Statement of Principles concerning haemorrhoids (Reasonable Hypothesis) (No. 3 of 2017) (Cth)

Statement of Principles concerning HAEMORRHOIDS (Reasonable Hypothesis) (No. 3 of 2017) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 20 December 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 haemorrhoids (Reasonable Hypothesis) (No. 3 of 2017). 2 Commencement This instrument commences on 23 January 2017. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning haemorrhoids No. 41 of 2008 made under subsection 196B(2) 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 haemorrhoids and death from haemorrhoids. Meaning of haemorrhoids (2) For the purposes of this Statement of Principles, haemorrhoids means: (a) inflammation, bleeding, thrombosis, prolapse or symptomatic enlargement of the haemorrhoidal cushions; and (b) excludes anorectal varices. (3) While haemorrhoids attracts ICD‑10‑AM code K64, O22.4 or O87.2, in applying this Statement of Principles the meaning of haemorrhoids 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 haemorrhoids (5) For the purposes of this Statement of Principles, haemorrhoids, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's haemorrhoids. 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 haemorrhoids and death from haemorrhoids 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 haemorrhoids or death from haemorrhoids with the circumstances of a person's relevant service: (1) being pregnant within the six weeks before the clinical onset of haemorrhoids; (2) straining at stool due to constipation or diarrhoea, within the two weeks before the clinical onset of haemorrhoids; (3) having a spinal cord injury at the time of the clinical onset of haemorrhoids; Note: spinal cord injury is defined in the Schedule 1 - Dictionary. (4) being obese at the time of the clinical onset of haemorrhoids; Note: being obese is defined in the Schedule 1 - Dictionary. (5) having a pelvic space occupying lesion of sufficient size to impinge on the haemorrhoidal veins at the time of the clinical onset of haemorrhoids; (6) an inability to consume an average daily intake of 20 grams of fibre in food for at least the three months before the clinical onset of haemorrhoids; Note: fibre in food is defined in the Schedule 1 - Dictionary. (7) having irritable bowel syndrome for at least the three months before the clinical onset of haemorrhoids; (8) chewing khat at least weekly, for at least the three months before the clinical onset of haemorrhoids; (9) being pregnant within the six weeks before the clinical worsening of haemorrhoids; (10) straining at stool due to constipation or diarrhoea, within the two weeks before the clinical worsening of haemorrhoids; (11) having a spinal cord injury at the time of the clinical worsening of haemorrhoids; Note: spinal cord injury is defined in the Schedule 1 - Dictionary. (12) being obese at the time of the clinical worsening of haemorrhoids; Note: being obese is defined in the Schedule 1 - Dictionary. (13) having a pelvic space occupying lesion of sufficient size to impinge on the haemorrhoidal veins at the time of the clinical worsening of haemorrhoids; (14) an inability to consume an average daily intake of 20 grams of fibre in food for at least the four weeks before the clinical worsening of haemorrhoids; Note: fibre in food is defined in the Schedule 1 - Dictionary. (15) having irritable bowel syndrome for at least the four weeks before the clinical worsening of haemorrhoids; (16) chewing khat at least weekly, for at least the three months before the clinical worsening of haemorrhoids; (17) for haemorrhoidal bleeding only, taking a drug from a class of drugs from the specified list of drugs, within the 30 days before the clinical worsening of haemorrhoids; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (18) having receptive anal intercourse within the 48 hours before the clinical worsening of haemorrhoids; (19) inability to obtain appropriate clinical management for haemorrhoids. 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(9) to 9(19) apply only to material contribution to, or aggravation of, haemorrhoids where the person's haemorrhoids 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.