Non melanotic malignant neoplasm of the skin - A course of therapeutic radiation Factor

RMA definition

The RMA has defined a course of therapeutic radiation  to mean "one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles".

General information

Therapeutic radiation (radiotherapy) may be given as a single treatment or may extend over several treatments.

Therapeutic radiation does not include:

• radiation given for diagnostic purposes (e.g. a chest or joint x-ray, CT scans, IVPs or barium studies),
• diagnostic use of, or treatment with, any radioactive substance such as radioactive iodine,
• laser therapy.
  • Former uses of therapeutic radiation
  • Current uses of therapeutic radiation

Preliminary questions [12813]

8575     there is some evidence that a course of therapeutic radiation may be a factor in the development of the condition under consideration.

5031     the veteran has received a course of therapeutic radiation at some time.

11835   the veteran has undergone a course of therapeutic radiation to side and site of the body at some time.

12846   the veteran has established the causal connection between the therapeutic radiation and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12848   the veteran has established the causal connection between the therapeutic radiation and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12847   the veteran has established the causal connection between the therapeutic radiation and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12847]

12850  the veteran received a course of therapeutic radiation to side and site of the body at least five years before the clinical onset of the condition under consideration.

12851  the veteran received a course of therapeutic radiation to side and site of the body for treatment of an illness or injury which is identifiable.

34498  for treatment of the identified illness or injury, the veteran received a course of therapeutic radiation to side and site of the body at least five years before the clinical onset of the condition under consideration.

3643    the identified illness or injury for which the course of therapeutic radiation to side and site of the body was undergone is causally related to operational service.

Clinical onset and eligible service [12848]

34497  the veteran received a course of therapeutic radiation to side and site of the body at least ten years before the clinical onset of the condition under consideration.

12851  the veteran received a course of therapeutic radiation to side and site of the body for treatment of an illness or injury which is identifiable.

34499  for treatment of the identified illness or injury, the veteran received a course of therapeutic radiation to side and site of the body at least ten years before the clinical onset of the condition under consideration.

3644    the identified illness or injury for which the course of therapeutic radiation to side and site of the body was undergone is causally related to eligible service.

Non melanotic malignant neoplasm of the skin- Atomic Radiation Factor

RMA definition

The RMA defines atomic radiation as "ionising radiation excluding:

• natural background radiation;
• therapeutic radiation; and
• radiation from diagnostic procedures."

Exposure to atomic radiation during VEA service

Australian service personnel with known atomic radiation exposure are:

• POW(J)s who were in the Nagasaki area on 9 August 1945.
• Personnel who served in or visited Hiroshima in connection with the occupation of Japan by the British Commonwealth Occupation Force from February 1946.
• Members of the defence forces who were involved in the British Nuclear Tests (BNT) Program in Australia between 1952 and 1963.

There are no other groups of Australian service personnel with eligible VEA service who have known service-related atomic radiation exposure.

There may also be other individual service personnel who contend exposure to atomic radiation during service covered by the VEA.  Such claims should be investigated on their merits.

Further information about atomic radiation is contained in: SOP bulletin No. 106 - Atomic Radiation and SOP bulletin No. 145 – Atomic Radiation – Update  British Nuclear Test Participants.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Exposure to Atomic Radiation	CR9171.pdf [3]	CR9171.docx [4]

Preliminary questions [31270]

30275 there is some evidence that atomic radiation may be a factor in the development of the condition under consideration.

31267  the veteran has established the causal connection between atomic radiation and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

31268   the veteran has established the causal connection between atomic radiation and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

31269   the veteran has established the causal connection between atomic radiation and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [31268]

31266 the veteran received a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to side and site of the body at some time.

31271 the veteran received a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to side and site of the body where this dose was accumulated at least five years before the clinical onset of the condition under consideration.

31272 operational service made a material contribution to the veteran receiving a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to side and site of the body where this dose was accumulated at least five years before the clinical onset of the condition under consideration.

31273 the cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to side and site of the body, to which operational service made a material contribution and the dose was accumulated at least five years before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [31269]

31274 the veteran received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to side and site of the body at some time.

31275 the veteran received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to side and site of the body where this dose was accumulated at least ten years before the clinical onset of the condition under consideration.

31276 eligible service made a material contribution to the veteran receiving a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to side and site of the body where this dose was accumulated at least ten years before the clinical onset of the condition under consideration.

31277 the cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to side and site of the body, to which eligible service made a material contribution and the dose was accumulated at least ten years before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

Non melanotic malignant neoplasm of the skin - Cigar smoking Factor

Cigar smoking

If there is a history of cigar smoking it will be necessary to obtain information about:

• the quantity smoked (the number of cigars smoked per week);
• when this took place; and
• the reasons for smoking.

The evidence gathered should be as complete and accurate as possible. Information already held in departmental files, eg in previous statements and clinical notes, should not be overlooked. Conflicting evidence should be resolved.

Before a causal link between a smoking habit and service may be established, consideration must be given to Repatriation Commission Guideline CM5030 - Guideline for claims assessors on smoking and alcohol related conditions and military service [5].

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [6]	CRD905.docx [7]
Claimant Report	Smoking	CRV905.pdf [8]	CRV905.docx [9]

Preliminary questions [34523]

22889 there is some evidence that cigar smoking may be a factor in the development of the condition under consideration.

4915   the veteran has ever smoked cigars.

34566 the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34567   the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34568   the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34567]

38716 any condition under consideration is a squamous cell carcinoma.

34558 the veteran has smoked at least five pack years of cigars before the clinical onset of the condition under consideration.

38724 the veteran smoked five pack years of cigars within the ten years before the clinical onset of the condition under consideration.

4921   the veteran has some period or periods of cigar smoking that are causally related to operational service.

or

38717 any condition under consideration is on the lipstick area of the lip.

38722 the veteran smoked at least 2.5 pack years of cigars before the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and eligible service [34568]

38716 any condition under consideration is a squamous cell carcinoma.

34699 the veteran smoked at least ten pack years of cigars before the clinical onset of the condition under consideration.

38725 the veteran smoked ten pack years of cigars within the ten years before the clinical onset of the condition under consideration.

4922   the veteran has some period or periods of cigar smoking that are causally related to eligible service.

or

38717 any condition under consideration is on the lipstick area of the lip.

38723 the veteran smoked at least five pack years of cigars before the clinical onset of non-melanotic malignant neoplasm of the skin.

Non melanotic malignant neoplasm of the skin - Cutaneous contact with high concentrations of polycyclic aromatic hydrocarbons Factor

RMA definition

The RMA has defined "agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified" to mean:

• concentrated coal tar distillates;
• creosote;
• crude oil;
• metal working fluids;
• molten bitumen or fumes from molten bitumen;
• shale oil; or
• soot.

Service exposure and SOP requirements

Polycyclic aromatic hydrocarbons (PAHs) are those chemical substances formed during the combustion of organic material or during high temperature processing of crude oil, coke, or other industrial carbon compounds.  The SOP factor requires the exposure to be cutaneous.  Cutaneous contact includes both external and internal skin (mucous membranes).

Most military personnel would not ordinarily be exposed to high levels of PAHs, however, service need only make a material contribution to the SOP quantity requirements.  Information about the scope and nature of particular service occupations may be found in Physical requirements, duties, and workplace hazards of specific military occupations which also contains an embedded hotword:  Military occupations with fumes and irritants component.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Cutaneous Contact with Polycyclic Aromatic Hydrocarbons	CR9194.pdf [14]	CR9194.docx [15]

Preliminary questions [31328]

31329 there is some evidence that cutaneous contact with high concentrations of polycyclic aromatic hydrocarbons (PAHs) may be a factor in the development of the condition under consideration.

31333 the veteran has had cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, at some time.

31330 the veteran has established the causal connection between cutaneous contact with polycyclic aromatic hydrocarbons (PAHs) and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

31331   the veteran has established the causal connection between cutaneous contact with polycyclic aromatic hydrocarbons (PAHs) and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

31332   the veteran has established the causal connection between cutaneous contact with polycyclic aromatic hydrocarbons (PAHs) and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [31331]

31334 the veteran had cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 1000 days, at some time.

31335 the veteran had cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 1000 days, before the clinical onset of the condition under consideration.

31336 operational service made a material contribution to the veteran having cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 1000 days, before the clinical onset of the condition under consideration.

Clinical onset and eligible service [31332]

38712 the veteran had cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 2000 days, at some time.

38713 the veteran had cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 2000 days, before the clinical onset of the condition under consideration.

31337 eligible service made a material contribution to the veteran having cutaneous contact of side and site of the body with agents containing high concentrations of polycyclic aromatic hydrocarbons (PAHs), as specified, on a cumulative total of at least 2000 days, before the clinical onset of the condition under consideration.

Non melanotic malignant neoplasm of the skin - Cutaneous contact with mustard gas Factor

Mustard gas exposure during service

Mustard gas was first used by the Germans at Ypres on 12.7.1917.  Although chlorine gas, lachrymatory (tear) gas and phosgene (in conjunction with chlorine) were used from 1915, a veteran could only have been exposed to mustard gas after 11.7.1917.

Australian defence personnel were exposed to mustard gas during World War 2 in two circumstances.  The first form of exposure, gas training, was by far the most common, and the majority of Australian defence personnel received this training.  Usually, trainees were assembled in a tent and were exposed to an agent that they were told was mustard gas.  They were instructed to don gas masks, breathe through the mask and leave the tent.  The training varied between establishments.  Most armed forces had this training, or similar, during World War Two.  In actual fact, due to the unavailability of mustard gas in some parts of Australia, substitutes such as tear gas was sometimes used, although the trainees were usually still told that the agent was mustard gas.  Personnel involved in the transportation and storage of mustard gas were also at risk of exposure.

The second form of exposure was far more serious.  It involved the deliberate exposure of a group of volunteers in Northern Queensland in a series of experiments to determine the effectiveness of mustard gas in tropical environments.  Whilst the majority of volunteers suffered little ill effect as a result of the experiments, the effects on others were more serious.  The severity of these effects indicates there was a significant exposure to mustard gas.

Each State has a list of those veterans who were associated with the experiments at Brook Island, Innisfail and Proserpine.  (Lists are generally held in the Review area).  The listing of a name is not conclusive evidence that the veteran actually took part in a trial.  Nor does failure to appear on the list mean conclusively that the veteran did not participate in a trial.  If there is alleged involvement in a trial and the veteran's name does not appear on the list, confirmation of involvement in a trial should be requested from the Director of Public Information, Department of Defence in accordance with Departmental Instruction B42/87 of 11.12.1987 [16].

Note: This Departmental Instruction contains instructions which are out of date.  To request information from the Department of Defence a request should be made to the SAM team via DocTracker.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Cutaneous Contact with Mustard Gas	CR9057.pdf [17]	CR9057.docx [18]

Preliminary questions [12820]

34484 there is some evidence that cutaneous contact with mustard gas may be a factor in the development of the condition under consideration.

27328 the condition under consideration is squamous cell carcinoma, carcinoma in situ, basal cellcarcinoma or basosquamous carcinoma.

34485 the veteran had cutaneous contact with mustard gas at some time.

34486 the veteran had cutaneous contact with mustard gas at side and site of the body at some time.

34487  the veteran has established the causal connection between cutaneous contact with mustard gas and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34488   the veteran has established the causal connection between cutaneous contact with mustard gas and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34489   the veteran has established the causal connection between cutaneous contact with mustard gas and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34488]

34490 the veteran had cutaneous contact with mustard gas at side and site of the body at least five years before the clinical onset of the condition under consideration.

34492 on operational service, the veteran had cutaneous contact with mustard gas at side and site of the body at least five years before the clinical onset of the condition under consideration.

34495 the cutaneous contact with mustard gas at side and site of the body, on operational service, at least five years before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [34489]

34491 the veteran had cutaneous contact with mustard gas at side and site of the body at least ten years before the clinical onset of the condition under consideration.

34493 on eligible service, the veteran had cutaneous contact with mustard gas at side and site of the body at least ten years before the clinical onset of the condition under consideration.

34494 as a causal result of eligible service, the veteran had cutaneous contact with mustard gas at side and site of the body at least ten years before the clinical onset of the condition under consideration.

34496 the cutaneous contact with mustard gas at side and site of the body, on eligible service, at least ten years before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

Non melanotic malignant neoplasm of the skin - Cutaneous contact with paraquat or bipyridine Factor

RMA definition

Paraquat is "a dipyridilium compound whose dichloride and dimethylsulphate salts are used as contact herbicides".  The SoP factor in non-melanotic malignant neoplasm of the skin requires cutaneous contact with "paraquat or bipyridine in the process of paraquat manufacture".

Paraquat is produced synthetically from bipyridine and has been available commercially since 1961.  Gramoxone was the commercial name for the paraquat herbicide used by the Australian Forces in Vietnam.

Paraquat is a highly toxic herbicide.  Between 1975 and 1977 a stenching agent, an emetic to induce vomiting, and a blue dye were added, to nearly all products, to prevent accidental poisoning.  Personal protection would require overalls, face shield, goggles, mask or respirator, elbow-length impervious gloves, splash apron and rubber boots.  Contact with the skin can cause inflammation, blistering and white spots on the nails.  Treatment would usually require immediate washing with water then soap and water.

Although bipyridine may be used as a laboratory reagent in other processes, it is only relevant to this SOP factor when used in the process of paraquat manufacture.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Cutaneous Contact with Paraquat	CR9240.pdf [19]	CR9240.docx [20]

Preliminary questions [34510]

34511 there is some evidence that cutaneous contact with paraquat or bipyridine as specified may be a factor in the development of the condition under consideration.

34512 the veteran has had cutaneous contact of side and site of the body with paraquat or bipyridine as specified at some time.

34515  the veteran has established the causal connection between cutaneous contact with paraquat or bipyridine and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34516   the veteran has established the causal connection between cutaneous contact with paraquat or bipyridine and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34517   the veteran has established the causal connection between cutaneous contact with paraquat or bipyridine and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34516]

34513 the veteran had cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 1000 days at some time.

34514 the veteran had cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 1000 days before the clinical onset of the condition under consideration.

34518 operational service made a material contribution to the veteran having cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 1000 days before the clinical onset of the condition under consideration.

Clinical onset and eligible service [34517]

38714 the veteran had cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 2000 days at some time.

38715 the veteran had cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 2000 days before the clinical onset of the condition under consideration.

34519 eligible service made a material contribution to the veteran having cutaneous contact of side and site of the body with paraquat or bipyridine as specified on a cumulative total of at least 2000 days before the clinical onset of the condition under consideration.

Non melanotic malignant neoplasm of the skin - Cutaneous scarring Factor

Cutaneous scarring for non melanotic malignant neoplasm of the skin

Everybody has at least one scar on their skin but cutaneous scarring is only significant as a cause of skin cancer if the skin cancer developed at the site of the scar. Therefore you should only investigate this contention if there is some evidence that the skin cancer arose at the site of a scar.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Cutaneous Scarring	MR9071.pdf [21]	MR9071.docx [22]

Preliminary questions [12816]

12962 there is some evidence that cutaneous scarring may be a factor in the development of the condition under consideration.

27328 the condition under consideration is squamous cell carcinoma, carcinoma in situ, basal cellcarcinoma or basosquamous carcinoma.

12869  the veteran has had cutaneous scarring at some time.

12870 the veteran has had cutaneous scarring of side and site of the body at some time.

12872  the veteran has established the causal connection between the cutaneous scarring and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12874   the veteran has established the causal connection between the cutaneous scarring and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12873   the veteran has established the causal connection between the cutaneous scarring and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12873]

12871 the veteran had cutaneous scarring of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

13804  the veteran had cutaneous scarring of side and site of the body as a result of an illness or injury which is identifiable.

31256 as a consequence of the identified illness or injury, the veteran had cutaneous scarring of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

12875  the identified illness or injury which caused the cutaneous scarring of side and site of the body is causally related to operational service.

Clinical onset and eligible service [12874]

31253 the veteran had cutaneous scarring of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

13804  the veteran had cutaneous scarring of side and site of the body as a result of an illness or injury which is identifiable.

31257 as a consequence of the identified illness or injury, the veteran had cutaneous scarring of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

12876  the identified illness or injury which caused the cutaneous scarring of side and site of the body is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Cutaneous ulceration Factor

Cutaneous ulceration

This is a localised defect or excavation of the skin which is produced by the sloughing (shedding) of inflammatory necrotic (dead) tissue.

If a veteran or member had cutaneous ulceration he or she probably would have sought medical attention at that time.Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of appropriate medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to cutaneous ulceration rather than to some other condition.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [12817]

12963 there is some evidence that cutaneous ulceration may be a factor in the development of the condition under consideration.

27328 the condition under consideration is squamous cell carcinoma, carcinoma in situ, basal cellcarcinoma or basosquamous carcinoma.

12877 the veteran has had cutaneous ulceration at some time.

12879 the veteran has had cutaneous ulceration of side and site of the body at some time.

12881  the veteran has established the causal connection between the cutaneous ulceration and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12883   the veteran has established the causal connection between the cutaneous ulceration and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12882   the veteran has established the causal connection between the cutaneous ulceration and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12882]

12880 the veteran had cutaneous ulceration of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

12878 the veteran had cutaneous ulceration of side and site of the body as a result of an illness or injury which is identifiable.

31258 as a consequence of the identified illness or injury, the veteran had cutaneous ulceration of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

12884  the identified illness or injury which caused the cutaneous ulceration of side and site of the body is causally related to operational service.

Clinical onset and eligible service [12883]

31254 the veteran had cutaneous ulceration of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

12878 the veteran had cutaneous ulceration of side and site of the body as a result of an illness or injury which is identifiable.

31259 as a consequence of the identified illness or injury, the veteran had cutaneous ulceration of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

12885  the identified illness or injury which caused the cutaneous ulceration of side and site of the body is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Exposure to arsenic Factor

The requirements for some arsenic exposure is the same for both reasonable hypothesis and for balance of probabilities Statement of Principles but most are different in terms of the duration of exposure required.

• Being exposed to arsenic as specified in the reasonable hypothesis Statement of Principles
• Being exposed to arsenic as specified in the balance of probabilities Statement of Principles

Compounds containing arsenic are not now recommended for therapeutic use.  Formerly they were taken internally - Fowler's solution and Asiatic pills as a treatment for psoriasis and Donovan's solution as treatment for venereal diseases.

A veteran or member would not have consumed drinking water with an arsenic content higher than 0.05 ppm during service in Australia.  This is because in major Australian reticulated water supplies, concentrations of arsenic range up to 0.015 µg/litre (this is equivalent to 0.015 ppm), with typical values usually less than 0.005 µg/litre.

Arsenic is a naturally occurring element which can be introduced into water through the dissolution of minerals and ores, or from industrial effluent, atmospheric deposition, drainage from old gold mines, or the use of some types of sheep dip.

Arsenic is used in many pesticides including:

• Insecticides – such as CCA (copper chrome arsenate) treatment of timber, arsenic trioxide treatment of buildings
• Herbicides - used to control vegetation; dimethyl arsenic acid (or cacodylic acid) was in the Agent Blue used in Vietnam as a defoliant for military purposes.
• Rodenticides - used to control rats or mice
• Parasiticides - used to control parasites.

If excessive arsenic exposure is suspected blood and urine tests would be conducted as well as an ECG, and sensory conduction tests particularly in the lower limbs.  Some investigation would be done to determine the source of arsenic poisoning in order to prevent on-going exposure.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Exposure to Arsenic	CR9241.pdf [23]	CR9241.docx [24]

Preliminary questions [12812]

12957 there is some evidence that exposure to arsenic as specified may be a factor in the development of the condition under consideration.

12833 the veteran has been exposed to arsenic as specified at some time.

12834  the veteran has established the causal connection between the exposure to arsenic as specified and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12835   the veteran has established the causal connection between the exposure to arsenic as specified and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12836   the veteran has established the causal connection between the exposure to arsenic as specified and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12835]

31444 the veteran was exposed to arsenic as specified in the reasonable hypothesis Statement of Principles for the condition under consideration at some time.

12837 the veteran was exposed to arsenic as specified in the reasonable hypothesis Statement of Principles for the condition under consideration at least five years before the clinical onset of the condition under consideration.

12841 operational service made a material contribution to the veteran's exposure to arsenic as specified in the reasonable hypothesis Statement of Principles for the condition under consideration at least five years before the clinical onset of the condition under consideration.

12843 the veteran's exposure to arsenic as specified in the reasonable hypothesis Statement of Principles for the condition under consideration, to which operational service made a material contribution at least five years before the clinical onset, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [12836]

31445 the veteran was exposed to arsenic as specified in the balance of probabilities Statement of Principles for the condition under consideration at some time.

12839 the veteran was exposed to arsenic as specified in the balance of probabilities Statement of Principles for the condition under consideration at least ten years before the clinical onset of the condition under consideration.

12842 eligible service made a material contribution to the veteran's exposure to arsenic as specified in the balance of probabilities Statement of Principles for the condition under consideration at least ten years before the clinical onset of the condition under consideration.

12844 the veteran's exposure to arsenic as specified in the balance of probabilities Statement of Principles for the condition under consideration, to which eligible service made a material contribution at least ten years before the clinical onset, was due to the veteran's serious default, wilful act or serious breach of discipline.

Non melanotic malignant neoplasm of the skin - Human papilloma virus infection Factor

Description

Human papilloma viruses (HPVs) selectively infect the epithelium of the skin and mucous membranes. HPVs may be asymptomatic, produce warts, or be associated with a variety of benign and malignant neoplasias.  Most HPVs are transmitted through direct contact with infectious lesions.

Signs and symptoms

• Condyloma acuminatum, which manifests as anogenital warts, is a common sexually transmitted disease.
• HPV infection of the uterine cervix produces the squamous-cell abnormalities most frequently detected on Papanicolaou (Pap) smears.  HPV infection is closely associated with abnormal cell development and growth of the penis, anus, vagina, vulva, and particularly cancer of the uterine cervix.
• HPV infection can also occur in the mouth.

Establishing Onset

• Clinical onset means the first appearance of signs or symptoms.
• The veteran/member may not have sought medical intervention for some time, due to the nature of the symptoms, however, a medical examination tests would have been necessary to obtain a diagnosis.
• In the absence of doctors’ notes and/or hospital records, a reliable history of appropriate signs and symptoms at a particular time may suffice.
• If the evidence is unclear, seek advice from a medical officer.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [34521]

34538 there is some evidence that human papilloma virus infection may be a factor in the development of the condition under consideration.

34537 any condition under consideration is of the anogenital skin.

34539 the veteran has had human papilloma virus infection at some time.

34540 the veteran had human papilloma virus infection of the anogenital skin.

34541 the veteran had human papilloma virus infection of the anogenital skin at the time of the clinical onset of the condition under consideration.

34542  the veteran has established the causal connection between human papilloma virus infection and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34543   the veteran has established the causal connection between human papilloma virus infection and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34544   the veteran has established the causal connection between human papilloma virus infection and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34543]

34545  the human papilloma virus infection of the anogenital skin is causally related to operational service.

Clinical onset and eligible service [34544]

34546  the human papilloma virus infection of the anogenital skin is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Immunosuppressive drugs Factor

Immunosuppressive drugs are defined by the RMA as meaning "drugs or agents administered for the purpose of suppressing immune responses, but does not include inhaled or topical steroids".  In the SOPs for cardiomyopathy and solar keratosis the method of administration is specified as "orally, intravenously or intramuscularly" whereas the SOP for soft tissue sarcoma also includes administration rectally or subcutaneously.

Immunosuppressive drugs can be given as treatment for organ transplant, autoimmune diseases (such as rheumatoid arthritis, SLE, some kidney diseases (such as nephrotic syndrome), vasculitis and some cancers.

Corticosteroids are the most commonly prescribed immunosuppressive drugs.  Other drugs include Cyclophosphamide, Azathioprine, Methotrexate and Cyclosporin. Seek medical or pharmaceutical advice for details as to whether a particular drug is immunosuppressive.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [38706]

12967 there is some evidence that treatment with immunosuppressive drugs may be a factor in the development of the condition under consideration.

34536 the veteran has been treated with immunosuppressive drugs at some time.

13976 the veteran has been treated with immunosuppressive drugs for a continuous period of twelve weeks at some time.

13977 the treatment with immunosuppressive drugs for a continuous period of twelve weeks was materially contributed to by treatment of an illness or injury which is identifiable.

38707  the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

38708   the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

38709   the veteran has established the causal connection between the identified illness or injury for which treatment with immunosuppressive drugs was given and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [38708]

38710 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of at least twelve weeks at least one year before the clinical onset of the condition under consideration.

34505  the identified illness or injury which made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twelve weeks is causally related to operational service.

Clinical onset and eligible service [38709]

34500 the veteran has been treated with immunosuppressive drugs for a continuous period of twenty-four weeks at some time.

34501 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of twenty-four weeks.

38711 the identified illness or injury made a material contribution to the veteran being treated with immunosuppressive drugs for a continuous period of at least twenty-four weeks at least two years before the clinical onset of the condition under consideration.

Non melanotic malignant neoplasm of the skin - Increased risk due to solar exposure on service Factor

Only investigate this factor if the claim cannot succeed under any other SOP factor.

All people living in Australia experience a significant level of harmful solar radiation which can cause a number of conditions.  The risk of damage due to solar exposure may have been increased significantly by conditions experienced during service: Physical requirements, duties, and workplace hazards of specific military occupations.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [21702]

39410 there is some evidence that increased risk due to solar exposure on service may be a factor in the development of the condition under consideration.

21703  the veteran has established the causal connection between the increased risk due to solar exposure on service and VEA service for the clinical onset of the condition under consideration.

21704   the veteran has established the causal connection between the increased risk due to solar exposure on service and operational service for the clinical onset of the condition under consideration.

or

21705   the veteran has established the causal connection between the increased risk due to solar exposure on service and eligible service for the clinical onset of the condition under consideration.

Clinical onset and operational service [21704]

10158 the veteran had an increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to operational service of at least 10 percent before the clinical onset of the condition under consideration.

10160 the veteran's increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to operational service of at least 10 percent before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [21705]

10159 the veteran had an increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to eligible service of at least 20 percent before the clinical onset of the condition under consideration.

10161 the veteran's increased risk of solar UV damage from ultraviolet radiation exposure to side and site of the body due to eligible service of at least 20 percent before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

Non melanotic malignant neoplasm of the skin - Infected cutaneous sinus tract Factor

Definition and description

The RMA has defined 'sinus tract' as "an abnormal channel or fistula permitting the escape of pus".

An infected cutaneous sinus tract is one where the sinus tract opens to the skin.  It may result from various infections such as a subcutaneous abscess that ruptures to form a fistula to the skin surface, through to osteomyelitis where infection may expand through the bone cortex and spread under the periosteum, with formation of subcutaneous abscesses that may drain spontaneously through the skin.

Establishing the presence of an infected cutaneous sinus tract

If a veteran or member had an infected cutaneous sinus tract he or she probably would have sought medical attention at that time.Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of appropriate medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to an infected cutaneous sinus tract rather than to some other condition.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [12819]

12965 there is some evidence that an infected cutaneous sinus tract may be a factor in the development of the condition under consideration.

27328 the condition under consideration is squamous cell carcinoma, carcinoma in situ, basal cellcarcinoma or basosquamous carcinoma.

12894 the veteran has had an infected cutaneous sinus tract at some time.

12895 the veteran has had an infected cutaneous sinus tract of side and site of the body at some time.

12899  the veteran has established the causal connection between the infected cutaneous sinus tract and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12901   the veteran has established the causal connection between the infected cutaneous sinus tract and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12900   the veteran has established the causal connection between the infected cutaneous sinus tract and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12900]

12897 the veteran had an infected cutaneous sinus tract of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

12896  the infected cutaneous sinus tract of side and site of the body was due to an illness or injury which is identifiable.

31260 as a consequence of the identified illness or injury, the veteran had an infected cutaneous sinus tract of side and site of the body for at least the six months before the clinical onset of the condition under consideration.

12902  the identified illness or injury which caused the infected cutaneous sinus tract at side and site of the body is causally related to operational service.

Clinical onset and eligible service [12901]

31255 the veteran had an infected cutaneous sinus tract of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

12896  the infected cutaneous sinus tract of side and site of the body was due to an illness or injury which is identifiable.

31261 as a consequence of the identified illness or injury, the veteran had an infected cutaneous sinus tract of side and site of the body for at least the one year before the clinical onset of the condition under consideration.

12903  the identified illness or injury which caused the infected cutaneous sinus tract at side and site of the body is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Infection with the human immunodeficiency virus (HIV) Factor

HIV infection

• HIV infection is infection with the human immunodeficiency virus.  HIV was discovered in 1981.
• The HIV-1 virus was previously referred to as human T-cell lymphotropic virus type III (HTLV-III), lymphadenopathy-associated virus (LAV) or AIDS-related virus (ARV).  HIV-2 was identified in 1986.
• HIV infection can only be established by a blood test.
• HIV infection is the cause of AIDS (Acquired Immuno Deficiency Syndrome).
• Sexual contact is the major mode of transmission of the infection but it may also be transmitted via blood or blood products.
• HIV infection is particularly prone to spread among intravenous drug users.

Preliminary questions [12821]

17599 there is some evidence that HIV may be a factor in the development of the condition under consideration.

2464  the veteran has been infected with the human immunodeficiency virus (HIV).

28121 the veteran was infected with human immunodeficiency virus (HIV) at the time of the clinical onset of the condition under consideration.

12915  the veteran has established the causal connection between being infected with HIV and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

12916   the veteran has established the causal connection between being infected with HIV and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

12917   the veteran has established the causal connection between being infected with HIV and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [12916]

2466     the human immunodeficiency virus (HIV) infection is causally related to operational service.

Clinical onset and eligible service [12917]

7788     the human immunodeficiency virus (HIV) infection is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Lichen sclerosis Factor

Description

Lichen sclerosis is a chronic inflammatory, often itchy, skin disease characterised by flat-topped white macules or patches. Other names for this condition are 'balanitis xerotica obliterans' and 'lichen sclerosus et atrophicus'.

Signs and symptoms

Lichen sclerosis appears as chronic white patches on the skin. Like any form of epidermal atrophy the skin becomes thinned and crinkled. The skin tears easily and bright red or purple discolouration from bleeding appears.  In more severe cases scarring can occur.

Establishing Onset

The veteran/member may not have sought medical intervention for some time, due to the nature of the symptoms, however, a medical examination would have been necessary to obtain a diagnosis. In the absence of doctors' notes and/or hospital records, a reliable history of appropriate signs and symptoms at a particular time may suffice. If the evidence is unclear, seek advice from a medical officer.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [34520]

34527 there is some evidence that lichen sclerosis may be a factor in the development of the condition under consideration.

34528 the veteran has had lichen sclerosis at some time.

34529 the veteran has had lichen sclerosis of side and site of the body at some time.

34530 the veteran had lichen sclerosis of side and site of the body at the time of the clinical onset of the condition under consideration.

34531  the veteran has established the causal connection between lichen sclerosis and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34532   the veteran has established the causal connection between lichen sclerosis and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34533   the veteran has established the causal connection between lichen sclerosis and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34532]

34534  the lichen sclerosis is causally related to operational service.

Clinical onset and eligible service [34533]

34535  the lichen sclerosis is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - No clinical management for non melanotic malignant neoplasm of the skin Factor

Appropriate clinical management of non melanotic malignant neoplasm of the skin includes accurate identification of the type of lesion followed by treatment appropriate to the type. BCC is generally satisfactorily treated with cryosurgery (freezing with liquid nitrogen), excision or curettage. Cytotoxic agents may occasionally be used. Basosquamous carcinoma of the skin, because of its tendency to metastasise is best treated by surgical excision. SCC is treated according to site by the best method to ensure its total destruction, and with the best cosmetic and functional result. This may include local destruction, radiotherapy or surgery (including graft procedures). Merkel cell carcinoma may be treated by surgery, radiation therapy or chemotherapy.

Inability to obtain appropriate clinical management

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Inability to Obtain Appropriate Clinical Management	GQACM.pdf [25]	GQACM.docx [26]

Preliminary questions [10164]

11109  the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.

7066     there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.

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.

7378     the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.

7379     the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.

11234   the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.

11235  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.

or

11236  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.

Clinical worsening and operational service [11235]

7384     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.

21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.

7387     the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7390     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.

7392     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Clinical worsening and eligible service [11236]

7385     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.

7386     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.

7388     the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7391     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.

7393     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Non melanotic malignant neoplasm of the skin - Non-Hodgkin's lymphoma or chronic lymphoid leukaemia Factor

RMA definition

Non-Hodgkin’s lymphoma means a malignant neoplastic disease arising from the lymphoid components of the immune system, characterised by the absence of Reed-Sternberg cells.  This definition includes non-Hodgkin’s lymphoma arising within parenchymal organs and excludes Burkitt’s lymphoma, plasma cell malignancy, hairy cell leukaemia and chronic lymphoid leukaemia

General information about non-Hodgkin’s lymphoma

The term non-Hodgkin’s lymphoma covers essentially any lymphoma that is not of the Hodgkin’s disease type.  Burkitt’s lymphoma is a non-Hodgkin’s lymphoma, but is excluded from the RMA SoP for non-Hodgkin’s lymphoma because of its particular aetiology.  Other conditions covered by the SoP include reticulosarcoma, mycosis fungoides, Sezary’s disease/syndrome, and adult T cell leukaemia/lymphoma.

Signs and symptoms

Main sign is persistent painless swelling of lymph nodes in the neck, armpits or groin.  Other possible signs include fever, sweating, fatigue, and weight loss.  Biopsy is required to confirm if cancer is present.

Establishing onset

If a veteran or member had non-Hodgkin’s lymphoma he or she would have needed significant medical attention at that time.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, if these records have been destroyed or can no longer be obtained and there is a reliable history of non-Hodgkin’s lymphoma at a particular time, this generally will be accepted, unless there is contradictory evidence.  Obtain medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to non-Hodgkin’s lymphoma rather than to some other condition.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [31284]

31278 there is some evidence that non-Hodgkin's lymphoma or chronic lymphoid leukaemia may be a factor in the development of the condition under consideration.

31279  the veteran has had non-Hodgkin's lymphoma or chronic lymphoid leukaemia at some time.

7436     the veteran has had non-Hodgkin's lymphoma at some time.

or

31280 the veteran has had chronic lymphoid leukaemia at some time.

3441     the veteran had the identified illness or injury before the clinical onset of the condition under consideration.

31281  the veteran has established the causal connection between the identified illness or injury and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

31282   the veteran has established the causal connection between the identified illness or injury and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

31283   the veteran has established the causal connection between the identified illness or injury and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [31282]

22451  the identified illness or injury is causally related to operational service.

Clinical onset and eligible service [31283]

22452  the identified illness or injury is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Phimosis Factor

Phimosis is a condition in which the foreskin (prepuce) of the penis is so tight that it cannot be pulled back (retracted) to reveal the head (glans) of the penis. Phimosis may be present at birth. It also can be caused by an infection, or by scar tissue that formed as a result of injury or chronic inflammation. Another cause of phimosis is balanitis, which leads to scarring and tightness of the foreskin. Immediate medical attention is necessary if the condition makes urination difficult or impossible.

Phimosis is not to be confused with paraphimosis which occurs when the foreskin, once retracted, cannot return to its original location.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [34526]

34547 there is some evidence that phimosis may be a factor in the development of the condition under consideration.

34548 any condition under consideration is of the glans penis or prepuce of the penis.

34549 the veteran has had phimosis at some time.

34550 the veteran had phimosis for a period of at least two years at some time.

34551 the veteran had phimosis for a period of at least two years before the clinical onset of the condition under consideration.

34552  the veteran has established the causal connection between phimosis and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34553   the veteran has established the causal connection between phimosis and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34554   the veteran has established the causal connection between phimosis and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34553]

34555  the veteran's phimosis is causally related to operational service.

Clinical onset and eligible service [34554]

34556  the veteran's phimosis is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Prolonged sunlight exposure Factor

Sunlight exposure as a factor requires only a total dose (in hours) of sun exposure to unprotected skin at the affected site.  It will be necessary to consider and determine different body sites separately (see Advisory Note No. 4 of '04 [31]) to account for different exposure at the different sites. The factor requires sunlight exposure for a specified number of hours while in a tropical area or equivalent sunlight exposure in other latitude zones. The RMA has specified a weighting factor to be applied depending on the latitude zone where sunlight exposure took place.

Last reviewed for CCPS 26 September 2007.

Preliminary questions [34474]

34475  the veteran has established the causal connection between sunlight exposure to unprotected skin and VEA service for the clinical onset of the condition under consideration.

34476   the veteran has established the causal connection between sunlight exposure to unprotected skin and operational service for the clinical onset of the condition under consideration.

or

34477   the veteran has established the causal connection between sunlight exposure to unprotected skin and eligible service for the clinical onset of the condition under consideration.

Clinical onset and operational service [34476]

34478 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, at some time.

34480 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, before the clinical onset of the condition under consideration.

34482 operational service made a material contribution to the veteran's sunlight exposure to unprotected skin of side and site of the body for at least 2250 hours, normalised for latitude, before the clinical onset of the condition under consideration.

Clinical onset and eligible service [34477]

34479 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, at some time.

34481 the veteran had sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, before the clinical onset of the condition under consideration.

34483 eligible service made a material contribution to the veteran's sunlight exposure to unprotected skin of side and site of the body for at least 4500 hours, normalised for latitude, before the clinical onset of the condition under consideration.

Non melanotic malignant neoplasm of the skin - PUVA treatment Factor

PUVA is defined by the RMA as "photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation".

Description

Psoralen (which may be referred to as methoxypsoralen, methoxsalen or oxsoralen) is a photosensitiser which may be in capsule form or as a lotion for topical application.  It has been used to treat many cases of vitiligo but is also used to treat severe, recalcitrant or disabling psoriasis.  Oxsoralen alone has no effect but must be followed by UV exposure (either sunlight or artificial source) and only the skin that is exposed is altered.  Following ingestion, the skin becomes photosensitive in about 1 hour.  Peaking 2 hours after intake, this sensitivity vanishes in 8 hours.  The exposure time and intensity of UV light must be measured and controlled.

Note:  The RMA definition of PUVA treatment limits this to the oral taking of psoralen with long-wave UVA.  It does not include topical application of psoralen.

Establishing a history of PUVA therapy

If a person had undergone PUVA treatment, this would have been carried out by a specialist.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, these records may have been destroyed or can no longer be obtained.  Therefore, if there is a reliable history of PUVA treatment at a particular time, this generally will be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed PUVA treatment is medically feasible.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF format	Word Format
Medical Report	PUVA Therapy	MR9266.pdf [32]	MR9266.docx [33]

Preliminary questions [12814]

12960 there is some evidence that PUVA treatment may be a factor in the development of the condition under consideration.

12852 the veteran underwent PUVA therapy at some time.

12853 the veteran underwent PUVA therapy to side and site of the body at some time.

34506 the veteran underwent PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, at some time.

34507 the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, was materially contributed to by treatment of an illness or injury which is identifiable.

12855  the veteran has established the causal connection between PUVA treatment and VEA service for the clinical onset of the condition under consideration.

12857   the veteran has established the causal connection between PUVA treatment and operational service for the clinical onset of the condition under consideration.

or

12858   the veteran has established the causal connection between PUVA treatment and eligible service for the clinical onset of the condition under consideration.

Clinical onset and operational service [12857]

12859 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration.

12861 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.

34508  the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to operational service.

Clinical onset and eligible service [12858]

12860 the veteran has undergone PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, at some time.

12845 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered.

12856 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration.

12862 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.

34509  the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to eligible service.

Non melanotic malignant neoplasm of the skin - Smoking tobacco products - material contribution Factor

Smoking and CCPS

Smoking cigarettes, cigars or pipe tobacco due to VEA service need only have made a material contribution to the minimum smoking requirements specified in the SOP (refer Kattenberg v Repatriation Commission [2002] FCA 412).  It has not been possible to make changes to the smoking module in CCPS to take account of this, but for many cases this is of no consequence because service-related smoking alone is sufficient to meet the SOP requirements.  However, for smoking cases that do not succeed under the CCPS smoking module, there is a contention:

• Smoking tobacco products - material contribution

This contention covers all types of smoking – cigarettes, pipe and cigars - with rulebase questions to ascertain whether or not VEA service made a material contribution to the SOP requirements.  This may entail addressing issues that have already been covered in the smoking module because it has not been possible to isolate specific facts established within that module.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [34]	CRD905.docx [35]
Claimant Report	Smoking	CRV905.pdf [36]	CRV905.docx [37]

Preliminary questions [34525]

30303 the veteran has smoked cigarettes, cigars or pipe tobacco at some time.

34572  the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of non-melanotic malignant neoplasm of the skin.

34573   the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of non-melanotic malignant neoplasm of the skin.

or

34574   the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of non-melanotic malignant neoplasm of the skin.

Clinical onset and operational service [34573]

38716 any condition under consideration is a squamous cell carcinoma.

34560 the veteran smoked at least five pack years of cigarettes or the equivalent thereof in other tobacco products within the ten years before the clinical onset of non-melanotic malignant neoplasm of the skin.

38763 smoking as a causal result of operational service made a material contribution to the SOP requirements for squamous cell carcinoma of the skin and smoking tobacco products.

or

38717 any condition under consideration is on the lipstick area of the lip.

38730 the veteran smoked at least 2.5 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of non-melanotic malignant neoplasm of the skin.

34561 smoking as a causal result of operational service made a material contribution to the SOP requirements for non-melanotic malignant neoplasm of the skin and smoking tobacco products.

Clinical onset and eligible service [34574]

38716 any condition under consideration is a squamous cell carcinoma.

38732 the veteran smoked at least ten pack years of cigarettes or the equivalent thereof in other tobacco products within the ten years before the clinical onset of non-melanotic malignant neoplasm of the skin.

38764 smoking as a causal result of eligible service made a material contribution to the SOP requirements for squamous cell carcinoma of the skin and smoking tobacco products.

or

38717 any condition under consideration is on the lipstick area of the lip.

38731 the veteran smoked at least five pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of non-melanotic malignant neoplasm of the skin.

34562 smoking as a causal result of eligible service made a material contribution to the SOP requirements for non-melanotic malignant neoplasm of the skin and smoking tobacco products.