Statement of Principles concerning cholelithiasis (Balance of Probabilities) (No. 52 of 2016) (Cth)

Statement of Principles concerning CHOLELITHIASIS (Balance of Probabilities) (No. 52 of 2016) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 22 April 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 cholelithiasis (Balance of Probabilities) (No. 52 of 2016). 2 Commencement This instrument commences on 23 May 2016. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning cholelithiasis No. 8 of 2008 made under subsection 196B(3) of the VEA is revoked. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 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 cholelithiasis and death from cholelithiasis. Meaning of cholelithiasis (2) For the purposes of this Statement of Principles, cholelithiasis means the aggregation of bile constituents into a stone or calculus with a diameter exceeding two millimetres, in the gallbladder or in the intrahepatic or extrahepatic bile ducts; and which may present as biliary colic. (3) While cholelithiasis attracts ICD‑10‑AM code K80, in applying this Statement of Principles the meaning of cholelithiasis 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 cholelithiasis (5) For the purposes of this Statement of Principles, cholelithiasis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cholelithiasis. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that cholelithiasis and death from cholelithiasis can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, cholelithiasis or death from cholelithiasis is connected with the circumstances of a person's relevant service: (1) being obese for at least the five years before the clinical onset of cholelithiasis; Note: being obese is defined in the Schedule 1 - Dictionary. (2) having rapid and extreme weight loss within the one year before the clinical onset of cholelithiasis; Note: rapid and extreme weight loss is defined in the Schedule 1 - Dictionary. (3) having a very low calorie diet for the one year before the clinical onset of cholelithiasis; Note: very low calorie diet is defined in the Schedule 1 - Dictionary. (4) undergoing bariatric surgery within the two years before the clinical onset of cholelithiasis; Note: bariatric surgery is defined in the Schedule 1 - Dictionary. (5) taking a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least six months before the clinical onset of cholelithiasis, and where treatment has ceased, the clinical onset of cholelithiasis has occurred within three months of cessation; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (6) having cirrhosis of the liver at the time of the clinical onset of cholelithiasis; (7) having a haemolytic disease at the time of the clinical onset of cholelithiasis; Note: haemolytic disease is defined in the Schedule 1 - Dictionary. (8) having Crohn's disease at the time of the clinical onset of cholelithiasis; Note: Crohn's disease is defined in the Schedule 1 - Dictionary. (9) having an ileal resection or ileal bypass before the clinical onset of cholelithiasis; (10) having type 2 diabetes mellitus at the time of the clinical onset of cholelithiasis; Note: type 2 diabetes mellitus is defined in the Schedule 1 - Dictionary. (11) having total parenteral nutrition for a continuous period of at least three weeks before the clinical onset of cholelithiasis, and where total parenteral nutrition has ceased, the clinical onset of cholelithiasis has occurred within 30 days of cessation; Note: total parenteral nutrition is defined in the Schedule 1 - Dictionary. (12) being pregnant within the three months before the clinical onset of cholelithiasis; (13) having estrogen therapy for a continuous period of at least six months before the clinical onset of cholelithiasis, and where estrogen therapy has ceased, the clinical onset of cholelithiasis has occurred within three months of cessation; Note: estrogen therapy is defined in the Schedule 1 - Dictionary. (14) having a spinal cord injury at the time of the clinical onset of cholelithiasis; Note: spinal cord injury is defined in the Schedule 1 - Dictionary. (15) having a gastric or oesophageal resection, or another operation that included a vagotomy, before the clinical onset of cholelithiasis; (16) having a foreign body in the biliary tract, or a mechanical obstruction of the biliary tract, before the clinical onset of cholelithiasis; Note: foreign body and mechanical obstruction of the biliary tract are defined in the Schedule 1 - Dictionary. (17) having a parasitic disease from the specified list of parasitic diseases of the biliary tract, at the time of the clinical onset of cholelithiasis; Note: specified list of parasitic diseases is defined in the Schedule 1 - Dictionary. (18) having cholangiohepatitis or recurrent pyogenic cholangitis at the time of the clinical onset of cholelithiasis; (19) having a somatostatinoma at the time of the clinical onset of cholelithiasis; Note: somatostatinoma is defined in the Schedule 1 - Dictionary. (20) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of cholelithiasis; Note: MET is defined in the Schedule 1 - Dictionary. (21) being obese for at least the five years before the clinical worsening of cholelithiasis; Note: being obese is defined in the Schedule 1 - Dictionary. (22) having rapid and extreme weight loss within the one year before the clinical worsening of cholelithiasis; Note: rapid and extreme weight loss is defined in the Schedule 1 - Dictionary. (23) having a very low calorie diet for a continuous period of the one year before the clinical worsening of cholelithiasis; Note: very low calorie diet is defined in the Schedule 1 - Dictionary. (24) undergoing bariatric surgery within the two years before the clinical worsening of cholelithiasis; Note: bariatric surgery is defined in the Schedule 1 - Dictionary. (25) taking a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least six months before the clinical worsening of cholelithiasis, and where treatment has ceased, the clinical worsening of cholelithiasis has occurred within three months of cessation; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (26) having cirrhosis of the liver at the time of the clinical worsening of cholelithiasis; (27) having a haemolytic disease at the time of the clinical worsening of cholelithiasis; Note: haemolytic disease is defined in the Schedule 1 - Dictionary. (28) having Crohn's disease at the time of the clinical worsening of cholelithiasis; Note: Crohn's disease is defined in the Schedule 1 - Dictionary. (29) having an ileal resection or ileal bypass before the clinical worsening of cholelithiasis; (30) having type 2 diabetes mellitus at the time of the clinical worsening of cholelithiasis; Note: type 2 diabetes mellitus is defined in the Schedule 1 - Dictionary. (31) having total parenteral nutrition for a continuous period of at least three weeks before the clinical worsening of cholelithiasis, and where total parenteral nutrition has ceased, the clinical worsening of cholelithiasis has occurred within 30 days of cessation; Note: total parenteral nutrition is defined in the Schedule 1 - Dictionary. (32) being pregnant within the three months before the clinical worsening of cholelithiasis; (33) having estrogen therapy for a continuous period of at least six months before the clinical worsening of cholelithiasis, and where estrogen therapy has ceased, the clinical worsening of cholelithiasis has occurred within three months of cessation; Note: estrogen therapy is defined in the Schedule 1 - Dictionary. (34) having a spinal cord injury at the time of the clinical worsening of cholelithiasis; Note: spinal cord injury is defined in the Schedule 1 - Dictionary. (35) having a gastric or oesophageal resection, or another operation that included a vagotomy, before the clinical worsening of cholelithiasis; (36) having a foreign body in the biliary tract, or a mechanical obstruction of the biliary tract, before the clinical worsening of cholelithiasis; Note: foreign body and mechanical obstruction of the biliary tract are defined in the Schedule 1 - Dictionary. (37) having a parasitic disease from the specified list of parasitic diseases of the biliary tract, at the time of the clinical worsening of cholelithiasis; Note: specified list of parasitic diseases is defined in the Schedule 1 - Dictionary. (38) having cholangiohepatitis or recurrent pyogenic cholangitis at the time of the clinical worsening of cholelithiasis; (39) having a somatostatinoma at the time of the clinical worsening of cholelithiasis; Note: somatostatinoma is defined in the Schedule 1 - Dictionary. (40) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of cholelithiasis; Note: MET is defined in the Schedule 1 - Dictionary. (41) inability to obtain appropriate clinical management for cholelithiasis. 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(21) to 9(41) apply only to material contribution to, or aggravation of, cholelithiasis where the person's cholelithiasis 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(3) 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.