SOP Bulletin No. 76

3 — rd Floor AMP Place, 10 Eagle St Brisbane 3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

18 August 2003

THE FOLLOWING RMA DECLARATIONS/SOPS ARE TO BE GAZETTED ON

20 AUGUST, 2003

IMPORTANT OPERATIONAL FEATURES

Gulf War Syndrome

The RMA has determined that “Gulf War Syndrome” is not a disease under the VEA. Claims for “Gulf War Syndrome” should be investigated to see whether any other diagnoses can be made to answer the claim, but “Gulf War Syndrome” should be treated as “no incapacity found”.

The declaration finalises the formal investigation into this non-SOP condition.  During the investigation, claims could not be determined for this condition.  Outstanding cases may now be finalised.

Obesity

The RMA has completed the formal investigation into obesity.  The RMA has issued a SOP for morbid obesity (see below), but declared that obesity of lesser extent than that specified in the morbid obesity SOP definition is not a disease under the VEA.  Claims for obesity that do not satisfy the morbid obesity SOP definition should therefore be treated as “no incapacity found”.  As for Gulf War Syndrome, claims for obesity that could not be determined because of the investigation, can now be finalised.

These are new SOPs, which result from the investigation into obesity.

The definition of Morbid Obesity in the SOPs requires:

1. a BMI of at least 40, or
2. a BMI of at least 35 together with a requirement for:

1. ongoing, medically prescribed drug therapy for weight reduction; or
2. surgical intervention for weight reduction (other than cosmetic surgery).

The new SOPs have a number of causal factors with time requirements for both RH and BOP, including drugs, binge-eating disorder, hypercortisolism, hypothyroidism, hypothalmic disorder causing hyperphagia, and having a caloric intake excessive for energy needs that cannot be compensated by physical activity.  These factors are similar to those in the existing statement about the causes of “being obese”.

A number of other SOPs have “being obese” as a causal or worsening factor.  In cases where that factor needs to be considered:

1. If the veteran meets the morbid obesity SOP definition then that SOP should be propagated to and applied.
2. If the claim is not successful via the morbid obesity SOP:

1. For those conditions where the SOP definition of 'being obese' includes reference to the RMA's Statement about the causes of "being obese", this statement should then be applied;
2. For those conditions where the SOP definition of 'being obese' does not refer to the RMA's Statement about the causes of "being obese", the relationship between obesity and VEA service must be determined based on the evidence, including medical advice about the causes of obesity.

These are new SOPs.  Restless legs was also one of the non-SOP investigations for which claims could not be determined.  Outstanding claims can now be finalised.

Restless legs syndrome is a common disorder in the community, although it is not frequently claimed by veterans.

There are causal and aggravating factors for iron deficiency, chronic renal failure, peripheral neuropathy or radiculopathy, and specified drugs, in both RH and BOP.

There are ca — u — sal and aggravating factors for diabetes in RH only.

In the RH SOP only, there are new causal and worsening factors for both clinically significant anxiety disorders and clinically significant depressive disorders, with time requirements.

The alcohol factors no longer refer to alcohol dependence or abuse.  These factors now require consumption of an average of at least 200gm/wk (RH) or 300 gm/wk (BOP) of alcohol, which cannot be decreased to less than this average at the time of clinical onset.

There are new causal and aggravating factors for inability to undertake a mildly strenuous level of physical activity, with time requirements, for both RH and BOP.

The renal factors have been reorganised with no change to the effect.  Injury to a kidney or a renal artery is now included in the chronic renal disease or injury factor (as renal scarring, renal ischaemia/infarction).  There are new ca — u — sal and aggravating factors for renal transplantation in both RH and BOP.

The list of diseases in the endocrine factors has been expanded to include acromegaly and primary hypoparathyroidism.

There is a new sub-factor (e)(iii) in the RH SOP for being on board a vessel and consuming potable water produced by evaporative distillation of estuarine Vietnamese waters, for a cumulative period of at least 30 days.  This consumption can have occurred after a vessel had left Vietnamese waters, if the water was produced as above.  This factor reflects the finding of a Departmentally sponsored study that dioxin is not removed from water by evaporative distillation.

The herbicide factor has been removed from the BOP SOP.

Hodgkin's disease is now a causal factor for Non-Hodgkin's Lymphoma, with different time requirements in the RH and BOP SOPs.

The coeliac disease factor in the RH SOP is no longer limited to primary non-Hodgkin's disease of the small intestine.  The limitation remains in the BOP SOP.

The list of diseases in the systemic immunosuppressive drug therapy factors has been expanded to also include psoriasis, systemic lupus erythematosus, ulcerative colitis and Crohn's disease.

There are changes to the wording and set out of the definition, without any change in meaning.

The alcohol factors have been re-worked to a yearly alcohol consumption; the dose remains different for males and females, as well for RH and BOP.

There is a new ca — u — sal factor for aspirin, with specified time requirements.  The dose is different for RH and BOP.

There is a new causal strenuous physical activity factor for RH only.

The oral contraceptive pill and the severe stressor factors have been removed from the BOP SOP.

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