Tinea - Being in an immunocompromised state Factor

RMA definition

For the purposes of this Statement of Principles, an immunocompromised state means a state where the immune response has been attenuated by administration of immunosuppressive drugs, or by irradiation, certain types of infection, malnutrition, or a malignant disease process.

In most cases, medical advice will be needed to establish whether or not the veteran is in an immunocompromised state.

Last reviewed for CCPS 26 August 2004.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Development of Tinea	CR9008.pdf [4]	CR9008.docx [5]

Preliminary questions [234]

13472 there is some evidence that being in an immunocompromised state may be a factor in the development or worsening of the condition under consideration.

7445     the veteran has been in an immunocompromised state at some time.

10098  the veteran's immunocompromised state was due to an illness or injury which is identifiable.

278        the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and VEA service for tinea of the skin.

33879 the identified illness or injury caused the immuno-compromised state at the time of the clinical onset of tinea of the skin.

33873   the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and VEA service for the clinical onset of tinea of the skin.

33878  the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and operational service for the clinical onset of tinea of the skin.

or

33877  the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and eligible service for the clinical onset of tinea of the skin.

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.

33880 the identified illness or injury caused the immuno-compromised state at the time of the clinical worsening of tinea of the skin.

33874   the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and VEA service for the clinical worsening of tinea of the skin.

33875  the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and operational service for the clinical worsening of tinea of the skin.

or

33876  the veteran has established the causal connection between the identified illness or injury which caused the immuno-compromised state and eligible service for the clinical worsening of tinea of the skin.

Clinical onset and operational service [33878]

7451     the identified illness or injury which caused the immunocompromised state is causally related to operational service.

Clinical onset and eligible service [33877]

7452     the identified illness or injury which caused the immunocompromised state is causally related to eligible service.

Clinical worsening and operational service [33875]

7451     the identified illness or injury which caused the immunocompromised state is causally related to operational service.

276       the clinical onset of tinea of the skin occurred prior to that part of operational service to which the identified illness or injury that caused the immuno-compromised state is causally related.

Clinical worsening and eligible service [33876]

7452     the identified illness or injury which caused the immunocompromised state is causally related to eligible service.

33881 the clinical onset of tinea of the skin occurred prior to that part of eligible service to which the identified illness or injury that caused the immuno-compromised state is causally related.

Tinea - Chronic ischaemia of the lower limb Factor

Ischaemia occurs as a result of obstruction of the arterial blood supply or inadequate blood flow leading to hypoxia in the tissues.

A severely ischaemic foot is painful, cold, and often numb. In chronic cases, the skin may be dry and scaly with poor nail and hair growth. As ischaemia worsens, ulceration may appear (typically on the toes or heel, occasionally on the leg), especially after local trauma.

Last reviewed for CCPS 26 August 2004.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Development of Tinea	CR9008.pdf [4]	CR9008.docx [5]

Preliminary questions [233]

33940 there is some evidence that chronic ischaemia may be a factor in the development or worsening of the condition under consideration.

33939 the condition under consideration is tinea pedis.

33954 the veteran has had chronic ischaemia of a lower limb at some time.

33955 the veteran has had chronic ischaemia of the limb affected by tinea pedis at some time.

33956 the chronic ischaemia of the limb affected by tinea pedis was a consequence of an illness or injury which is identifiable.

33941 the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and VEA service for tinea of the skin.

33948 the identified illness or injury caused the chronic ischaemia of the limb affected by tinea pedis at the time of the clinical onset of tinea of the skin.

33942   the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and VEA service for the clinical onset of tinea of the skin.

33944  the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and operational service for the clinical onset of tinea of the skin.

or

33945  the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and eligible service for the clinical onset of tinea of the skin.

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.

33949   the identified illness or injury caused the chronic ischaemia of the limb affected by tinea pedis at the time of the clinical worsening of tinea of the skin.

33943   the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and VEA service for the clinical worsening of tinea of the skin.

33946  the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and operational service for the clinical worsening of tinea of the skin.

or

33947  the veteran has established the causal connection between the identified illness or injury which caused the chronic ischaemia and eligible service for the clinical worsening of tinea of the skin.

Clinical onset and operational service [33944]

33950  the identified illness or injury which caused the chronic ischaemia of the limb affected by tinea pedis is causally related to operational service.

Clinical onset and eligible service [33945]

33951  the identified illness or injury which caused the chronic ischaemia of the limb affected by tinea pedis is causally related to eligible service.

Clinical worsening and operational service [33946]

33950  the identified illness or injury which caused the chronic ischaemia of the limb affected by tinea pedis is causally related to operational service.

33952  the clinical onset of tinea of the skin occurred prior to that part of operational service to which the identified illness or injury that caused the chronic ischaemia of the limb affected by tinea pedis is causally related.

Clinical worsening and eligible service [33947]

33951  the identified illness or injury which caused the chronic ischaemia of the limb affected by tinea pedis is causally related to eligible service.

33953  the clinical onset of tinea of the skin occurred prior to that part of eligible service to which the identified illness or injury that caused the chronic ischaemia of the limb affected by tinea pedis is causally related.

Tinea - Diabetes mellitus Factor

Definition

Diabetes mellitus is an endocrine disease where there is diminished insulin action. It can also be referred to as "sugar diabetes", juvenile onset diabetes, Type I diabetes, IDDM (insulin dependent diabetes mellitus), NIDDM (non insulin dependent diabetes mellitus), Type II diabetes and maturity onset diabetes.

Signs and symptoms

• Insulin dependent diabetes usually begins before the age of 40 with the abrupt onset of symptoms such as thirst, excessive urination, increased appetite and weight loss.
• Non insulin dependent diabetes usually begins in middle life or beyond, and the typical patient is overweight. The onset of symptoms is more gradual, or there may be no symptoms and diabetes is diagnosed on routine testing.

Establishing onset

If a veteran had diabetes mellitus there would be specific evidence with regard to blood sugar levels and the need for diet, weight loss, insulin or drugs to lower blood sugar levels (eg Daonil, Euglocon, Glimel, Diabinese, Rastinon, Diamicron, Minidiab, Melizide), drugs to help insulin work better (eg Diabex, Diaformin, Glucophage) and drugs to slow the digestion of carbohydrates (eg Glucobay).

Last reviewed for CCPS 26 August 2004.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Development of Tinea	CR9008.pdf [4]	CR9008.docx [5]

Preliminary questions [6714]

20239  there is some evidence that diabetes mellitus may be a factor in the development or worsening of the condition under consideration.

489        the veteran has diabetes mellitus.

10547 the veteran has insulin dependent diabetes mellitus (type 1).

or

10548 the veteran has non-insulin dependent diabetes mellitus (type 2).

30273  the veteran has established the causal connection between diabetes mellitus and VEA service for the condition under consideration.

28495 the veteran had the identified illness or injury at the time of the clinical onset of the condition under consideration.

30271   the veteran has established the causal connection between diabetes mellitus and VEA service for the clinical onset of the condition under consideration.

30286  the veteran has established the causal connection between diabetes mellitus and operational service for the clinical onset of the condition under consideration.

or

30287  the veteran has established the causal connection between diabetes mellitus and eligible service for the clinical onset of the condition under consideration.

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.

28497   the veteran had the identified illness or injury at the time of the clinical worsening of the condition under consideration.

30272   the veteran has established the causal connection between diabetes mellitus and VEA service for the clinical worsening of the condition under consideration.

30288  the veteran has established the causal connection between diabetes mellitus and operational service for the clinical worsening of the condition under consideration.

or

30289  the veteran has established the causal connection between diabetes mellitus and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [30286]

17527  the identified illness or injury, a type of diabetes mellitus, is causally related to operational service.

Clinical onset and eligible service [30287]

17528  the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service.

Clinical worsening and operational service [30288]

17527  the identified illness or injury, a type of diabetes mellitus, is causally related to operational service.

26450  the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury is causally related.

Clinical worsening and eligible service [30289]

17528  the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service.

26451  the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury is causally related.

Tinea - Inability to obtain appropriate clinical management for tinea of the skin Factor

Appropriate clinical management for tinea may include identification of the organism, topical treatment with various antifungal creams, powders or paints, and keeping the skin clean and dry.. Resistant cases or those with widespread involvement require systemic therapy such as griseofulvin (Grisovin or Griseostatin) tablets. Until recently, griseofulvin was the most widely used systemic antifungal drug, but its use as first-line treatment of cutaneous fungal infections is decreasing with the availability of newer drugs. Newer systemic drugs include itraconazole(Sporanox), fluconazole (Diflucan), and terbinafine (Lamisil).

Inability to obtain appropriate clinical management

Last reviewed for CCPS 26 August 2004.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Development of Tinea	CR9008.pdf [4]	CR9008.docx [5]
Medical Report	Inability to Obtain Appropriate Clinical Management	GQACM.pdf [6]	GQACM.docx [7]

Preliminary questions [6762]

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.

Tinea - Skin maceration Factor

The RMA defines skin maceration as “the softening of the skin by moisture”.  A typical example of skin maceration is the classic wrinkling that occurs when hands or feet have been immersed in water for longer than normal periods.  This softening of the skin creates an ideal environment for the development and/or worsening of tinea of the skin at the site of the maceration.  Maceration often occurs in the feet and groin areas – the most common sites of tinea of the skin – due to sweating.  The sweating may be due to living/working conditions in a hot or humid climate, physical exertion, military training, exercises or other duties, wearing waterlogged boots or clothes, or rubber gloves.  Skin maceration is not a disease process, however, medical conditions such as obesity or hyperhidrosis (excessive perspiration associated with overactive sweat glands) may contribute to its development or worsening.  Given the physical demands of military personnel, it would be expected that all veterans or members of the ADF would have experienced skin maceration at some time.

Last reviewed for CCPS 26 August 2004.

Investigative Documents

Type	Title	PDF Format	Word Fromat
Claimant Report	Skin maceration - Tinea of the Skin	CR9254.pdf [8]	CR9254.docx [9]

Preliminary questions [231]

246        the veteran has established the causal connection between the skin maceration and VEA service for tinea of the skin.

33858 the veteran suffered skin maceration at the affected site within the 14 days before the clinical onset of tinea of the skin.

1322     the veteran has established the causal connection between the skin maceration and VEA service for the clinical onset of tinea of the skin.

230        the veteran has established the causal connection between the skin maceration and operational service for the clinical onset of tinea of the skin.

or

6732     the veteran has established the causal connection between the skin maceration and eligible service for the clinical onset of tinea of the skin.

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.

33859   the veteran suffered skin maceration at the affected site within the 14 days before the clinical worsening of tinea of the skin.

33855   the veteran has established the causal connection between the skin maceration and VEA service for the clinical worsening of tinea of the skin.

33856  the veteran has established the causal connection between the skin maceration and operational service for the clinical worsening of tinea of the skin.

or

33857  the veteran has established the causal connection between the skin maceration and eligible service for the clinical worsening of tinea of the skin.

Clinical onset and operational service [230]

33860  on operational service, the veteran suffered skin maceration at the affected site within the 14 days before the clinical onset of tinea of the skin.

6736     the skin maceration at the affected site on operational service within the 14 days before the clinical onset of tinea of the skin was due to the veteran's serious default, wilful act or serious breach of discipline.

or

33863   the veteran suffered skin maceration at the affected site as a result of an illness or injury which is identifiable.

33864   as a consequence of the identified illness or injury, the veteran suffered skin maceration at the affected site within the 14 days before the clinical onset of tinea of the skin.

247       the identified illness or injury which caused the skin maceration is causally related to operational service.

Clinical onset and eligible service [6732]

33865   in the course of eligible service duties, the veteran suffered skin maceration at the affected site within the 14 days before the clinical onset of tinea of the skin.

6737     the skin maceration at the affected site on eligible service within the 14 days before the clinical onset of tinea of the skin was due to the veteran's serious default, wilful act or serious breach of discipline.

or

33863   the veteran suffered skin maceration at the affected site as a result of an illness or injury which is identifiable.

33864   as a consequence of the identified illness or injury, the veteran suffered skin maceration at the affected site within the 14 days before the clinical onset of tinea of the skin.

6739     the identified illness or injury which caused the skin maceration is causally related to eligible service.

Clinical worsening and operational service [33856]

33938   in the course of operational service duties, the veteran suffered skin maceration at the affected site within the 14 days before the clinical worsening of tinea of the skin.

33870   the skin maceration at the affected site on operational service within the 14 days before the clinical worsening of tinea of the skin was due to the veteran's serious default, wilful act or serious breach of discipline.

or

33863   the veteran suffered skin maceration at the affected site as a result of an illness or injury which is identifiable.

33867   as a consequence of the identified illness or injury, the veteran suffered skin maceration at the affected site within the 14 days before the clinical worsening of tinea of the skin.

247        the identified illness or injury which caused the skin maceration is causally related to operational service.

Clinical worsening and eligible service [33857]

33871   in the course of eligible service duties, the veteran suffered skin maceration at the affected site within the 14 days before the clinical worsening of tinea of the skin.

33872   the skin maceration at the affected site on eligible service within the 14 days before the clinical worsening of tinea of the skin was due to the veteran's serious default, wilful act or serious breach of discipline.

or

33863   the veteran suffered skin maceration at the affected site as a result of an illness or injury which is identifiable.

33867   as a consequence of the identified illness or injury, the veteran suffered skin maceration at the affected site within the 14 days before the clinical worsening of tinea of the skin.

6739     the identified illness or injury which caused the skin maceration is causally related to eligible service.