New SOP's

WA "The Listening Post 2002"

Updates on SOPs: 'TUNE IN'
"The Bush Wireless"
by MARGOT HARNESS War Compensation Officer

As you would be aware, the fundamental basis for any new claim is a 'Statement of Principles' (SOP) for each of the various conditions, compiled and published by a body called the 'Repatriation Medical Authority' (RMA) - and are part of the Veterans' Entitlements Act. From time to time, as I have pointed out in the past, the RMA periodically produces 'upgraded' versions, as more up-todate medical and research data comes on-stream.

The repat system 'shifts the goalposts' in other words. When this happens, I try to promulgate changes through this column - because although the 'causative Factors' are sometimes 'tightened' - they are sometimes 'loosened up'. As I've remarked before, the latter is always a bonus, as this makes a successful claim by a veteran more achievable. My particular concern though is that veterans, who have been previously 'knocked back' on the earlier version of a SOP, might have succeeded under its slightly 'easier' successor (and/or are free again to claim afresh).
This column is one of the few avenues to 'get-the-word-out' to inform of these changes, and alert veterans that they might get a 'second chance'.

Among some of the most recent advantageous changes are: Psoriasis: I have never before seen an SOP 'loosened up' and broadened in scope more dramatically than this. It now allows Factors for 'skin injury/lesion' (which can be quite minor - eg: blistered heel/barbed wire puncture); or war-related psychostressors/ psychiatric conditions/ alcoholism as causal factors - none of which would have been accepted as the grounds of causation previously. Cervical/Lumbar/Thoracic Spondyloses: The new versions now recognise more fully:

	The risks inherent from 'G forces' for air crews - so former pilots and navigators tune in! Take note though, that for veterans with active service, a cumulative 500 hours flying time is required; for peace-time eligible Defence service, the requirement is doubled: 1,000 hours.
	A second big 'relaxation' of the rules, is the removal of the word 'acute' from the various necessary symptoms following the 'trauma' in the SOP definition - a subtle, but significant change I've been lobbying for, for years.
	War-caused obesity, again, is now allowable as a causative Factor;
	A new inclusion - Thoracic and Lumbar only - (not so much for men with active service - who did 10 years at war?!) but very relevant to the men with long service careers in peacetime between Dec 1972 and Apr 1994 (especially such physically demanding categories as RAAF armament fitters/Army infantry/PTIs etc): PLEASE NOTE IT!: Repetitive or persistent flexion, extension or twisting or the lumbar spine for at least one hour each day on more days than not for at least 10 years before the clinical onset of lumbar/thoracic spondylosis. (For peace-time people, onset must be within 25 years of such activity to be recognized by the DVA). Gastro oesophageal Reflux disease: The new SOP version now recognizes war-related obesity; treatment with antiinflammatory medication for war-related musculo-skeletal A/Ds (at last!!); and suffering from a war-caused hiatus hernia, as precursors.

Osteoarthrosis of knees: The previous version included a '10 years heavy wear-and-tear' Factor applicable to hips and knees, which has been reworked.

I quote verbatim from the new: "for O/A of hip or knee joints lifting loads of at least 25 kg while weight bearing to a cumulative total of 120,000 kg within any 10 year period before the clinical onset of O/A". Well, as old Joh B-P used to exclaim: "Goodness gracious me!" - who on earth would be counting? - I hear you cry. Some quick calculations however, remove some of the mystique. Distilled down, 120,000 kg over 10 years works out at an average of 231 kilograms a week - about 9 - 10 x 25kg items over the seven days. There would be quite a few ex-career servicemen who could relate to this factor under these terms. Men in queues, passing stores/ammo shells etc hand to hand etc. But bear in mind the '10 year' requirement.

HOWEVER . . let me enthusiastically point out a totally new, additional factor, pertaining to knees only, that is far more straightforward: "kneeling or squatting for at least one hour each day on more days than not for at least one year before the clinical onset of O/A in the knee joint". (The most 'relaxed' causative Factor to emerge since the introduction of Osteoarthritis SOPs!)

Aortic Stenosis: New Factors: suffering from (war-related) hypertension (the SOP for Hypertension would have to be satisfied first); or suffering front war-caused renal failure (a ain, this would have to be relate to war-causation as a prerequisite).

The SOPs for Cancer of the Bowel and Cancer of the Rectum have been revoked and replaced by a combined Cancer of the Colorectum. In general, this SOP has been tightened up - but the Factor regarding asbestos exposure has been relaxed from a requirement of five years exposure occupationally during war - to 2,000 hours (84 days minimum) in an enclosed space at a time when asbestos fibres were being removed/cut/drilled /dislodged etc. The new version also includes a Factor to do with war-related obesity.

NOTE FOR PENSIONS OFFICERS: I cannot stress enough that it is ESSENTIAL for any pensions officer, assisting a veteran or ex-member to complete a DVA claim for a musculoskeletal disability, to:

	Produce the relevant SOP to show the claimant;
	Go through it with him/her, and both - together (two heads are better than one) discuss which 'causative Factor' appears to offer the best chance when applied to the circumstances of the person's injury and service history. Many veterans/lay people have little idea or awareness that arthritic problems in a specific joint are usually attributable to 'trauma' (many put it down to 'lifting'; 'the cold'; 'sleeping on the ground' and so on). Many people often remember only a 'pulled muscle' - assuming it healed completely - and have never considered further repercussions might follow.
	Explain the definitions - that 'trauma' requires a certain number of days of symptoms immediately following; or if 'permanent ligamentous instability' is being argued - seek confirmation of the 'recurring episodes';
	Suggest he show the SOP' to his local GP - make sure he/she takes it home to study more closely;
	Obtain x-rays (past, if possible, as well as up-to-date - and CT scans or MRIs if necessary); compile a tabled, sequential list summarising past medical help sought, as well as physio or chiropractic treatment over the years. Ensure claimant Stat Decs, witness statements, any service med docs, photos, logbooks etc - anything that can be submitted with the claim as supportive documentary evidence, are collated, to accompany the claim. (DON'T WAIT for the DVA to instigate follow-up details: anticipate - and put everything possible forward in the first instance, WITH THE CLAIM).
	I also always inquire as to whether past MVAs and/or MCAs ever occurred - as many people tend to discount the effects these events may have also had in their past musculoskeletal histories. If there has never been a previous accident of this nature, it is worthwhile to make that point within the body of the claim; or, if none has ever occurred, make a point of excluding this as an alternate causal explanation for the premature degeneration. Bear in mind that musculoskeletal claims to DVA demand FAR more stringent, objective evidential standards than claims such as psychiatric, smoking/alcohol-related matters, which are based almost wholly on anecdotal testimony.
	Despite all the information dispensed in TIP training courses etc, I am still seeing, time and time again, poorly framed claims for arthritic knees/backs/hips/ shoulders etc - attributing causation to 'carrying heavy loads in Vietnam'/'many falls playing football' and so on. These sorts of contentions do not have a hope of meeting the SOPs, and make it glaringly obvious that the assisting representative has NOT even TRIED to address the respective SOP. Best regards to all.