Being obese

Haemorrhoids - Obesity as a factor for haemorrhoids Factor

The haemorrhoids SOP for reasonable hypothesis cases includes a factor of "being obese".  This term is defined in the SOP.  The RMA has also issued a SOP for morbid obesity.  If there is a history of "being obese" but the claim for haemorrhoids does not succeed via this factor, you will be asked to consider whether there is a history of morbid obesity, as this is an extreme form of obesity.

RMA definition of being obese

In this Statement of Principles the Repatriation Medical Authority has defined being obese as meaning "an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The measurement used to define “being obese” is the Body Mass Index (BMI).

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres".

(For Imperial weights and measures, BMI = wt. in lbs/(ht in inches2) x 703.1).

This definition excludes weight gain not resulting from fat deposition such as gross oedema, peritoneal or pleural effusion, or muscle hypertrophy.  "Being obese" develops when energy intake is in excess of expenditure for a sustained period of time.

Establishing the presence of obesity

If it is not possible to obtain specific height/weight measurements, a medical comment that the person was obese will be sufficient.  If height/weight measurements can be obtained, the BMI formula should be applied.

A history of obesity may be documented in the evidence.  However, the person may not have sought medical attention and the condition may not have been recorded in medical records.  In addition, doctors' and hospitals' records may have been destroyed or can no longer be obtained.

Therefore, if clinical records of obesity cannot be obtained, a statement by the person about his or her weight at a particular time will generally be accepted, unless there is contradictory evidence.  This weight can then be used to calculate whether the person was obese at that time.

INVESTIGATIVE DOCUMENTS

PRELIMINARY QUESTIONS [30152]

17512 there is some evidence that obesity may be a factor in the development or worsening of the condition under consideration.

587       the veteran has a history of obesity.

30172  the veteran has established the causal connection between being obese and operational service for haemorrhoids.

30177   the veteran has established the causal connection between being obese and operational service for the clinical onset of haemorrhoids.

or

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

30179   the veteran has established the causal connection between being obese and operational service for the clinical worsening of haemorrhoids.

CLINICAL ONSET AND OPERATIONAL SERVICE [30177]

17307 the veteran was obese at the time of the clinical onset of the condition under consideration.

591       the obesity was caused by operational service.

or

9004     the veteran has a history of morbid obesity.

9007     the veteran was morbidly obese at the time of the clinical onset of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

CLINICAL WORSENING AND OPERATIONAL SERVICE [30179]

17308 the veteran was obese at the time of the clinical worsening of the condition under consideration.

591       the obesity was caused by operational service.

17309 the clinical onset of the condition under consideration occurred prior to that part of operational service which caused the obesity.

or

9004     the veteran has a history of morbid obesity.

9008     the veteran was morbidly obese at the time of the clinical worsening of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

9009     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the morbid obesity is causally related.