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16. Determining the Claim -
Once the investigative stage is complete, the matter will be determined by the claims assessor.
Having regard to the particular standard of proof required by the circumstances of the applicant's service, the claims assessor will accept the claim if they are satisfied that:
- a medical diagnosis was made by a psychiatrist;
- the diagnosed condition is an injury or disease;
- the symptoms of the conditions are clear and permanent;
- If a MRCA or VEA claim, if there is a SOP that applies to the condition it is met; and
- the available evidence establishes that the condition is service-related.
Acceptance of liability under the VEA and MRCA will be in accordance with the Guideline CM 5017 Application of Section 120 of the VEA following the Full Federal Court case in Deledio.
Where the claims assessor is not satisfied that all of these elements are met, the claim will be refused.
For claimants identified as being at risk of self-harm or suicide, refer to the current Departmental policies and procedures to ensure the appropriate processes are adhered to in communicating this decision to the claimant.
An eligible claimant with a diagnosis of PTSD, Anxiety or Depression made by a psychiatrist is able to receive treatment for their condition under S88A or S85(2) of the VEA, even if the condition is not accepted as service-related. In situations where the Department is unable to confirm the diagnosis immediately, a provisional grant of treatment can apply. Internal users should consult the Diagnostic Protocol Changes Businessline for further information.