Statement of Principles
No. 36 of 2013
for the purposes of the
Veterans’ Entitlements Act 1986
Military Rehabilitation and Compensation Act 2004
1. This Instrument may be cited as Statement of Principles concerning colorectal adenoma No. 36 of 2013.
2. The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 63 of 2002 concerning colorectal adenoma; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (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. Anatomically the colorectum is defined as extending 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 and nonepithelial neoplasms of the large intestine.
(c) Colorectal adenoma attracts ICD-10-AM code D12.0-D12.5, D12.7 or D12.8.
(d) In the application of this Statement of Principles, the definition of "colorectal adenoma" is that given at paragraph 3(b) above.
Basis for determining the factors
4. 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 under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
6. The factor 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 is:
(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 ten years before the clinical onset of colorectal adenoma; and
(ii) where smoking has ceased, the clinical onset of colorectal adenoma has occurred within 30 years of cessation; or
(b) drinking at least 500 kilograms of alcohol within any 25 year period before the clinical onset of colorectal adenoma; or
(c) for adenoma of the colon only,
(i) an inability to undertake any physical activity greater than three METs for at least 20 consecutive years within the 30 years before the clinical onset of colorectal adenoma; or
(ii) being obese for at least ten years within the 30 years before the clinical onset of colorectal adenoma; or
(d) inability to obtain appropriate clinical management for colorectal adenoma.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(d) 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.
Inclusion of Statements of Principles
8. 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 as in force from time to time.
9. For the purposes of this Statement of Principles:
"adenoma of the colon" means a benign epithelial neoplasm of the colon. Anatomically the colon is defined as extending from the caecum, including the ileocaecal junction, to the sigmoid colon, not including the rectosigmoid junction;
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;
"being obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of thirty 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), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"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 7300 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 7.3 kilograms 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) under the VEA;
(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c) peacetime service under the MRCA;
"terminal event" means the proximate or ultimate cause of death and includes:
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
10. This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
Date of effect
11. This Instrument takes effect from 3 July 2013.
Dated this twenty-first day of June 2013
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
PROFESSOR NICHOLAS SAUNDERS AO