Chapter 6 Falling Through the Cracks
This chapter considers the three outcomes available to an Australian
Defence Force (ADF) member who has been wounded or injured on Operations; a full
return to work, transfer specialisation, or discharge. This Chapter also
considers the medical classification process, and moves toward the role that the
Department of Veterans’ Affairs (DVA) plays in the recuperation process post-discharge.
It also considers a reassessment of veteran health care eligibility.
The Department of Defence (Defence) submitted that they have a new
policy to confirm the Member Support Coordination arrangements. Member Support
Coordination is the overall coordination effort required to ensure that a
member, whose circumstances meet the definition of complex, is effectively
supported throughout their recovery, rehabilitation and either their return to
duty or transition from the Australian Defence Force (ADF). Responsibility for
the initiation and management of such coordination resides with the member’s
Return to work
Major General (MAJGEN) Angus Campbell DSC AM, Deputy Chief of Army, told
the Committee that of the then 249 personnel physically wounded in Afghanistan
(two from Navy and the rest from Army), 69 per cent had returned to full duties.
Defence submitted that they are committed to ensuring that, for those servicemen
and women who become wounded and injured due to their participation on Defence
operations, their recovery, rehabilitation and return to work is a priority.
The increased focus on a recovery-based, return to work approach to
rehabilitation in the ADF has seen a significant increase in rehabilitation
referrals and rehabilitation programs over the past two years.
Air Marshal Mark Binskin AO, Acting Chief of the Defence Force, advised the Committee
that Defence has extended the time that wounded, ill and injured personnel can
remain on rehabilitation programs with the express intent of retaining them in
The Committee received evidence, however, that this has not always been the
case. One Defence member, despite consistently requesting rehabilitation back
into the workforce, submitted that the ADF was not willing to interpret the
progressive nature of the return to work goals and jumped straight to
transition out of the ADF, presupposing a negative rehabilitation outcome.
Young Diggers, however, submitted that when a member can return to work, the
arrangements in general appear reasonable.
The Australian Centre for Post-traumatic Mental Health (ACPMH) highlighted
the importance of ensuring a clinically sound and consistent assessment
practice. This included integration with general health services noting that
it will be critical that the assessment process is ongoing. This would then
ensure that assessments retains a focus on maximising rehabilitation outcomes,
whether within Defence or through discharge.
Change of employment
The history of the ADF over many years has shown that personnel who have
been wounded or injured may still be able to perform duties that support the
more active personnel, such as clerical support, administration of stores,
transport and movement control. The Vietnam Veterans’ Association of Australia
(VVAA) encourage the ADF to provide retraining and employment to wounded and
injured veterans no longer able to maintain the military skills and knowledge
that would otherwise be lost.
Through clinical and occupational rehabilitation services, Defence argues
that it is successfully reducing the impact of injury or illness, including
mental health conditions, and returning significant numbers of ADF personnel to
the workforce. The Chairman of Soldier
On, Professor Peter Leahy AC, agreed, making the point that:
As we went to war and we started getting wounded soldiers
again, the question was: how do we keep these people? That is where we are at
the moment culturally and that is why I applaud what [Lieutenant General] Ken
Gillespie and [Lieutenant General] David Morrison are doing: they are keeping
their soldiers, they are retraining them and, where they can, they are giving
them jobs that they can do.
Major General (MAJGEN) (Retired) John Cantwell AO DSC praised the ADF
remarking that ‘We have grown up’. He told the Committee that in the past, a
medical downgrade had meant automatic discharge. The ADF is now being smarter
and trying to retain skills where possible. The result being that there are people
with missing limbs working in headquarters or elsewhere:
Why on earth cannot someone who has shown some difficulties
emotionally be looked after, given a job that is not so demanding and
difficult, with flexible hours, a chance to get some therapy and to stay in
uniform for a bit longer.
Medical Employment Classification Review
The Returned and Services League of Australia (RSL) Queensland Branch submitted
that there are serious issues with the time taken by the ADF to arrange Medical
Employment Classification (MEC) Review Boards (MECRB), which currently take three
to four months to convene.
Further, DVA is not always advised of the results of the MECRB decision
for the member to separate from the ADF, and therefore their claims for
compensation may not be finalised by the time the member separates from the ADF.
Discharge and transition
The ADF Rehabilitation Program aims to support a member’s return to work
in current or different duties or trade or, if this is not possible, they will
be rehabilitated, medically separated and supported to transition to the
civilian environment. General Cantwell
There is not necessarily a happy ending. Some people will be
medically downgraded, and permanently so. They will then be shown the door,
unfortunately. I have met people like that. It has broken their hearts.
There was widespread praise of the support provided by Defence and DVA
which was described as mostly very good or excellent.
The Returned and Services League (RSL) of Australia’s South Australian branch believed
that the transition from the ADF is well handled by the ADF and the broader RSL
organisation believes that there is generally good support provided by DVA and
other agencies to ensure that the management of these personnel is efficient
and is handled with empathy. However the RSL submitted that this that but
should be enhanced.
Notwithstanding the generally positive view of the provided by Defence
and DVA, some members submitted that they received no help, counselling, or
support from the ADF or DVA while their discharge was being processed.
Young Diggers submitted that if the member is going to be discharged, then in
some cases the treatment deteriorates as the member gets closer to discharge.
Within the mental health sphere, the ACPMH highlighted the importance of
mental health service system clinical roles being clearly demarcated and
delineated, and that providers are trained and capable of delivering current
evidence-based interventions for the key post-operational mental health
problems and disorders. This requires high quality and consistent training
models, effective on-going clinical supervision opportunities, and quality
The RSL Western Australian Branch (RSL WA) submitted that entitlements
and avenues of appeal need to be better explained and that the RSL should be
nominated for this role. The Committee did hear
that members were often unaware of their entitlements when they are preparing
Medically unfit for further service
Defence submitted that in an effort to achieve a seamless transition for
a member, the various elements of Defence (including Joint Health Command, the
three Services, and the Defence Community Organisation (DCO)) and DVA work
closely and collaboratively. Defence highlighted the particular importance of
early involvement of DVA to ensure that the appropriate arrangements for
support post-discharge are understood.
Dr Andrew Khoo, a consultant psychiatrist and the Director of Group
Therapy Day Programs at Toowong Private Hospital (TPH), submitted that care
should also be taken to involve the ADF member as much as is reasonably
possible in decision making. He noted that the process of resolving the loss
of one’s career path is easier for an individual if they feel that it was their
considered choice, or at least that their difficulties were acknowledged. He submitted
that a collaborative process of medical discharge would allay the feelings of
abandonment by the Services often reported in recently discharged personnel.
It was pointed out that this perception of rejection contributes in a
significant way to anger and guilt, both of which are poor prognostic factors
in post-traumatic stress disorder (PTSD), anxiety disorders, mood disorders and
Defence submitted that ADF members are referred to a regional ADF
Transition Centre as soon as it is deemed likely that they may be classified as
‘MEC 4’ (indicating a member is neither employable nor deployable), and
therefore medically separated from the ADF. There are 18 regional ADF
Transition Centres that advise and assist members and their families on
accessing whole-of-government transition support services, completing Defence
separation requirements and accessing separation benefits and entitlements.
As part of the separation preparation, the ADF Transition Centre links
members to a variety of services including DVA compensation, ComSuper,
Centrelink, Veterans and Veterans Families Counselling Service (VVCS) and other
support services as required.
The Vietnam Veterans’ Association of Australia (VVAA) submitted,
however, that the medically unfit for further service process (as assessed by
their welfare officers, pension officers and advocates) lowers the moral of
those personnel affected in that they feel uncertain of their future prospects
and that they have no control of their situation. This was said to lead to stress
and depression, and in many cases leads to the need for mental health treatment
that may not otherwise be required.
Organisations such as Soldier On are assisting with programs linking
soldiers to employment in the private sector and have five veterans currently
being supported through the recruitment process and being matched to jobs.
Member support coordination
In a recently released Defence Instruction, Defence has recognised that
Defence members who find themselves in complex circumstances that have the
potential to restrict, alter or end their service, require effective
command-initiated and coordinated support. Such circumstances may result from
being wounded or injured on operations, but also equally apply to those
diagnosed with a serious illness or suffering some other injury resulting in
significant disruption to the member’s career and/or personal and family
Defence states in the Instruction that it is committed to supporting
members, and their families, who find themselves in complex circumstances
throughout the member’s recovery, rehabilitation and either their return to
duty or transition from the ADF. Member support may also involve interaction
with a range of service providers internal and external to Defence.
Member Support Coordination is therefore the overall coordination effort
required to ensure that a member in complex circumstances is effectively supported
throughout their recovery, rehabilitation and either their return to duty or
transition from the ADF. The RSL’s National Conditions of Service Committee submitted
that their only criticism of the new policy is that it places strain on the
member’s parent unit.
Health care support transition
Defence advised the Committee that the transition from ADF managed
health care and support to that managed by DVA is the responsibility of the
relevant single Service. Transition support services provided by the Directorate
of National Programs in DCO seek to ensure that members and their families
remain well informed, and are encouraged to access educational, financial,
rehabilitation, compensation and other government services to facilitate a
Informing military members of these transition support services is one
of the roles of the regional ADF Transition Centres, where members are required
to finalise their administrative arrangements well before their date of
separation from the ADF.
Defence submitted that if a member is on a Rehabilitation Program, then
prior to separation the Joint Health Command assigned Rehabilitation Consultant
ensures the member understands, and has access to, all appropriate services and
ensures the member completes all required separation tasks. The ADF
Rehabilitation Program provides access to vocational and functional assessments
to assist the member in determining appropriate vocational choices post-separation.
The Rehabilitation Consultant also works closely with ADF Transition Centres
and the DVA to provide information to assist in their determination regarding
funding and training requirements.
Defence submitted that it is also committed to providing flexible
support for those military members who need to separate at short notice for
medical or compassionate reasons. Separating members are provided with
effective and appropriate rehabilitation support. The Rehabilitation
Consultant liaises with all key stakeholders including the treating doctor, ADF
Transition Centres, DVA and DCO to ensure all ongoing services required are in
place, including medical assistance and vocational rehabilitation, before their
transition to civilian life.
In addition to the regional ADF Transition Centres, information on
transition support services is available through a variety of resources. For
example, the ADF Transition Handbook is a quick guide to transition information,
and support and is available on the internet.
Defence advised the Committee that the DVA On Base Advisory Service (OBAS)
was introduced as a Support to Wounded, Injured and Ill Program (SWIIP) initiative
in October 2011 at selected bases around Australia. Skilled DVA staff provide
information, advice and support to all ADF members on matters relating to the
provision of the DVA services and benefits. This service is provided using an
agreed visit schedule ranging from five days/week to one or two days per week
or month. This ensures a more streamlined and integrated approach between
Defence and the DVA to support wounded, injured or ill ADF members.
Functions of the DVA On Base Advisory Service are to:
n Provide information
and support relating to DVA services and benefits to all ADF personnel who seek
n Provide support for
any current or prospective compensation claims;
n Provide early
identification of health, rehabilitation and income support requirements post
n Liaise with ADF
Rehabilitation Program to identify injured personnel and provide appropriate
advice and support;
n Liaise with Support
Coordinators and other Defence personnel dealing with injured ADF personnel and
provide appropriate advice;
n Present and
participate in transition management seminars and information sessions and
n Where requested,
brief ADF personnel and families as part of their pre- and post-deployment
n Identify and report
on trends and issues arising; and
n Develop and maintain
relationships with the ADF community, Garrison Health Operational Staff, ADF
rehabilitation consultants, Welfare Boards and where necessary, the Defence
Defence submitted that the co-location of DVA officers in Joint Health
Command health facilities wherever possible has encouraged a collegiate
approach between the two Departments ensuring ADF personnel are provided timely
and accurate advice. A commitment to the longer term availability of this
service has been undertaken and this includes ongoing access to existing
infrastructure capability within Defence health facilities.
The implementation of the DVA OBAS is a significant service delivery
enhancement for members of the ADF. Member enquiries to the On Base Advisory
Service have steadily increased since the service’s inception, and feedback received
in relation to the service has reportedly been positive.
Nevertheless, RSL WA submitted that there is a problem with some members
understanding that all aspects of their claims need to be recorded and
documented prior to separation, and that considerable support is required in
this critical area of activity. RSL WA submitted that this also needs to be
strongly enforced by ADF administrative staff well before separation and not
left to the individual to ensure it is done.
How DVA recognises service-related injuries
DVA submitted that if a serving or ex-serving ADF member has a medical
condition (including due to injury or wounding) for reasons related to their
service, then he or she may make a claim to DVA for rehabilitation,
compensation, care, or a combination of these. DVA assesses claims to
establish if there is a connection between an illness, injury or disease and
service in the ADF.
DVA submitted that it operates under complex legislative arrangements. Most
claims are assessed under one or more of three pieces of legislation:
n the Veterans’
Entitlements Act 1986 (VEA);
the Safety, Rehabilitation and Compensation Act 1988
n the Military
Rehabilitation and Compensation Act 2004 (MRCA).
Claims under VEA or MRCA are assessed using Statements of Principles for
any disease, injury or death that could be related to military service, based
on sound medical-scientific evidence.
The Repatriation Medical Authority (RMA) consists of a panel of
practitioners eminent in fields of medical science whose role is to determine
the Statements of Principles which are the factors that ‘must’ or ‘must as a
minimum’ exist to cause a particular kind of disease, injury or death. Claims
under SRCA are assessed using available medical evidence to support
consideration of a disease, injury or illness.
DVA noted that in its 2010-11 Annual Report, the RMA stated that since
its inception, it has determined 1,833 Statements of Principles, with 304
particular kinds of injury or disease currently covered by these Statements of
DVA submitted that if a claim is accepted, then services may include
rehabilitation (including vocational assistance), medical treatment (either
through reimbursement of medical or care expenses or the use of White or Gold
Repatriation Treatment Cards), attendant care, household services, and a range
of other benefits – depending upon the particular illness, disease or injury,
and its level of severity.
Financial assistance may also be provided for an inability or reduced
ability to work, or to recognise the effects of a permanent impairment
resulting from a service-related event.
DVA’s Veterans and Veterans’ Families Counselling Service (VVCS) run
Stepping Out which is designed to help the transition from the ADF to civilian
life. In the program, participants learn about:
n The experience of
change as part of life,
n The transition from
the ADF to civilian life,
n Skills for planning
n Skills for staying
motivated and adaptable,
attitudes and troubleshooting, and
relationships and seeking support.
This voluntary Program is held over two full days and is available
across Australia through the fifteen VVCS centres. It is available for all ADF
personnel and their partners who are in the process of separation from the ADF
or have separated in the last twelve months. Currently serving personnel
attending the program are considered to be on duty for the duration of the
program, and the program is endorsed by the ADF.
Stepping Out is a voluntary program which was developed for ADF members
and their partners who are about to leave the military, or those who have
recently done so. DVA has increased marketing of Stepping Out over the last
three years, including presenting at all transition seminars and on key ADF
bases. This has increased the take-up of the program from 138 in 2008-09 to
333 in 2010-11, and DVA anticipate the uptake continuing to increase.
DVA submitted that once they have left the military, former personnel
who are wounded, injured or ill from operations are a sub-group of veterans
with operational service, and all ex-serving personnel. Accordingly, wounded
or injured personnel from recent operations share characteristics with their
contemporary peers on top of the unique experience of and needs arising from
their own injury.
Between 4,000 and 6,000 personnel leave the ADF each year to form the
broader group of all ex-serving ADF personnel. This includes those who retire,
resign, or who are discharged, including for medical reasons. This broader
group has a range of different service experiences, including peacetime
Some personnel with peacetime service only may also become ill or
injured as a result of their service, for instance from serious accidents such
as the 1996 Black Hawk helicopter accident.
Just over 60 per cent of serving personnel in a recent Defence survey
reported that they had been deployed, including 43 per cent reporting they had
multiple deployments. As at June 2011, this level of deployment contributed to
a count of around 45,000 surviving veterans with operational service from
conflicts since 1999.
Defence submits that it ensures ADF members receive a smooth transition
to the DVA and other support agencies. This includes a handover from the ADF
Rehabilitation Consultant of key information and the Rehabilitation Authority
to the DVA. Air Marshal Binskin highlighted
the importance of Defence’s close cooperation with DVA to ensure the transition
from ADF managed care and support to DVA managed care and support is seamless.
Similarly, DVA submitted that it is working closely with the ADF to make
the process of discharge from the military into civilian life as smooth as
possible, including for those personnel who have sustained wounds or injuries
from their service.
For personnel discharging from the military, the move to civilian life
(also known as ‘transition’) can be a stressful process. For those who are
wounded, injured or ill there are additional challenges, including accessing
care and support that will address their needs appropriately. For instance, an
ADF member may also be changing locations and not able to access the same
health care or rehabilitation provider. They may also need specialised
assistance in re-location and setting up arrangements at home, work, and for
The Committee repeatedly heard that ensuring that transition arrangements
between Defence and DVA for clients are as seamless as possible is a priority
for both agencies. DVA quoted Minister Snowdon:
…as well as having responsibility for Veterans, I also have
responsibility in the Defence portfolio, for Personnel matters. And ·what is
clear to me that the leadership in both organisations understand the need for
collaboration and integration in servicing the needs of our current serving
veterans. Particularly those in transition.
And that’s why since I took the job, now just on twelve
months ago, I have worked hard to bring the Defence and Veterans Departments
DVA further submitted that in May 2012, the Secretaries of the DVA and
Defence and the CDF agreed key principles for delivering the best possible
outcomes for all ADF personnel past and present. These principles set out the
responsibilities of both agencies and how they will work together.
DVA has had a long involvement with helping ADF personnel move into
civilian life. They submitted that from 2000 to 2011, the Department under
contract from Defence, delivered a Transition Management Service for full-time
serving personnel leaving the ADF on medical grounds. Following the cessation
of the Department’s role in this service, Defence has resumed full responsibility
for the service though DVA continues to actively support Defence in the
Young Diggers submitted that when a member gets a medical discharge their
transition through to and including DVA is mostly very good, as is the ongoing
health care and the ACPMH submitted
that the past decade has witnessed a significant increase in the collaborative
relationship between Defence and DVA.
The Committee received evidence, however, that instances of poor communication
between Defence and DVA are occurring and families are not receiving the
support they are entitled to require. The RSL Victoria Branch
submitted that ensuring communications between Defence and DVA is vital and
that poor communications have meant that treatment, rehabilitation and benefits
support to ADF members wounded or seriously injured on operations has ‘gone
awry’. RSL Queensland’s State
President, Mr Terence Meehan, advocated improvement in communications between
the two Departments:
Expedite the removal of the gulf that has existed between the
Department of Defence and the Department of Veterans’ Affairs. I am aware that
both departments are working very hard to remove it, but it should be a
seamless transition so that people who have put their lives on the line for
Australia in uniform when they leave the Australian Defence Force and their
families should continue to be looked after.
Associate Professor Malcolm Hopwood, Clinical Director of the Austin
Health’s Psychological Trauma Recovery Service (PTRS), gave evidence that transition
management was not as effective as would be desired. PTRS submitted that many
individuals leaving the ADF are at risk of having, or have, an established
mental health disorder and they are very concerned that there is often a
significant delay after leaving the ADF before members receive effective mental
health care. PTRS emphasised that it is a shared responsibility between
Defence and DVA.
Associate Professor Susan Neuhaus CSC submitted that it would appear
that there are also a number of vulnerabilities, particularly for those without
established claims, and for those who may not be aware of the linkages of their
condition to their service. This is of particular relevance post transition
from the ADF.
Defence Families Australia (DFA) suggested that a single identification
reference number for Defence personnel that is also used with DVA is needed to
address this connectivity issue and recommended that the Personnel Management
Keys Solution (PMKeyS) number be used by different agencies, making tracking of
an individual simpler.
Defence submitted that they are currently engaging with DVA on the
possibility of a single identification (ID) number that works across both
Departments. The aim would be to reduce complexity and resolve proof of
identification from the start of a member’s service by using an existing
numbering system rather than introducing an additional number, but this will
require further consultation and scoping.
Defence, through Joint Project 2080 Phase 2b.l a (the Defence Personnel
Systems Modernisation (DPSM) project), has proposed to implement a ‘Single
Person ID’ which will be integrated into PMKeys and will improve the ability to
track individuals through a variety of relationships within Defence, over
time. Defence went on to submitted that they are currently progressing through
the design release of this phase of the project and will continue to consult
with the DVA and other relevant stakeholders in relation to the possibility of
a single identification number.
The Committee feel that implementation of a single identification number
is a fundamental and important initiative.
The Committee recommends that
the departments of Defence and Veterans’ Affairs expedite the development of
a unique service/veteran health identification number.
The Legacy Australia Council submitted that an organisational gap exists
in the continuity of care for wounded and injured personnel at the boundary
between the Defence and DVA. They submitted that the organisational structure
makes very difficult the achievement of unity of effort or to achieve continuity
of care and support. A poor transition of a veteran from Defence to DVA
complicates and extends their recovery at greater expense to Government and
greater distress the veteran and their family. General Cantwell
I think there is still some difficulty in getting people to
engage properly with DVA. I was very well managed by the Department of
Veterans Affairs in my own transition, and I am very grateful for that. But I
was a General and I probably got special treatment … Not every young man and
young woman that we are discharging from the military has those advantages. There
are some gaps in the ability of those people to engage with DVA.
Professor Neuhaus also agreed with this assessment. She told the Committee
that despite ‘immense efforts’ by DVA in particular to reach down into the
group transitioning out of the ADF, there remain those who fall between the
gaps in what is inherently a ‘prismatic and polarised system’. She argued that
it is a system where an accepted claim remains the gateway to accessing care.
Austin Health’s PTRS’ principal concern with current arrangements lay in
the distance between care arrangements under the auspices of the ADF, and those
under the auspices of DVA, with the outcome being that many individuals with
operationally related mental health disorders are often without treatment for
an extended period after leaving the ADF. Mr Tony Ralph,
President of Brisbane Legacy highlighted that:
Continuity of care is critical, and it is essential for
organisational collaboration between all departments … and the wider community
and health sector providers.
Professor Neuhaus submitted that a system integrated across the spectrum
health care would not only provide greater equity of health care for all with
service related health conditions, but would enable greater coordination and
synergy between multiple care providers and agencies.
Similarly, South Australia’s Veterans’ Health Advisory Council (VHAC) submitted
that there is a need to improve local coordination of care and the development
of a network of interested mental health professionals. The lack of funding
and clear service delivery models has not led to any sustained coordination at
the local level, at least in South Australia, they submitted. VHAC recommended
the development of an agreed assessment procedure between ADF and DVA services,
whether these services are in the private or public sector, and the
establishment of coordinated clinical network of service providers who are known
to provide evidence based care. Such a network would have components that
address those who have first presentation and acute illnesses, as well as the
need to establish long term coordinated rehabilitation services.
VHAC submitted that this would be a more effective and efficient
delivery system. It would enable better management of demand, given that
evidence indicates that interventions are more effective if they are provided
early in the course of a disorder. Services were also said to be required to
address the diverse needs of different genders, and of families. VHAC
submitted that there is a need for the future Mental Health Delivery system to
be more robust and flexible, but coordinated.
Additionally, DFA highlighted that there are barriers associated with
the Privacy Act that reduce continuity of care for ADF members and sharing of
information between ADF and DVA, providers and locations.
Professor Sandy McFarlane AO summarised the issue and submitted that
mental health services provided to currently serving members and ex-serving
personnel should be at the same standards or better than those provided to the
Australian community, which was a recommendation of the Dunt Report (the Review
of Mental Health Care in the ADF and Transition through Discharge).
Professor McFarlane submitted that the nexus between Defence and DVA is
even more important for those with mental health disorders than those with
physical injuries due to the fact that many individuals with psychiatric
injuries arising from being a member of the ADF are discharged without being
diagnosed or treated. Professor McFarlane submitted that the Dunt Report has
been, and should remain, the key driver to improving mental health care in the
ADF. Professor McFarlane submitted that a number of its recommendations have
taken on a new urgency with the findings of the 2010 ADF Mental Health
Prevalence and Wellbeing Study, due to the rates of disorder identified.
Electronic Health Records
DVA is also working with other agencies to help implement a new
Personally Controlled Electronic Health Record (eHealth record). Participation
in the eHealth record system is voluntary, with functions available
incrementally from July 2012. The eHealth record system is open for consumer
The VVCS information management system is planned to be compatible with
the eHealth record system. If they consent to an eHealth record, VVCS clients
can have summary information about services they receive from VVCS included in
their eHealth record. If the client wishes, this summary information can be
made available to other health care providers and their VVCS counsellor can see
important information from other service providers.
The eHealth record will assist in the transition process for current
serving ADF personnel, in terms of appropriate care coordination for clients,
including for those wounded or injured.
DVA has, since 2006, used an electronic system to manage requests to
Defence for service and medical records to streamline the claims process and
ensure records are returned to Defence as necessary.
MAJGEN Elizabeth Cosson AM CSC, the First Assistant Secretary, Client and
Commemorations in the DVA admitted that at the moment, the Defence and DVA Information
Technology systems do not communicate ‘as effectively as you would want them to’.
Mr Sean Farrelly, the First Assistant Secretary for Rehabilitation and Support
with DVA, told the Committee that:
Systems do need to talk to each other and it is not as
straightforward as any of us would like, but we are working hard on it.
DVA is now working with Defence to ensure maximum interoperability with
Defence’s Joint eHealth Data and Information System Project. The purpose of
this project is to develop and implement an ADF electronic health information
system that will link health data from recruitment to discharge. It will
generate an electronic health record for ADF personnel that with the client’s
consent may be used by health care providers after discharge. This system will
also assist with claims for rehabilitation and compensation, enabling DVA staff
to have shared access to necessary documentation.
Retention of records
The RSL National Conditions of Service Committee submitted that Defence medical
history files be released only to the member whilst he or she is alive, and
that their permission be required for dissemination within the medical
fraternity. They submitted that after a member’s death, they should not be
publicly released for a term of thirty years.
Memorandum of Understanding
DVA advised that a Memorandum of Understanding (MOU) between DVA and
Defence has been developed to better coordinate the delivery of services to
veterans, and particularly to create a continuum of service between Defence and
DVA to ensure that there is clear responsibility at every point for one
department or the other.
The MOU establishes key principles for the cooperative delivery of care
and support arrangements for clients and is built on previous agreements between
DVA and Defence, incorporating the formal recognition of responsibilities.
MAJGEN Dave Chalmers AO CSC, DVA’s First Assistant Secretary for Client
and Commemorations, told the Committee that Defence has the lead in caring for
and supporting serving members. DVA has the lead in caring for and supporting
widows, widowers and dependants, and wounded, injured or ill ex-service
members. DVA is also responsible for providing compensation and other support
to eligible serving and former members.
The National President of the RSL, Rear Admiral (RADM) (Retired) Ken
Doolan AO told the Committee that the RSL had argued for some years that the
Minister for Veterans’ Affairs and the Minister for Defence Science and
Personnel should be the same minister and that the current situation was a ‘happy
Health care community awareness
Ms Veronica Hancock, the Assistant Secretary for Mental and Social
Health in DVA, told the Committee that DVA has several ways of engaging with
providers, including some specific online training for community nurses. The
training is designed to assist in recognising issues they may be related to an
individual’s war service. DVA has produced a mental health advice book
specifically for general practioners designed to alert them to the sorts of
symptoms and issues that they might be encountering when dealing with veterans.
Dr Graeme Killer, Principal Medical Advisor with the Department of Veterans’
It is all about recognising veterans. As soon as someone
comes in you ask them if they have military service, and if they do, a red
light should come on.
Professor David Forbes, Director of ACPMH, advised that the Centre
worked with general practitioners to encourage them to more consistently ask
questions about whether their patients are serving members, or have been
serving members of the Defence Force. Professor Forbes told the Committee that
ACPMH understands that, in many cases, general medical practioners may not even
recognise that the patients they treat have been members of the ADF, and may
not think to relate a medical condition to military service.
Professor Neuhaus submitted that this complexity, and the lack of a
unique veteran identifier within Federal, State and Territory Health
organisations, creates challenges as it relies on the individual and/or their
health professional to make a link between their medical condition and a
particular aspect of their service.
Professor Neuhaus told the Committee that the health community does not
have a very good concept of what a contemporary veteran looks like,
particularly in terms of reservists and women. She said that without a
specific identifier or longitudinal tracking system that recognition was
missing. She told the Committee that it was routine to identify Aboriginal and
Torres Strait Islanders presenting to general practioners or hospitals for
assistance. Medical admission forms routinely have a check-box to identify Aboriginal
and Torres Strait Islander heritage; a similar check-box could identify
ex/servicemen and veterans to assist healthcare professionals that a patient’s
medical condition could be associated with service.
Professor Forbes highlighted that providing longitudinal tracking or
online identification systems can benefit the individual. The alternative would
be to contact veterans who leave Defence on a periodic basis to remind them
about the DVA’s existence and the fact that it is there to support them. Such
an arrangement would also recognise that sometimes it can take time for
physical or psychological issues to present.
Carry On (Victoria) gave evidence that DVA should take up a greater
monitoring role for all ex-servicemen, not just veterans.
Uncontested healthcare liability
The Committee is concerned that a significant difference exists in the
treatment of personnel who discharge with a condition that is recognised by
DVA, and those who discharge and subsequently develop a service-related
Professor Neuhaus told the Committee that in her opinion, a simpler,
more elegant solution to the whole issue of veterans ‘falling through the
cracks’ may be to consider an uncontested healthcare liability for all Australian
servicemen and women who have served on active duty.
She submitted that, by accepting the system of comprehensive healthcare
for life (which has parallels with the no-fault motor vehicle injury
compensation schemes, or a gold card equivalent) there is the opportunity not
only to honour the covenant that Australian society has with those who put
themselves in harm’s way for national interests, but also to ‘swathe through
layers of entitlement bureaucracy and red tape’, and thereby decrease the
distress to service personnel and their families of having to establish and
verify claims and the accompanying secondary trauma.
Dr Khoo agreed:
We have to decrease the barriers to care, because that is the
biggest problem in accessing the guys. … It’s a great idea. … We have to be
freer with funding and less suspicious that somebody is talking about something
that they might not actually have and are trying to fool the system.
[Have I ever treated a patient that was just trying to get
something out of the system?] Yes, but no-one with PTSD … or any military
Professor Neuhaus submitted that this would enable the medical system to
prospectively follow the latest cohort of veterans, provide visibility on
future health issues and identify any such issues early enough to intervene and
thereby avoid the anguish seen following the Vietnam conflict. It would
separate the issue of compensation entitlement from the issue of care and
enable DVA and other key agencies to focus on the provision of appropriate,
timely and responsive healthcare to those who have served, and possibly garner
significant national cost savings. She contended that many of those costs are
already currently being met by Commonwealth resources through the Medicare
The Committee concludes that regardless of any subsequent findings about
the circumstances of an injury, veterans being treated by DVA should continue
to be treated by DVA given that the costs will be borne by the Commonwealth
either way. Furthermore, this would ensure greater continuity of care for
The Committee agrees that an uncontested healthcare liability model
would be appropriate for Australian veterans.
The Committee recommends that
the Government conduct a cost-benefit study of a comprehensive uncontested veteran
healthcare liability model and publish the results.
VHAC submitted that amongst healthcare administrators and providers at a
State level, there is little understanding of the fact that members leaving the
ADF do not automatically become DVA clients on discharge. The fact that ADF
members may leave Defence with health conditions that do not attract a DVA
entitlement, as well as having deployment related health conditions, adds to
this confusion. The State health system only identifies members with a DVA
entitlement rather than ex-ADF members more generally.
This lack of identification of military service means that some ADF
members may present with an illness that would attract a DVA entitlement but
its relationship to military service has not been identified or assessed as the
individual is not recognized as being an ex ADF member.
Defence submitted that equity with provisions of the Health Insurance
Act 1973 underpins the basic entitlement to the range of medical services
provided to members of the Permanent Forces. Usually the range of, and ease of
access to, health care provided to such members will exceed that available
through the public health care system because of the requirement to meet and
maintain operational readiness. However, from time to time the Surgeon General
Australian Defence Force will issue policies which may exclude or limit the
provision of certain medical or dental treatment on the grounds that such
treatment is contra-indicated or unnecessary for operational readiness.
The Committee agrees with the basic concepts outlined in the Defence
White Paper and affirms that it remains critical that:
n The service has
adequate staffing with psychiatrists and clinically trained psychologists that
augment the primary health care system and that professional development of
staff remains a high priority;
n These services need
to be provided in the context of an occupational health model that addresses
rehabilitation in the ADF context;
n Adjustment programmes
need to address the future risk associated with subclinical symptoms;
n The quality and
adequacy of services provided to those injured on deployment depends on the
standards of care provided within the broader ADF community; and
n An ongoing health
surveillance programme identifies emerging trends of physical and mental
disorder in those who have deployed and monitors their treatment and that these
findings are an initial driver for the introduction of innovative and high
The Committee notes Acting CDF’s evidence that:
We do not want even one member to fall through the cracks or
feel unsupported, but we recognise that at times mistakes will be made. We are
committed to learning from these mistakes and ensuring that they are not
systemic or repeated in the future. We will work hand in hand with DVA to
ensure our system and support mechanisms remain relevant, sensitive to members
and families, and provide the services our members require, both while in
service and following the transition from the services.
The Committee is nonetheless concerned about the health and welfare of
servicemen and women transitioning out of Defence and agrees that no one must
be allowed to ‘fall through the cracks’.
The Committee recommends that
the departments of Defence and Veterans’ Affairs coordinate to clarify the Australian
service delivery models to reduce the complexity, overlaps and gaps in
service identified in this report.
The Committee further
recommends that it be provided with a progress report within six months, and
a final implementation report within 12 months.
The Committee is of the opinion that priority should be given to
allowing wounded or injured members to carry on within the broader Defence
organisation, if they are unable to stay in uniform.
The Committee recommends that a
wounded or injured soldier who wishes to remain in the Defence environment
and applies for a position within the Australian Public Service, for which
they have the required skills and competencies, be selected preferentially.
The Committee further
recommends that the Government encourage private sector providers to take a
similar approach to the preferential employment of wounded and injured
While there has been some criticism of the lack of information
technology connectivity between Defence and DVA, the Committee acknowledges
that it is not a simple process to introduce seamlessly connected systems. The
Committee is pleased to note that DVA is working with Defence to get early
access to health and personnel systems where appropriate. Nonetheless the Committee
is concerned that progress is hampering service provision to veterans.
The Committee recommends that
the departments of Defence and Veterans’ Affairs expedite the rectification
of information technology connectivity issues.
The Committee further
recommends that it be provided with a progress report within six months, and
a final implementation report within 12 months.
The Committee also agrees that it is imperative that the national health
system is able to track identify personnel potentially wounded, injured or
harmed by service in the ADF and prompt recognition of the potential for a
service-related medical condition.
The Committee recommends that:
an immediate priority, the national healthcare community include a
military/ex-military checkbox as a standard feature on all medical forms; and
Government commission a longitudinal tracking system to identify the
engagement of military/ex-military personnel with the healthcare system.