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The Statements of Principles Monitoring, Aetiology and CCPS Commentary Unit

4th floor AMP Place, 10 Eagle St Brisbane Qld 4000.  Facsimile 07 3223 8722

Bob Connolly

07 3223 8325  (Manager)

Dr Jon Kelley

07 3223 8412

Maureen Anderson

08 8290 0365

Sue Lee

08 8290 0227

Duncan Cape

07 3223 8757

Christine Melloy

07 3223 8331

Dr Bev Grehan

07 3223 8376

Vicki Saunders

07 3223 8513

SOP BULLETIN Number 1

12 September, 1997

THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 17 SEPTEMBER 1997

New SOPs

  • Internal Derangement of the Knee
  • Osteoporosis
  • Extrinsic Allergic Alveolitis
  • Photocontact Dermatitis

Replacement SOPs

  • Chronic Bronchitis and Emphysema (replaces Chronic Airflow Limitation)
  • Malignant Neoplasm of the Stomach
  • Non-Hodgkin's Lymphoma
  • Contact Dermatitis
  • Carpal Tunnel Syndrome

Amendments

  • Asthma
  • Ischaemic Heart Disease

The following comments detail the important operational features of these SOPs.

Chronic Bronchitis and Emphysema

revocation

These replace and extend the Chronic Airflow Limitation SOPs.  The SOP now covers C.A.L. (with abnormal spirometry) as before, and also:

  • Non-obstructive chronic bronchitis, and
  • Non-obstructive emphysema (with impaired diffusing capacity but normal FEV1 and FVC), and
  • Chronic bronchitis and/or emphysema with small airways obstruction (but normal FEV1 and FVC).

Advice will be forthcoming on interpreting the diffusing capacity and small airways function requirements in the SOP definition.

These SOPs now cover all smoking-induced chronic benign lung disease.  The non-specific ICD code 496 is not included in this SOP.  Asthma is covered by its own SOP.

Internal Derangement of the Knee

new SOP

These SOPs apply to chronic meniscal and ligament disorders of the knee.  They fill the diagnostic gap between the Acute Sprains/Strains SOPs and the Osteoarthrosis SOPs.  They will apply particularly to claimants with current or recent eligible service.

Chondromalacia patellae, congenital discoid meniscus, cysts of the menisci and osteoarthrosis are specifically excluded. There are separate SOPs for chondromalacia patellae and Osteoarthrosis.  Congenital discoid meniscus and cysts of the menisci are non-SOP conditions at present.

Osteoporosis

new SOP

Note the very specific definition.  For this SOP to be applied there must be:

(i)evidence of an osteoporotic fracture, or

(ii)bone densitometry results meeting the criteria in the definition

If the definition is not met the SOP does not apply.  Claims for osteoporosis where bone densitometry is greater than the defined minimum and where there is no osteoporotic fracture should be diagnosed as No Incapacity Found.

The factors upon which claims are most likely to be based are smoking and alcohol.  The dietary factors in these SOPs only apply to particular circumstances i.e. POWs, anorexia, and malabsorption.

Contact Dermatitis

revocation

The ICD code for unspecified dermatitis (692.9) has been removed from the SOP.

Specific time periods, rather than just  " immediately before " have been included in the factors.

Malignant Neoplasm of the Stomach

revocation

Major changes:

  • Lymphomas and sarcomas of the stomach are now excluded (a common feature of all recently-issued malignancy-of-an-organ SOPs)
  • Causal factors are now included in the BOP SOP.
  • The factors now require knowledge of the histological type (carcinoma or not) and in some instances, the tumour site (cardia or rest of stomach).
  • The Helicobacter pylori infection definition no longer specifies the circumstances in which infection may be presumed.  (see below)
  • The asbestos exposure factor is has been removed from the RH SOP.  A factor for chronic atrophic gastritis is in both SOPs.

Helicobacter pylori infection is to be subject to a formal investigation by the RMA, with a view to issuing a separate SOP for the condition.

Until such a SOP is issued, causation of Helicobacter pylori infection should be assessed using the standard that has been in use to date, and that remains (for now) in the Peptic Ulcer Disease SOP, namely:

" infection with Helicobacter pylori " may be presumed if the person was, for at least 180 days (RH) and five years (BOP), living in a community with:

(i) Overcrowded conditions with poor hygiene; and

(ii) shared eating facilities and utensils; and

(iii) limited opportunities for bathing

Non-Hodgkin's Lymphoma

revocation

A Helicobacter pylori infection factor has been added for non-Hodgkin's lymphoma (B cell type only) arising in the stomach (to be applied as above).

Extrinsic Allergic Alveolitis

new SOP

This is a rare condition and the diagnosis can be difficult to establish.  The feature of this SOP is that the specific probable causal agent needs to be identified in order for the SOP to be applied.

Asthma

amendment

There has been a minor change to the SOP definition of asthma, adding the sentence:

" The airflow obstruction may be completely or only partially reversible ".

Carpel Tunnel Syndrome

revocation

The wording in factors (a), (c), (q) and (s) has been changed to give clear meaning to the time periods required for " .. performing repetitive activities with the affected hand .. ".  The current obesity statement has also been included.

Ischaemic Heart Disease

amendment

The SOPs have been amended to include a factor for occupational exposure to, and handling of, products containing nitroglycerine or nitroglycol (a very rare job these days).  Note that the ICD code 414.9 is not included in this SOP.  That code should only be used to encode the rare diagnosis of coronary atherosclerosis with no evidence of ischaemia.

Photocontact Dermatitis

new SOP

Very rarely claimed.  Note that this SOP does not cover skin rashes etc. due only to  sun exposure.  This SOP evolved out of the review of the SOP for Contact Dermatitis.