Statement of Principles
concerning
ACUTE PANCREATITIS
No. 85 of 2011
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 acute pancreatitis No. 85 of 2011.
Determination
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 45 of 1997, as amended by Instrument No. 74 of 1998 and Instrument No. 41 of 2003, concerning acute pancreatitis; and
(b) determines in their place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about acute pancreatitis and death from acute pancreatitis.
(b) For the purposes of this Statement of Principles, "acute pancreatitis" means an acute inflammatory condition due to auto-digestion of pancreatic tissue by its own enzymes, typically presenting with abdominal pain, and usually associated with raised levels of pancreatic enzymes in blood or urine.
(c) Acute pancreatitis attracts ICD-10-AM code K85.
(d) In the application of this Statement of Principles, the definition of "acute pancreatitis" 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 acute pancreatitis and death from acute pancreatitis 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 acute pancreatitis or death from acute pancreatitis with the circumstances of a person’s relevant service is:
(a) having cholelithiasis at the time of the clinical onset of acute pancreatitis; or
(b) having biliary microlithiasis or biliary sludge at the time of the clinical onset of acute pancreatitis; or
(c) drinking at least 36 kilograms of alcohol within any two year period, and continuing to consume alcohol at the time of the clinical onset of acute pancreatitis; or
(d) having an acute infection with an organism from the specified list at the time of the clinical onset of acute pancreatitis; or
(e) having ascariasis or clonorchiasis at the time of the clinical onset of acute pancreatitis; or
(f) being infected with human immunodeficiency virus at the time of the clinical onset of acute pancreatitis; or
(g) having pancreatic outflow obstruction due to a disorder from the specified list at the time of the clinical onset of acute pancreatitis; or
(h) being treated with a drug from the specified table at the time of the clinical onset of acute pancreatitis; or
(i) being treated with a drug which is associated in the individual with:
(i) the development of the symptoms or signs of acute pancreatitis within two months of commencing drug therapy; and
(ii) the cessation of the symptoms or signs of acute pancreatitis within weeks of discontinuing drug therapy; and
(iii) an absence of clinical or laboratory evidence of acute pancreatitis prior to beginning drug therapy; and
where treatment with the drug continued for at least the three days before the clinical onset of acute pancreatitis; or
(j) smoking at least 15 pack-years of cigarettes or the equivalent thereof in other tobacco products, before the clinical onset of acute pancreatitis, and where smoking has ceased, the clinical onset has occurred within ten years of cessation; or
(k) undergoing intra-abdominal or intrathoracic surgery within the 30 days before the clinical onset of acute pancreatitis; or
(l) undergoing solid organ transplantation before the clinical onset of acute pancreatitis; or
(m) having penetrating or major blunt trauma to the upper abdomen within the seven days before the clinical onset of acute pancreatitis; or
(n) undergoing endoscopic retrograde cholangio-pancreatography, endoscopic sphincterotomy of the sphincter of Oddi or manometry of the sphincter of Oddi within the seven days before the clinical onset of acute pancreatitis; or
(o) having hypertriglyceridaemia resulting in triglyceride levels above 1000 milligrams per decilitre (or 11.3 millimoles per litre) at the time of the clinical onset of acute pancreatitis; or
(p) having hypercalcaemia at the time of the clinical onset of acute pancreatitis; or
(q) having a disease from the specified list at the time of the clinical onset of acute pancreatitis; or
(r) envenomation by a snake or scorpion from the specified list within the seven days before the clinical onset of acute pancreatitis; or
(s) having acute toxicity after oral ingestion of mushrooms containing alpha-amanitin within the seven days before the clinical onset of acute pancreatitis; or
(t) ingesting an agent from the specified list and experiencing acute toxicity within the seven days before the clinical onset of acute pancreatitis; or
(u) having a disorder resulting in disseminated intravascular coagulation and/or profound systemic hypotension with pancreatic acinar damage within the seven days before the clinical onset of acute pancreatitis; or
(v) having a course of peritoneal dialysis for renal disease at the time of the clinical onset of acute pancreatitis; or
(w) inability to obtain appropriate clinical management for acute pancreatitis.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(w) applies only to material contribution to, or aggravation of, acute pancreatitis where the person’s acute pancreatitis 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 disease from the specified list" means:
(a) Henoch-Schönlein purpura;
(b) inflammatory bowel disease;
(c) microangiopathic haemolytic anaemia;
(d) microscopic polyangiitis;
(e) polyarteritis nodosa; or
(f) systemic lupus erythematosus;
"a snake or scorpion from the specified list" means:
(a) Cerastes cerastes;
(b) Tityus asthenes;
(c) Tityus trinitatis; or
(d) Viperidae family;
"acute infection with an organism from the specified list" means serological and/or clinical evidence of acute infection with one or more of the following:
(a) coxsackievirus;
(b) Cryptosporidium;
(c) cytomegalovirus;
(d) Epstein-Barr virus;
(e) hepatitis A virus;
(f) hepatitis B virus;
(g) hepatitis C virus;
(h) hepatitis E virus;
(i) herpes simplex virus;
(j) Legionella spp;
(k) Leptospira spp;
(l) measles virus;
(m) mumps virus;
(n) Mycobacterium avium;
(o) Mycobacterium tuberculosis;
(p) Mycoplasma pneumoniae;
(q) Salmonella enterica;
(r) Salmonella bongori; or
(s) varicella-zoster virus;
"alpha-amanitin" means the cyclopeptide toxin present in some mushrooms such as Amanita phalloides which produces amanita poisoning;
"an agent from the specified list" means:
(a) carbamate insecticide;
(b) methyl alcohol;
(c) organophosphorous insecticide; or
(d) paracetamol in overdose;
"being treated with a drug from the specified table" means being treated with any drug listed in column 2 of the following table:
Class
Drug
Cardiovascular
ACE inhibitors
Captopril, enalapril, lisinopril, ramipril
Angiotensin receptor blockers
Losartan
Centrally acting agents
Methyldopa
Loop diuretics
Furosemide
Thiazide diuretics
Chlorothiazide, hydrochlorothiazide
Anti-arrhythmics
Amiodarone
HMG-CoA reductase inhibitors
Simvastatin, pravastatin, fluvastatin
Other cholesterol lowering drugs
Bezafibrate
Antimicrobial
Antibacterials
Tetracycline, metronidazole, dapsone, cotrimoxazole, nitrofurantoin, clarithromycin, erythromycin
Antituberculars
Isoniazid
Antivirals
Nelfinavir, lamivudine, didanosine, interferon/ribavirin
Others
Pentamidine, sodium stibogluconate, meglumine antimonite
Gastrointestinal
Acid suppressants
Cimetidine, ranitidine, omeprazole
IBD drugs
Azathioprine, mercaptopurine, mesalamine, olsalazine, sulphasalazine
Neuropsychiatric
Anticonvulsants
Valproic acid
Antipsychotics
Clozapine
Hormone-related
Oestrogens
Conjugated oestrogen, clomifene, premarin, tamoxifen
Anti-thyroid agents
Thimazole, carbimazole
Oncological
Alkylating agents
Ifosfamide
Antimetabolites
Cytarabine
Other
Asparaginase
Analgesic
Opioids
Codeine
NSAIDs
Sulindac, naproxen, ketoprofen
Other
Marijuana, isotretinoin, pyritinol, IV or oral corticosteroid, propofol
"biliary microlithiasis or biliary sludge" means the presence of small stones (1-2 mm) due to aggregation of bile constituents into a stone or calculus or a collection of crystals, glycoproteins, protein, cellular debris and mucin in the biliary tract;
"death from acute pancreatitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s acute pancreatitis;
"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-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 7300 cigarettes, or 7.3 kilograms of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;
"pancreatic outflow obstruction due to a disorder from the specified list" means a demonstrated obstruction to the pancreatic ductal system and may be caused by the following disorders:
(a) ampullary, duodenal or pancreatic tumours (primary or secondary tumours);
(b) choledococoele; or
(c) periampullary duodenal diverticula;
"relevant service" means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) warlike service under the MRCA; or
(e) 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 13 July 2011.
Dated this first day of July 2011
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRPERSON
