Statement of Principles concerning pilonidal sinus (Balance of Probabilities) (No. 28 of 2019) (Cth)

Statement of Principles concerning PILONIDAL SINUS (Balance of Probabilities) (No. 28 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 1 March 2019

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 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 pilonidal sinus (Balance of Probabilities) (No. 28 of 2019). 2 Commencement This instrument commences on 25 March 2019. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning pilonidal sinus No. 72 of 2010 (Federal Register of Legislation No. F2010L02311) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 pilonidal sinus and death from pilonidal sinus. Meaning of pilonidal sinus (2) For the purposes of this Statement of Principles, pilonidal sinus: (a) means an inflammatory tissue reaction of the skin to an embedded hair which is manifested by the development of a sinus or fistula; and (b) includes pilonidal cyst and pilonidal fistula; and (c) excludes ingrown hair. Note: Pilonidal sinus principally occurs in the sacrococcygeal region, but can also occur in the interdigital webs of the hands and in other regions of the body. (3) While pilonidal sinus attracts ICD‑10‑AM code L05, in applying this Statement of Principles the meaning of pilonidal sinus 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 pilonidal sinus (5) For the purposes of this Statement of Principles, pilonidal sinus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pilonidal sinus. 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 pilonidal sinus and death from pilonidal sinus 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. 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, pilonidal sinus or death from pilonidal sinus is connected with the circumstances of a person's relevant service: (1) for pilonidal sinus of the hand or foot only: (a) working as a hairdresser or barber within the six months before the clinical onset of pilonidal sinus; or (b) having cutaneous exposure to animal hair within the six months before the clinical onset of pilonidal sinus; Note: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary. (2) for pilonidal sinus of the sacrococcygeal region only: (a) driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical onset of pilonidal sinus; or (b) being overweight or obese within the six months before the clinical onset of pilonidal sinus; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (3) for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical onset of pilonidal sinus; (4) for pilonidal sinus of the hand or foot only: (a) working as a hairdresser or barber within the six months before the clinical worsening of pilonidal sinus; or (b) having cutaneous exposure to animal hair within the six months before the clinical worsening of pilonidal sinus; Note: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary. (5) for pilonidal sinus of the sacrococcygeal region only: (a) driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical worsening of pilonidal sinus; or (b) being overweight or obese within the six months before the clinical worsening of pilonidal sinus; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (6) for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical worsening of pilonidal sinus; (7) inability to obtain appropriate clinical management for pilonidal sinus. 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(4) to 9(7) apply only to material contribution to, or aggravation of, pilonidal sinus where the person's pilonidal sinus 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.