AN03 DEALING WITH CLAIMS - POST SERVICE DIET | Compensation and Support Reference Library, Advisory Notes, 2001

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AN03 DEALING WITH CLAIMS - POST SERVICE DIET

Document

Advisory from Disability Compensation Branch

No 3 of 2001

Please note: For further information in relation to Malignant Neoplasm of the Prostate and Consumption of Animal Fat refer to Advisory Note 1 of 2007.


This is an advisory note only.  Disability Compensation Branch and Legal Services Group have agreed this policy view.  It is not a Repatriation Commission Guideline or a Departmental Instruction.   The advice is not intended to conflict with the proper application of the Veterans' Entitlements Act 1986 or the judgements of the Courts.  It may be subject to change as a result of further interpretation by the Courts of the legislation.  Nevertheless it represents a considered view that should be taken into account by all delegates.

DEALING WITH CLAIMS RELATING TO POST SERVICE DIET AND MALIGNANT NEOPLASM OF THE PROSTATE

This paper is intended to assist decision-makers in applying the animal fat consumption factors in the Statements of Principles for malignant neoplasm of the prostate.  It contains a “Dietary Survey Form” for use whenever it is appropriate.

Decision-makers should also refer to Advisory No 3 of 1999 for other information.

2.The paper deals predominantly with WW2 veterans, as they are the main group to whom the SoPs apply.

Daily fat consumption

3.In relation to WW2 veterans, the requirement to have animal fat consumption of at least 70gms/day is easily satisfied, as both civilian and military diets at that time typically had animal fat content well in excess of that level.  The requirement to maintain an intake of at least 70gms/day for 20 or 25 years is also easily satisfied, as typical Australian diets contained animal fat in excess of that level until at least the 1970s.

4.This means that a general claim that a military diet was “fattier” than the previous civilian diet is untenable without a dietary history of both periods.  Individual claims must be treated on their merits.

5.The SoP factor requirement for an increase in consumption by at least 40% is the real test to be satisfied.  This is because an average civilian diet before and during WW2 contained more animal-fat than most service rations.  In addition the SoP factors require that increased level of consumption to be maintained for 20 or 25 years and for that increased consumption to be attributable to service.

Prostate Cancer and Dietary Fat

6.The President of the AAT, in the six test cases heard to date, has accepted that in some limited circumstances a veteran may have had a diet higher in fat than the civilian diet or the military diets of any other theatres of war.  A veteran of World War II who had service in the SouthWest Pacific theatre from 4 February 1944 to the end of the war in 1945 is such a circumstance.

7.However, this diet is not of the required 40% increase required by the SoP.  Nevertheless, it appears that in certain circumstances this connection could be accepted as causing post war dietary fat increases to the required level and maintenance of that increased consumption of higher amounts of dietary fat for the requisite 20-year period.

8.A second conclusion is that this connection does not apply to “eligible service” cases (see Grace).  On the balance of probabilities the military diet does not carry over to the post war civilian diet.

9.On the basis of these decisions it seems possible that operational service cases with service in the SouthWest Pacific theatre in World War 2 (post 1944) could be accepted if they were to satisfy the Statements of Principles requirements of a 40% increase. At the same time the case of Collingwood shows that the requirement for the connection and the increase is a matter that must be the subject of a finding of fact by the decision-maker, else it can not succeed.

10.Without a connection of 40% higher fat diet for a period of 20 years to an increase on service the acceptance of prostate cancer as service related is tenuous.  The connection would depend on the facts emerging from the diet questionnaires.  The AAT itself remarked that it had no evidence before it that might indicate the minimum increase or duration of an increase on service before it could be implicated in a later 40% increase.  To date there has been no such evidence available.

11.In addition, cases involving operational service in all theatres of operations might give rise to an hypothesis (see the Deledio Guidelines) where there was a pre-war diet very low in animal fat or service rations were supplemented by foods high in animal fat. All other aspects of the factor, eg the need for a 40% increase in fat consumption that lasts for at least 20 years, must still be satisfied.

What questions need to be asked?

12.There are four questions that need to be answered.  It requires a “yes” answer to all of them for the SoP factors to be satisfied.

  1. Did animal-fat intake in the diet increase by at least 40%?
  2. Was that increased intake maintained for at least 20 years in operational and equivalent service cases and 25 years for those with eligible WW2 or defence service post 1972?
  3. Was the initial increase in animal-fat consumption attributable to service?
  4. Was the increased intake over the next 20/25 years attributable to service?

Diet history

13.Self-reports of a change in dietary habit (or otherwise) are of little probative value.   Statements concerning the circumstances of service or past experiences by a veteran, or widow, are relevant, but uncorroborated self-reports on any issue are generally unreliable. However, an attempt to get as much information as possible should be made.

14.This material, including claimed alteration in a person's dietary habit, is capable of critical assessment by an appropriate specialist as long as sufficient information is made available.

15.An accredited practising dietitian is an appropriate expert to consult in relation to dietary allegations.  Such an opinion can mean that an essential fact for the hypothesis can be considered under the Deledio Guidelines at Stage 4.

16.Suitable dietitians in each State exist and Tribunal advocates can advise Claims Assessors of appropriate specialists.

The Survey Form

17.The attached Diet Survey Form is for use in situations where information is required in order to enable a dietitian to report on the level of fat consumption.

John R Douglas

Carolyn Spiers

Director

Director

Policy, Eligibility and Research

Legal Advising

13 March 2001


DIETARY SURVEY for   ...................................................

This dietary survey includes questions on what foods were eaten by the veteran and how often they were eaten during two different periods.  These periods cover:

1. Before his service enlistment for World War 2.

2. After World War 2 for a period of at least 20 years, before the veteran's clinical signs of prostate cancer.

If you are unable to provide this information for either of these two periods (eg  if you did not know your husband before World War 2 ), please indicate this by ticking the No box.  Please record your reason for making this decision.

First we need some background information on yourself.

1.

What is your date of birth?

__/__/__

2.

What year were you married to the veteran?

19_____

3.

How many years were you cooking and preparing meals that your husband was eating?  Ignore years away from home

_____yrs

4.

Did you know your husband prior to World War 2?  Tick appropriate box

Yes     No

5.

Please indicate the occupation/s of your husband before and after World War 2.

  1. Before World War 2
  2. After World War 2

(a)............................

.................................

(b)........................................................................................

6.

Did you know your husband's mother?

Tick appropriate box

Yes     No

6A.

If  yes, was his mother's cooking style before marriage similar or different to yours after marriage?

Yes     No

6B.

If it was different, please tell us how it was different.

.............................................................

1

13 March 2001


WE WILL BE ASKING YOU ABOUT THE TYPES OF FOODS EATEN BY THE VETERAN, HOW MUCH AND HOW OFTEN.  First you will be asked to record the usual daily eating pattern of your husband.  What foods he usually ate at meals and between meals. An example of a completed daily eating pattern is given below:

EXAMPLE OF DAILY EATING PATTERN

MEALFOOD and QUANTITY (if possible)

Breakfast

Porridge - 1 cup with milk (1/4 cup) and sugar (2 tsp)

Boiled eggs - 2 number

Toast - 2 slices, with butter (4 tsp) and jam (1 tabs)

Coffee- 1 cup made with milk and sugar (2tsp).

Mid Morning

Sweet biscuits - 4 number

Tea - 1 cup with milk (2 tabs) and sugar (2tsp)

Lunch

Home-made soup - 1 cup

Bread roll - 1 number with butter (3 tsp)

2 sandwiches - 4 slices bread with butter (4 tsp) and meat (2 slices), salad and mustard (1 tsp)

Cake - 1 slice

Tea - - 1 cup with milk (2 tabs) and sugar (2tsp)

Mid Afternoon Nothing

Dinner

Meat dish - usually grill (medium ), stew (1 cup) or roast (4 slices)

Potatoes - usually chipped or mashed (1 cup)

Vegetables - 3 servings (1 cup each) with margarine (1 tsp each)

Bread - 2 slices with butter (2 tsp)

Dessert - usually ice-cream (scoop) or baked custard (1/2 cup) and fruit (1/2 cup).

Coffee - 1 cup with milk (2 tabs) and sugar (2 tsp)

Late Evening

Cocoa - 1 cup, made with 1/2 cup milk and sugar (1 tsp)

Sweet biscuits - 4 plain

Chocolates- 4 pieces

After you have completed the daily eating pattern, you will see a list of foods with an amount written against each food.  For each food would you indicate with a tick how often on average, your husband would have eaten the amount of that food, either served by you or obtained from someone else.  This may vary from less than once a week to more than 3 times per day.   If appropriate, please include cooking method.

For example, if your husband drank a cup ( 250ml) of milk each day on average (including milk used on cereal or in tea and coffee), place a tick in the 1 time per day  column like this:

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Whole milk

1cup (250ml)

?

If he drank twice this amount, that is two cups a day, then place a tick in the 2-3 times per day column like this:

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Whole milk

1cup (250ml)

?

1

13 March 2001


PERIOD 1:  PRE-WORLD WAR 2  - BEFORE ENLISTMENT

7A.If you are unable to provide information for this period, please tick the following box:

NO

Reason for not completing section ..............................................................

.......................................................................................................

(And sign the bottom of the page)

7B.If you are able to provide information for this period, please complete the daily eating pattern of the veteran in the table below.

DAILY EATING PATTERN - PRE-WORLD WAR 2

FOOD and QUANTITY (if possible)

Breakfast

.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Mid Morning

.................................................................................................................

Lunch

...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Mid Afternoon

...............................................................................................................

...............................................................................................................

Dinner

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Late evening

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................


8.To help us to estimate the nutrient content of the veteran's diet, please now look at the lists of foods below. For each food listed, indicate how often on average your husband ate the food.  If he never ate a particular food or ate it less than once a week, just tick the first column.  Try to fill in each list to the best of your memory.

Dairy

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Whole milk

1cup (250ml)

Milk condensed

sweetened - 1/2 cup

Evaporated milk-1/2 cup

Milk dried, whole-1 Tbsp

Cream -1 Tbsp

Ice cream- 1/2 cup

Cheese-1 slice (30g)

Butter added to food and bread -1 teasp

Fats other than butter

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Lard, dripping,suet,

margarine- 1 Tabls 30g

Olive, salad oil

1 Tablsp 30g

Meats

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Beef steak, roast

small steak, roast

4 slices - 120g

Beef, lamb stew

1 cup

Beef/pork sausage

Meat pie, small

Pork Chop, roast

4 slices – 120g

Ham/bacon

4 slices -120g

Lamb, mutton chop

roast -4 slices 120g

Meat (continued)

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Lamb's fry, kidneys serving-90g

Veal, chop, roast - 4 slices 120g

Chicken, duck, rabbit  roast-1 serving (120g),

stew- I cup

Small goods (frankfurts, brawn, cooked / canned meats)-1 serving 120g

Other foods

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Biscuits, 1

Cake, bun, scone

1 serving  60g

Eggs, 1 number

Fish, seafood, canned, fresh -1 serving 90g

Potato chips, other vegetable, fried-1 cup

Fruit pie 1 slice

Baked, milk

puddings- 1/2 cup

Steamed puddings, suet puddings 1/2 cup

Soup, home-made-1 cup

Chocolate- 4 pieces

Beer/wine- 1 glass


OTHER QUESTIONS

9.PLEASE TICK THE KIND OF FAT USUALLY USED FOR FRYING OR ROASTING MEAT AND VEGETABLES?

ButterDripping

LardVegetable Oil

Margarine

10.WHAT TYPE OF COOKING OIL DID YOU REGULARLY USE?

...............................................................................................................

11.HOW OFTEN WOULD YOU SERVE ROAST VEGETABLES?

...............................................................................................................

12.WHAT WAS THE NORMAL COOKING METHOD USED FOR VEGETABLES?

...............................................................................................................

13.HOW OFTEN DID YOU ADD BUTTER/OTHER FAT TO COOKED VEGETABLES? ....................................................................................

14.HOW OFTEN DID YOU ADD GRAVY TO FOOD?

...............................................................................................................

15.HOW OFTEN WAS A SAUCE ADDED TO FOOD?

...............................................................................................................

15A. What types of sauces? ...........................................................................

  1. WHAT FAT WAS USUALLY USED FOR BAKING CAKES, BISCUITS OR PIES AT HOME?

ButterMargarine

LardSuet

Vegetable OilNone, did not cook

Other, please specify.................................................................

17.WAS YOUR HUSBAND ON A SPECIAL PRESCRIBED DIET?

Tick appropriate box

NoYes, please specify-----------------------------------------

18.HOW OFTEN DID YOUR HUSBAND EAT TAKE-AWAY FOOD?...............

  1. WHAT TYPE OF TAKE-AWAY FOOD DID YOU EAT?

...........................................................................................................

PERIOD 2:  POST-WAR , BEFORE CLINICAL SIGNS OF PROSTATE CANCER

20.If you are unable to provide information on the long term post-war diet of the veteran, covering a period of at least 20 years, please tick the following box:

NO

Reason for not completing section ..............................................................

.......................................................................................................

(And sign the bottom of the page)

21.If you are able to provide this information, please tick the years including the 20 year diet period

1946-55

1956-64

1965-74

1975-84 &

1985 -94

After 1994

22.Please complete the daily eating pattern of the veteran in the table below.

DAILY EATING PATTERN - POST-WAR, BEFORE CLINICAL CANCER SIGNSFOOD and QUANTITY (if possible)

Breakfast

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

Mid Morning

.................................................................................................................

Lunch

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

Mid Afternoon

.................................................................................................................

Dinner

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

.................................................................................................................

Late evening

.................................................................................................................

.................................................................................................................

23.To help us to estimate the nutrient content of the veteran's diet, please now look at the lists of foods below. For each food listed, indicate how often on average your husband ate the food.  If he never ate a particular food or ate it less than once a week, just tick the first column.  Try to fill in each list to the best of your memory.

Dairy

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Whole milk-1 cup (250ml)

Fat reduced milk-1 cup

Skim milk-1 cup

Milk condensed

sweetened - 1/2 cup

Evaporated milk-1/2 cup

Milk dried, whole-1 Tbsp

Cream -1 Tbsp

Ice cream- 1/2 cup

Yoghurt-1 carton 200ml

Cottage, ricotta cheese 1/2 cup

Hard cheese- 1 slice (30g)

Butter added to food and bread

- 1 teasp

Fats other than butter

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Margarine, added to food and bread-1tsp

Lard, dripping, suet,  margarine-1 Tabls 30g

Olive, salad oil

1 Tablsp 30g

Meats

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Beef steak, roast

Small steak, roast

4 slices - 120g

Beef, lamb stew – 1 cup

Beef hamburger – 1 no.

Beef/pork sausage-1 no.

Meat pie, small –1 no.


Meat (continued)

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Pork chop, roast

4 slices - 120g

Ham/bacon

4 slices -120g

Lamb, mutton chop,

roast-4 slices, 120g

Lamb's fry, kidneys serving-90g

Veal, chop, roast - 4 slices 120g

Chicken, duck, rabbit roast-1 serving (120g)

stew-1 cup

Small goods (frankfurts,

brawn, cooked / canned  meats)-1 serving 120g

Other foods

Foods

Never or

Week/times

Day/times

Usual cooking

<1/week

1

2 –4

5 –6

1

2-3

>3

Method

Croissant- 1 no.

Biscuits, 1 no.

Cake, bun, scone

1 serving  60g

Eggs, 1 number

Fish, seafood,canned,

fresh -1 serving 90g

Potato chips, other vegetable, fried-1 cup

Fruit pie 1 slice

Milk pudding - 1/2 cup

Steamed puddings, suet puddings 1/2 cup

Soup, 1 cup

Chocolate- 4 pieces

Beer/wine- 1 glass


OTHER QUESTIONS

24.PLEASE TICK THE KIND OF FAT USUALLY USED FOR FRYING OR ROASTING MEAT AND VEGETABLES?

ButterDripping

LardVegetable Oil

Margarine

25.WHAT TYPE OF COOKING OIL DID YOU REGULARLY USE?

...............................................................................................................

26.HOW OFTEN WOULD YOU SERVE ROAST VEGETABLES?

...............................................................................................................

27.WHAT WAS THE NORMAL COOKING METHOD USED FOR VEGETABLES?....................................................................................

28.HOW OFTEN DID YOU ADD BUTTER/OTHER FAT TO COOKED VEGETABLES? ..........................................................................................

29.HOW OFTEN DID YOU ADD GRAVY TO FOOD?

...............................................................................................................

30.HOW OFTEN WAS A SAUCE ADDED TO FOOD?

...............................................................................................................

30A. What types of sauces?  ...........................................................................

  1. WHAT FAT WAS USUALLY USED FOR BAKING CAKES, BISCUITS OR PIES AT HOME?

ButterMargarine

LardSuet

Vegetable OilNone, did not cook

Other, please specify.................................................................

32.WAS YOUR HUSBAND ON A SPECIAL PRESCRIBED DIET?

Tick appropriate box

NoYes, please specify-----------------------------------------

33.HOW OFTEN DID YOUR HUSBAND EAT TAKE-AWAY FOOD? ...............

34.WHAT TYPE OF TAKE-AWAY FOOD DID HE EAT?

...............................................................................................................

Thank you for providing this information.

Signature

Date