Establishing a person cannot work for more than 10 hours per week with a less than 50 percent probability that rehabilitation will improve the person’s capacity, within a 5-year period, for remunerative work, must be supported by evidence from the person's relevant specialist/s.
Any improvement in the person’s capacity (medical, psycho-social or vocational) must be considered in the context of their capacity to undertake remunerative work.
Medical evidence should only be accepted from a registered or licensed medical practitioner. A specialist, especially a treating specialist, is to be preferred over a GP. However, a GP is acceptable where this is appropriate.
The following example illustrates when the use of a GP is appropriate. A veteran is 45 years of age and has 77 impairment points from a number of conditions. The veteran has been discharged for 10 years, recently reclassified to receive a class A CSC pension, and has been receiving incapacity payments for the past 5 years based on medical certification provided by the treating GP. Specialist information is out of date and cannot be reasonably considered as contradicting the more recent evidence. Previous rehabilitative programs have been unsuccessful. Despite there being no current specialist opinion on the persons capacity to return to remunerative work, the weight of evidence available would support finding the person SRDP eligible.
A delegate may determine eligibility based on existing evidence or may choose to seek specific or additional evidence from the person’s relevant specialist in order to be satisfied that the person meets criteria 199(1)(d). There are no set time limits on how long medical evidence remains relevant for. Relevancy depends on the person’s conditions and circumstances, and the information provided at the time by the specialist i.e. whether the specialist set a review period. When considering and evaluating evidence, delegates may seek the opinion or guidance of a Contracted Medical Advisor (CMA).
A person does not have to have undertaken a DVA rehabilitation program or assessment in order to meet criteria 199(1)(d). A rehabilitation assessment specifically for determining SRDP eligibility is not required by the legislation in order to make a decision.
Where the person does not have a treating specialist or the treating specialist is unable to provide an opinion on whether the person’s capacity for employment could be increased by rehabilitation, a rehabilitation assessment by a DVA rehabilitation advisor or provider may be used to assist a delegate to make a decision. A DVA rehabilitation advisor or provider can facilitate engagement with the relevant specialist/s to consolidate medical and rehabilitation evidence. Together with information on the person’s current circumstances and capacity for employment, the advisor or provider should report on whether rehabilitation will likely increase this capacity.
SRDP eligibility should be determined based on consideration of the available evidence and all relevant factors, including the person’s circumstances and their level of impairment (i.e. impairment points). Evidence can include (but not limited to):
- annual incapacity reviews provide medical evidence, as a GP or specialist report addressing the medical capacity for work questionnaire is required
- any previous rehabilitation programs that also provide relevant information to be considered (such as vocational/psychosocial goals, outcomes, etc)
- 'Chronically Incapacitated' Category A - indicates the person is unlikely to return to employment
Delegates have flexibility to obtain further evidence, including a second opinion from a relevant medical specialist, or an opinion from a DVA rehabilitation advisor or provider where the existing evidence is in conflict or does not clearly support a decision to accept or deny eligibility for SRDP.