Statement of Principles concerning malignant neoplasm of the colorectum No. 1 of 2004

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE COLORECTUM

Instrument No. 1 of 2004 as amended

made under section 196B(2) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 6 July 2011 taking into account Amendment of Statement of Principles concerning MALIGNANT NEOPLASM OF THE COLORECTUM (Instrument No. 39 of 2011)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE COLORECTUM

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.58 of 2002; and

(b) determines in its place the following Statement of Principles.

Kind of injury, disease or death

2. (a) This Statement of Principles is about malignant neoplasm of the colorectum and death from malignant neoplasm of the colorectum.

(b)              For the purposes of this Statement of Principles, "malignant neoplasm of the colorectum" means a primary malignant 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 malignant neoplasm of the colorectum excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin’s lymphoma and Hodgkin’s disease.

(c)               Malignant neoplasm of the colorectum attracts ICD-10-AM code C18, C19 or C20.

(d)              In the application of this Statement of Principles, the definition of "malignant neoplasm of the colorectum" is that given at paragraph 2(b) above.

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the colorectum and death from malignant neoplasm of the colorectum 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 factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the colorectum or death from malignant neoplasm of the colorectum with the circumstances of a person’s relevant service is:

(a)               having a colorectal adenoma before the clinical onset of malignant neoplasm of the colorectum; or

(b) smoking at least 15 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of malignant neoplasm of the colorectum, and

(i) smoking commenced at least 20 years before the clinical onset of malignant neoplasm of the colorectum, and

(ii)              where smoking has ceased, the clinical onset has occurred within 30 years of cessation; or

(c) drinking at least 250 kilograms of alcohol within a 25 year period within the 40 years immediately before the clinical onset of malignant neoplasm of the colorectum; or

(d) having an altered dietary pattern resulting in an increase of at least 100 grams in average daily total consumption of unprocessed beef, veal, pork, lamb or mutton for at least 10 years, where the increased consumption of unprocessed beef, veal, pork, lamb or mutton occurred at least 20 years before the clinical onset of malignant neoplasm of the colorectum; or

(e)               having an altered dietary pattern resulting in an increase of at least 25 grams in average daily total consumption of processed meat product for at least 10 years, where the increased consumption of processed meat product occurred at least 20 years before the clinical onset of malignant neoplasm of the colorectum; or

(f)                having ulcerative colitis for at least five years before the clinical onset of malignant neoplasm of the colorectum; or

(g)              having Crohn’s disease of the colorectum for at least five years before the clinical onset of malignant neoplasm of the colorectum; or

(h)              having familial adenomatous polyposis before the clinical onset of malignant neoplasm of the colorectum; or

(i)                having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the colorectum at least five years before the clinical onset of malignant neoplasm of the colorectum; or

(j)                an inability to undertake any physical activity greater than 3 METs for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the colorectum; or

(k)              being obese for at least 15 years before the clinical onset of malignant neoplasm of the colorectum; or

(l)                for malignant neoplasm of the colon only, inhaling respirable asbestos fibres in an enclosed space for a cumulative period of at least 2000 hours:

(i)                at the time material containing asbestos fibres was being applied, removed, dislodged, cut or drilled, and

(ii)             the first inhalation of asbestos fibres commenced at least 10 years

before the clinical onset of malignant neoplasm of the colorectum; or

(m)            an inability to consume an average daily intake of 20 grams of fibre in food (or a total of 36 500 grams of fibre in food) over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum; or

(n)              an inability to consume an average daily intake of 150 micrograms of folate in food (or a total of 0.27 grams of folate in food) over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum; or

(o)              inability to obtain appropriate clinical management for malignant neoplasm of the colorectum.

Factors that apply only to material contribution or aggravation

6. Paragraph 5(o) applies only to material contribution to, or aggravation of, malignant neoplasm of the colorectum where the person’s malignant neoplasm of the colorectum 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:

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

"an enclosed space" means a substantially enclosed area, for example, the interior of a building, ship or aircraft, a covered workshop or factory;

"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;

"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents;

"death from malignant neoplasm of the colorectum" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s malignant neoplasm of the colorectum;

"fibre in food" means the complex carbohydrates of plant origin consumed as vegetables, fruits or cereals which resist digestion by gastrointestinal enzymes in the gastrointestinal tract, and include plant cell walls and non-starch polysaccharides from sources other than cell walls, including cellulose and pectins. This definition does not include fibre in fortified foods or supplements;

"folate in food" means a B group vitamin found in natural foods, which consists of a family of monoglutamates or polyglutamates of pteroic acid that is used in DNA methylation, synthesis and repair. This definition does not include folic acid in fortified foods or supplements;

"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;

"malignant neoplasm of the colon" means a primary malignant neoplasm arising from the epithelial cells of the colon, which extends from the caecum, including the ileocaecal junction, to the sigmoid colon, not including the rectosigmoid junction.  This definition of malignant neoplasm of the colon excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin’s lymphoma and Hodgkin’s disease;

"MET" means 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;

"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;

"processed meat product" means preserved or cured meats, including ham, frankfurters, salami and bacon;

"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.

Notes to Statement of Principles concerning malignant neoplasm of the colorectum (Instrument No. 1 of 2004)

The Statement of Principles concerning malignant neoplasm of the colorectum (Instrument No. 1 of 2004) in force under section 196B(2) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments