Statement of Principles

concerning

DIVERTICULAR DISEASE OF THE COLON
(Reasonable Hypothesis)

(No. 15 of 2016)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans’ Entitlements Act 1986.

Dated 4               March 2016

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO

Chairperson

Contents

1 Name

2 Commencement

3 Authority

4 Revocation

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning diverticular disease of the colon (Reasonable Hypothesis) (No. 15 of 2016).

2               Commencement

              This instrument commences on 4 April 2016.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.

4               Revocation

The Statement of Principles concerning diverticular disease of the colon No. 13 of 2008, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about diverticular disease of the colon and death from diverticular disease of the colon.

Meaning of diverticular disease of the colon

(2)          For the purposes of this Statement of Principles, diverticular disease of the colon means:

(a)          acquired herniations of the mucosa of the colon through the muscular layers of the bowel wall, which may manifest without inflammation, as diverticulosis, or with inflammation, as diverticulitis; and

(b)          includes diverticular bleeding, perforation of a diverticulum, diverticular abscess and diverticulitis complicated by fistula.

(3)          While diverticular disease of the colon attracts ICD‑10‑AM code K57.2 or K57.3, in applying this Statement of Principles the meaning of diverticular disease of the colon is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.

Death from diverticular disease of the colon

(5)          For the purposes of this Statement of Principles, diverticular disease of the colon, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s diverticular disease of the colon.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that diverticular disease of the colon and death from diverticular disease of the colon 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 MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diverticular disease of the colon or death from diverticular disease of the colon with the circumstances of a person’s relevant service:

(1)          having systemic sclerosis before the clinical onset of diverticular disease of the colon;

(2)          smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of diverticular disease of the colon, and where smoking has ceased, the clinical onset of diverticular disease of the colon has occurred within ten years of cessation;

Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.             

(3)          being overweight for at least the five years before the clinical onset of diverticular disease of the colon;

Note:  being overweight is defined in the Schedule 1 - Dictionary.             

(4)          an inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of diverticular disease of the colon;

Note: MET is defined in the Schedule 1 - Dictionary.

(5)          an inability to consume an average daily intake of at least 30 grams of fibre in food for a period of at least five consecutive years within the ten years before the clinical onset of diverticular disease of the colon;

Note: fibre in food is defined in the Schedule 1 - Dictionary.             

(6)          consuming an average daily intake of at least 200 grams of red meat, for at least the five years before the clinical onset of diverticular disease of the colon;

Note: red meat is defined in the Schedule 1 - Dictionary.             

(7)          drinking at least 180 kilograms of alcohol within the ten year period before the clinical onset of diverticular disease of the colon;

Note: alcohol is defined in the Schedule 1 - Dictionary.

(8)          for diverticular bleeding, perforation, abscess and fistula only, using a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin and paracetamol, for a continuous period of at least four weeks before the clinical onset of diverticular disease of the colon, where the last dose of the drug within that period was taken within the seven days before the clinical onset of diverticular disease of the colon;

(9)          for diverticular bleeding only, being treated with an antiplatelet agent before the clinical onset of diverticular disease of the colon, where the last dose of the antiplatelet agent was taken within the seven days before the clinical onset of diverticular disease of the colon;

Note: antiplatelet agent is defined in the Schedule 1 - Dictionary.

(10)      smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of diverticular disease of the colon, and where smoking has ceased, the clinical worsening of diverticular disease of the colon has occurred within ten years of cessation;

Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.             

(11)      being overweight for at least the five years before the clinical worsening of diverticular disease of the colon;

Note:  being overweight is defined in the Schedule 1 - Dictionary.

(12)      an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of diverticular disease of the colon;

Note: MET is defined in the Schedule 1 - Dictionary.

(13)      using a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin and paracetamol, for a continuous period of at least four weeks before the clinical worsening of diverticular disease of the colon, where the last dose of the drug within that period was taken within the seven days before the clinical worsening of diverticular disease of the colon;

(14)      being treated with an antiplatelet agent before the clinical worsening of diverticular disease of the colon, where the last dose of the antiplatelet agent was taken within the seven days before the clinical worsening of diverticular disease of the colon;

Note: antiplatelet agent is defined in the Schedule 1 - Dictionary.

(15)      using a drug belonging to the opioid class of drugs for a continuous period of at least four weeks before the clinical worsening of diverticular disease of the colon, where the last dose of the opioid within that period was taken within the seven days before the clinical worsening of diverticular disease of the colon;

(16)      being treated with an immunosuppressive drug for at least the four weeks before the clinical worsening of diverticular disease of the colon;

Note:  being treated with an immunosuppressive drug is defined in the Schedule 1 - Dictionary.

(17)      inhaling at least 1 600 micrograms of budesonide, or equivalent inhaled glucocorticoid, daily, for at least the six months before the clinical worsening of diverticular disease of the colon;

Note: equivalent inhaled glucocorticoid is defined in the Schedule 1 - Dictionary.

(18)      undergoing solid organ or bone marrow transplantation before the clinical worsening of diverticular disease of the colon;

(19)      having chronic kidney disease at the time of the clinical worsening of diverticular disease of the colon;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

(20)      inability to obtain appropriate clinical management for diverticular disease of the colon.

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(10) to 9(20) apply only to material contribution to, or aggravation of, diverticular disease of the colon where the person’s diverticular disease of the colon was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                             abnormality of kidney structure or function means:

(a)          having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or

(b)          having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or

(c)          having had a kidney transplant.

                             alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

                             antiplatelet agent means a pharmacological agent that blocks platelet adhesion or aggregation, including aspirin, clopidogrel, dipyridamole, monoclonal antibodies and peptides.

                             being overweight means having a Body Mass Index (BMI) of 25 or greater.

Note: BMI is also defined in the Schedule 1 - Dictionary.

                               being treated with an immunosuppressive drug means being treated with a drug or agent which results in substantial suppression of immune responses.  This definition includes systemic corticosteroids other than inhaled or topical corticosteroids, drugs used to prevent transplant rejection, tumour necrosis factor-α inhibitors and chemotherapeutic agents used for the treatment of cancer.

                               BMI means W/H2 and where:

W is the person's weight in kilograms; and

H is the person's height in metres.

                             chronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.

Note: abnormality of kidney structure or function is also defined in the Schedule 1 - Dictionary.

                             diverticular disease of the colon—see subsection 7(2).

                             equivalent inhaled glucocorticoid means:

(a)          640 micrograms of ciclesonide; or

(b)          800 micrograms of beclomethasone; or

(c)          800 micrograms of fluticasone propionate; or

(d)          a therapeutically equivalent dose of another inhaled glucocorticoid.

                             fibre in food means complex carbohydrates of plant origin consumed as vegetables, fruits or cereals which resist digestion by gastrointestinal enzymes in the gastrointestinal tract, and include plant cell walls and non-starch polysaccharides from sources other than cell walls, including cellulose and pectins.

                             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, 1.0 kcal/kg of body weight per hour or resting metabolic rate.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             pack-years 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 7 300 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 mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.

                             red meat means all types of mammalian muscle meat, such as beef, veal, pork, lamb, mutton, horse and goat.

                             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 the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.