SOP Bulletin No. 92

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

29 April 2005

RELEASE NOTES - CCPS VERSION 2005/04

Version 2005/04 of the Medical Knowledge Base for CCPS is planned for release into production on Monday 2 May 2005.  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	Malignant neoplasm of unknown primary site Epicondylitis
SOP amendments incorporated into CCPS	Chronic bronchitis and emphysema Haemorrhoids Hodgkin's lymphoma Non-melanotic malignant neoplasm of the skin Rheumatoid arthritis Solar keratosis
Enhancements of CCPS rulebases and commentary	Acquired cataract Acute pancreatitis Atrial fibrillation Cardiomyopathy Carpal tunnel syndrome Chondromalacia patellae Chronic pancreatitis Cirrhosis of the liver Colorectal adenoma Gout Hypertension Impotence Malignant neoplasm of the breast Malignant neoplasm of the colorectum Malignant neoplasm of the larynx Malignant neoplasm of the liver Malignant neoplasm of the lung Malignant neoplasm of the oesophagus Malignant neoplasm of the oral cavity or hypopharynx Peripheral neuropathy Sensorineural hearing loss Subarachnoid haemorrhage Tinnitus
Additional amendments – not noteworthy	Asthma Deep vein thrombosis Seborrhoeic dermatitis

New SOPs incorporated into CCPS

Malignant neoplasm of unknown primary site

For information on this SoP refer to SoP Bulletin No. 87 of 15/11/04.

Epicondylitis

For information on this SoP refer to SoP Bulletin No. 89 of 20/12/04.

SOP amendments incorporated into CCPS

Chronic bronchitis and emphysema

Changes made regarding the new and changed factors as well as adding the alternate smoking tobacco products factor, which gives effect to the Kattenberg decision.

For information on this SoP refer to SoP Bulletin No. 86 of 18/10/04.

Haemorrhoids

For information on this SoP refer to SoP Bulletin No. 86 of 18/10/04.

Hodgkin's lymphoma

There are many factors that apply only to reasonable hypothesis cases and commentary for the Contention Management Screen provides additional guidance by marking these factors with an asterisk*.  This commentary can be viewed by clicking the Policy button on the Contention Management Screen. All the above line contentions in CCPS apply only to operational or peacekeeping service.

The Epstein-Barr virus infection factor requires serological proof of infection before the clinical onset of Hodgkin's lymphoma.  The rulebase allows for the infection to be symptomatic or asymptomatic.  Symptomatic Epstein-Barr virus infection is covered by a SoP whereas asymptomatic infection is non-SoP.

For more information on the Hodgkin's lymphoma SoP refer to SoP Bulletin No. 86 of 18/10/04.

Non-melanotic malignant neoplasm of the skin and Solar keratosis

• The major change is the new prolonged sunlight exposure factor which is based on the number of hours of sunlight exposure relative to latitude.  The commentary provides advice on calculating the hours of exposure and a list of operational areas in their respective latitude zones.

• A new claimant questionnaire has not been developed for this factor and the existing Solar Damage Assessment form is unchanged.  Obviously only one questionnaire regarding sunlight or UV radiation exposure can be sent to a veteran (or dependent), and both factors (increased solar UV risk and prolonged sunlight exposure) may need to be tested. The existing form seeks details needed to meet the formula for increased solar UV risk; this information can also be used to assess hours spent in sunlight and levels of direct exposure.
• Details of weekend exposure may not be so relevant for the prolonged sunlight exposure factor in which case the Solar Damage Assessment form can be edited accordingly.

For more information on the SoPs refer to SoP Bulletin No. 89 of 20/12/04, for non melanotic malignant neoplasm of the skin and SoP Bulletin No. 90 of 7/3/05 for solar keratosis.

Rheumatoid arthritis

• Smoking is the only above line factor.  If smoking is contended it will be necessary to establish the serological type of rheumatoid arthritis as the factor applies only to seropositive rheumatoid arthritis.  This information should be sought from the treating doctor. 

• The factor for taking a drug which cannot be ceased or substituted, has been split into two contentions in CCPS.  This is because the drugs that have been reported (in a peer reviewed medical or scientific publication) as causing rheumatoid arthritis are not the same as those reported as worsening rheumatoid arthritis. 
• It is also worth noting that some drugs used to treat rheumatoid arthritis have been found to aggravate the condition.  If you are investigating the worsening path and find that the drug treatment was for rheumatoid arthritis, you should not identify this condition because it will be impossible to establish a causal link between service and rheumatoid arthritis via this path – the CCPS rulebase will get stuck in a “loop”.

• If the only aggravating drug treatment was for rheumatoid arthritis, then you should answer 'no' to the question which asks if you can identify the condition for which the drug treatment was given, and proceed to provide appropriate reasons.  However, if there are other conditions for which the drug was given, these should be investigated.

For more information on the rheumatoid arthritis SoP refer to SoP Bulletin No. 86 of 18/10/04.

Enhancements of CCPS rulebases and commentary

Atrial fibrillation

The recommendations from SOP monitoring report 2005-01 have been implemented.  Accordingly, the factor label 'a specified disease causing atrial fibrillation' has been replaced with single factors.  Above line are:  IHD, emphysema & chronic bronchitis with pulmonary obstruction;  below line are:  cardiomyopathy and hyperthyroidism.  The hyperthyroidism hotword has been revised to provide more information in relation to atrial fibrillation.

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

• Acquired cataract (smoking, atomic radiation, drug treatments)

• Acute pancreatitis (alcohol)
• Cardiomyopathy (alcohol)

• Carpal tunnel syndrome (repetitive or forceful activities, wheelchair self-propulsion, vibrating activities) – note that if the person does not have any service attracting the RH standard of proof, the questionnaires for these factors should be edited to reflect the BOP requirement of 260 hours

• Chondromalacia patellae (running)
• Chronic pancreatitis (alcohol)

• Cirrhosis of the liver (alcohol)

• Colorectal adenoma (alcohol)

• Gout (alcohol)
• Hypertension (alcohol)
• Impotence (smoking)

• Malignant neoplasm of the breast (alcohol)
• Malignant neoplasm of the colorectum (alcohol)

• Malignant neoplasm of the larynx (smoking, alcohol)
• Malignant neoplasm of the liver (alcohol)
• Malignant neoplasm of the lung (smoking, passive smoking, asbestos, atomic radiation, radon, dioxin, crystalline silica, coke oven, diesel engine exhaust, specified fumes)

• Malignant neoplasm of the oesophagus (alcohol)
• Malignant neoplasm of the oral cavity or hypopharynx (alcohol)
• Peripheral neuropathy (alcohol)
• Sensori — neural hearing loss (high noise level)
• Subarachnoid haemorrhage (alcohol)
• Tinnitus (high noise level)

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