9 Sep 2020 Update – DVA Diagnoses done!

Today we helped a currently serving ADF Member who is is the process of discharging from the ADF.

Over the course of an hour, we worked through a lengthy history, completed 9 DVA Diagnosis forms to assist with his DVA claims, worked through some possible claims that may have been missing based on his history.

We also added in some additional claims that were a consequence of claimed incidents.

DVA claims were done to the level of having the DVA SOP and WHO ICD-10 code included in the diagnosis. It was a bit tricky as some of teh cliams literally didnt have a code on either structure, so we approximated the code as well as described the nature of the incident, though it spossible that this claim may prove difficult just in terms of finding a diagnosis that goes with that. 

 

Veterans Health Centre

 

(07) 3844 4111

SmartClinics, 79 Boundary St, West End, QLD. 4010

DVA’s guides to assess compensation

DVA’s guides to assess compensation

DVA’s guides to assess compensation

Courtesy of https://www.dva.gov.au/financial-support/compensation-claims/laws-cover-claims/our-guides-assess-compensation

This page provides a brief explanation of the legislative instruments used to assess the degree of incapacity or impairment from war-caused or defence-caused injury or disease. These instruments are in force under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA).

What is GARP?

GARP refers to one of two different instruments: GARP V or GARP M. GARP V is the fifth edition of the Guide to the Assessment of Rates of Veterans’ Pensions used to assess disability pension under the VEA. GARP M, or the Guide to Determining Impairment and Compensation, is a specially adapted edition of GARP V that is used to assess compensation claims under MRCA. Their provisions are binding on the Repatriation Commission, the Military Rehabilitation and Compensation Commission, the Veterans’ Review Board and the Administrative Appeals Tribunal.

Why do we have GARP?

GARP is designed to provide accurate and equitable assessment of incapacity from war-caused or defence-caused injuries and diseases. This ensures that veterans receive their rightful entitlement under the VEA or MRCA.

GARP V has been in force since 1998, and GARP M since 2004. Both were developed in consultation with representatives of the ex-service organisations.

How does GARP work?

Both GARP V and GARP M look at the medical impairment you suffer as a result of your war-caused or defence-caused disabilities, and the effect they have on your lifestyle.

The assessment tables across both GARPs are substantially the same. The differences between the GARP V and GARP M is in the last few chapters: GARP M includes an additional chapter 25 for working out the amount of compensation payable under the MRCA, where the person has an injury or disease accepted under the VEA and or the Safety, Rehabilitation and Compensation (Defence-related claims) Act 1988.

How is medical impairment assessed?

Medical impairment is assessed by looking at any physical loss or disturbance to your body systems, and any loss of function that you might suffer as a result.

The GARPs contain a series of tables relating to the various body systems. There are also tables used to assess specific types of impairment, such as malignant conditions, intermittent impairment, and disfigurement and social impairment.

The tables contain descriptions of the various levels of impairment that a person might suffer as a result of war-caused or defence-caused incapacity, and a rating is allocated to each level.

When a rating is selected from each appropriate table, the ratings are combined (not added arithmetically) to arrive at an impairment rating for all war-caused or defence-caused conditions.

Where does the information come from to assess medical impairment?

When considering an assessment under GARP, the Claims Assessor might ask you to attend a medical examination and assessment. The medical practitioner will examine you and may ask you questions about how your war-caused or defence-caused injuries and diseases affect you. The information gathered by the medical practitioner at this examination will be sent to DVA and placed on your file.

The Claims Assessor might also ask you to attend for other tests, such as a hearing test or a respiratory function test, or specialist examinations, depending on your claimed war-caused or defence-caused injuries and diseases. The results of these tests and examinations will also be sent to DVA and placed on your file.

The decision-maker will look at these results and any other current information on your file relating to your war-caused or defence-caused injuries and diseases to determine the level of medical impairment from which you suffer.

How is the lifestyle effect assessed?

GARP looks at four components of a veteran’s life that may be affected by war-caused or defence-caused incapacity or impairment:

  • personal relationships;
  • mobility;
  • recreational and community activities; and
  • employment and domestic activities.

A table under each component sets out descriptions of the levels of effect that war-caused or defence-caused incapacity or impairment might have on a veteran’s lifestyle. A rating is then allocated to each level.

The ratings selected from each table are added together, and the total is divided by four to arrive at the overall lifestyle rating.

Where does the information come from to assess the lifestyle effect?

When you lodge a claim, the claims assessor will ask you to complete a Lifestyle Rating form. This form will give you three options:

  • you can choose to self-assess your lifestyle effect. You will be asked to complete a Lifestyle Rating form on which you answer questions about the effects of your war-caused or defence-caused incapacity on your lifestyle, and you select what you believe to be the appropriate rating for your lifestyle effect;
  • you can complete a Lifestyle Questionnaire that asks questions about the effects of your war-caused or defence-caused incapacity on your lifestyle; or
  • you can choose not to self-assess or complete a Lifestyle Questionnaire. If you choose this option the decision maker will allocate an average lifestyle rating based on the level of medical impairment.

Whichever option you choose the decision maker will look at the information you have provided, as well as reports of your current medical condition, to determine your lifestyle rating.

How does the decision maker determine how much I will be paid?

When the medical impairment rating and the lifestyle rating have been determined, they are compared with a chart in GARP to convert them to a degree of incapacity or a factor for compensation payment.

For payments of permanent impairment compensation, the factor for compensation is multiplied by the maximum lump sum payment available under the MRCA. For further information, see You were injured after 30 June 2004.

If a disability pension is to be paid at the General Rate, the degree of incapacity will determine the amount of disability pension to be paid. For further information, see Special and Intermediate rates.

Can I appeal against the assessment of my claim?

Yes. When the decision maker tells you about the amount of disability pension or impairment compensation you will be paid, the decision maker will also tell you what you can do if you are not satisfied with the assessment. There are strict time limits for lodging appeals against these assessments. The decision maker will tell you about the time limits. For further information, see:

TYPE 2 DIABETES RISK EVALUATION

HISTORY

updating the patient’s history

PREVIOUS CARDIOVASCULAR RISK

List any previous cardiovascular risks

PREVIOUS METABOLIC AND CARDIOVASCULAR SEROLOGY

LFTs

Fasting Lipids

TC

HDL

LDL

TG

HBa1c

FBSL

SNAPE

  • Smoking – nil
  • Alcohol – minimial at x per day
  • Nutrition – adequate and varied good nutritional intake that appears toy be inaccordance with the NHMRC guidelines
  • Mental Health – NAD
  • Exercise – 30 min per day on average

SUN EXPOSURE

History of sun exposure

early signs of skin cancer

FAMILY HISTORY

Any familiy histpry of chronic disease

MEDICATIONS

List medications

EXAMINATION

undertaking physical examinations

Observations

Gen – well

Obs – NAD

Blood Pressure – xx/xx

Random BSL

done in office

RBSL =

Anthropometrics

Height

Weight

BMI

Waist circumference

Neck circumference

Cardiovascular system

Pulse Rate – xx regular

Heart Auscultation – HS I + II + O

Carotid pulse character  – NAD

Radial pulse character – NAD

Radio-radial delay – NAD

Lower Limb examination

Paedal pulses intact at dorsalis pedis and medial malleolus

Nil signs of peripheral neuropathy

Nil trophic changes

Nil ulcers

ABI =

Tone – NAD

Power – NAD

Reflexes – NAD

Coordination – NAD

Sensation – NAD

Upper Limb Examination

Nil signs of peripheral neuropathy

Nil trophic changes

Nil ulcers

Tone – NAD

Power – NAD

Reflexes – NAD

Coordination – NAD

Sensation – NAD

Ophthalmic Examination

Nil signs of diabetic retinopathy seen on fundoscopy

Nil arcus cornelius

Nil xantholasma

Nil signs of cataracts on red reflex examination

Skin

Nil bruising or bleeding

Nil skin tags

Nil spider naevi

No early signs of skin cancer

Abdo

Nil hepatosplenomegaly

Nil palpable liver

OFFICE INVESTIGATIONS

ECG

UWT

Fingerprick Glucose

ABI

AUSDRISK SCORE

The type 2 diabetes risk evaluation must include:

? evaluating a patient’s ‘high risk’ score as determined by the Australian Type 2

Diabetes Risk Assessment Tool, which has been completed by the patient within a

period of 3 months prior to undertaking the type 2 diabetes risk evaluation;

INVESTIGATIONS RESULTS

LFTs

Fasting Lipids

TC

HDL

LDL

TG

HBa1c

FBSL

IMPRESSION

Habitus – Obese with BMI x

T2DM risk = x

Cardiovascular risk factors = x

Lifestyle = x

Fracture risk =

CVD Risk =

PLAN

Refer for investigations

Advice regarding weight management provided

Advice regarding nutrition provided

Advice regarding lifestyle changes provided

Human papillomavirus (HPV) test every five years

Mammogram for women dependent on her individual degree of risk

Alcohol Use and Misuse in Aviation Medicine

Return to flying after alcohol use requires documented abstinence from problematic use, no sequelae from use, and normalisation of blood tests (LFTS, MCV and carbohydrate deficient transferrin (CDT))

dr thomas perkins, casa designated aviation medical examiner

Definition

This protocol refers to suspected or confirmed “problematic use” of alcohol such as:

  • Positive workplace test
  • DAME opinion
  • DUI within 5 years of application
  • Self-reported use and confirmatory blood tests (e.g. LFT’s / MCV and CDT)

Aeromedical Implications

Effect of aviation on condition

  • Hypoxia – increase cognitive decrement caused by alcohol

Effect of condition on aviation

  • Subtle incapacitation – impaired alertness / reaction / decision-making
  • Loss of situational awareness & vertigo
  • Distraction due to impaired concentration.

Approach to medical certification

Based on the condition

  • As per CASR 67.150 Table 67.150.1.5 and 1.6.
    • demonstrated abstinence from problematic use
  • no sequelae from problematic use
  • Normalisation of blood tests

Based on Treatment

  • As per CASR 67.150 Table 67.150.1.5 and 1.6, 2.5 and 2.6, 3.5 and 3.6. – currently undertaking or completion of appropriate course of therapy
  • no safety-relevant medications (benzodiazepine or naltrexone)

Demonstrated Stability

  • Abstinence or harm minimisation as per risk stratification
  • Blood parameters and breath testing
  • Sponsor reports
  • Surveillance plan from applicant and/or employer detailing intended alcohol use and monitoring by doctor, laboratory and sponsors

Risk assessment protocol – Information required

New cases

  • Fellow of the Australasian Chapter of Addiction Medicine specialist [FAChAM] for an assessment in regards to:
    • diagnosis
    • past and present alcohol consumption
    • current clinical status
    • physical and psychological sequelae/co-morbidities
    • LFTS, MCV and carbohydrate deficient transferrin (CDT)
    • treatment, response to treatment and side effects
    • prognosis
    • ongoing management plan
  • FAChAM follow-up report, where applicable following treatment intervention, demonstrating
    • abstinence from problematic use of alcohol and other substances.
    • freedom from the ill-effects of substance misuse
    • recent blood tests (LFT’s, MCV and CDT)
  • Consider Police report

Renewal

  • Fellow of the Australasian Chapter of Addiction Medicine specialist FAChAM for an assessment in regards to:
    • diagnosis
    • alcohol consumption
    • review of physical and psychological sequelae/co-morbidities
    • current clinical status and compliance with established goals and requirements
    • review of LFTS, MCV and carbohydrate deficient transferrin (CDT)
    • review of sponsor reports and tests as listed below
    • treatment, response to treatment and side effects
    • prognosis
    • ongoing management and surveillance plan

(NOTE: In certain circumstances, reports may be accepted from psychiatrists or other alcohol or addiction medical specialists. Prior agreement must be sought to avoid unnecessary expense and delays.)

  • 3 monthly LFT’s MCV and CDT
  • Random breath alcohol testing
  • Sponsor / peer / employer reports (as appropriate)

Indicative outcomes

The onus is on the applicant to demonstrate fulfilment of the regulatory requirements. Careful attention to the conditions requiring testing or reports by a particular date, is essential to give confidence that aviation safety is being maintained. Failure to submit tests and reports on time will be treated as indicators of possible relapse.

Favourable

  • Demonstrated absence of problematic use for a pre-defined period. This is usually a minimum of 12 months, and includes sponsor and clinical reports
  • Ongoing normal blood and breath-alcohol tests

Unfavourable

  • Problematic use
  • 2 relapses following diagnosis
  • Alcohol-related convictions: 3 or more
  • Abnormal blood or breath-alcohol tests
  • Complications of alcohol-use e.g. psychiatric, portal hypertension, varices, clotting etc.

Pilot and Controller Information

  • The hazardous and problematic use of alcohol has been associated with aviation accidents
  • For pilots and controllers who have problematic use of alcohol, the most successful treatment has resulted from abstinence from all alcohol use. For this reason, certification may be possible when pilots and controllers demonstrate abstinence
  • The best way to demonstrate abstinence is through objective evidence of abstinence and careful attention to monitoring
  • Problematic use of alcohol is associated with serious medical problems quite apart from the hazard to aviation activities..

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.Last modified: 5 September 2018

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