Instrument No.21 of 2001
Revocation and Determination
of
Statement of Principles
concerning
INFLAMMATORY BOWEL DISEASE
ICD-10-AM CODES: 555, 556K50, K51
Veterans’ Entitlements Act 1986
1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.144 of 1996 and Instrument No.179 of 1996; and
(b) determines in their place the following Statement of Principles.
Kind of injury, disease or death
2. (a) This Statement of Principles is about inflammatory bowel disease and death from inflammatory bowel disease.
(b) For the purposes of this Statement of Principles, “inflammatory bowel disease” means one of a group of chronic inflammatory disorders involving the gastrointestinal tract, attracting ICD-10-AM code K50 or K51. This definition includes ulcerative colitis and Crohn's disease, but excludes bowel inflammation secondary to vascular insufficiency, radiation, infection or known gastrointestinal toxins.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that inflammatory bowel disease and death from inflammatory bowel disease can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting inflammatory bowel disease or death from inflammatory bowel disease with the circumstances of a person’s relevant service are:
(a) for ulcerative colitis only, in a person with a history of a regular smoking habit,
(i) ceasing to smoke within the 10 years immediately before, and
(ii) continuing not to smoke for the three months immediately before,
the clinical onset of inflammatory bowel disease; or
(b) for Crohn’s disease only,
(i) smoking at least one half pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of inflammatory bowel disease, and where smoking has ceased, the clinical onset has occurred within four years of cessation; or
(ii) using the combined oral contraceptive pill for a period of at least six months within the two years immediately before the clinical onset of inflammatory bowel disease; or
(iii) smoking at least one half pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of inflammatory bowel disease, and where smoking has ceased, the clinical worsening has occurred within four years of cessation; or
(c) inability to obtain appropriate clinical management for inflammatory bowel diseaseinflammatory bowel disease.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(b)(iii) to 5(c) apply only to material contribution to, or aggravation of, inflammatory bowel disease where the person’s inflammatory bowel disease was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(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:
“a regular smoking habit” means having smoked at least five pack years of cigarettes or the equivalent thereof in other tobacco products;
“death from inflammatory bowel disease” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s inflammatory bowel disease;
“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), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“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 (being the “standard” cigarette pack contents) 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) operational service; or
(b) peacekeeping service; or
(c) 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;
Application
9. This Instrument applies to all matters to which section 120A of the Act applied.
Dated this Nineteenth day of March 2001
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN