DATE OF ISSUE: 5 February 1993
IMPLEMENTATION OF STATEMENTS OF PRINCIPLE FOR USE BY REPATRIATION COMMISSION DELEGATES IN THE COMPENSATION SUB-PROGRAM
Purpose
The purpose of this instruction is to outline the rationale behind the development and implementation of the Statements of Principle (SoP), and the procedures to be followed by Branch Office staff when using the SoP. Officers involved in investigating or determining claims should have access to a complete set of SoP.
Background
2.The Commission has been concerned for some time with the question of consistency in decision‑making and has decided to issue Statements of Principle (SoP) to its delegates as a guide when deciding claims.
3.On 20 May 1992, Commission formally approved the first four SoP. These SoP covered Ex‑prisoners of war of the Japanese (0001), non‑Hodgkin's lymphoma and Vietnam service (0002), sensori‑neural hearing loss and acoustic trauma (0608) and skin damage and solar exposure(1203).
4.In July 1992 a symposium was held in Canberra to consider more than 100 conditions that are commonly claimed by veterans. It is from those deliberations that the latest SoP emerge.
Purpose of SoP
5.The SoP are a general standard to assist determining officers when deciding claims. They are consistent with current medical knowledge and case law. They are not to be blindly applied formulae nor do they subvert the statutory requirements of the Veterans' Entitlements Act 1986 (the VEA). Commission delegates are still required to consider the facts of individual cases. Once the facts are found the SoP will promote a consistent outcome in similar medical fact cases, regardless of which Determining Officer is deciding the case or in which state the claim is determined.
Aims of the SoP
6.The major aims of the SoP are:
.to promote national consistency in decision‑making;
.to provide useful guidelines for Repatriation Commission delegates;
.to reduce appeals to the VRB and the AAT;
.to improve the timeliness and effectiveness of decision‑making;
.to reflect the best available medical knowledge;
.to reflect current views on legislative interpretation.
Date of effect
7.The SoP will take effect from 1 February 1993 and will apply to all claims decided on or after that date.
Implications
8.The SoP will affect the way in which claims investigation and determinations are currently undertaken. However, not all claims received will have a SoP for reference. Currently there are SoP covering many of the most commonly claimed diseases or conditions. SoP for other conditions will be developed on an ongoing basis and will be issued from time to time. Existing SoP will be added to, revised or withdrawn as a result of further developments in the medical field or changes in the law.
Further Development
9.These Statements of Principle do not represent the end of the process of research and development. Ex‑service organisations will be sent exposure drafts on balance of probabilities conditions. It is hoped that in the early part of 1993 a second Symposium will be held to consider additions to these Statements.
Glossary of Terms
10.Some phrases and terms have a consistent meaning throughout the Statements of Principle and are included in the Glossary.
Legislation
11.It is not intended that changes be made to the VEA as a result of the SoP.
Publicity
12.The development of the SoP has been undertaken over many months and has included workshops, seminars and representation and input from branch offices, from the ex‑service community and from medical specialists.
13.The major ex‑service organisations have been involved in the process at each stage and are well placed to inform their members of the developments and changes occurring. Articles in DVA publications (such as CATS and "Vetaffairs") as well as ex‑service journals and papers are planned. Representatives from both central and branch offices will be visiting each state when the SoP are implemented to brief staff and provide basic training. Ex‑service organisation should be invited to attend sessions at Branch Offices.
14.Copies of all publicity material will be despatched to branch offices.
Compensation claims processing procedures
15.The following are interim procedures pending the implementation of CCPS.
16.Some change from the present investigative steps is warranted in the meantime as there is scope to utilise good practice to "fast track" SoP cases. This fast tracking mostly involves avoidance of unnecessary queues by having a claims investigator keep close control of a case and seek expert advice on a "by hand" basis. Suggested and recommended steps to do this are outlined below.
17.Claims will be registered and passed to Compensation in the normal manner. On receipt of the claim in the Compensation area, an officer (for example, Vetting Officers in NSW) will be responsible for identifying if any element of a claim is covered by a SoP. If a case does not involve a SoP, no change to present processing is required.
18.If the case is identified as being covered by a SoP it should be allocated immediately to a responsible officer (for example, Claims Investigator) as "case manager." It would be appropriate to "flag" the file so it is easily identifiable as a SoP case. It is expected that the case manager will be responsible for all aspects of processing that claim up to referring the case to a delegate for decision. This should not significantly alter current staffing arrangements or team set ups. The SoP cases will form part of a person's usual workload with the change being in short-cutting some of the processing steps rather than case volume.
19.If there is no diagnosis or the diagnosis is in doubt, and the case is one that might be covered by a SoP, it should be taken "by hand" to a DMO for advice. The DMO will confirm the diagnosis or direct the investigation necessary to confirm the diagnosis. Again, once such a case is identified as one involving a SoP it should be passed to a case manager for control and processing.
20.It is the responsibility of the case manager to ensure that each hypothesis covered by the SoP is investigated or eliminated as a possible avenue. In this way the SoP becomes the tool that guides the case manager in deciding what matters require investigation. It is immaterial whether or not the hypotheses have been raised by the claimant. Where a SoP refers to time frames, amounts or exposures, the case manager must address these questions in the investigation so that the decision maker can determine whether or not the facts of the case are sufficient to give rise to a causal connection. Where a condition is not covered under the SoP the claim should be processed in the normal manner. In circumstances where a potential hypothesis is not addressed in the SoP medical advice should be sought.
21.The case manager may need to seek advice from a delegate in determining the investigation necessary to finalise a claim involving a SoP. This should always be carried out "by hand" to avoid queuing delays. Similarly, if an opinion or direction by a DMO is sought, the case should be referred "by hand."
22.Advice from a DMO should be sought on matters of diagnosis involving a SoP or the viability of a new or unusual contention. Other referrals to a DMO for investigative matters should normally be generated through delegates. DMOs should also be available to give ad hoc verbal advice to case managers and delegates.
23.Under no circumstances should a delegate or DMO place these cases at "the end of a queue." Practices should be developed so that SoP cases referred for expert advice in this manner be returned to the case manager on the day of referral. It is the responsibility of the case manager to follow up referrals to ensure they are returned within 24 hours.
24.Branches should develop practices to ensure that at least one DMO and one delegate are available to case managers for advice on a daily basis. It is expected that advice will be given on specific questions raised by the case manager. This means that written advice from DMOs and delegates can often be quite short and given on the spot.
25.Investigation for any non-SoP disabilities included in the claim should be arranged concurrently with the SoP covered disability.
26.The telephone is often the best tool available to eliminate unnecessary investigations. Its use by Claims Investigators, Medical Officers and delegates is actively encouraged. (CCPS, when introduced, will request Claims Assessors to make increased use of the telephone.) For example, if a veteran claims "Carpal Tunnel Syndrome" as a result of repetitive use, a telephone call to the veteran may quickly eliminate the need to further investigate hypotheses of gout, tuberculosis, septic arthritis, osteoarthritis, etc. Information obtained from veterans via the telephone should be confirmed in writing if the case is to be rejected. The veteran should be advised of the facts to be taken into account and that any further comments or amendments to the original information should be made, and returned, within 14 days. Obtaining confirmation from the veteran should not delay the claims process.
27.In most cases there will be no need to seek written confirmation when eliminating possible hypotheses by telephone call to the claimant, claimant's representative or LMO. However, there may be some circumstances when written confirmation is warranted. For example, a claimant may have a litigious history or may have been vague in giving answers. Ultimately, whether or not written confirmation is sought in an individual case is a matter decided by the decision maker. Therefore oral advice from a delegate should be sought when a case manager is in doubt.
28.If all the hypotheses covered by the SoP are eliminated, the case should immediately be referred to a delegate for decision (unless there are other parts of a claim still outstanding). Similarly, once the investigation shows that a hypothesis for the disability is met, the investigation should cease and the case be sent for decision.
29.The present practice of concurrent investigation of pension assessment with the disability claim investigation should be continued. However, the case manager needs to exercise judgement in this area. If it appears unlikely that any of the hypotheses contained within a SoP apply to a particular veteran, there is little point commencing a pension investigation.
30.Other than in rare circumstances, it is not expected that contentions apart from the hypotheses contained in the SoP will lead to an acceptance of the disability covered by the SoP. The Medical Symposium that led to the present SoP considered as many contentions as could be raised by the collective expertise of the determining officers, DMOs and epidemiological experts present at the meeting. As a result of this process, the hypotheses contained in the SoP give the scenarios that the Repatriation Commission considers might raise a reasonable hypothesis. For this reason there is little point in commencing investigations of scenarios not included in the acceptance profiles covered by the SoP. However, following the High court decision in Bushell, it may be possible for a veteran to raise an hypothesis not addressed in the SoP. In circumstances where the advice of a medical officer is that there is a need for further investigation, the claim should not be decided until the medical investigation is complete.
31.If the case manager considers or is advised that the contention is new or different, a DMO should be asked for advice on the medical viability of the contention. The DMO should provide a short statement indicating that either the contention is not medically viable or giving reasons why the contention is worth exploring. If the DMO considers that the contention is worthy of further investigation, the case manager must contact Compensation Section Central Office on the telephone for advice (the Compensation help line is Central Office ext. 4711). The case manager should provide details of the contention, the disability claimed and contact details for a return call. Compensation will contact the case manager as soon as possible with advice on the investigation of the claim.
Reference Material
32.Background discussion material and medical literature references are available for some conditions in a separate folder entitled "Statements of Principle, Reference Material".
Monitoring the application and effects of SoP
33.A process to interrogate the claims management system will be implemented in February 1993. The attributes will be accessed via the CMS after the claim has been decided. Each Statement of Principle will be identified by the Code Number that appears in the top right of the SoP. Each contention will be listed under that code and an indication of which contention led to an accept will be checked. It will be possible to identify new contentions and to identify those claims where the connection with war service was rejected although a contention identified in the SoP was advanced. A separate DI on the Attributes will be despatched.
34.Monitoring of the SoP will include:
.DO compliance;
.Consistency of decisions nationally;
.Ex‑service organisation and client acceptance;
.Outcomes at all levels of the determining system.
35.Monitoring and the evaluation of the SoP will be a joint function of the state branch offices and central office. Performance monitoring will be the responsibility of branches who will need to prepare reports on the use of SoP and changes to current acceptance rates.
36.Managers Compensation are requested to provide details to Director Compensation (CO) on the methodology to be adopted by their sections in handling SoP cases. This should be done by 1 March 1993. Performance monitoring on SoP, as outlined in paragraph 35 should be reported in the usual manner.
Training
37.Training in the use of SoP will be in February 1993. For staff currently working as DOs, this will consist of "question and answer" sessions. Training will be undertaken by Compensation section and Medical Services Adviser in consultation and in conjunction with branch office staff who attended the Symposium. Information sessions will be provided to all staff whose work will be affected by the SoP. Investigation staff will be involved in the briefing sessions after they have had an introductory session on the SoP. Staff will be further advised of SoP briefings and training.
Distribution
38.It is the responsibility of the Compensation Section in Central Office to print, publish and distribute the SoP and reference material.
39.SoP will be available to:
.Delegates and Claims Examiners
.Departmental Medical Officers
.Senior Medical Officers
40.Copies for information and reference are available to:
.Compensation/Entitlement investigation staff
.The Administrative Appeals Tribunal
.Advocates of the Repatriation Commission
.VAAS areas
.DVA Libraries
.Ex‑service Organisations
41.The SoP are available for inspection or sale from the offices of the Department of Veterans' Affairs.
Contact officers
42.Further details or information can be obtained by phoning the Compensation team in CO:
John Douglas — 06 289 6450
Julia Pittard — 06 289 6459
Felicity Donnelly — 06 289 6452
PETER HAWKER
NATIONAL PROGRAM DIRECTOR (BENEFITS)