Section 13 of the Military Rehabilitation and Compensation (Consequential and Transitional Provisions) Act 2004 [2] (CTPA) applies where a person with a condition accepted under the VEA and/or the DRCA lodges a claim for permanent impairment compensation under section 319(2) of the MRCA [3].
On 30 February 2020, a veteran lodges a claim for condition A under the MRCA. At that date, the following claims were relevant:
Condition B is not included in the assessment because although it was claimed under DRCA before the MRCA PI claim date, liability was not accepted for the condition under after the MRCA PI claim date.
Condition C is included in the assessment because the determination to accept the condition under VEA was made before the MRCA PI claim date.
Condition D and condition E are included in the assessment because the determinations to accept the conditions under DRCA were made before the MRCA PI claim date.
One purpose of determining the impairment points from the VEA and/or DRCA condition is to establish whether the person meets the criteria for other benefits, such as:
Note: Please see chapter 12.7.7 of the Transitional Provisions Policy Manual for a complete list of other benefits veterans may be entitled to as a result of their total combined permanent impairment rating under MRCA.
The following table is a quick reference guide to assist delegates in determining which methodology applies for MRCA PI claims received before and after 1 July 2013.
If…
|
Apply…
|
Date of effect [8] and date of PI claim are both prior to 1 July 2013 |
Old
|
Date of effect [8] and date of PI claim are both on/after 1 July 2013
|
New |
Date of PI claim is after 1 July 2013 and date of effect [8] prior to 1 July 2013
|
New |
Date of PI claim is prior to 1 July 2013 and date of effect [8] on/after 1 July 2013 and:
|
New |
Date of PI claim is prior to 1 July 2013 and date of effect [8] on/after 1 July 2013 and:
|
Old |
Note: Please see the Compensation Claims Procedures [9] manual for the methodology to apply in relation to PI claims made:
Note: Please see chapter 12.7.2 for more information about each of the steps contained within chapter 25 of GARP M (to apply in relation to PI claims made on and after 1 July 2013).
The following is a summary of the purpose of chapter 25 of GARP M:
This chapter provides guidance on each of the steps contained within Chapter 25 of GARP M to apply to MRCA PI claims made on and after 1 July 2013 (i.e. the new methodology):
At Step 1 the delegate is calculating the total compensation that would be notionally payable under MRCA for all accepted conditions (regardless of the Act they are accepted under) at the date the veteran makes their MRCA PI claim.
Step 1 asks the delegate to:
(a) all MRCA accepted conditions, and
(b) any VEA and DRCA accepted conditions which were accepted conditions on the date of the MRCA PI claim
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of Step 1.
At step 2 the delegate is deciding whether, under GARP M, the MRCA accepted condition contributes at least 5 impairment points to the overall impairment rating.
Step 2 provides the following two options:
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of step 2.
Relevant definitions
MRCA accepted condition means: ‘the injury or disease for which the Commission has accepted liability under section 23 of the Act’.
At Step 3 the delegate is calculating the compensation that would notionally be payable under the MRCA for the VEA and DRCA accepted conditions referred to in Step 1(b).
Step 3 asks the delegate to use GARP M to work out the amount of compensation that would be payable under the MRCA for the VEA and DRCA accepted conditions referred to in Step 1 as at the date of the MRCA determination.
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of step 3.
Relevant definitions
DRCA accepted condition means: ‘in relation to a person, means the person’s injury for which there is liability to pay compensation under the DRCA’.
VEA accepted condition means: ‘in relation to a person, means the person’s incapacity from an injury or disease that the Repatriation Commission has determined under section 19 of the Veterans’ Entitlements Act 1986 (including as affected by section 71 of that Act) entitles the person to be granted a pension’.
At step 4 the delegate is subtracting the dollar amount worked out at Step 3 from the amount worked out at Step 1.
This means the delegate is subtracting:
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of step 4.
Step 5 advises the delegate that the amount worked out at Step 4 is the amount of MRCA PI compensation payable, subject to the proviso in Step 6.
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of step 5.
At Step 6 the delegate is deciding whether the amount of compensation already received for all accepted conditions exceeds the maximum weekly permanent impairment (PI) compensation amount payable under the MRCA.
Step 6 asks the delegate to add the following amounts together:
If the total of these amounts:
Note: Please see Payment Rates [12] in the Compensation and Support Reference Library for more information.
Note: Please see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of Step 6.
Conversion of DRCA lump sums
The DRCA amounts are converted to a current lump sum value (by multiplying by the ratio of the current value for maximum DRCA section 24 payment to the value when the lump sum payment was made) and each lump sum converted to a 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 that the person would have been on their next birthday at the time the DRCA lump sum was paid. The converted amount is indexed annually (on 1 July) using the indexation factor calculated under section 404 of the MRCA.
Conversion of VEA DCP
At this step, delegates must use the percentage rate of DCP at the date the client lodged their MRCA PI claim, however use the current rate of payment applicable at the date of MRCA PI determination. This is to take into consideration any rate increases to the DCP percentage that have occurred between the time of MRCA PI claim and MRCA PI determination. It is important to note that at this step the delegate is not taking into consideration any increase in DCP percentage as a result of a new claim or an Application for Increase (AFI) under VEA occurring after the MRCA PI claim date. As DCP is a fortnightly amount, the delegate will halve the DCP to find the weekly equivalent rate.
Example: A veteran lodges a MRCA PI claim on 1/01/2022. At that date, the veteran is receiving DCP at 30% of the General Rate under VEA. On 01/03/2022, the veteran lodges an Application for Increase under VEA and their DCP is increased to 40% of the General Rate on 01/05/2022, with effect from 1/02/2022. At the date of determination of MRCA PI on 01/10/2022 and at Step 6, the delegate is taking into consideration the DCP percentage payable at the date of MRCA PI claim, that is, 30% DCP. However, the dollar amount taken into consideration is 30% DCP at the rate payable at the date of MRCA PI determination, on 01/10/2022.
Relevant definitions
MRCA determination means: ‘in relation to a person, means the determination by the Commission of the degree of impairment suffered by the person as a result of a compensable condition under the Act’.
DRCA accepted condition means: ‘in relation to a person, means the person’s injury for which there is liability to pay compensation under the DRCA’.
VEA percentage means: 'the amount of disability pension payable under the VEA for the conditions referred to in Step 1 as at the date of the MRCA claim expressed as a percentage of the General Rate at that date’.
The delegate has already established that the total amount worked out at Step 6 exceeds the maximum weekly compensation amount payable under MRCA.
At Step 7, the delegate is working out the amount payable under MRCA by subtracting the MRCA PI excess from the amount worked out at Step 4.
MRCA PI excess equals:
Therefore, the final amount of PI payable under MRCA is:
Please see Payment Rates [12] in the Compensation and Support Reference Library for more information.
Please also see the Compensation Claims Procedures [9] manual for more information about the procedural aspects of step 7.
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 an equivalent weekly amount and subtracting this from the total weekly amount of PI payable at Step 4 or 7 of GARP M, whichever is applicable. When converting the lump sum to an equivalent weekly amount, the delegate is essentially finding the indexed weekly amount the veteran would be receiving now, if they had not converted their payment to a lump sum. This is discussed in more detail in Chapter 5.6.2 of the MRCA PI Policy Manual [15].
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 4 or 7 of GARP M.
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.
In transitional cases, delegates will likely encounter situations where the conditions being assessed arise from a combination of both peacetime and warlike/non-warlike service.
In determining the relevant compensation factor in these situations, delegates will need to apply the ‘Combined Ratings’ formula in Chapter 23 of GARP M. This is commonly referred to as the weighted compensation factor.
How are VEA and DRCA conditions treated for the purpose of determining the weighted compensation factor?
It is not explicit in Chapter 23 or Chapter 25 of GARP M that impairment arising under VEA and DRCA be treated a particular way when determining the weighted compensation factor. This may be as a result of Chapter 23 being drafted based on simple MRCA-only scenarios, and is reflected in the simple example provided in Chapter 23, where only one condition arose from warlike service and only one condition from peacetime service. This example would reflect the exception rather than the norm, as most claims for MRCA PI involve more than one condition accepted under the service differentials.
The agreed methodology is as follows:
In bringing across VEA and DRCA 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. Generally the bottom lifestyle rating of the shaded area will be applied. For more information about interim payments please see chapter 5.8 of the MRCA PI Policy Manual [17].
Where interim PI has been paid, the client is not required to lodge a claim in order for their impairment to be reassessed (under section 75(4)) upon stabilisation of their conditions (see Chapter 5.8.6 for more information on this).
What is the relevant date for including VEA and or DRCA conditions (and related payments)?
Where a person is being reassessed (due to stabilisation of their conditions) following interim compensation being paid, the most recent PI claim date preceding the section 75(4) assessment (i.e. finalising an interim) is the relevant date for the purposes of determining which VEA and/or DRCA conditions (and related payments) to include or exclude in the assessment.
For the purpose of considering the VEA and/or DRCA conditions (and related payments), the delegate should ask the following question:
Has the person lodged any further MRCA PI claims since the initial PI claim was made resulting in the interim determination?
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 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/DRCA conditions and related payments are included/excluded in the reassessment, the last MRCA PI claim date is 26 March 2012.
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. There is also nothing preventing the highest resting joint pain rating from being applied to the MRCA conditions and to the VEA/DRCA conditions, as long as the delegate is satisfied the medical evidence supports the 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 through the Delegate Support Framework [18].
The total impairment rating arrived at in Step 1 of GARP M is the impairment rating to be used to assess the following:
Dependants of deceased members may be entitled to claim benefits under section 12 of MRCA,
PI compensation threshold impairment points under sections 69, 70, 71, 72 and 75 of MRCA;
Additional compensation for severe impairment under section 80 of MRCA,
Compensation for the cost of financial advice under section 81 of MRCA,
Choice to receive a Special Rate Disability Pension under section 199 of MRCA;
Eligibility for MRCA supplement under section 221 of MRCA,
Special assistance via MRCAETS to certain eligible young people under section 258 of the MRCA; and
Gold Repatriation Health Card under sections 281 and 282 of MRCA and subsection 85(7A) of the VEA (including when MRCA contribution points are assessed as zero).
Last amended: 12 December 2014
Section 69 of the MRCA requires that a claimant is not eligible for PI compensation unless the claimant’s initial total impairment rating constitutes 10 impairment points. Where additional compensation is claimed, section 71 requires an increase in the overall impairment rating of at least 5 points for additional PI compensation to be payable. In either case, impairment points from more than one accepted condition can be combined to meet the relevant impairment point requirement, including impairment points resulting from VEA and/or DRCA conditions which were accepted at the time of the client’s MRCA PI claim. See the following table:
Eligibility Table for MRCA PI based on accepted conditions. | |||
---|---|---|---|
VEA/DRCA Conditions | MRCA Conditions | Total Overall Impairment | MRCA PI Compensation Eligibility |
Below threshold | Below threshold | Below threshold | Not eligible |
At/Above threshold | Below threshold | Below threshold | Not eligible |
Below threshold | At/Above threshold | Below threshold | Not eligible |
Below threshold | Below threshold | At/Above threshold | Eligible |
At/Above threshold | Below threshold | At/Above threshold | Eligible |
Below threshold | At/Above threshold | At/Above threshold | Eligible |
At/Above threshold | At/Above threshold | At/Above threshold | Eligible |
Note: ‘Below threshold’ includes zero MRCA impairment points.
The methodology for calculating the amount of PI payable in Chapter 25 of GARP requires an additional threshold to be met which does not allow points from VEA/DRCA conditions to be taken into account.
Although a client may meet the relevant threshold for eligibility for PI (and other entitlements as noted in Chapter 12.7.2) under the MRCA based on the inclusion of VEA and/or DRCA conditions in the impairment points, the additional threshold requirement in step 2 of the methodology for calculating the amount payable under Chapter 25 of GARP, may mean that no PI is payable. Please see the Compensation Claims Procedures [9] manual for more information. For PI to be payable step 2 requires the new MRCA condition/s alone to contribute at least 5 impairment points to the whole person impairment (WPI).
The following calculations are required to determine whether the requirements of step 2 are met:
Initial PI claim (section 68 claim)
Where the PI claim is being determined in response to a client’s first PI claim the calculation is very simple. The contribution of the MRCA condition/s in such cases equals the number of MRCA impairment points determined in the assessment of that first claim.
Reassessment PI claim (section 71 claim)
Where the PI claim is being determined in response to a subsequent claim the calculation is as follows:
Total number of impairment points under the MRCA following the new assessment LESS
the total number of impairment points under the MRCA following the previous assessment.
This additional threshold means that for compensation to be payable in transitional reassessment claims, an increase in 5 points must be met by all conditions (MRCA, DRCA and VEA) under section 71, alongside an increase in 5 points from MRCA conditions only, as required by GARP M.
Example
John Smith makes his first MRCA claim in July 2013. Following that claim he is determined as having 25 MRCA impairment points. He also has VEA and DRCA conditions which together with his MRCA conditions result in an overall impairment rating under the MRCA of 55 points.
For the purpose of determining whether he meets step 2 of the methodology the number of points that his MRCA conditions are contributing to the overall impairment rating are his total number of MRCA points – that is, 25 points.
He makes a second MRCA claim in September 2013. As a result of that claim he now has 36 MRCA points and his overall impairment rating has increased to 77 (one of his non-MRCA conditions has worsened). The contribution of his MRCA conditions to the overall impairment rating from this second claim is calculated as follows:
36 MRCA points from current assessment LESS 25 MRCA points following the previous assessment.
His MRCA contribution to the overall impairment rating is now 11 points.
Mr Smith is eligible to be paid additional compensation as his overall impairment rating has increased by at least 5 points (from 55 to 77), and his MRCA condition have also contributed at least 5 additional impairment points (11 points).
He makes a third MRCA claim in January 2014. Following this claim he has 48 MRCA points and his overall impairment rating is now 80. The contribution of his MRCA conditions to the overall impairment rating from this third claim is calculated as follows:
48 MRCA points from current assessment LESS 36 MRCA points following the previous assessment.
His MRCA contribution to the overall impairment rating is now 12 points.
Whilst Mr Smith's MRCA conditions have contributed an additional 5 impairment points, his overall impairment (from 77 to 80 points) has not increased by at least 5 impairment points. In this instance, Mr Smith is not entitled to be paid additional compensation and his claim should be disallowed.
The exceptions to the 10 impairment points requirement are impairments of the fingers, the toes, the sense of taste and smell, and hearing loss.
For these impairments, section 69(2) of the MRCA requires that a claimant is only eligible for PI compensation where the impairment suffered as a result of one of those conditions alone constitutes 5 impairment points. In other words, impairment points from more than one other condition cannot be combined to meet the 5 impairment point requirement. Once the claimant meets the 5 point threshold for one of these conditions alone, impairment from other conditions can be combined in order to calculate the amount of PI payable, provided the relevant threshold of 10 impairment points is met.
In circumstances where it appears the client will not meet the threshold requirements for payment of compensation for loss of hearing under either the DRCA or MRCA individually due to apportionment under GARP M, it should be referred to Benefits & Payments Policy for advice specific to the individual circumstances of the case.
Broadly speaking, the Commission takes the view that existing DRCA and/or VEA evidence can be used with the client's consent wherever such evidence is medically appropriate, and where it confirms a beneficial outcome. For more information about the age and currency of medical evidence, please see chapter 5.6.3 of the MRCA PI Policy Manual. [22]
Where the use of DRCA and VEA evidence is inappropriate, delegates will need to arrange an appointment for MRCA PI compensation claimants to undergo an up-to-date medical examination of their VEA and/or DRCA conditions in order to determine the impairment ratings under GARP M.
If a claimant's DRCA and VEA evidence cannot be used, and the client is not willing to undergo a new medical examination of the VEA and/or DRCA conditions, MRCA compensation cannot be calculated. For more information about unreasonable refusal to undergo medical examination please see chapter 5.5 of the MRCA PI Policy Manual. [22]
Please see the Compensation Claims Procedures [9] manual for more information.
If a person's DRCA condition has not stabilised for the purpose of a determination under section 24 [24] [2] of the DRCA, a MRCA PI determination cannot be made under sections 69, 70, 71 or 72 until the condition has stabilised and a determination regarding the amount of compensation payable (if any) is determined under section 24(2) of the DRCA.
This may occur in situations where:
In this situation, the delegate may wish to offer an interim compensation payment under section 75, if the MRCA conditions alone meet the legislative criteria. However, it should be noted that once the DRCA condition has stabilised and compensation determined, any interim payment that has been made under the MRCA may result in an overpayment. In such a case, it is open to another delegate to revisit the amount of interim compensation paid via section 347 [25] [33] of the MRCA, providing the Veterans’ Review Board (VRB) and/or the Administrative Appeals Tribunal (AAT) have not made a decision relating to that determination. If an overpayment has resulted, the delegate can recover it under section 415 [24] [2] of the MRCA.
Note: Where DVA has made a determination in respect of a condition accepted under DRCA that compensation is payable under section 24(2) of DRCA, it is reasonable to expect that the condition is considered stable for the purposes of determining a MRCA PI claim and conducting a Chapter 25 assessment.
The situation is different in relation to conditions accepted under the VEA, in respect of which there is no requirement for a condition to be stable before a grant of DCP can be effected. Once a decision has been made under the VEA to grant DCP at a particular rate, all of the pre-conditions for the application of section 13 of the CTPA and Chapter 25 of GARP M will have been met and a determination should be made in relation to a claim for PI compensation under the MRCA.
Where there are outstanding DRCA PI claims registered and still undergoing investigation, it is advisable that the MRCA PI assessment should await the outcome of the DRCA determination/s. The MRCA PI delegate should liaise with their DRCA PI colleagues to gauge how long the investigation may take. A delegate should however use their discretion here. In cases where it is highly unlikely the DRCA PI claim would ever succeed (e.g. tinnitus) then it may be possible for the MRCA assessment to proceed.
In cases where DRCA PI has not been claimed, a delegate should again use their discretion. If the DRCA accepted conditions are limited to conditions which have likely resolved (e.g. a sprain of the finger accepted in 1998) or are conditions which may never incur a PI payment (such as tinnitus), then the delegate should not set aside the MRCA assessment on that basis. Further, a delegate may decide to contact the veteran to gauge whether they intend on claiming PI for their newly accepted DRCA condition(s) and, depending on the outcome of the conversation, the delegate may decide to set aside the MRCA assessment or proceed with determining the claim.
Where no DRCA lump sum has been paid because the client declined payment so that their VEA DCP would not be affected, or DRCA PI is unlikely ever to be paid because the client has a condition which will fully resolve and has only claimed liability in order to get rehabilitation, treatment, incapacity payments etc. the delegate should include that DRCA condition in Steps 1, 3 and 6 with an impairment rating of 0.
Where no DCP is payable because there is ‘no incapacity found’ a delegate should include that VEA condition in Steps 1, 3 and 6 with an impairment rating of 0.
Reconsiderations, reviews or appeals of a DCP assessment under the VEA and/or a DRCA PI lump sum do not provide sufficient grounds for delegates to refuse to process a MRCA PI compensation claim. This is notwithstanding the fact that the rate of VEA DCP or DRCA PI lump sum awarded might be increased (or decreased) with retrospective effect upon review by the VRB, the AAT or the Federal Court.
If a VEA DCP assessment, DRCA liability and/or compensation decision is retrospectively backdated upon review, it is open to another delegate to revisit a MRCA PI determination via section 347, providing the VRB and/or AAT have not made a decision relating to that MRCA PI determination. If an overpayment has resulted, the delegate can recover it under section 415 of the MRCA. Where a delegate is aware that a claimant has a VEA and/or DRCA conditions or related payments that are subject of a review, they should inform the claimant that if the amount of VEA DCP or DRCA PI lump sum payable is subsequently increased, they may be asked to repay any overpayment that results under the MRCA.
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/18884%23comment-form
[2] https://www.legislation.gov.au/Series/C2004A01286
[3] https://www.legislation.gov.au/Series/C2004A01285
[4] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/512-additional-payment-severe-impairment
[5] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/87-other-provisions/871-treatment-available-under-vea-eligible-mrca-persons
[6] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-13-special-rate-disability-pension
[7] https://clik.dva.gov.au/user/login?destination=comment/reply/18870%23comment-form
[8] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/57-date-which-permanent-impairment-compensation-payable
[9] http://auth-clik.dvastaff.dva.gov.au/compensation-claims-procedures/mrca-permanent-impairment-procedures/transitional-provisions-interaction-between-mrca-vea-and-drca
[10] https://clik.dva.gov.au/user/login?destination=comment/reply/18858%23comment-form
[11] https://clik.dva.gov.au/user/login?destination=comment/reply/18869%23comment-form
[12] http://auth-clik.dvastaff.dva.gov.au/compensation-and-support-reference-library/payment-rates
[13] https://www.legislation.gov.au/Details/F2020L00296
[14] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/actuary-tables-used-age-adjusting-lump-sum-payments
[15] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/56-calculating-amount-pi-compensation-payable/562-additional-pi-compensation-payment
[16] https://clik.dva.gov.au/user/login?destination=comment/reply/18849%23comment-form
[17] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/58-interim-permanent-impairment-compensation
[18] https://dvashare.dvastaff.dva.gov.au/BusinessUnits/Support/DSR/RC/MRCGTools/Pages/Escalations.aspx
[19] https://clik.dva.gov.au/user/login?destination=comment/reply/18864%23comment-form
[20] https://clik.dva.gov.au/user/login?destination=comment/reply/18863%23comment-form
[21] https://clik.dva.gov.au/user/login?destination=comment/reply/18857%23comment-form
[22] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/56-calculating-amount-pi-compensation-payable/563-age-medical-evidence
[23] https://clik.dva.gov.au/user/login?destination=comment/reply/18865%23comment-form
[24] http://www.comlaw.gov.au/Details/C2014C00790
[25] http://auth-clik.dvastaff.dva.gov.au/www.comlaw.gov.au/Details/C2014C00790
[26] https://clik.dva.gov.au/user/login?destination=comment/reply/18878%23comment-form
[27] https://clik.dva.gov.au/user/login?destination=comment/reply/18859%23comment-form