Approved by the Commissions on 24 August 2011
Amended by the Commissions on 5 July 2018 (MRCC33/2018)
ATTACHMENT A TO THE GUIDELINES FOR PSYCHIATRIC COMPENSATION CLAIMS: CM7014
Posthumous Diagnosis of Psychiatric Conditions
A decision concerning a diagnosis of a psychiatric condition in relation to a deceased veteran should usually be made by one or more members of the Posthumous Psychiatric Diagnosis Panel, which consists of independent qualified psychiatrists.
Should a panel be unable to be convened, other options exist to assess the condition.
This guideline sets out the evidence that must as a minimum exist for a diagnosis of a psychiatric condition to be produced as well as the evidence to be considered in producing the diagnosis.
Operation of the Panel
The Panel will consist of a number of pyschiatrist members, who will individually produce diagnoses. In complex cases, the Panel member may choose to collaborate with another member at their own discretion.
Should a panel of psychiatrists be unable to be convened, a number of options exist to allow claims assessors to obtain a diagnosis:
- A panel may be established comprising of a psychiatrist with a psychologist and other suitably qualified health professional(s); or
- A consulting psychiatrist can make a diagnosis from a review of the available evidence (with or without assistance from a psychologist who has reviewed the available evidence); or
- The Chief Health Officer or their delegate may chair a panel and/or make a decision regarding a posthumous diagnosis, including in cases where a psychiatrist can not be obtained in a timely manner.
Requirement for a pre-death diagnosis
The following evidence should usually be present to support a contention that the veteran had a psychiatric condition:
- Diagnosis:
- Diagnosis by treating psychiatrist;
- Diagnosis by treating General Practitioner; or
- Diagnosis by another individual who in the Panel member's opinion is appropriately qualified to produce a diagnosis in the context of the case; AND
- Documented evidence of treatment in response to diagnosis.
If the treating specialist/GP had reason to believe that the veteran had a psychiatric condition before death, then this condition should usually have been diagnosed, and as a result the treating specialist/GP would usually have treated the condition and/or its symptoms.
However, should a mental health condition be considered to be a probable contributing factor to the death and there is no prior diagnosis, recognising that some persons with mental illness may not have sought help or may have experienced barriers to effective care, a posthumous diagnosis of a mental health condition may be sought on the basis of the avialable evidence without there being a pre-death diagnosis. There should, however be some indication or evidence to support the contention that a mental health condition contributed significantly to the death.
Evidence to be considered
If the above evidence or situtation is present, a member of the Panel (or panel alternatives) may then consider other further evidence to identify a diagnosis.
In identifying a diagnosis, a member of the Panel may consider oral or written evidence from:
- Treating General Practitioner;
- Treating Psychiatrist;
- Treating psychologist or VVCS;
- Widow(er) and other immediate family members ie. parents, siblings and/or children;
- Defence medical and service records;
- Evidence from ADF peers or chain of command;
- ADFIS/IGADF enquiry if relevant;
- Coroners reports and any evidence provided to a coronial enquiry;
- Information provided by investigating police or emergency services involved in incidencts involving the deceased;
- Any writings (electronic or otherwise) by the deceased; and/or
- Medical files held by treating specialist, GP or DVA.
The above list is not exhaustive.
A forensic psychologist may, if required, be contracted to assist the panel or panel substitutes in assessing the evidence. The psychologist may not however make a stand-alone diagnosis and must simply provide advice and/or case summary information to the panel or panel substitutes.
Disclaimer
This guideline is not a directive and should not be used as a substitute for the proper application of the law, medical expertise and international standards for diagnosis of psychiatric conditions. It represents the Repatriation Commission's policy on the evidence that must as a minimum exist for an argument to be raised that a psychiatric condition existed prior to the veteran's death, and the evidence that can be considered relevant to the diagnosis of that condition.