Statement of Principles concerning colorectal adenoma (Reasonable Hypothesis) (No. 15 of 2022) (Cth)

Statement of Principles concerning COLORECTAL ADENOMA (Reasonable Hypothesis) (No. 15 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 December 2021

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM 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 colorectal adenoma (Reasonable Hypothesis) (No. 15 of 2022). 2 Commencement This instrument commences on 31 January 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning colorectal adenoma No. 35 of 2013 (Federal Register of Legislation No. F2013L01138) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 colorectal adenoma and death from colorectal adenoma. Meaning of colorectal adenoma (2) For the purposes of this Statement of Principles, colorectal adenoma: (a) means a benign neoplasm arising from the epithelial cells of the colorectum; and (b) includes: (i) adenomatous polyp; (ii) sessile serrated adenoma; and (iii) traditional serrated adenoma; and (c) excludes: (i) benign neoplasms of the anus and anal canal; (ii) familial adenomatous polyposis; (iii) non-neoplastic polyps of the colon; (iv) nonepithelial neoplasms of the colon; and (v) non-polypoid dysplasia. (3) While colorectal adenoma attracts ICD‑10‑AM code D12.0, D12.1, D12.2, D12.3, D12.4, D12.5, D12.7 or D12.8, in applying this Statement of Principles the meaning of colorectal adenoma 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 colorectal adenoma (5) For the purposes of this Statement of Principles, colorectal adenoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's colorectal adenoma. 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 colorectal adenoma and death from colorectal adenoma 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 colorectal adenoma or death from colorectal adenoma with the circumstances of a person's relevant service: (1) having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of colorectal adenoma; and (b) commencing at least 5 years before the clinical onset of colorectal adenoma; and if smoking has ceased before the clinical onset of colorectal adenoma, then that onset occurred within 30 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) consuming at least 250 kilograms of alcohol before the clinical onset of colorectal adenoma; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (3) being overweight or obese for at least 5 years within the 30 years before the clinical onset of colorectal adenoma; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (4) having diabetes mellitus for at least 5 years before the clinical onset of colorectal adenoma; (5) inability to consume an average of at least 20 grams per day of fibre in food, for at least 5 consecutive years within the 10 years before the clinical onset of colorectal adenoma; Note: fibre in food is defined in the Schedule 1 - Dictionary. (6) having a solid organ transplant at least 5 years before the clinical onset of colorectal adenoma; (7) having a ureterosigmoidostomy involving the affected part of the colorectum at least 5 years before the clinical onset of colorectal adenoma; (8) for adenoma of the colon only: (a) inability to undertake any physical activity greater than 3 METs for at least 10 consecutive years within the 30 years before the clinical onset of adenoma of the colon; Note: adenoma of the colon and MET are defined in the Schedule 1 - Dictionary. (b) having acromegaly before the clinical onset of adenoma of the colon; Note: acromegaly and adenoma of the colon are defined in the Schedule 1 - Dictionary. (c) consuming an average of at least 100 grams per day of red meat, for at least 5 years within the 10 years before the clinical onset of adenoma of the colon; Note: adenoma of the colon and red meat are defined in the Schedule 1 - Dictionary. (d) consuming an average of at least 25 grams per day of processed meat product, for at least 5 years within the 10 years before the clinical onset of adenoma of the colon; Note: adenoma of the colon and processed meat product are defined in the Schedule 1 - Dictionary. (e) inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least the 5 years before the clinical onset of adenoma of the colon; Note: adenoma of the colon is defined in the Schedule 1 - Dictionary. (9) inability to obtain appropriate clinical management for colorectal adenoma. 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(9) applies only to material contribution to, or aggravation of, colorectal adenoma where the person's colorectal adenoma 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.