Statement of Principles
concerning
 
INFLAMMATORY BOWEL DISEASE
No. 19 of 2012
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1.         This Instrument may be cited as Statement of Principles concerning inflammatory bowel disease No. 19 of 2012.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 21 of 2001 concerning inflammatory bowel disease; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (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 a chronic, autoimmune disorder of the gastrointestinal tract, characterised by diarrhoea and abdominal pain and sometimes associated with extra-intestinal manifestations, including peripheral arthritis, episcleritis, aphthous stomatitis, erythema nodosum and pyoderma gangrenosum. This definition includes ulcerative colitis, Crohn's disease and inflammatory bowel disease of unspecified type, but excludes bowel inflammation secondary to vascular insufficiency, food allergy, radiation, infection or gastrointestinal toxins.
(c)                Inflammatory bowel disease attracts ICD-10-AM code K50 or K51.
(d)              In the application of this Statement of Principles, the definition of "inflammatory bowel disease" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         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 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.
Factors
6.         The factor 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 is:
(a)                for ulcerative colitis only, in a person with a history of a regular smoking habit,
(i)         ceasing to smoke within the ten years before the clinical onset of inflammatory bowel disease; and
(ii)        continuing not to smoke for the three months before the clinical onset of inflammatory bowel disease; or
(b)               for Crohn’s disease only,
(i)         smoking at least one 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 of inflammatory bowel disease has occurred within four years of cessation; or
(ii)        immersion in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours before the clinical onset of inflammatory bowel disease, and where exposure to tobacco smoke haze has ceased, the clinical onset of inflammatory bowel disease has occurred within four years of cessation of exposure; or
(c)                using the combined oral contraceptive pill for a period of at least six months before the clinical onset of inflammatory bowel disease, and where use of the oral contraceptive pill has ceased, the clinical onset of inflammatory bowel disease has occurred within one year of cessation; or
(d)               being treated with a drug or a drug from a class of drugs in the specified list, for at least the seven days before the clinical onset of inflammatory bowel disease; or
(e)                undergoing solid organ, bone marrow or stem cell transplantation before the clinical onset of inflammatory bowel disease; or
(f)                for Crohn’s disease only,
(i)         smoking at least one 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 of inflammatory bowel disease has occurred within four years of cessation; or
(ii)        immersion in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours before the clinical worsening of inflammatory bowel disease, and where exposure to tobacco smoke haze has ceased, the clinical worsening of inflammatory bowel disease has occurred within four years of cessation of exposure; or
(g)               being treated with a drug or a drug from a class of drugs in the specified list, for at least the seven days before the clinical worsening of inflammatory bowel disease; or
(h)               undergoing solid organ, bone marrow or stem cell transplantation before the clinical worsening of inflammatory bowel disease; or
(i)                 experiencing a category 1A stressor within the three months before the clinical worsening of inflammatory bowel disease; or
(j)                 experiencing a category 1B stressor within the three months before the clinical worsening of inflammatory bowel disease; or
(k)               experiencing a category 2 stressor within the one month before the clinical worsening of inflammatory bowel disease; or
(l)                 having a clinically significant depressive disorder for at least the one year before the clinical worsening of inflammatory bowel disease; or
(m)             having clinical or laboratory evidence of a bowel infection in the one month before the clinical worsening of inflammatory bowel disease; or
(n)               inability to obtain appropriate clinical management for inflammatory bowel disease.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(f) to 6(n) 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.
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.
Other definitions
9.         For the purposes of this Statement of Principles:
"a category 1A stressor" means one or more of the following severe traumatic events:
(a)              experiencing a life-threatening event;
(b)             being subject to a serious physical attack or assault including rape and sexual molestation; or
(c)              being threatened with a weapon, being held captive, being kidnapped, or being tortured;
"a category 1B stressor" means one of the following severe traumatic events:
(a)              being an eyewitness to a person being killed or critically injured;
(b)             viewing corpses or critically injured casualties as an eyewitness;
(c)              being an eyewitness to atrocities inflicted on another person or persons;
(d)             killing or maiming a person; or
(e)              being an eyewitness to or participating in, the clearance of critically injured casualties;
"a category 2 stressor" means one or more of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:
(a)              being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;
(b)              experiencing a problem with a long-term relationship including: the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation, or divorce;
(c)              having concerns in the work or school environment including: on-going disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful work loads, or experiencing bullying in the workplace or school environment;
(d)              experiencing serious legal issues including: being detained or held in custody, on-going involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;
(e)              having severe financial hardship including: loss of employment, long periods of unemployment, foreclosure on a property, or bankruptcy;
(f)               having a family member or significant other experience a major deterioration in their health; or
(g)              being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability;
"a drug or a drug from a class of drugs in the specified list" means:
(a)               interferons;
(b)               isotretinoin;
(c)               non-steroidal anti-inflammatory drugs; or
(d)              tumour necrosis factor antagonists;
"a regular smoking habit" means having smoked at least one pack-year of cigarettes or the equivalent thereof in other tobacco products;
"an eyewitness" means a person who observes an incident first hand and can give direct evidence of it. This excludes a person exposed only to media coverage of the incident;
"clinically significant" means sufficient to warrant ongoing management, which may involve regular visits (for example, at least monthly), to a psychiatrist, counsellor or general practitioner;
"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), Seventh Edition, effective date of 1 July 2010, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 154 5;
"pack-year of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals 20 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)                operational service under the VEA;
(b)                peacekeeping service under the VEA;
(c)                hazardous service under the VEA;
(d)               British nuclear test defence service under the VEA;
(e)                warlike service under the MRCA; or
(f)                 non-warlike service under the MRCA;
"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
10.       This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11.       This Instrument takes effect from 7 March 2012.
Dated this   twenty-fourth   day of   February   2012
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
KEN DONALD
CHAIRPERSON