Statement of Principles
concerning
 
INFLAMMATORY BOWEL DISEASE
No. 20 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. 20 of 2012.
Determination
2.         The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 22 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.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that inflammatory bowel disease and death from inflammatory bowel disease 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.
Factors
6.         The factor that must exist before it can be said that, on the balance of probabilities, inflammatory bowel disease or death from inflammatory bowel disease is connected 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 five 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, smoking at least two pack-years 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
(c)               using the combined oral contraceptive pill for a period of at least one year 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, smoking at least two pack-years 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
(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)                 having clinical or laboratory evidence of a bowel infection in the one month before the clinical worsening of inflammatory bowel disease; or
(j)                 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(j) 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 drug or a drug from a class of drugs in the specified list" means:
(a)               isotretinoin;
(b)               non-steroidal anti-inflammatory drugs; or
(c)               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;
"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)        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:
(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 120B of the VEA or section 339 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