2.1.1 Subject to these Principles, the Commission may provide or arrange for treatment in Australia of:
(a) entitled persons who have been issued with:
(i) a Gold Card;or
(ii) a White Card; or
(iii) a written authorisation issued on behalf of the Commission; and
(b) Vietnam veterans and their dependants, who are not otherwise eligible, and who are certified by a medical practitioner as requiring urgent hospital treatment for an injury or disease.
Note: See Principle 2.5 in relation to urgent treatment for Vietnam veterans and their dependants.
2.2 Treatment for entitled persons residing or travelling overseas
2.2.1 Subject to these Principles, the Commission will accept financial responsibility for the treatment overseas of war-caused injuries or diseases only for:
(a) a veteran who is resident overseas; or
(b) a veteran who is travelling overseas.
2.2.2 Except where the Commission decides otherwise, the Commission will not accept financial responsibility under paragraph 2.2.1 for costs incurred in the treatment of a war-caused injury or disease while a veteran is temporarily absent from Australia unless, prior to departure, an office of the Department has been notified of the veteran’s intention to travel.
2.2.3 Except in an emergency, financial responsibility under paragraph 2.2.1 will be limited to:
(a) except in the cases of residential care or residential care (respite), the cost of treatment provided in accordance with the mode and duration that would have been provided or arranged, under these Principles, in Australia; or
(b) except in the cases of residential care or residential care (respite), the cost of treatment provided by a health authority or facility nominated by the Commission; or
(c) in the case of residential care or residential care (respite) provided for a period to a veteran, whether provided in an emergency or not — the lesser of:
(i) the amount charged the veteran; or
(ii) the amount of residential care subsidy (at classification level 1 for residential care or at classification level 3 for residential care (respite)) and the residential care amount (if any) that would have been accepted by the Commission in respect of the veteran if the veteran had received residential care or residential care (respite), as the case may be, at the classification level 1 or the classification level 3, respectively, for the same period in Australia;or
Note (1): A "veteran" includes a former POW. In most, but not all cases, the Commission accepts liability for the residential care amount for former POWs receiving residential care or residential care (respite) but, in the case of entitled persons other than former POWs, who receive residential care (respite), the Commission only accepts liability for the residential care amount for up to 28 days in a Financial year and in the case of residential care being provided to such persons, does not accept liability for any residential care amount.
Note (2): Subject to the Principles, the Commission will not accept financial responsibility for medical or allied-health treatment applied to the "non-war caused conditions" (i.e non-accepted conditions) of the holder of a Gold Card or White Card residing or travelling overseas.
Note (3): "classification level 1" and "classification level 3" mean "residential care classification level 1"and "residential care classification level 3", respectively, under the Aged Care Act 1997. By virtue of Part 10 of the Principles the Commission, in the first instance, rather than the Commonwealth, accepts financial responsibility for the provision of residential care and residential care (respite) under the Aged Care Act 1997 to entitled persons (the veteran community).
Note (4): the "residential care amount", also commonly known as the "basic daily care fee" or "resident fee", is the amount to be worked out under section 58-3, or the amount to be worked out under subsection 58-4(1), of the Aged Care Act 1997 as amended from time to time, depending on which of those provisions applied to the circumstances of the veteran.
(d) in the case of residential care (respite), the cost of that care (as worked out under paragraph (c)) for only a maximum of 63 days in any Financial year.
Note (1):the intention is that the Commission will not accept any further financial responsibility for "a respite admission" in a Financial year where in that year the person had already spent 63 days in residential care as a respite admission.
Note (2): for the purpose of calculating the number of days spent by a veteran in residential care (respite) in a Financial year, any day spent in residential care (respite) in Australia in that year is also to be taken into account.
2.2.5 Notwithstanding paragraphs 2.2.2 or 2.2.3, the Commission will not be responsible for treatment costs incurred by any person who travels overseas from Australia where a significant reason for that travel is to obtain treatment or rehabilitation appliances.
2.2.6 Subject to these Principles, the Commission will accept financial responsibility for the treatment of an entitled widow who is resident overseas if her husband had been awarded the Victoria Cross.
2.2.7 Despite paragraph 2.2.1, the Commission will accept financial responsibility for the treatment of entitled persons for any injury or disease
who were residing in Papua New Guinea at the date of independence (16 September 1975) and who have continued to reside there.
Note: Travelling to, or taking up, residence in Papua New Guinea after the date of independence is regarded as travelling to or residing in a foreign country.
No Overseas Veterans' Home Care or HomeFront
2.2.8 The Commission will not accept financial liability for the provision overseas of treatment under the Veterans' Home Care Program or under the HomeFront Program.
Note: the HomeFront Program is the common name given to accident prevention and personal safety treatment provided under paragraphs 11.9.1 to and including paragraph 11.9.8 of the Principles.
2.3 Treatment of associated non-war-caused injuries or diseases
2.3.1 Subject to these Principles, the Commission will provide, arrange, or accept financial responsibility for treatment of an injury or disease that is not war-caused to the extent that it is a necessary part of treatment for a war-caused injury or disease.
2.4 Treatment of malignant neoplasia, pulmonary tuberculosis, and post-traumatic stress disorder.
2.4.1 The Commission will provide, or accept financial responsibility for, treatment of a veteran for malignant neoplasia, pulmonary tuberculosis, and post-traumatic stress disorder (even if that injury or disease is not war-caused) on and from the date that is three months before the date on which an application to be provided with that treatment is received at an office of the Department in Australia.
2.4.2 The Commission will provide, or accept financial responsibility for, treatment of a veteran under paragraph 2.4.1 if the treating medical practitioner considers that a malignant neoplasm or pulmonary tuberculosis, as the case may be, is the actual or most likely diagnosis.
2.4.2A The Commission will provide, arrange, or accept financial responsibility for, treatment of a veteran under paragraph 2.4.1 in respect of post-traumatic stress disorder if the veteran has been assessed and diagnosed as suffering from post-traumatic stress disorder, by a psychiatrist, in accordance with the criteria for such assessment and diagnosis as set out in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (commonly known as DSM-IV) in force on the date in Schedule 1.
2.4.2B For the purpose of establishing whether or not post-traumatic stress disorder is the actual or most likely diagnosis, the Secretary may require a veteran to be examined, at Commonwealth expense, by a psychiatrist.
2.4.3 Continuing financial responsibility for treatment under paragraph 2.4.1 may be reviewed and may be withdrawn by the Commission if —
(a) the diagnosis is not confirmed to the satisfaction of the Commission within three months from the day on which an application to be provided with that treatment (referred to in subsection 85(2) of the Act) is received at an office of the Department in Australia; or
(b) the Commission is satisfied that the veteran does not suffer, or no longer suffers, any incapacity from a malignant neoplasm, pulmonary tuberculosis, or post-traumatic stress disorder.
2.4.4 The Commission will provide or accept financial responsibility for the treatment of other conditions, symptoms, or sequelae resulting from the treatment of malignant neoplasia where it has provided treatment or accepted financial responsibility under paragraph 2.4.1.
2.4.5 The Commission will provide, arrange, or accept financial responsibility for the reasonable treatment of an injury or disease that is not war-caused to the extent that it is a necessary part of, and is directly associated with, the treatment of the veterans' post-traumatic stress disorder.
Note: Injuries or diseases to which this paragraph might apply include alcohol or other substance abuse.
2.5 Determination that specified veteran is eligible for specified kind of treatment
2.5.1 Subject to these Principles, the Commission will accept financial responsibility for treatment of a veteran eligible for that treatment pursuant to a determination under section 88A of the Act.
2.6 Referrals by the Veterans and Veterans Families Counselling Service
2.6.1 The Veterans and Veterans Families Counselling Service may refer its clients to other counselling services.
2.6.2 The Commission will accept financial responsibility for counselling referred under paragraph 2.6.1 only where that referral is in accordance with guidelines prepared by the Commission.
Note: The guidelines are prepared by the Commission after, and subject to, consideration of advice from the National Advisory Committee on the Veterans and Veterans Families Counselling Service.
2.7 Gulf War Health Study
2.7.1 Entitlement to medical examination, diagnostic test, radiology and pathology services, transport, accommodation, and meals and leave-of-absence from employment or work (social assistance).
(1) The following terms are defined for the purposes of paragraph 2.7.1:
Claim Form means the form approved by the Commission under subsection 111(2) of the Act to be used to apply for travelling expenses in connection with travel under subsection 110 of the Act.
Determination 22/2000 means the Determination made under section 88A of the Act entitled Veterans' Entitlements Treatment (Gulf War Health Study) Determination 22/2000.
Note:Although "section 88A Determinations" are not part of the Principles copies are stored at the end of the Principles for convenience.
Gulf War Health Study means the Gulf War Health Study defined in Determination 22/2000;
Leave-of-absence treatment means that part of the treatment a Veteran is eligible for under Determination 22/2000 comprised of the provision of, in the case of a Veteran employed by another person, unpaid leave from the Veteran's employment (social assistance) and, in the case of a self-employed Veteran, absence from the Veteran's work (social assistance).
Note: As the provision of unpaid leave from employment/work is treatment, the Commission may accept financial responsibility for the cost of that treatment. The cost of that treatment is the earnings the Veteran would otherwise have received but for the Veteran taking unpaid leave from employment/work to participate in the Gulf War Health Study. It is not the intention that the Commission accept financial responsibility for any cost to a Veteran's employer that may have resulted from the provision of the unpaid leave.
Medical Treatment means that part of the treatment a Veteran is eligible for under Determination 22/2000 comprised of a medical examination, diagnostic test, radiology service, and pathology service.
Travel Treatment means that part of the treatment a Veteran is eligible for under Determination 22/2000 comprised of transport, accommodation, and meals.
Travel Regulations means those provisions in the Veterans' Entitlements Regulations 1986 that govern the circumstances in which the Commission may accept financial liability for travelling expenses in connection with a person who travels for treatment under section 110 of the Act;
Note: the reference to "treatment" (last occurring) does not include treatment comprised of transport, accommodation or meals.
treatment means (unless there is a contrary intention) medical examination, diagnostic test, radiology service, pathology service, transport, accommodation, and meals and leave-of-absence from employment or work;
Veteran means a veteran eligible for treatment under Determination 22/2000.
(2) The Commission will accept financial liability in accordance with Part 4 of the Principles for Medical Treatment provided to a Veteran, and will accept financial liability for Travel Treatment provided to a Veteran, and will accept financial liability for Leave-of-absence treatment provided to a Veteran, on condition that:
(a) the conditions of eligibility for treatment for the Veteran under Determination 22/2000 are satisfied; and
Note: it is a condition of eligibility for treatment under Determination 22/2000 that the treatment relates to the Gulf War Health Study.
(b) in the case of Travel Treatment, the Commission would have accepted financial liability for the Travel Treatment under the Act, as amended from time to time, and under the Travel Regulations, as amended from time to time, if the Veteran had been a person who had travelled, with the approval of the Commission, for the purpose of obtaining treatment, and who, during the course of travel, had incurred transport, accommodation or meal costs, as the case may be;and
Note: the reference to "treatment" (last occurring) does not include treatment comprised of transport, accommodation or meals.
(c) in the case of Leave-of-absence treatment:
(A) the Veteran provides to the Commission satisfactory evidence of:
(i) where the Veteran has an employer — the provision to the Veteran of unpaid leave from employment by the employer and the amount of salary, wages or other earnings the Veteran would have received but for taking that unpaid leave;or
(ii) where the Veteran is apparently self-employed — self-employment and the amount of earnings the Veteran would have received but for being absent from work.
(B) the Commission is not financially liable for that part of the cost of leave-of-absence treatment that exceeds, in respect of a day of unpaid leave from employment or a day of absence from work —$1,000.00.
(3) For the purposes of (2)(b):
(a) a reference in the Act relating to travel for the purposes of section 110 of the Act shall mean travel for the purposes of the Gulf War Health Study;
(b) a reference in the Travel Regulations or in the Claim Form to "application", "Claim", or "form" or to a similar word respectively shall mean an application under the Principles by a Veteran for reimbursement of any transport, accommodation or meal costs incurred by the Veteran in relation to the Gulf War Health Study;
(c) a reference in the Act, the Travel Regulations or the Claim Form to "travelling expenses" shall mean the amount required to reimburse a Veteran for costs incurred by the veteran for transport, accommodation or meals in relation to the Gulf War Health Study;
(d) a reference in the Travel Regulations relating to travel by an entitled person for the purposes of section 110 of the Act shall mean travel by a Veteran in relation to the Gulf War Health Study;
(e) a reference in the Travel Regulations to "entitled person" and a reference in the Claim Form to "veteran" shall mean a Veteran;
(f) a reference in the Travelling Regulations and in the Claim Form to "treatment" shall mean Medical Treatment of a Veteran for the purposes of the Gulf War Health Study;
(g) a reference in the Travelling Regulations to "treatment location" shall mean the location at which a Veteran receives Medical Treatment for the purposes of the Gulf War Health Study;
(h) a reference in the Travel Regulations relating to "endorsed for treatment" shall mean written confirmation endorsed on a Veteran's application for travelling expenses, as modified for (2)(b), by the veteran's treating practitioner, that the treatment location was as close as practical to the Veteran's residence and that the treatment of the Veteran was for the purposes of the Gulf War Health Study;
Note: the reference to "treatment" (last occurring) means Medical Treatment.
(i) a requirement in the Claim Form relating to details of a condition of a veteran shall be satisfied by providing the details: "Gulf War Health Study";
(j) a requirement in the Claim Form relating to details of whether the treatment of the veteran met the health care needs of the veteran and whether the Health Provider was the closest practical provider shall be deemed to be a requirement for details as to whether any Medical Treatment of the Veteran was for the purposes of the Gulf War Health Study and whether the Health Provider was the closest practical provider to provide that Medical Treatment.
2.7A Centre for Military and Veterans’ Health Treatment
2.7A.1 The Commission may accept financial liability for CMVH treatment provided for the benefit of an entitled veteran who is eligible for such treatment by virtue of Determination no.6/2003 made under section 88A of the Act and entitled Veterans’ Entitlements Treatment (Centre for Military and Veterans’ Health) Determination 2003.
Note (1): under subsection 80(1) of the Act treatment can be action taken with a view to maintaining a person in physical or mental health.
Note (2): the intention is that the Commission may accept liability for CMVH treatment even though such treatment is not provided by the Centre for Military and Veterans’ Health.
Note (3): The Treatment Principles establish the treatment called “CMVH treatment” and Determination no.6/2003 establishes eligibility for that treatment.
Note (4): Unlike most of the eligibility provisions in Part V of the Act, eligibility for treatment under a “s.88A determination” need not relate to an injury or disease but can relate to a person’s condition generally.
Note (5): prior approval for CMVH treatment is not required.
2.7B Australian Centre for Posttraumatic Mental Health Treatment
2.7B.1 The Commission may accept financial liability for ACPMH treatment provided for the benefit of an entitled veteran who is eligible for such treatment by virtue of Determination no.R32/2007 made under section 88A of the Act and entitled Veterans’ Entitlements Treatment (Australian Centre for Posttraumatic Mental Health) Determination 2007.
Note (1): under subsection 80(1) of the Act treatment can be action taken with a view to maintaining a person in physical or mental health.
Note (2): the intention is that the Commission may accept liability for ACPMH treatment even though such treatment is not directly provided by the Australian Centre for Posttraumatic Mental Health but under its auspices.
Note (3): The Treatment Principles establish the treatment called ACPMH treatment and the Determination entitled Veterans’ Entitlements Treatment (Australian Centre for Posttraumatic Mental Health) Determination 2007 (R32/2007), made under s.88A of the Act, establishes eligibility for that treatment.
Note (4): Unlike most of the eligibility provisions in Part V of the Act, eligibility for treatment under a “s.88A determination” need not relate to an injury or disease but can relate to a person’s condition generally.
Note (5): prior approval for ACPMH treatment is not required.
2.8 Loss of eligibility for treatment
2.8.1 Unless the Commission makes a determination under subsection 85(8) of the Act, it will not provide, arrange, or accept financial responsibility for treatment for a person, as an entitled person, on or from:
(a) the date of notification that the person is no longer eligible under section 85, 86 or 88A of the Act; or
(b) the effective date of reduction or cancellation of the qualifying pension;
whichever is the later.
Note: Subsection 85(8) provides, in effect, that where a service pension is suspended, the Commission may determine that, for the purposes of treatment eligibility, the person is deemed to be continuing to receive that pension during the period, or part of the period, of suspension.
2.8.2 Where a person’s pension is reduced or cancelled because the person supplied false or misleading information, and that reduction or cancellation results in a reduction or loss of eligibility for treatment, treatment benefits will be reduced or will terminate from the date of reduction or cancellation of the pension.