AN01 Malignant Neoplasm of the Prostate and Consumption of Animal Fat

Advisory from Veterans' Compensation Group

No. 1/2007

This is an advisory note only.  Veterans' Compensation Group and Legal Services have agreed with this approach.  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.

Malignant Neoplasm of the Prostate and Consumption of Animal Fat

1. This paper is intended to assist decision-makers in applying the animal fat consumption factor in the Statements of Principles (SoP) for malignant neoplasm of the prostate.  Advisory Notes No 3 of 1999 (Animal Fat Consumption) and No 3 of 2001 (Dealing with Claims Relating to Post Service diet and Malignant Neoplasm of the Prostate) also contain helpful information in spite of the subsequent changes to the SoP requirements and definition of animal fat.

APPLICATION OF THE STATEMENT OF PRINCIPLES

2. Effective from 28 September 2005, the factors relating to animal fat consumption were modified and the Statements of Principles now read:

3. Since 16 October 2002, “animal fat” has meant “fat contained in or derived from meat, other flesh or offal from animals (including birds but excluding seafood); dairy products; or eggs from birds.”

4. The new SoP factors indicate a shift in emphasis from levels of animal fat in the diet in the immediate post-war period to levels of animal fat in the diet nearer the clinical onset of malignant neoplasm of the prostate.  The typical Australian diet has included declining levels of animal fat since the 1960s/70s with the advent of vegetable oils replacing butter and lard in the diet and in the cooking process.  The SoP now requires that the 40% increase in animal fat consumption be maintained for at least 5/10 years within the 25 years before the clinical onset of malignant neoplasm of the prostate.  For example, if consumption of animal fat is increased from 100gm/day by 40% to 140gm/day (or more), then the level of animal fat consumed within the relevant period cannot fall below 140gm/day in order to meet the SoP factor.

5. In the normal course of events, with the onset of malignant neoplasm of the prostate many decades after service, the level of animal fat intake within the 25 years before onset could be expected to have declined significantly from the level at the time of service, in line with the decline in intake in the general population (see table in paragraph 8 below).

RELATIONSHIP TO SERVICE

6. This factor may be related to service through:

• increased animal fat consumption via service diet; or
• increased animal fat consumption via a diet as treatment for a medical condition that is due to service (e.g. the 'ulcer diet').

SERVICE DIET AND THE SOP FACTOR

7. The elements to be addressed in determining if the factor is met by consumption of animal fat during service, are:

1. level of animal fat consumed in pre-service diet:  gm/day
2. level of animal fat consumed during service:  gm/day
3. level of animal fat consumed post service:  gm/day
4. whether the increase  gm/day, if any, in consumption of animal fat is due to service
5. whether service materially contributed to an increase of at least 40% to at least 50gm/day of animal fat
6. whether the increased level of animal fat (by at least 40% to at least 50gm/day) was consumed for at least 5/10 years
7. whether the 5/10 years of this high animal fat diet occurred within the 25 years before the clinical onset of malignant neoplasm of the prostate.

Pre-service diet is unknown

8. Where specific details of the pre-service diet are unknown, but the applicant contends that the diet was average or typical for the time, an agreement should be sought with the applicant (and any nominated representative) to use the average male civilian diet at about that time in Australia.  The following table (found in CCPS in the hotword Service diet after World War 2) provides some useful data based on the current animal fat definition:

Animal fat consumption trends in civilian Australian diets.

Validating pre-service and post-service diet

9. In a number of recent cases, the AAT commented to the effect that, the dietary surveys are inherently inaccurate because of the difficulty witnesses have in recalling the details of meals eaten by someone else many years ago.  However, more often than not, it is the only available evidence of the veteran's diet.

10. A qualified dietician may provide an opinion on the validity of the survey by matching energy requirements and weight outcomes with dietary survey data.  This calculation would usually include some weightings for the nature of the work performed by the veteran and the effect of other factors on the metabolic rate, such as smoking.  If the calculation included allowances in the applicant's favour and still the dietary survey was assessed by the dietician as significantly under or over-estimating level of animal fat in the diet, then it would be reasonable to consider that the dietary data were unreliable.

11. The dietician may also be able to advise whether the foods claimed to have been consumed were available at that time.

12. The survey and any such expert opinion form part of the whole of the material to be considered in determining the claim.  Such evidence needs to be weighed and the material facts determined.  Consideration in weighing the evidence can be given to relevance, credibility, reliability, specified details and expertise.

Service diet

13. There must be something in a veteran's eligible service that caused the change in food preferences during service and for the relevant period after service.  Stress of service, privations and/or bland diet during operational service, separation from normal life, and longing for favourite foods may be such factors.  The service related diet containing at least 50gm/day (which must also represent at least a 40% increase) of animal fat must be maintained for the relevant period within the 25 years before clinical onset.  If, after service, a veteran merely ate what was served to him and he did not have any input as to food preferences then it could be said that service did not contribute to the post-service diet.

DIET AS TREATMENT FOR A MEDICAL CONDITION

14. Specific diets were prescribed as treatment for peptic ulcer disease in the 1950s and 1960s.  The practice of prescribing these diets then went out of favour when it was established they were ineffective.  Other conditions such as tuberculosis may also have been treated by diet.

15. The 'ulcer diet' was intended to neutralise gastric acids by the consumption of large amounts of milk and other dairy foods and by the avoidance of irritant or stimulating foods such as fried foods, high fibre foods, seeds and skins of fruit, spices and alcohol.

16. These diets were bland and unpalatable to most people and would have been difficult to comply with, particularly given they were largely ineffective in treating the symptoms of peptic ulcer.

17. The elements to be addressed in determining if the factor is met by consumption of animal fat as treatment for a medical condition and if it is related to service, are:

1. level of animal fat consumed before the treatment diet:  gm/day
2. level of animal fat consumed during the treatment diet:  gm/day
3. level of animal fat consumed after the treatment diet:  gm/day
4. whether the increase  gm/day, if any, in consumption of animal fat is due to service related injury or disease
5. whether service materially contributed to an increase of at least 40% to at least 50gm/day of animal fat
6. whether the increased level of animal fat (by at least 40% to at least 50gm/day) was consumed for at least 5/10 years
7. whether the 5/10 years of this high animal fat diet occurred within the 25 years before the clinical onset of malignant neoplasm of the prostate.

18. More detailed information can be found in SoP Bulletin No.69 issued by the Decision Support Unit on 2 April 2003 on the 'Animal fat factor and the ulcer diet'.

THE SURVEY FORM

19. The Diet Survey Form has been revised and is now available on the DVA internet by clicking on DVA Forms. There are separate forms for veterans and widows.

John Geary

National Manager

Veterans' Compensation

14 September 2007