Statement of Principles concerning MESENTERIC PANNICULITIS (Balance of Probabilities) (No. 50 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 27 April 2018 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factor that must exist 9 Relationship to service Schedule 1 - Dictionary 1 Definitions 1 Name This is the Statement of Principles concerning mesenteric panniculitis (Balance of Probabilities) (No. 50 of 2018). 2 Commencement This instrument commences on 28 May 2018. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about mesenteric panniculitis and death from mesenteric panniculitis. Meaning of mesenteric panniculitis (2) For the purposes of this Statement of Principles, mesenteric panniculitis: (a) means an inflammatory condition of the fatty layer (panniculus) that underlies the mesentery, omentum and peritoneum in the abdominal cavity, and which is clinically symptomatic or requires treatment; and (b) excludes sclerosing encapsulating peritonitis, retroperitoneal fibrosis (Ormond disease), peritoneal adhesions, acute peritonitis, infectious peritonitis, and the radiological phenomenon of "misty mesentery" not diagnosed specifically as mesenteric panniculitis. Note 1: Clinical symptoms commonly include acute or chronic abdominal pain, an abdominal mass or abdominal swelling, fever, weight loss, diarrhoea or vomiting. The symptoms are often due to obstruction of the bowel or mesenteric vessels. Note 2: The inflammation is histologically characterised by chronic inflammatory infiltration by lymphocytes and macrophages, fat necrosis and fibrosis. Mesenteric panniculitis is diagnosed by histology or by abdominal imaging using established radiological criteria. Note 3: Mesenteric panniculitis may also be known as mesenteric lipodystrophy or sclerosing mesenteritis. (3) While mesenteric panniculitis attracts ICD‑10‑AM code K65.8, in applying this Statement of Principles the meaning of mesenteric panniculitis 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 mesenteric panniculitis (5) For the purposes of this Statement of Principles, mesenteric panniculitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's mesenteric panniculitis. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 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 mesenteric panniculitis and death from mesenteric panniculitis can be related to relevant service rendered by veterans 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. 8 Factor that must exist The factor that must exist before it can be said that, on the balance of probabilities, mesenteric panniculitis or death from mesenteric panniculitis is connected with the circumstances of a person's relevant service is inability to obtain appropriate clinical management for mesenteric panniculitis. 9 Relationship to service The existence in a person of the factor referred to in section 8, applies only to material contribution to, or aggravation of, mesenteric panniculitis where the person's mesenteric panniculitis was suffered or contracted before or during (but did not arise out of) the person's relevant service. Schedule 1 - Dictionary Note: See Section 5 1 Definitions In this instrument: mesenteric panniculitis—see subsection 6(2). MRCA means the Military Rehabilitation and Compensation Act 2004. relevant service means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime 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.