SOP Bulletin No. 50

4 — th Floor AMP Place, 10 Eagle St Brisbane  3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

4 June 2001

THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 6 June, 2001

IMPORTANT OPERATIONAL FEATURES

• Minor modification to definition of otitic barotrauma.

• Factor for aural barotrauma changed to otitic barotrauma.

• The definition of hypertension is changed to mean "permanently elevated blood pressure".  The definition requires that any diagnosis of hypertension be based on evidence of a usual blood pressure reading where systolic is greater than or equal to 140 and/or where diastolic is greater than or equal to 90, or on the regular administration of antihypertensive therapy to reduce blood pressure.
• The effect of including "permanent" in the definition means that a reading where the systolic pressure is < 140 and/or diastolic pressure is <90 at any time (not due to treatment) will generally preclude the diagnosis of hypertension prior to that time.  A "usual blood pressure reading" can only be established on the basis of several readings - it cannot be established on one lone reading.

• The phrase "accurate determination of hypertension" has been replaced by the usual phrase "clinical onset of hypertension" which, in keeping with most other SOPs, is not defined by the RMA.
• The phrase "clinical worsening of hypertension" is no longer defined in the SOP.
• There are new causal and worsening factors for sleep apnoea.
• There is a leaner definition of "being obese" which does not change its present meaning.

• The definition has been modified to include a clinical entity of "recurrent or chronic patellofemoral pain".
• Previous factors for trauma to the meniscus etc and for twisting injury have been combined into a new causal and aggravating factor:

Suffering an injury to the affected knee resulting in meniscal damage or permanent ligamentous instability

• There is a new causal factor for RH SOP only:

Running for at least six hours per week for at least four consecutive weeks before the clinical onset of chondromalacia patellae and where such activity has ceased the clinical onset of chondromalacia patellae has occurred within four weeks of cessation

• A specific reference to oat cell carcinoma has been removed from the first smoking factor because it was considered to be covered by the histological type small cell carcinoma; and another histological type - carcinosarcoma - has been added.

• Latency periods have been added to both smoking factors, ie "where smoking has commenced at least five (10 BOP) years before clinical onset". 

• Similar changes have been made to the visible tobacco smoke haze factor; and the exposure period is now 5,200 hours for both SOPs.

• There are now 2 factors for inhaling respirable asbestos fibres – one in an enclosed space and one in an open environment.  The difference is essentially that in an enclosed space just one exposure is sufficient whereas at least 1000 hours of exposure are required in an open environment.
• Pulmonary TB and pneumonia have been removed from the list of respiratory conditions that can cause this malignancy.
• There are new causal factors for:

Asbestosis

Diesel engine exhaust

Inhaling chemical agents contaminated by 2,3,7,8-TCDD (effectively replaces handling herbicides)

Atomic radiation (effectively replaces being within 4km of Hiroshima or Nagasaki)

Radon exposure

Silicosis

Inhaling respirable crystalline silica dust (RH only)

Inhaling organic arsenic fumes, cadmium fumes, nickel fumes, hexavalent chromate fumes, beryllium fumes and bis(chloromethyl)ether or chloromethyl methyl ether fumes.

• These factors have been removed – caring for birds and handling insecticides.

SOLAR UV DAMAGE

•      The UV factors have been changed to require the UV damage factor ratio to be measured both for the affected area and at the time of clinical onset.

The SOPs affected by this change are:

• Acquired cataract
• Malignant neoplasm of the lip epithelium
• Non melanotic malignant neoplasm of the skin
• Pterygium
• Solar keratosis (replaces chronic solar skin damage)

The SOPs for Malignant melanoma of the skin have the clinical onset change only.

• Reminder: when using the UV Risk calculator the date of clinical onset becomes the evaluation date.
• In all the above listed new SOPs the presentation of the UV formula has been changed principally by removing duplication and adding the clinical onset element, but its application remains unchanged.
• Information about other changes made to these SOPs follows.

• The smoking requirements have effectively been halved and the factor now requires 10 RH/ 20 BOP pack years or the equivalent thereof.
• These SOPs also have the new type atomic radiation exposure factors for both RH & BOP.  The dose required is 0.5 Sv/RH & 1.0 Sv/BOP.  Advice on how to apply this factor is contained in SOP Bulletin No. 42 update.
• The trauma factor is now for “physical trauma to the eyeball of the affected eye”.  Physical trauma is defined.
• The steroid factor has been reworded, different doses for RH and BOP are specified in the associated definitions, and the period during which treatment must have taken place has been extended to ten years before clinical onset/worsening of acquired cataract.
• There are new causal and aggravating factors for a thermal burn to the lens, an electrical injury, being treated with a drug as specified, and for intra-ocular inflammation.  A new ca — u — sal and aggravating factor for chronic hypocalcaemia applies to cortical and subcapsular cataracts only.
• All causal factors except UV and smoking are now aggravating factors.
• The order of the factors in the SOPs has been changed.

• The new causal UV factor requires the UV damage ratio to be measured at the time of the clinical onset, but there is no affected area component. 
• There are new causal factors for immunosuppressive drugs for organ transplantation or systemic malignancy, and for having PUVA therapy. 

• All three new factors apply to both RH & BOP SOPs.
• The SOPs have been reorganised to follow the new standard format for SOPs.

• There is now one smoking factor which covers “pack years of cigarettes or the equivalent in other smoking products”, which is defined and includes pipe smoking.  The smoking cessation requirements have been removed.

• There are new causal factors for atomic radiation in both RH & BOP.  The dose required is 0.05 Sv/RH & 0.5 Sv/BOP.  Advice on how to apply this factor is contained in SOP Bulletin No. 42 update.  The POW(J) factor remains.
• The factors for PUVA treatment and therapeutic radiation are no longer limited to squamous cell carcinoma and basal cell carcinoma only.  The time period for the therapeutic radiation factor has been reduced to 5 years for both RH & BOP.
• The chronic radiodermatitis factor has been removed effectively replaced by the therapeutic radiation factor. 
• There are new causal factors for non-Hodgkin's lymphoma or chronic lymphoid leukaemia, and cutaneous exposure to polycyclic aromatic hydrocarbons (PAHs) in both RH & BOP SOPs.  The PAH factor has an associated definition describing the situations when cutaneous contact may occur.
• There has been reorganisation of the SOPs in terms of order and wording, and some minor definitional changes, but these have not changed the application of the SOPs.

• Minor changes to the definition of “heavy exposure of the eyes to dust”, but its application is unchanged.

• These SOPs replace the SOPs for Chronic Solar Skin Damage, and cover Solar Keratosis only.  These SOPs no longer cover other skin damage due to solar exposure.
• This means the ICD-9-CM code 692.74 will no longer be covered by this SOP.  Code 702.0 will still be covered and be able to be used without side or site specification.  The site specific codes 702.00 to 702.04 inclusive will continue to be covered by this SOP.
• Thus when dealing with a claim for “chronic solar skin damage”, decision makers will need to consider if one or more of the following diagnoses are required to answer the claim:

1.                         Non Melanotic Malignant Neoplasm of the Skin
2.                       Solar Keratosis
3.                     Actinic Skin Damage e.g. solar elastosis, now non-SOP, code 692.74.

• In practice, most claims for non-malignant solar skin damage will be best answered by a diagnosis of solar keratosis, as this is the clinically significant component, the one requiring treatment.

• There is a new causal factor for being treated with immunosuppressive drugs for organ transplantation in both the RH & BOP SOPs.

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