Statement of Principles concerning irritable bowel syndrome (Reasonable Hypothesis) (No. 65 of 2019) (Cth)

Statement of Principles concerning IRRITABLE BOWEL SYNDROME (Reasonable Hypothesis) (No. 65 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 21 June 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 irritable bowel syndrome (Reasonable Hypothesis) (No. 65 of 2019). 2 Commencement This instrument commences on 22 July 2019. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning irritable bowel syndrome No. 27 of 2011 (Federal Register of Legislation No. F2011L00783) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 irritable bowel syndrome and death from irritable bowel syndrome. Meaning of irritable bowel syndrome (2) For the purposes of this Statement of Principles, irritable bowel syndrome means recurrent abdominal pain occurring on average at least one day per week for at least three months, where the pain is associated with two or more of the following: (a) defaecation; (b) a change in the frequency of stool; or (c) a change in the form (appearance) of stool; with the symptom onset at least six months prior to the diagnosis. (3) While irritable bowel syndrome attracts ICD‑10‑AM code K58, in applying this Statement of Principles the meaning of irritable bowel syndrome 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 irritable bowel syndrome (5) For the purposes of this Statement of Principles, irritable bowel syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's irritable bowel syndrome. 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 irritable bowel syndrome and death from irritable bowel syndrome 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: 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting irritable bowel syndrome or death from irritable bowel syndrome with the circumstances of a person's relevant service: (1) being a prisoner of war before the clinical onset of irritable bowel syndrome; (2) having a clinically significant disorder of mental health as specified within the six months before the clinical onset of irritable bowel syndrome; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (3) having an episode of severe diarrhoea within the six months before the clinical onset of irritable bowel syndrome; Note: episode of severe diarrhoea is defined in the Schedule 1 - Dictionary. (4) living or working in a hostile or life-threatening environment for a cumulative period of at least four weeks within the six months before the clinical onset of irritable bowel syndrome; Note: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary. (5) experiencing a category 1A stressor within the six months before the clinical onset of irritable bowel syndrome; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (6) experiencing a category 1B stressor within the six months before the clinical onset of irritable bowel syndrome; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (7) experiencing a category 2 stressor within the one year before the clinical onset of irritable bowel syndrome; Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation. Note 2: category 2 stressor is defined in the Schedule 1 - Dictionary. (8) experiencing severe childhood abuse before the clinical onset of irritable bowel syndrome; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (9) having a clinically significant disorder of mental health as specified within the six months before the clinical worsening of irritable bowel syndrome; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (10) having an episode of severe diarrhoea within the six months before the clinical worsening of irritable bowel syndrome; Note: episode of severe diarrhoea is defined in the Schedule 1 - Dictionary. (11) living or working in a hostile or life-threatening environment for a cumulative period of at least four weeks within the six months before the clinical worsening of irritable bowel syndrome; Note: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary. (12) experiencing a category 1A stressor within the six months before the clinical worsening of irritable bowel syndrome; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (13) experiencing a category 1B stressor within the six months before the clinical worsening of irritable bowel syndrome; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (14) experiencing a category 2 stressor within the one year before the clinical worsening of irritable bowel syndrome; Note: category 2 stressor is defined in the Schedule 1 - Dictionary. (15) inability to obtain appropriate clinical management for irritable bowel syndrome. 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(15) apply only to material contribution to, or aggravation of, irritable bowel syndrome where the person's irritable bowel syndrome 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.