' then the investigation can proceed; if 'no' then the relevant rulebase will be disabled.

If one of the preliminary diagnostic questions is answered No, a 'reject reasons' paragraph will not be generated by CCPS.  For example, if the BOP definition is not met but the RH is, then only the RH rulebase questions will be asked; if these are not met, only the RH reject reasons will appear.  You will need to edit the reasons to indicate why the BOP definition is not met.  Something along the following lines might be useful:

Although Mr {X} has been diagnosed as having osteoporosis, the level of bone mineral loss is not sufficient such that the {BOP/RH} SoP can be applied to this claim.  However as the bone mineral loss requirements are different for the {RH/BOP} SoP I have been able to apply this SoP.  For this reason my decision relates only to the {RH/BOP} SoP.

Changes have been made to the factors for smoking, alcohol consumption and altered dietary pattern resulting in decreased calcium intake to reflect the material contribution as set out in the Federal court decision in Kattenberg.  For details see below.  In addition different time requirements for the calcium intake factor have been changed for the RH version of this factor.

These changes were announced in Departmental Instruction C23/2004 of 24 August 2004.

Enhancements of CCPS rulebases and commentary

Following the Federal Court decision in the case of Kattenberg it is necessary to amend the CCPS rulebase for many SOP conditions to take account of the principles re 'material contribution by service'.  For some SOP factors this is a straightforward process but particular problems have been experienced with smoking and alcohol factors.  The changes described below are being progressively incorporated into CCPS.

Smoking factors

SOP Bulletin No 84 which accompanied the MKB release in May 2004, advised of the addition of 3 contentions in the CCPS rulebase for ischaemic heart disease:

• Cigarette smoking - material contribution
• Cigar smoking - material contribution
• Pipe smoking - material contribution.

It has now been decided to amalgamate these three contentions into one:

• Smoking tobacco products – material contribution.

This new contention will be progressively introduced into all conditions where the smoking contention is affected by Kattenberg.

Because there is no system support in this contention as far as calculating pack years and relevant onset date of the condition under consideration, it will only be necessary to investigate this contention if a claim in respect of a smoker is unsuccessful after using the smoking module.

The amalgamated contention will be particularly useful w — here a smoking habit consists of different types of tobacco consumption (pipes, cigars, cigarettes).  The new contention can be used to calculate the total pack year history by adding the various types and their equivalents together. The commentary includes details of equivalence of types of smoking.

It will still be necessary to edit the system produced reasons paragraphs to remove duplication and unnecessary paragraphs and to ensure that a sensible decision advice is provided to the claimant.

Alcohol factors

The Repatriation Commission Guideline dealing with alcohol related conditions and military service must be considered when investigating the relationship between alcohol consumption and VEA service.  However, where alcohol was consumed because of a psychiatric or medical condition it will no longer be necessary to encode this condition in CCPS.  However, such a condition must still be identified and the causal relationship with service investigated having regard to the appropriate SOP (SOPs and information about their factors are contained in the CCPS Research Library).  The connection with service or otherwise still needs to be explained in the reasons for decision.

Kattenberg changes have been made to the following condition and the factors specified:

Atherosclerotic peripheral vascular disease (smoking, inability to undertake physical activity)

Atrial fibrillation (alcohol, inability to undertake physical activity)

Cerebrovascular accident (inability to undertake more than mildly strenuous physical activity, alcohol, smoking, treatment with aspirin)

Depressive disorder (chronic pain)

Diabetes mellitus (smoking)

Gastro-oesophageal reflux disease (smoking)

Ischaemic heart disease (inability to undertake physical activity, smoking)

Macular degeneration (smoking)

Malignant neoplasm of the colorectum (smoking)

Malignant neoplasm of the prostate (consuming increased animal fat)

Osteoarthrosis (lifting loads, kneeling or squatting, using a vibrating tool)

Peptic ulcer disease (smoking, treatment with NSAIDs, treatment with aspirin)

Rotator cuff syndrome (activities with hand raised, using upper limbs for transfer)

Psoriasis

Treatment with a synthetic antimalarial drug has been removed from the specified drugs list and is now a separate factor in CCPS.  Synthetic antimalarial drugs are usually taken for prophylactic purposes and this new factor does not require an illness or injury to be identified as the reason for taking the drug.

Morbid obesity

Recommendations made in Monitoring Report No 2004-05 have been implemented.  The binge eating disorder hotword now refers to the need for psychiatric opinion and comment;  and the factor label excessive caloric intake has been replaced with excessive caloric intake that cannot be compensated by physical activity to better reflect the factor requirements.

Physical injury due to munitions discharge & Cuts, stabs, abrasions or lacerations

In the CCPS Library these two SOPs are grouped together and share a common rulebase because they have common ICD 9 codes.  However in the past the folder was called 'Cuts, stabs, abrasions, lacerations and physical injury due to munitions discharge”, and only the Physical injury due to munitions discharge SOP was displayed within the folder. This led to confusion about what is covered by these two SOPs.  The two SOPs are still contained in the one folder in CCPS, but this folder is now called “Physical injury due to munitions discharge, cuts, stabs, abrasions or lacerations”, and both SOPs can be viewed by opening the folder.

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