Statement of Principles concerning chronic pruritus ani (Balance of Probabilities) (No. 32 of 2019) (Cth)

Statement of Principles concerning CHRONIC PRURITUS ANI (Balance of Probabilities) (No. 32 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 chronic pruritus ani (Balance of Probabilities) (No. 32 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 chronic pruritus ani No. 76 of 2010 (Federal Register of Legislation No. F2010L02315) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 chronic pruritus ani and death from chronic pruritus ani. Meaning of chronic pruritus ani (2) For the purposes of this Statement of Principles, chronic pruritus ani means intense itching of more than six weeks duration affecting the perianal skin. Death from chronic pruritus ani (3) For the purposes of this Statement of Principles, chronic pruritus ani, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic pruritus ani. 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 chronic pruritus ani and death from chronic pruritus ani 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, chronic pruritus ani or death from chronic pruritus ani is connected with the circumstances of a person's relevant service: (1) an inability to maintain adequate anal hygiene for at least the four weeks before the clinical onset of chronic pruritus ani; Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary. (2) undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical onset of chronic pruritus ani; Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary. (3) having daily episodes of diarrhoea for at least the seven days before the clinical onset of chronic pruritus ani; Note: diarrhoea is defined in the Schedule 1 - Dictionary. (4) having faecal incontinence for at least the four weeks before the clinical onset of chronic pruritus ani; Note: faecal incontinence is defined in the Schedule 1 - Dictionary. (5) having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical onset of chronic pruritus ani; Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary. (6) having a perianal or anal infection from the specified list of infections, at the time of the clinical onset of chronic pruritus ani; Note: specified list of infections is defined in the Schedule 1 - Dictionary. (7) having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical onset of chronic pruritus ani; Note: specified list of infestations is defined in the Schedule 1 - Dictionary. (8) having a pathological vaginal discharge at the time of the clinical onset of chronic pruritus ani; Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary. (9) having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical onset of chronic pruritus ani; Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary. (10) having a systemic disease from the specified list of systemic diseases at the time of the clinical onset of chronic pruritus ani; Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary. (11) undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical onset of chronic pruritus ani; (12) having corticosteroid-related atrophy of the perianal skin at the time of the clinical onset of chronic pruritus ani; (13) an inability to maintain adequate anal hygiene for at least the four weeks before the clinical worsening of chronic pruritus ani; Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary. (14) undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical worsening of chronic pruritus ani; Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary. (15) having daily episodes of diarrhoea for at least the seven days before the clinical worsening of chronic pruritus ani; Note: diarrhoea is defined in the Schedule 1 - Dictionary. (16) having faecal incontinence for at least the four weeks before the clinical worsening of chronic pruritus ani; Note: faecal incontinence is defined in the Schedule 1 - Dictionary. (17) having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical worsening of chronic pruritus ani; Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary. (18) having a perianal or anal infection from the specified list of infections, at the time of the clinical worsening of chronic pruritus ani; Note: specified list of infections is defined in the Schedule 1 - Dictionary. (19) having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical worsening of chronic pruritus ani; Note: specified list of infestations is defined in the Schedule 1 - Dictionary. (20) having a pathological vaginal discharge at the time of the clinical worsening of chronic pruritus ani; Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary. (21) having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical worsening of chronic pruritus ani; Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary. (22) having a systemic disease from the specified list of systemic diseases at the time of the clinical worsening of chronic pruritus ani; Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary. (23) undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical worsening of chronic pruritus ani; (24) having corticosteroid-related atrophy of the perianal skin at the time of the clinical worsening of chronic pruritus ani; (25) inability to obtain appropriate clinical management for chronic pruritus ani. 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(13) to 9(25) apply only to material contribution to, or aggravation of, chronic pruritus ani where the person's chronic pruritus ani 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.