Statement of Principles concerning colorectal adenoma No. 63 of 2002 (Cth)

Instrument No.63 of 2002

Determination

of

Statement of Principles

concerning

COLORECTAL ADENOMA

ICD-10-AM CODES: D12.0 - D12.5, D12.7, D12.8

Veterans’ Entitlements Act 1986

1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act).

Kind of injury, disease or death

2.         (a)       This Statement of Principles is about colorectal adenoma and death from colorectal adenoma.

(b)For the purposes of this Statement of Principles “colorectal adenoma” means a benign neoplasm arising from the epithelial cells of the colorectum, which extends from the caecum, including the ileocaecal junction to the junction with the anal canal.  This definition of colorectal adenoma includes colorectal adenomatous polyp and serrated adenoma, but excludes benign neoplasms of the anus and anal canal, familial adenomatous polyposis, non-neoplastic polyps of the large intestine or non-epithelial neoplasms of the large intestine.  Colorectal adenoma attracts ICD-10-AM code D12.0 - D12.5, D12.7 or D12.8.

Basis for determining the factors

3.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that colorectal adenoma and death from colorectal adenoma can be related to relevant service rendered by veterans or members of the Forces.

Factors that must be related to service

4.         Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.

Factors

5.         The factors that must exist before it can be said that, on the balance of probabilities, colorectal adenoma or death from colorectal adenoma is connected with the circumstances of a person’s relevant service are:

(a)       smoking at least 20 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of colorectal adenoma, and

(i)        smoking commenced at least 15 years before the clinical onset of colorectal adenoma, and

(ii)      where smoking has ceased, the clinical onset has occurred within 10 years of cessation; or

(b)drinking at least 500 kilograms of alcohol within a 25 year period within the 30 years immediately before the clinical onset of colorectal adenoma; or

(c)for adenoma of the colon only, an inability to undertake more than a mildly strenuous level of physical activity for at least 20 years within the 30 years before the clinical onset of colorectal adenoma; or

(d)for adenoma of the colon only, being obese for at least 30 years within the 40 years before the clinical onset of colorectal adenoma; or

(e)inability to obtain appropriate clinical management for colorectal adenoma.

Factors that apply only to material contribution or aggravation

6.         Paragraph 5(e) applies only to material contribution to, or aggravation of, colorectal adenoma where the person’s colorectal adenoma was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(d) of the Act refers.

Inclusion of Statements of Principles

7.         In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.

Other definitions

8.         For the purposes of this Statement of Principles:

“adenoma of the colon” means a benign epithelial neoplasm of the colon, which extends from the ileocaecal junction to the sigmoid colon;

“alcohol” is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;

“an inability to undertake more than a mildly strenuous level of physical activity” means the presence of an incapacity which prevents any physical activity greater than 3 METS, where a “MET” is a unit of measurement of the level of physical exertion.  1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.  (A MET approximates to the energy required to rest quietly in bed.  A 70 kg man would use about 3 METS when walking at 4 km per hour.);

“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The BMI = W/H² and where:

W is the person’s weight in kilograms and

H is the person’s height in metres;

“death from colorectal adenoma” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s colorectal adenoma;

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9.  Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

“pack years of cigarettes or the equivalent thereof in other tobacco products” means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7 300 cigarettes.  One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack year of tailor made cigarettes equates to 7 300 cigarettes, or 7.3kg of smoking tobacco by weight.  Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;

“relevant service” means:

(a)       eligible war service (other than operational service); or

(d)defence service (other than hazardous service);

“terminal event” means the proximate or ultimate cause of death and includes:

(a)       pneumonia;

(b)       respiratory failure;

(c)       cardiac arrest;

(d)       circulatory failure; or

(e)       cessation of brain function.

Dated this       Sixth         day of              August               2002

The Common Seal of the    )

Repatriation Medical Authority                   )

was affixed to this instrument   )

in the presence of:   )

KEN DONALD

CHAIRMAN