Statement of Principles concerning IRRITABLE BOWEL SYNDROME (Balance of Probabilities) (No. 66 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) 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 (Balance of Probabilities) (No. 66 of 2019). 2 Commencement This instrument commences on 22 July 2019. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning irritable bowel syndrome No. 28 of 2011 (Federal Register of Legislation No. F2011L00766) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 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 On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that irritable bowel syndrome and death from irritable bowel syndrome 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, irritable bowel syndrome or death from irritable bowel syndrome is connected with the circumstances of a person's relevant service: (1) 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. (2) having an episode of severe diarrhoea within the three months before the clinical onset of irritable bowel syndrome; Note: episode of severe diarrhoea is defined in the Schedule 1 - Dictionary. (3) experiencing severe childhood abuse before the clinical onset of irritable bowel syndrome; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (4) 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. (5) having an episode of severe diarrhoea within the three months before the clinical worsening of irritable bowel syndrome; Note: episode of severe diarrhoea is defined in the Schedule 1 - Dictionary. (6) 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(4) to 9(6) 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(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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management: (a) agoraphobia; (b) alcohol use disorder; (c) anxiety disorder; (d) bipolar disorder; (e) depressive disorder; (f) eating disorder; (g) obsessive compulsive disorder; (h) panic disorder; or (i) posttraumatic stress disorder. Note 1: Management of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner. Note 2: To warrant ongoing management does not require that any actual management was received or given for the condition. episode of severe diarrhoea means an acute illness characterised by the passage of frequent, loose, watery motions assessed as being caused by an infective organism, and of sufficient severity to warrant medical attention, or in the absence of medical intervention, lasting at least four days. irritable bowel syndrome—see subsection 7(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. severe childhood abuse means: (a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or (b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years; where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child. 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.