Instrument No.104 of 1996
Determination
of
Statement of Principles
concerning
IRRITABLE BOWEL SYNDROME
ICD CODE: 564.1
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 irritable bowel syndrome and death from irritable bowel syndrome.
(b) For the purposes of this Statement of Principles, “irritable bowel syndrome” means a heterogeneous group of disorders of diverse symptomatology in which abdominal pain is associated with defaecation or changes in bowel habit, and with features of disordered defeacation and with distention, and which is characterised by the following symptom criteria:
At least three months, continuous or recurrent symptoms of:
(A) Abdominal pain or discomfort which is
- relieved by defaecation;
- and/or associated with a change in frequency of stool;
- and/or associated with a change in consistency of stool;
plus
(B) An irregular pattern of defaecation at least 25% of the time, consisting of two or more of the following:
- altered stool frequency;
- altered stool form (lumpy/hard or loose/watery);
- altered stool passage (straining, urgency, or feeling of incomplete evacuation);
- passage of mucus;
- bloating or feeling of abdominal distension,
attracting ICD code 564.1.
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 irritable bowel syndrome 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, the factors set out in the paragraphs 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, irritable bowel syndrome or death from irritable bowel syndrome is connected with the circumstances of a person’s relevant service are:
(a) suffering a specified psychiatric condition within the six months immediately before the clinical onset of irritable bowel syndrome; or
(b) suffering an episode of severe diarrhoea within the six months immediately before the clinical onset of irritable bowel syndrome; or
(c) suffering a specified psychiatric condition within the six months immediately before the clinical worsening of irritable bowel syndrome; or
(d) suffering an episode of severe diarrhoea within the six months immediately before the clinical worsening of irritable bowel syndrome; or
(e) inability to obtain appropriate clinical management for irritable bowel syndrome.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(c) to 5(e) apply only to material contribution to, or aggravation of, irritable bowel syndrome where the person’s irritable bowel syndrome 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.
Other definitions
7. For the purposes of this Statement of Principles:
“a specified psychiatric condition ” means:
(a) a psychiatric condition with features of anxiety, including:
(i) generalised anxiety disorder, ICD code 300.02; or
(ii) panic disorder, ICD code 300.01; or
(iii) adjustment disorder with features of anxiety, ICD code 309.24, 309.28, 309.3, 309.4, or 309.9; or
(iv) post traumatic stress disorder, ICD code 309.81; or
(b) a psychiatric condition with depressive features, including:
(i) major depressive disorder, ICD code 296.2 or 296.3; or
(ii) neurotic depression, ICD code 300.4; or
(iii) other depressive disorders, ICD code 311; or
(iv) adjustment disorder with depressed mood, ICD code 309.0, 309.1, 309.4 or 309.28;
“episode of severe diarrhoea” means the acute onset of an illness characterised by the passage of frequent loose watery motions accompanied by a marked urgency to defaecate, caused by an infective organism, and of sufficient severity to warrant medical attention, or in the absence of medical intervention, lasting at least four days;
“ICD code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;
“relevant service” means:
(a) eligible war service (other than operational service); or
(b) defence service (other than hazardous service).
Dated this Sixteenth day of August 1996
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of )
KEN DONALD
CHAIRMAN