The following table outlines the method contained within Chapter 25 of GARP M for calculating PI (including interim) compensation where a person has a condition accepted under the MRCA and a condition accepted under the VEA and/or the SRCA and the MRCA PI claim is made prior to 1 July 2013 and the date of effect of the PI is also prior to 1 July 2013.  Some of the steps are not listed in Chapter 25 of GARP M.  In the absence of specific instructions, the following steps have been extrapolated from the primary legislation and the legislative instrument.

In order to work out the net MRCA periodic payment for Step 7, lump sums paid to the person under SRCA sections 24, 25 and 27 must be converted to a periodic payment.

The SRCA amounts are converted to a current lump sum value (by multiplying by the ratio of the current value for maximum SRCA section 24 payment to the value when the lump sum payment was made) and each lump sum is converted to a weekly periodic payment by dividing by an age-based number provided by the Australian Government Actuary for this purpose. The age to be used in applying this age-based number is the age the person would have been on their next birthday at the time the SRCA lump sum was paid.

In order to work out the net DP for Step 6, for any VEA conditions that were accepted conditions on the date the person claimed MRCA PI:

(a) on VIEW determine the client’s General Rate DP % (or above General Rate) entitlement on the date of the MRCA PI claim (see under ‘Level’ heading in VIEW/Payabilities/Pensions Recurring Payability History/Payabilities);

(b) using the General Rate DP % (or above General Rate) determined at (a), apply the statutory rate payable as at Date of PI determination (Step 2).

Note that the same process should be applied where a client’s DP is being reduced due to recovery of an overpayment.  Information on whether a client’s DP is being reduced/limited can be accessed on VIEW under the Comments tab and under the ‘Adjustment Type’ heading in the Payabilities/Pensions Recurring Payability History/Payabilities folder.

Where an offset is applied because of the payment of a SRCA lump sum or because of other compensation payments, convert the actual amount of DP being paid at the date of the PI claim to a % of the General Rate on that date.  That % should then be applied to the General Rate at the date of the MRCA PI determination to calculate the amount of DP to be included in Step 6.

Example 1: No offset being applied to client’s DP/client’s DP is being reduced by an overpayment

PI claim date:11/02/2011

MRCA Date of Determination: 13/10/2012

1. On VIEW determine the amount of DP being paid to the client on the MRCA PI date of claim - $232.98.
2. If no offset applies, on VIEW determine the client’s General Rate DP % (or above General Rate) entitlement at that point in time (see under ‘Level’ heading in VIEW/Payabilities/Pensions Recurring Payability History/Payabilities) – 60% of the General Rate (1 January 2011).
3. Using the client’s General Rate DP % entitlement at the time of the MRCA PI claim (Step 2), determine the statutory rate payable for this % as at Date of PI determination – $252.00 (20 September 2012).
4. Then convert the DP amount above (step 3) to a weekly amount - $252.00/2 = $126.00

Example 2: client’s DP is being reduced by an offset due to receipt of SRCA PI Lump sum or compensation from another source

PI claim date: 25/06/2012

MRCA Date of Determination: 30/03/2013

1. On VIEW determine the amount of DP being paid to the client on the MRCA PI date of claim - $110.31
2. If this amount was being reduced by an offset due to the client’s receipt of a SRCA PI lump sum, determine what their General rate DP % entitlement was at that point in time - 100% of the General Rate = $410.10 (20 March 2012).
3. Calculate the actual DP paid as a percentage of the client’s General Rate DP % entitlement amount at that time - $110.31/$410.10 =26.89%
4. Using the client’s General Rate DP % entitlement at the time of their MRCA PI claim (Step 2), determine the statutory rate payable for this % as at Date of PI determination - $432.60.
5. Apply the % obtained at Step 3 to the statutory rate payable for the client’s General Rate DP % entitlement as at Date of PI determination - $432.60 x 26.89% = $116.33.
6. Then convert the DP amount above (step 5) to a weekly amount – 116.33/2 = $58.16.

When a previous MRCA PI lump sum has been paid, the additional amount of PI payable is calculated by converting the lump sum paid to a current weekly amount and subtracting this from the total weekly amount of PI payable at step 5 or 8 whichever is applicable.

If the person is in receipt of periodic compensation the additional amount of PI payable is calculated by subtracting the previous periodic payment rate from the amount calculated in step 5 or 8.

Where the client has received both periodic and lump sum MRCA payments, both the converted weekly amount of the lump sum/s and the periodic amount are deducted from the newly assessed rate to determine the additional amount of PI payable.

Determine the compensation factor to be applied using GARP M Chapter 23 Calculating Permanent Impairment Compensation. It may be necessary to utilise the formula under the heading “Combined Ratings” in Chapter 23 to arrive at a weighted compensation factor.

In order to use this formula, conditions accepted under the VEA should be treated as if they relate to warlike/non-warlike service and conditions accepted under the SRCA should be treated as if they relate to peacetime service.  Where a condition is accepted under both the VEA and the SRCA, treat the condition as if it were related to warlike/non-warlike service.

In bringing across VEA and SRCA conditions, it may be necessary to apply apportionment under Chapter 20 of GARP where the client has two or more conditions accepted under two different Acts which affect the same body system.  As per a single Act situation, apportionment is used to establish the separate contribution each condition makes to the overall functional impairment. It may be required in some cases to determine the appropriate impairment rating and the relevant compensation factor to be applied.

An initial interim transitional determination is processed in the same manner as a determination based on a person with stable conditions with the exception of the applicable lifestyle factor to be used.

Where interim compensation has been paid and the client is being reassessed due to the stabilisation of all of their conditions (i.e. under section 75(4)), the relevant PI claim date to be used for the purposes of determining which VEA and/or SRCA conditions (and related payments) are included and/or excluded from the assessment is, the date of the last MRCA PI claim:(i.e. the date of the most recent PI claim that resulted in an assessment, immediately preceding the section 75(4) reassessment). Refer to the example in Chapter 5.8.6 of this manual for further clarification on what is considered the last MRCA PI claim for these purposes.

For the purposes of transitional PI claims, this means that the PI claim date, which is used to determine what VEA and/or SRCA conditions and related payments are included and/or excluded from the calculation, is the date of the initial interim PI claim.  However, if the client has lodged further PI claims since the initial interim PI claim which have resulted in an assessment, the PI claim date to be used for the purposes of determining which VEA and/or SRCA conditions (and related payments) are included and/or excluded from the assessment, is the date of the last MRCA PI claim preceding the s75(4) determination

For example, a transitional client lodges a PI claim on 13 July 2011 which results in payment of interim compensation due to one condition being unstable. On 26 March 2012, the client lodges another PI claim based on new conditions which results in an additional payment of interim compensation. The client lodges a further PI claim on 18 September 2012 based on a worsening of existing conditions but does not meet the required impairment point threshold for payment of additional interim compensation. On 9 December 2012, all of the client’s conditions stabilise and a reassessment is undertaken under section 75(4). For the purposes of determining what VEA and/SRCA conditions and related payments are included/excluded in the reassessment, the last MRCA PI claim date is 26 March 2012.

Please note that where interim PI has been paid, the client is not required to lodge a claim in order for their impairment to be reassessed upon stabilisation of their conditions (see Chapter 5.8.6 for more information on this).

The transitional arrangements under section 13 of the Military, Rehabilitation and Compensation (Consequential and Transitional Provisions) Act 2004 (CTPA) requires that impairment points from VEA and/or DRCA conditions are included as part of the MRCA assessment. 

Chapter 25 of the GARP M contains the method for calculating the amount of PI compensation payable in transitional scenarios and requires an assessment of all MRCA accepted conditions and a separate assessment of all VEA/DRCA accepted conditions.

Resting Joint Pain

Where the medical evidence shows resting joint pain arising from conditions accepted under both MRCA and VEA/DRCA, the delegate may assign a rating under the MRCA and then a separate rating under the VEA/DRCA. This may result in two resting joint pain ratings.

The total ratings under MRCA are then combined with the total ratings under the VEA/DRCA to calculate the client's overall impairment rating.

As with any impairment rating, the allocation of resting joint pain should be based on the available medical evidence. Where it is clear that resting joint pain is attributable to only MRCA conditions, or only the VEA/DRCA conditions, then it would not be appropriate to assign two ratings.

Examples – Resting Joint Pain

A veteran has accepted conditions of the spine and ankles under the VEA/DRCA as well as accepted conditions of the knees and shoulders under the MRCA. The medical evidence shows the spine condition causes pain which limits the veterans comfortable sitting time and the delegate is satisfied a rating of 5 is assigned for resting joint pain to the accepted VEA/DRCA conditions. The medical evidence also shows the knee conditions cause severe pain which is not ameliorated by treatment. The delegate is satisfied a rating of 10 is assigned to the accepted MRCA conditions. In this scenario, a rating of 10 for resting joint pain may be included in Step 1(a) of Chapter 25, and, another rating of 5 for resting joint pain in Step 2(b).  

Disfigurement and Social Impairment

As with resting joint pain, where the medical evidence shows disfigurement and social impairment arising from both MRCA accepted conditions and VEA/DRCA accepted conditions, the delegate may decide to allocate two ratings.

Where it is clear that disfigurement and social impairment is attributable to only MRCA conditions, or the VEA/DRCA conditions only, then it would not be appropriate to assign two ratings. Additionally, there may be times where the delegate may need to apportion the impairment by using Chapter 19. Chapter 17 directs that Chapter 19 may be used where there is a non-accepted condition contributing to disfigurement and social impairment. It is acknowledged that this scenario may be rare, because non-accepted conditions are not always known, however the option to use Chapter 19 to adjust for non-accepted conditions is available for the delegate if appropriate.

Examples – Disfigurement and Social Impairment

A veteran has accepted skin conditions under the VEA/DRCA including deep scarring on the cheek and eyebrow from the removal of BCCs and SCCs. The veteran also has PTSD and anxiety disorder accepted under the MRCA. The medical evidence shows the scarring on the veteran’s face is noticeable to others, and the delegate is satisfied a rating of 2 may be assigned to the accepted VEA/DRCA conditions. The medical evidence shows the mental health conditions causes the veteran to become agitated in public causing frequent outbursts, which are obvious to others, and cause the veteran to avoid some normal activities. The delegate is satisfied a rating of 2 may also be assigned to the accepted MRCA conditions. In this scenario, a rating of 2 for disfigurement may be included in Step 1(a) of Chapter 25, and, another rating of 2 in Step 2(b).   

A veteran has an accepted right knee condition under the DRCA and suffered a worsening of the condition which is now accepted under the MRCA. The veteran has undergone extensive surgeries and as a result suffers noticeable scarring on the knee, thigh and shin, as well as a limp which requires the use of a cane. The medical practitioner provided an opinion apportioning the total lower limb impairment as 50% to the original condition accepted under DRCA and 50% to the worsening of the condition under MRCA. The delegate decides a total rating of 10 is applicable for disfigurement as a result of the knee condition. It would be open to the delegate in this scenario to take into consideration the medical practitioner’s opinion and provide a rating of 5 for disfigurement for inclusion in Step 1(a) and a rating of 5 for inclusion at Step 1(b) of Chapter 25.

A veteran has accepted conditions under the VEA/DRCA which are not causing any significant disfigurement and only slight embarrassment. The delegate is satisfied a rating of 0 for disfigurement may be allocated to the accepted VEA/DRCA conditions. The veteran also has lumbar spondylosis accepted under the MRCA. The report provided by the treating orthopaedic surgeon shows the veteran also suffers scoliosis, which is not accepted under MRCA. The orthopod advises that as a result of the total spine conditions the veteran suffers a significant leg shortening on one side effecting his gait, but that lumbar spondylosis contributes about 50% to the impairment. The delegate decides a total rating of 10 is applicable for disfigurement, but notes the contribution by the non-accepted condition. It would be open to the delegate in this scenario to use Chapter 19 to calculate the appropriate rating to be included at Step 1(a) of Chapter 25 for accepted MRCA conditions and a rating of 0 for inclusion at Step 1(b).

It is acknowledged that the examples provided on this page may not cover every scenario. If the decision maker requires any further guidance with respect to either resting joint pain or disfigurement and social impairment in transitional cases, they are encouraged to contact Benefits & Payments Policy.