Statement of Principles

concerning

CHRONIC PANCREATITIS
(Reasonable Hypothesis)

(No. 64 of 2020)

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

Dated 28 August 2020

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

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 chronic pancreatitis (Reasonable Hypothesis) (No. 64 of 2020).

2               Commencement

              This instrument commences on 28 September 2020.

3               Authority

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

4               Repeal

The Statement of Principles concerning chronic pancreatitis No. 104 of 2011 (Federal Register of Legislation No. F2011L01735) made under subsections 196B(2) and (8) of the VEA is repealed.

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 chronic pancreatitis and death from chronic pancreatitis.

Meaning of chronic pancreatitis

(2)          For the purposes of this Statement of Principles, chronic pancreatitis means a progressive inflammatory disease of the pancreas resulting in irreversible morphological change with parenchymal damage and fibrosis of the organ.

Note: Chronic pancreatitis typically presents with abdominal pain, malnutrition and loss of exocrine and endocrine pancreatic function.

(3)          While chronic pancreatitis attracts ICD‑10‑AM code K86.0 or K86.1, in applying this Statement of Principles the meaning of chronic pancreatitis 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from chronic pancreatitis

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

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 chronic pancreatitis and death from chronic 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 MRCA.

Note: MRCA, relevant service and VEA are 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 chronic pancreatitis or death from chronic pancreatitis with the circumstances of a person's relevant service:

(1)          having smoked at least 20 pack-years of tobacco products before the clinical onset of chronic pancreatitis, and where smoking has ceased, the clinical onset of chronic pancreatitis has occurred within ten years of cessation;

Note:  pack-year of tobacco products is defined in the Schedule 1 - Dictionary.               

(2)          having consumed a cumulative total of at least 90 kilograms of alcohol within any five year period before the clinical onset of chronic pancreatitis and where alcohol consumption has ceased, the clinical onset of chronic pancreatitis has occurred within ten years of cessation;

Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

(3)          undergoing a course of therapeutic radiation for cancer, where the pancreas was in the field of radiation, at least one year before the clinical onset of chronic pancreatitis;

(4)          having complete or partial obstruction of the ductal system draining the secretions of the exocrine pancreas at the time of the clinical onset of chronic pancreatitis;

(5)          having cholelithiasis at the time of the clinical onset of chronic pancreatitis;

(6)          having hyperparathyroidism at the time of the clinical onset of chronic pancreatitis;

(7)          having hypertriglyceridaemia resulting in triglyceride levels above 11.3 millimoles per litre (or 1,000 milligrams per decilitre) at the time of the clinical onset of chronic pancreatitis;

(8)          having an episode of acute pancreatitis before the clinical onset of chronic pancreatitis;

(9)          having chronic renal failure before the clinical onset of chronic pancreatitis;

Note: chronic renal failure is defined in the Schedule 1 - Dictionary.             

(10)      inability to obtain appropriate clinical management for chronic pancreatitis.

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 factor set out in subsection 9(10) applies only to material contribution to, or aggravation of, chronic pancreatitis where the person's chronic pancreatitis 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:

                             chronic pancreatitis—see subsection 7(2).

                               chronic renal failure means:

(a)          having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or

(b)          a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or

(c)          undergoing chronic dialysis.

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                             pack-year of tobacco products means:

(a)          20 cigarettes per day for a period of one calendar year; or

(b)           7,300 cigarettes in a period of one calendar year; or

(c)          7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same, in a period of one calendar year.

                               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.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               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.