Statement of Principles
concerning
 
CHRONIC PRURITUS ANI
No. 75 of 2010
 
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 chronic pruritus ani No. 75 of 2010.
 
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 41 of 1996 concerning pruritus ani; and
(b)       determines in its place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about chronic pruritus ani and death from chronic pruritus ani.
(b)              For the purposes of this Statement of Principles, "chronic pruritus ani" means intense itching affecting the perianal skin of more than six months duration.
 
Basis for determining the factors
4.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that chronic pruritus ani and death from chronic pruritus ani 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 chronic pruritus ani or death from chronic pruritus ani with the circumstances of a person’s relevant service is:
 
(a)               being unable to maintain adequate anal hygiene for at least the 30 days before the clinical onset of chronic pruritus ani; or
 
(b)              having diarrhoea daily, for at least the seven days before the clinical onset of chronic pruritus ani; or
 
(c)              having a rectal or anal condition from the specified list at the time of the clinical onset of chronic pruritus ani; or
 
(d)              having a perianal or anal infection with an agent from the specified list of infections, at the time of the clinical onset of chronic pruritus ani; or
 
(e)              having a local perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical onset of chronic pruritus ani; or
 
(f)               having a pathological vaginal discharge at the time of the clinical onset of chronic pruritus ani; or
 
(g)              having a dermatological disease from the specified list affecting the perianal or anal region at the time of the clinical onset of chronic pruritus ani; or
 
(h)              undergoing a course of therapeutic radiation to the perianal area, within the 30 days before the clinical onset of chronic pruritus ani; or
 
(i)                having corticosteroid related atrophy of the perianal skin at the time of the clinical onset of chronic pruritus ani; or
 
(j)                being systemically treated with water-soluble corticosteroid phosphates within the 24 hours before the clinical onset of chronic pruritus ani; or
 
(k)              being treated with nicosamide, clioquinol or mineral oil within the 72 hours before the clinical onset of chronic pruritus ani; or
 
(l)                having a systemic disease from the specified list at the time of the clinical onset of chronic pruritus ani; or
 
(m)            being unable to maintain adequate anal hygiene for at least the 30 days before the clinical worsening of chronic pruritus ani; or
 
(n)              having diarrhoea daily, for at least the seven days before the clinical worsening of chronic pruritus ani; or
 
(o)              having a rectal or anal condition from the specified list at the time of the clinical worsening of chronic pruritus ani; or
 
(p)              having a perianal or anal infection with an agent from the specified list of infections, at the time of the clinical worsening of chronic pruritus ani; or
 
(q)              having a local perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical worsening of chronic pruritus ani; or
 
(r)               having a pathological vaginal discharge at the time of the clinical worsening of chronic pruritus ani; or
 
(s)               having a dermatological disease from the specified list affecting the perianal or anal region at the time of the clinical worsening of chronic pruritus ani; or
 
(t)                undergoing a course of therapeutic radiation to the perianal area within the 30 days before the clinical worsening of chronic pruritus ani; or
 
(u)              having corticosteroid related atrophy of the perianal skin at the time of the clinical worsening of chronic pruritus ani; or
 
(v)               being systemically treated with water-soluble corticosteroid phosphates within the 24 hours before the clinical worsening of chronic pruritus ani; or
 
(w)             being treated with nicosamide, clioquinol or mineral oil within the 72 hours before the clinical worsening of chronic pruritus ani; or
 
(x)              having a systemic disease from the specified list at the time of the clinical worsening of chronic pruritus ani; or
 
(y)              inability to obtain appropriate clinical management for chronic pruritus ani.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(m) to 6(y) apply only to material contribution to, or aggravation of, chronic pruritus ani where the person’s chronic pruritus ani 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 course of therapeutic radiation" means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;
 
"a dermatological disease from the specified list" means any of the following:
(a)                atopic dermatitis;
(b)               contact dermatitis;
(c)                lichen planus;
(d)               lichen sclerosus et atrophicus;
(e)                neurodermatitis;
(f)                 psoriasis; or
(g)                seborrhoeic dermatitis;
 
"a pathological vaginal discharge" means a discharge of fluid from the vagina due to one of the following diseases: vulvovaginal candidiasis, trichomonal vaginitis, bacterial vaginosis, chlamydia trachomatis cervicitis or gonorrhoea of the lower genitourinary tract;
 
"a rectal or anal condition from the specified list" means any of the following:
(a)                anal fissure;
(b)               anal fistula;
(c)                anal skin tags;
(d)               anal sphincter incompetence;
(e)                basal cell carcinoma of the anal or perianal region;
(f)                 Bowen's disease of the anal or perianal region;
(g)                colorectal adenoma;
(h)                familial adenomatous polyposis;
(i)                  haemorrhoids;
(j)                 inflammatory bowel disease;
(k)               Kaposi's sarcoma of the anal or perianal region;
(l)                  malignant melanoma of the anal or perianal region;
(m)              malignant neoplasm of the rectum;
(n)                Paget's disease of the anal or perianal region;
(o)               squamous cell carcinoma of the anal or perianal region; or
(p)               the presence of secondary tumour deposits in the anal or perianal region from any primary malignant neoplasm;
 
"a systemic disease from the specified list" means any of the following:
(a)                aplastic anaemia;
(b)               diabetes mellitus;
(c)                hyperbilirubinaemia;
(d)               hyperthyroidism;
(e)                iron deficiency anaemia;
(f)                 leukaemia;
(g)                liver failure;
(h)                lymphoma; or
(i)                  renal failure;
 
"adequate anal hygiene" means the personal maintenance of cleanliness of the perianal area by wiping with paper or washing with water;
 
"an agent from the specified list of infections" means any of the following:
(a)                Candida albicans;
(b)               Corynebacterium spp;
(c)                Neisseria gonorrhoeae (gonorrhoea);
(d)               herpes simplex virus;
(e)                human papilloma virus;
(f)                 Staphylococcus spp;
(g)                Streptococcus spp;
(h)                Treponeum pallidum (syphilis); or
(i)                  Tinea corporis (tinea);
 
"an agent from the specified list of infestations" means any of the following:
(a)                Enterobius vermicularis (pin worm);
(b)               Phthirus pubis or Pediculosis humanus (lice);
(c)                Sarcoptes scabiei (scabies); or
(d)               Strongyloides stercoralis (strongyloides);
 
"death from chronic pruritus ani" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s chronic pruritus ani;
 
"diarrhoea" means predominantly liquid faecal discharge;
 
"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 1 September 2010.
 
Dated this       eighteenth     day of              August               2010
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON