Statement of Principles concerning ANAL FISSURE (Reasonable Hypothesis) (No. 87 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 23 August 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 anal fissure (Reasonable Hypothesis) (No. 87 of 2019). 2 Commencement This instrument commences on 23 September 2019. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning anal fissure No. 73 of 2010 (Federal Register of Legislation No. F2010L02312) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 anal fissure and death from anal fissure. Meaning of anal fissure (2) For the purposes of this Statement of Principles, anal fissure: (a) means an acquired linear longitudinal split in the skin (anoderm) of the distal anal canal; and (b) excludes anal inflammatory bowel disease, anal neoplasia and anal infections. (3) While anal fissure attracts ICD‑10‑AM code K60.0, K60.1 or K60.2, in applying this Statement of Principles the meaning of anal fissure 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 anal fissure (5) For the purposes of this Statement of Principles, anal fissure, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's anal fissure. 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 anal fissure and death from anal fissure 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 anal fissure or death from anal fissure with the circumstances of a person's relevant service: (1) having trauma to the anal area at the time of the clinical onset of anal fissure; Note: trauma to the anal area is defined in the Schedule 1 - Dictionary. (2) having infection with human immunodeficiency virus before the clinical onset of anal fissure; (3) straining at stool due to constipation within the two weeks before the clinical onset of anal fissure; (4) being treated with isotretinoin at the time of the clinical onset of anal fissure; (5) inability to obtain appropriate clinical management for anal fissure. 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 factor set out in subsection 9(5) applies only to material contribution to, or aggravation of, anal fissure where the person's anal fissure 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: anal fissure—see subsection 7(2). MRCA means the Military Rehabilitation and Compensation Act 2004. relevant service means: (a) operational service under the VEA; (b) peacekeeping service under the VEA; (c) hazardous service under the VEA; (d) British nuclear test defence service under the VEA; (e) warlike service under the MRCA; or (f) non-warlike 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. trauma to the anal area means injury to the anal area including by childbirth, laceration by a foreign body, sexual assault and surgical procedure. VEA means the Veterans' Entitlements Act 1986.