C20/2004 SMRC Decision Concerning Osteoporosis, SOP 67 of 2002

DATE OF ISSUE:  20 July 2004

SMRC Decision Concerning Osteoporosis, SOP 67 of 2002

Purpose

The purpose of this instruction is to alert Disability Compensation State Office staff to a decision handed down by the Specialist Medical Review Council (SMRC) and advise the action that processing staff are required to take.

SMRC Decision

A SMRC decision concerning the Osteoporosis RH SOP, 67 of 2002, was gazetted on

21 July 2004.  The SMRC has directed the RMA to amend the SOP by changing the definition of osteoporosis and changing the onset and worsening factors that concern decreased calcium intake. The full changes are detailed in the table at Attachment 1.

The change to the actual SOP will not be able to be made by the RMA for some weeks but the date of effect of the decision will be 21 July 2004.  The BOP SOP is unaffected at this time.  This means there will be effectively different disease definitions in the RH and BOP SOPs as well as differing low calcium factor descriptions, at least for an interim period.

Definition Change

The current SOP definition requires (in the absence of fracture) bone density to be reduced relative to peak bone mass (T score -2.5 or lower) and relative to age-matched controls (Z score -1 or lower).  The new definition will require only a T score of lower than -2.5 (note: not -2.5 or lower). The age-matched controls are no longer required. Hence, a group of veterans who would not have been able to apply to have their condition considered under the current SOP because of the age-matched controls, are now able to be considered under the new SOP ie the new SOP is more favourable.

Change to Calcium factors

The following changes have been made to the Calcium factors:

• The new factors will have a lower calcium dose (400mg/day v 600 mg/day);
• The requirement that the low intake be within four years of onset/worsening will be removed; and

• The “Two years” of low intake requirement will be retained for a person under age 20, but increased to seven years after that age.  Low intake extending both before and after age 20 can be combined using a new definition for “the equivalent combination”.

The effect on the veteran community arising from this change is partly detrimental (lower level of calcium intake, longer period of low intake after age 20) and partly beneficial (low calcium intake at any time, not just in the four years before onset/worsening). However, the numbers likely to be adversely impacted by this change are estimated to be fewer than those who will be advantaged by the definition change.

RMA Action

The RMA is expected to issue an amendment to SOP no. 67 of 2002, to comply with the SMRC directions, following its next meeting in August.

The RMA may then decide to amend the BOP SOP, and/or undertake a further review of the RH SOP, so that the two instruments again have a consistent definition and similarly formatted factors.  However, the RMA will probably first declare an investigation into osteoporosis and a final outcome will be months away.

Operational Effects

The changes that are to be made to the RH SOP cannot be applied to individual cases until the RMA gazettes the changes in a new SOP.  Once the RMA has gazetted the new SOP, claims lodged on or after 21 July 2004 that have not been finalised are to be determined using the new SOP.

Action Required

Claims Assessors are required to undertake the following actions in regard to claims involving the Osteoporosis RH SOP 67 of 2002:

• Claims that do not meet the current SOP definition, by reason of not having a low enough Z score (i.e. the Z score is higher than -1), but that do have a T score of lower than -2.5, should be put on hold, awaiting the gazettal of a new RH SOP.
• Claims that meet the current SOP definition, where low calcium intake is contended, that don't succeed under any factor including the calcium factor, but will succeed under the proposed calcium factor, should be put on hold, awaiting the gazettal of a new RH SOP.
• Other claims, including those where the BOP standard of proof applies and those RH claims where the current definition is met and the claim can be accepted using any factor other than the calcium factor, should be processed as normal.

Further advice will be provided as soon as the RMA's decisions are known.

Mark Johnson

Branch Head

Disability Compensation

July 2004

Attachment 1

Changes Made to the Osteoporosis Reasonable Hypothesis SOP 67 of 2002