SOP Bulletin No. 146

Intranet site:  http://sharepoint/servingourcustomers/compensation/dsu

30 August 2010

THE FOLLOWING RMA SOPS TAKE EFFECT ON 01 SEPTEMBER, 2010

# Digital subtraction angiogram of cerebral aneurysm (arrow), a precursor to subarachnoid haemorrhage.

NOTEWORTHY FEATURES

• The previous separate SOPs for acute and chronic blepharitis have been combined.
• The previous onset factors have all been retained and updated, with some minor modifications (e.g. infections must now be of the eyelid – previously was “the eye”).
• There are new factors for: vitamin A or B complex deficiency; xerophthalmia; diabetes; smallpox immunisation and treatment with ep — idermal growth factor receptor.

• The old SOPs for nephrolithiasis and ureteric calculus have been amalgamated.
• The — re has been a major reorganisation of the SOP factors with hardly any of the old nephrolithiasis factors recognisable in the new SOP.
• The old factors for metabolic causes of stones (e.g. hypercalcuria) have been replaced by factors for conditions that cause those metabolic conditions (e.g. having primary hyperparathyroidism).
• Most other old factors have effectively been retained but recast.  Factors for congenital/hereditary conditions (e.g. horseshoe kidney) have been omitted.
• There are many new factors in the SOP.  Notable additions include factors for obesity, diabetes (type II), dehydration and many new drugs.

• The previous disease definition excluded haemorrhage due to trauma and certain bleeding disorders.  Those exclusions have now been removed.
• The alcohol factor dose requirements have changed from a one year dose to a per/week for 6 months dose.
• The smoking factor dose requirements have changed from 5 cigarettes/day for 5 years to 1 pack year (the cessation provision is unchanged).
• The physical activity factor requirements have reduced from > 11 METs within 30 minutes (of clinical onset) to ≥ 6 METs within 2 hours.  This previously RH only factor is now also in the BOP SOP.
• The drugs factor now has a longer list of drugs.
• There are new factors for:
• RH & BOP:
• pregnancy induced hypertension (replaces the previous pregnancy factor);
• infective vasculitis (replaces the intracranial mycotic aneurysm/arteritis factor);
• ceasing a statin medication;
• cerebral trauma (more severe trauma is stipulated in the BOP SOP).
• RH only:
• An acquired haematological disorder (as specified).
• The previous severe stressor (causing a temporary aggravation of hyperte — nsion) factor has been removed.

• The acute sprain definition has been recast.  Coverage is essentially the same as previously, but with a specific exclusion of recurrent sprain due to joint instability (now covered by the recent — ly issued joint instability SOP).
• The acute strain definition now covers complete tear or rupture of a tendon, which was previous excluded.
• The factors have been reworded, with no real change in effect.
• The previous factor covering joint instability has been omitted (consistent with the new SOP for that condition).

• This 1995 SOP has been updated.
• The previous factors for work as a hairdresser, exposure to animal hair and vehicle driving have been retained and updated, with the vehicle factor extended to passengers and also cyclists.
• A new RH factor has been added for obesity.

• This 1995 SOP has been updated.
• The previous factors have been reworded but retained.
• There is a new factor for being treated with nicorandil (RH & BOP) or isotretinoin (RH only).

• This 1996 SOP has been updated and renamed (adding “chronic”).
• The definition now requires a 6 month duration of symptoms.
• There is one new factor, for having a systemic disease as specified.
• The previous SOP factors and definitions have been reworded but are effectively unchanged, apart from two additions to the specified list of dermatological diseases.

• This is another update of an old SOP.
• The SOP has been renamed with “posterior adventitial” dropped from the title.  However, SOP coverage is unchanged.
• The only onset factor still covers ill-fitting footwear, but has been reworded to better reflect the mechanism involved.

• The name has been changed to the singular form (previously patellae). 
• There is no material change to the definition.  Evidence of “softening, fibrillation or erosion” of the patella cartilage is still required.  The SOP will apply to some but not all cases labelled as patellofemoral pain syndrome (PFPS), or the like.  PFPS is a non-specific label that covers a spectrum of conditions, including cases where there is no patella cartilage pathology (and hence no chondromalacia patella).  The diagnostic information currently on the DSU Intranet site and eventually in CCPS research provides further advice.
• The r — unning factor has been modified and added to the BOP SOP (was RH only):
• Was: running for ≥ 6 hours/wk for ≥ 4 consecutive weeks before onset & where ceased, onset was within four weeks of cessation.
• Now: running or jogging on average ≥ 10 km/wk (RH) / 20 km/wk (BOP) for the month before onset;
• Two new "overuse" factors have been added (RH & BOP) for:
• weight bearing involving forceful loading of the patellofemoral joint with the knee flexed (as specified); and
• an increase in weight bearing activity (as specified) within the 7 days before onset.
• There is one other new factor for patella dislocation.

• Glomerulonephritis is a complex and difficult area diagnostically.
• Crescentic glomerulonephritis is a histological diagnosis, so renal bio — psy is required for diagnosis.
• Rapidly progressive glomerulonephritis (RPGN) is a clinical diagnosis.  It is a severe disease, with subacute renal failure.  RPGN is the typical clinical pattern seen with crescentic glomerulonephritis (the histological pattern).  Both elements are required for the SOP to apply.

• The amendment is to the RH SOP only.
• The change is to the pesticide factors, which now cover a wider range of pesticides (including the agent orange herbicides - 2,4-D and 2,4,5-T).  The exposure requirements have also been changed from ≥ 500 occasions to ≥ 250/100 days.