Reasonable Hypothesis SOP [1] | 19 of 2022 |
Balance of Probabilities SOP [2] | 20 of 2022 |
SOP Bulletin 228 [3]
ICD-10-AM Codes: C18, C19, C20
This is a primary cancer of the lining of the large intestine (colon or rectum). Primary means that the cancer arose in the colon or rectum and did not arrive secondarily from another body site.
Information on histology (from biopsy, surgery, or autopsy) is required to confirm the diagnosis and apply the SOP. There are SOP factors specific to MN of the colon only, so information on tumour location will be required to apply those factors.
The relevant medical specialist is a general surgeon, colorectal surgeon or gastroenterologist.
* another SOP applies
# non-SOP condition
Clinical onset will generally be at the time of diagnosis. Symptoms are non-specific, but it may be possible to back-date onset on the basis of symptoms such as rectal bleeding, change in bowel habit or loss of weight.
The only SOP worsening factor is for inability to obtain appropriate clinical management. Colorectal cancer has a very variable course and prognosis. It is particularly amenable to treatment if found early. A delay in appropriate treatment could result in worsening of the condition. Establishing whether worsening beyond the normal course of the disease has occurred will generally require expert medical opinion.
The alcohol factor for malignant neoplasm of the colorectum requires consumption of specified amounts of alcohol (250 kg for reasonable hypothesis, 500 kg for balance of probabilities) within any 25 year period, and within specified periods (40 years RH, 30 years BOP) immediately before the clinical onset of malignant neoplasm of the colorectum.
In deciding whether or not malignant neoplasm of the colorectum can be related to VEA service through alcohol consumption, you must first establish whether or not the minimum SOP requirements have been met. You must then consider whether or not VEA service has made a material contribution to these requirements.
This requires consideration of the following:
A material contribution by service can be made in a number of ways:
The Repatriation Commission also agreed that arguments put to delegates that are outside the Guideline must still be considered for substance and medical and scientific support. However the Commission did not agree that the temporal connection of service life with alcohol consumption is enough to establish ‘habit’ as the cause of alcohol use.
“Habituation” is often an argument advanced to connect service conditions with post service alcohol consumption.
A search by the RMA for sound medical scientific evidence bearing on "habituation" revealed only one epidemiological study (as at April 2000) that bears on the ‘habituation’ issue, that is, whether a “habit” of alcohol drinking continues from the service environment into the community after discharge from service. In fact that paper suggested that not only was there no association with military service there is some evidence that military service produces the opposite effect.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Alcohol Consumption | CRD904.pdf [8] | CRD904.docx [9] |
Claimant Report | Alcohol Consumption | CRV904.pdf [10] | CRV904.docx [11] |
Medical Report | Alcohol Consumption | MR9244.pdf [12] | MR9244.docx [13] |
25686 the veteran has consumed alcohol at some time.
14849 the veteran has established the causal connection between the alcohol consumption and VEA service for the clinical onset of malignant neoplasm of the colorectum.
14850 the veteran has established the causal connection between the alcohol consumption and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
14851 the veteran has established the causal connection between the alcohol consumption and eligible service for the clinical onset of malignant neoplasm of the colorectum.
14812 the veteran consumed at least 250 kg of alcohol within a 25 year period within the 40 years immediately before the clinical onset of the condition under consideration.
33897 operational service made a material contribution to the veteran's consumption of at least 250 kg of alcohol within a 25 year period within the 40 years immediately before the clinical onset of the condition under consideration.
33898 the veteran's alcohol consumption during and as a result of operational service, which made a material contribution to at least 250 kg of alcohol within a 25 year period within the 40 years immediately before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.
14813 the veteran consumed at least 500 kg of alcohol within a 25 year period within the 30 years immediately before the clinical onset of the condition under consideration.
33899 eligible service made a material contribution to the veteran's consumption of at least 500 kg of alcohol within a 25 year period within the 30 years immediately before the clinical onset of the condition under consideration.
33900 the veteran's alcohol consumption during and as a result of eligible service, which made a material contribution to at least 500 kg of alcohol within a 25 year period within the 30 years immediately before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.
The RMA defines “processed meat product”, as “preserved or cured meats, including ham, frankfurters, salami and bacon”.
Other products that satisfy this definition include hotdogs, kabana, Fritz/devon, salami, metwurst, mortadella, Polish sausage, pepperoni, corned beef, pastrami, prosciutto, Spam and other similar luncheon meats and canned meats such as camp pie. However, the meat in frozen products such as beef pies and spaghetti bolognaise, and tinned products such as braised steak and onions is not preserved or cured.
Cured meats are products that have a distinctive texture, a pink colour and often a smoky flavour. Meat is cured using a preservative called sodium nitrite and most, but not all, cured meat products are smoked after the curing process. Curing inhibits the growth of food poisoning and spoilage micro-organisms.
Meat that has been marinated or seasoned does not satisfy the RMA’s definition.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Altered Dietary Pattern - Malignant Neoplasm of the Colorectum | CR9212.pdf [14] | CR9212.docx [15] |
32240 there is some evidence that the veteran had an altered pattern of consumption of processed meat.
32242 the veteran has established the causal connection between consuming processed meat and operational service for the clinical onset of malignant neoplasm of the colorectum.
32246 the veteran's average daily total consumption of processed meat increased as specified in the Statement of Principles.
32248 the increase in the veteran's average daily total consumption of processed meat as specified in the Statement of Principles occurred at least 20 years before the clinical onset of the condition under consideration.
32245 the veteran's consumption of processed meat increased during operational service.
32247 the increase in the veteran's average daily total consumption of processed meat as a result of operational service made a material contribution to the requirements specified in the Statement of Principles.
or
32244 the veteran's increased consumption of processed meat was due to an illness or injury which is identifiable.
32250 the increase in the veteran's average daily total consumption of processed meat as a consequence of the identified illness or injury made a material contribution to the requirements specified in the Statement of Principles.
32251 the identified injury or illness which caused the increase in average daily total consumption of processed meat is causally related to operational service.
The Statement of Principles refers to “unprocessed beef, veal, pork, lamb or mutton”. In other words this SOP factor concerns red meat only, and does not include white meat such as chicken and turkey. “Unprocessed” means not smoked, or cured.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Altered Dietary Pattern - Malignant Neoplasm of the Colorectum | CR9212.pdf [14] | CR9212.docx [15] |
32228 there is some evidence that the veteran had an altered pattern of consumption of unprocessed meat.
32234 the veteran has established the causal connection between consuming unprocessed meat and operational service for the clinical onset of malignant neoplasm of the colorectum.
32231 the veteran's average daily total consumption of unprocessed meat increased as specified in the Statement of Principles.
32232 the increase in the veteran's average daily total consumption of unprocessed meat as specified in the Statement of Principles occurred at least 20 years before the clinical onset of the condition under consideration.
32230 the veteran's consumption of unprocessed meat increased during operational service.
32229 the increase in the veteran's average daily total consumption of unprocessed meat as a result of operational service made a material contribution to the requirements specified in the Statement of Principles.
or
32236 the veteran's increased consumption of unprocessed meat was due to an illness or injury which is identifiable.
32238 the increase in the veteran's average daily total consumption of unprocessed meat as a consequence of the identified illness or injury made a material contribution to the requirements specified in the Statement of Principles.
32239 the identified injury or illness which caused the increase in average daily total consumption of unprocessed meat is causally related to operational service.
The RMA defines atomic radiation as "ionising radiation excluding:
(i) natural background radiation;
(ii) therapeutic radiation; and
(iii) radiation from diagnostic procedures."
Australian service personnel with known atomic radiation exposure are:
(i) POW(J)s who were in the Nagasaki area on 9 August 1945.
(ii) Personnel who served in or visited Hiroshima in connection with the occupation of Japan by the British Commonwealth Occupation Force from February 1946.
(iii) 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 Nulletin No. 145 – Atomic Radiation – Update British Nuclear Test Participants.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Exposure to Atomic Radiation | CR9171.pdf [16] | CR9171.docx [17] |
30275 there is some evidence that atomic radiation may be a factor in the development of the condition under consideration.
33903 the veteran has established the causal connection between the atomic radiation and VEA service for the clinical onset of malignant neoplasm of the colorectum.
33904 the veteran has established the causal connection between the atomic radiation and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
33905 the veteran has established the causal connection between the atomic radiation and eligible service for the clinical onset of malignant neoplasm of the colorectum.
33906 the veteran received a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to the colorectum.
33907 the veteran received a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to the colorectum where this dose was accumulated at least five years before the clinical onset of the condition under consideration.
33908 the veteran's operational service made a material contribution to the cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to the colorectum where this dose was accumulated at least five years before the clinical onset of the condition under consideration.
33915 the cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to the colorectum, to which operational service made a material contribution and this 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.
33909 the veteran received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the colorectum.
33910 the veteran received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the colorectum where this dose was accumulated at least five years before the clinical onset of the condition under consideration.
33911 the veteran's eligible service made a material contribution to the cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the colorectum where this dose was accumulated at least five years before the clinical onset of the condition under consideration.
33916 the cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the colorectum, to which eligible service made a material contribution and this 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.
RMA definition of being obese
In this Statement of Principles the Repatriation Medical Authority has defined being obese as meaningwhich results in a Body Mass Index (BMI) of 30 or greater.
The measurement used to define “being obese” is the Body Mass Index (BMI).
The BMI = W/H2 and where:
W is the person’s weight in kilograms and
H is the person’s height in metres".
(For Imperial weights and measures, BMI = wt. in lbs/(ht in inches) x 703.1).
Establishing the presence of obesity
If it is not possible to obtain specific height/weight measurements, a medical comment that the veteran or member was obese will be sufficient.If height/weight measurements can be obtained, the BMI formula should be applied.
A history of obesity may be documented in the evidence.However, the veteran or member may not have sought medical attention and the condition may not have been recorded in medical records.In addition, doctors' and hospitals' records may have been destroyed or can no longer be obtained.
Therefore, a statement by the veteran about his or her weight at a particular time will generally be accepted, unless there is contradictory evidence.This weight can then be used to calculate whether the veteran was obese at that time.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Obesity | CR9230.pdf [18] | CR9230.docx [19] |
Medical Report | Obesity | MR9305.pdf [20] | MR9305.docx [21] |
31344 there is some evidence that suffering from being obese may be a factor in the development of the condition under consideration.
587 the veteran has a history of obesity.
32328 the veteran has been obese for a period of at least 15 years at some time.
33245 the veteran satisfies the occurrence provisions for being obese and VEA service for the clinical onset of malignant neoplasm of the colorectum.
or
32281 the condition under consideration is malignant neoplasm of the colon.
32265 the veteran has established the causal connection between being obese and VEA service for the clinical onset of malignant neoplasm of the colorectum.
32266 the veteran has established the causal connection between being obese and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
32267 the veteran has established the causal connection between being obese and eligible service for the clinical onset of malignant neoplasm of the colorectum.
32268 the veteran was obese for at least fifteen years before the clinical onset of malignant neoplasm of the colorectum.
591 the obesity was caused by operational service.
or
9004 the veteran has a history of morbid obesity.
33246 the veteran was morbidly obese for at least fifteen years before the clinical onset of malignant neoplasm of the colorectum.
9005 the morbid obesity is causally related to operational service.
32269 the veteran was obese for at least thirty years before the clinical onset of malignant neoplasm of the colorectum.
3407 the obesity was caused by eligible service.
or
9004 the veteran has a history of morbid obesity.
33247 the veteran was morbidly obese for at least thirty years before the clinical onset of malignant neoplasm of the colorectum.
9006 the morbid obesity is causally related to eligible service.
If there is a history of cigar smoking it will be necessary to obtain information about:
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 [6].
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Smoking | CRD905.pdf [22] | CRD905.docx [23] |
Claimant Report | Smoking | CRV905.pdf [24] | CRV905.docx [25] |
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.
13794 the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of malignant neoplasm of the colorectum.
13795 the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
13796 the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of malignant neoplasm of the colorectum.
32272 the veteran has smoked at least 15 pack years of cigars before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 30 years of cessation.
32273 the veteran's service related cigar smoking commenced at least 20 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.
32274 the veteran has smoked at least 25 pack years of cigars before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 15 years of cessation.
32275 the veteran's service related cigar smoking commenced at least 35 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.
This factor deals with the personal use of cigarettes ie it does not include passive smoking.
If there is a history of cigarette smoking it will be necessary to obtain information about:
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 [6].
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Smoking | CRD905.pdf [22] | CRD905.docx [23] |
Claimant Report | Smoking | CRV905.pdf [24] | CRV905.docx [25] |
5803 the veteran has ever smoked cigarettes.
13786 the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical onset of malignant neoplasm of the colorectum.
13788 the veteran has established the causal connection between the cigarette smoking and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
13789 the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical onset of malignant neoplasm of the colorectum.
14834 the veteran has smoked at least fifteen pack years of cigarettes before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 30 years of cessation.
32270 the veteran's service related cigarette smoking commenced at least 20 years before the clinical onset of the condition under consideration.
3116 the veteran has some period or periods of cigarette smoking that are causally related to operational service.
14835 the veteran has smoked at least 25 pack years of cigarettes before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 15 years of cessation.
32271 the veteran's service related cigarette smoking commenced at least 35 years before the clinical onset of the condition under consideration.
3521 the veteran has some period or periods of cigarette smoking that are causally related to eligible service.
A colorectal adenoma is a visible protrusion from the inner lining surface of the large bowel. The condition is very common in the Western world and is found in some 30% of middle-aged or elderly people. It may also be referred to as a colorectal adenomatous polyp. Multiple polyps are common. The anatomical location of a polyp (colon or rectum) will have been recorded at the time of discovery. Polyps of the colon are more common than polyps of the rectum.
Most polyps are symptomless, being neither suspected nor detected. Occasionally bleeding from the lesion may result in frank blood loss being noted at defaecation, but more often the bleeding is so little as to go undetected except by an "occult blood" test. Symptoms vary with the anatomical location of the polyp and, depending on the size and location of the polyp, may impede the passage of stool, resulting in the development of abdominal cramping, occasional obstruction, and even perforation. There may be symptoms of haematochezia (the passage of bloody stools), tenesmus (painful and ineffectual straining at stool), and narrowing of the calibre of the stool.
A colorectal adenoma may be detected by proctosigmoidoscopy and/or colonoscopy (including virtual colonoscopies done by CT scan) which are relatively simple procedures. These are carried out on an outpatient basis and are preferable to barium enema examinations as direct visualisation is possible. The lesions are usually excised when noted at endoscopy because of their malignancy potential.
The specialist treating the veteran for a colorectal adenoma would have recorded any significant history of symptoms even if the veteran had not sought medical attention until some later time.
32226 the veteran has suffered from colorectal adenoma at some time.
32316 the veteran has adenoma of the colon.
or
32330 the veteran has adenoma of the rectum.
14841 the veteran suffered from the identified illness or injury before the clinical onset of malignant neoplasm of the colorectum.
14842 the veteran has established the causal connection between the colorectal adenoma and VEA service for the clinical onset of malignant neoplasm of the colorectum.
14843 the veteran has established the causal connection between the colorectal adenoma and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
14844 the veteran has established the causal connection between the colorectal adenoma and eligible service for the clinical onset of malignant neoplasm of the colorectum.
14805 the identified illness or injury, a colorectal adenoma, is causally related to operational service.
14806 the identified illness or injury, a colorectal adenoma, is causally related to eligible service.
Crohn's disease is an inflammatory disease of the bowel. It may also be called regional enteritis, granulomatous ileitis or ileocolitis. Diagnosis is by barium enema X-ray, sigmoidoscopy, and biopsy. Treatment may include drug therapy [often corticosteroids] or surgery. Significant medical attention would have been needed at some time although possibly not until symptoms had been present for some time.
Signs and symptoms
17600 there is some evidence that Crohn's disease may be a factor in the development of the condition under consideration.
32256 the veteran has Crohn's disease of the colorectum.
3719 the veteran has established the causal connection between the Crohn's disease of the colorectum and VEA service for the clinical onset of malignant neoplasm of the colorectum.
3721 the veteran has established the causal connection between the Crohn's disease of the colorectum and eligible service for the clinical onset of malignant neoplasm of the colorectum.
or
3720 the veteran has established the causal connection between the Crohn's disease of the colorectum and operational service for the clinical onset of malignant neoplasm of the colorectum.
32254 the veteran was suffering from Crohn's disease of the colorectum for at least five years before the clinical onset of malignant neoplasm of the colorectum.
3722 the Crohn's disease is causally related to operational service.
32255 the veteran was suffering from Crohn's disease of the colorectum for at least ten years before the clinical onset of malignant neoplasm of the colorectum.
3723 the Crohn's disease is causally related to eligible service.
This is a rare genetic condition in which 100 or more polyps carpet the colon and rectum. If this condition is left surgically untreated, colorectal cancer will develop in almost all patients prior to the age of 40. The condition usually starts around puberty and runs in families although, occasionally, probably through a spontaneous genetic mutation, there may be no evidence of a familial link. When familial adenomatous polyposis is accompanied by soft tissue tumours and bony tumours it is known as Gardner's syndrome. There are usually no symptoms until puberty when haematochezia [the passage of bloody stools], diarrhoea, and abdominal pain may develop. Often no disease is suspected until a parent or sibling develops symptoms and a diagnosis made. Colonoscopy of family members may then reveal the presence of unsuspected disease.
A history of familial adenomatous coli will be documented in the evidence, although the condition may not have been detected until the onset of symptoms of colorectal cancer.
9851 there is some evidence that familial adenomatous polyposis may be a factor in the development of the condition under consideration.
9849 the veteran has familial adenomatous polyposis.
9852 the familial adenomatous polyposis was present prior to the clinical onset of malignant neoplasm of the colorectum.
9853 the veteran has established the causal connection between the familial adenomatous polyposis and VEA service for the clinical onset of malignant neoplasm of the colorectum.
14803 the veteran has established the causal connection between the familial adenomatous polyposis and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
14804 the veteran has established the causal connection between the familial adenomatous polyposis and eligible service for the clinical onset of malignant neoplasm of the colorectum.
9856 the familial adenomatous polyposis is causally related to operational service.
9857 the familial adenomatous polyposis is causally related to eligible service.
The RMA has defined fibre in food as meaning “the complex carbohydrates of plant origin consumed as vegetables, fruits or cereals which resist digestion by gastrointestinal enzymes in the gastrointestinal tract, and include plant cell walls and non-starch polysaccharides from sources other than cell walls, including cellulose and pectins. This definition does not include fibre in fortified foods or supplements”.
On average, most Australians consume 18 to 25g of fibre daily. The Australian Heart Foundation recommends that adults should consume approximately 30g daily.
Examples of dietary fibre:
Food |
Fibre |
---|---|
1 cup Rice Bubbles |
0.3g |
4 slices white bread |
3.2g |
1 tablespoon peanut butter |
2g |
1 fruit |
3g |
1/2 cup canned fruit, undrained |
2g |
1/2 cup frozen mixed vegetables |
3g |
French fries large 110g |
2g |
1 cup white cooked rice |
1.2 |
1 plain dry biscuit eg SAO |
0.3g |
1 slice plain cake 60g |
1g |
1 cup commercial fruit juice |
0g |
Total |
18g |
Food |
Fibre |
---|---|
2 Weetbix Hi-Bran |
7g |
4 slices wholemeal + wholegrain bread eg Taylors bread |
7.2g |
1 tablespoon pure almond spread |
3g |
2 fruits |
6g |
1 cup frozen mixed vegetables |
6g |
1 small boiled potato with skin, 100g |
3.5g |
1/2 cup baked beans |
6g |
1 cup white cooked spaghetti |
3g |
1 whole grain dry biscuit eg Vita-Wheat 9 grains |
1.5g |
25 almonds |
4g |
1 cup whole fruit juice eg wild about fruit hi-fibre apple juice |
0.5g |
Total |
47.7g |
Dietary data from www.betterhealth.vic.gov.au [26]
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Inability to consume fibre/folate in food | CR9237.pdf [27] | CR9237.docx [28] |
33924 there is some evidence that an inability to consume fibre in food may be a factor in the development of the condition under consideration.
33926 the veteran has established the causal connection between the inability to consume fibre in food and operational service for the clinical onset of malignant neoplasm of the colorectum.
33928 the veteran was unable to consume fibre in food as specified in the Statement of Principles over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum.
33930 operational service made a material contribution to the veteran's inability to consume fibre in food as specified in the Statement of Principles over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum.
or
33932 the veteran's inability to consume fibre in food as specified in the Statement of Principles for malignant neoplasm of the colorectum was due to an illness or injury which is identifiable.
33936 the identified illness or injury which caused the inability to consume fibre in food as specified in the Statement of Principles for malignant neoplasm of the colorectum is causally related to operational service.
The RMA has defined folate in food as meaning “a B group vitamin found in natural foods, which consists of a family of monoglutamates or polyglutamates of pteroic acid that is used in DNA methylation, synthesis and repair. This definition does not include folic acid in fortified foods or supplements”.
Folate (or folic acid) can be found in such foods as asparagus, spinach, Brussels sprouts, oranges, bananas, strawberries and legumes. However because of its important role in the very early stages of foetal development and when a woman may not realise she is pregnant, common foods such as bread and breakfast cereal are supplemented with additional folate.
Folate is easily destroyed during the cooking process so most benefit is derived from eating some fruit and vegetables raw.
Food |
Folate (m g) |
---|---|
Pulses |
|
150 g chickpeas (boiled) |
81 |
150 g baked beans (canned) |
33 |
100 g blackye beans (boiled) |
210 |
50 g soy flour |
173 |
Grains |
|
A bowl of folate fortified breakfast cereal |
50 - 100 |
100 g folate fortified bread |
50 - 200 |
100 g whole grain bread |
90 |
100 g wholemeal flour |
57 |
10 g wheatgerm |
33 |
Vegetables |
|
50 g asparagus (boiled) |
78 |
50 g broccoli (boiled) |
32 |
50 g beetroot (boiled) |
55 |
50 g spinach (boiled) |
45 |
Fruit |
|
1 cup (250 ml) orange juice |
50 |
1 cup (125 g) raspberries/blackberries |
41 |
Nuts |
|
20 g peanuts |
22 |
20 g hazelnuts |
14 |
Dairy |
|
1 tub low- fat yoghurt |
38 |
Other |
|
1 tsp yeast extract (Vegemite/Marmite) |
50 |
100 g fried chicken liver |
500 |
Holland B et al. McCance and Widdowson's The Composition of Foods. fifth edition. Cambridge: The Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food; 1993
Dietary data from www.gograins.grdc.com.au [29]
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Inability to consume fibre/folate in food | CR9237.pdf [27] | CR9237.docx [28] |
33925 there is some evidence that an inability to consume folate in food may be a factor in the development of the condition under consideration.
33927 the veteran has established the causal connection between the inability to consume folate in food and operational service for the clinical onset of malignant neoplasm of the colorectum.
33929 the veteran was unable to consume folate in food as specified in the Statement of Principles over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum.
33931 operational service made a material contribution to the veteran's inability to consume folate in food as specified in the Statement of Principles over a continuous period of five years within the ten years immediately before the clinical onset of malignant neoplasm of the colorectum.
or
33933 the veteran's inability to consume folate in food as specified in the Statement of Principles for malignant neoplasm of the colorectum was due to an illness or injury which is identifiable.
33937 the identified illness or injury which caused the inability to consume folate in food as specified in the Statement of Principles for malignant neoplasm of the colorectum is causally related to operational service.
A "MET" is a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.
General information
A MET approximates to the energy required to rest quietly in bed. A 70 kg man would use about 3 METs when walking at 4 km per hour.
Note:
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Inability to Undertake Physical Activity | CR9213.pdf [30] | CR9213.docx [31] |
Medical Report | Inability to Undertake Physical Activity | MR9321.pdf [32] | MR9321.docx [33] |
33917 there is some evidence that an inability to undertake any physical activity greater than 3 METs may be a factor in the development of the condition under consideration.
14791 the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and VEA service for the clinical onset of malignant neoplasm of the colorectum.
14792 the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and eligible service for the clinical onset of malignant neoplasm of the colorectum.
or
9862 the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and operational service for the clinical onset of malignant neoplasm of the colorectum.
9860 the veteran was unable to undertake any physical activity greater than 3 METs for at least 10 years, within the 30 years before the clinical onset of malignant neoplasm of the colorectum.
33920 the veteran's inability to undertake any physical activity greater than 3 METs for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the colorectum was due to an illness or injury which is identifiable.
33921 the identified illness or injury which caused the inability to undertake any physical activity greater than 3 METs is causally related to operational service.
14793 the veteran was unable to undertake any physical activity greater than 3 METs for at least 20 years within the 30 years before the clinical onset of malignant neoplasm of the colorectum.
33920 the veteran's inability to undertake any physical activity greater than 3 METs for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the colorectum was due to an illness or injury which is identifiable.
25875 the identified illness or injury made a material contribution to the veteran's inability to undertake any physical activity greater than 3 METs for at least 20 years, within the 30 years before the clinical onset of malignant neoplasm of the colorectum.
33922 the identified illness or injury which caused the inability to undertake any physical activity greater than 3 METs is causally related to eligible service.
"Exposed to respirable asbestos fibres" means having been in an environment within which asbestos particles became airborne, and were breathed into the lungs.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Respirable asbestos fibres | CR9236.pdf [34] | CR9236.docx [35] |
4931 there is some evidence that inhaling respirable asbestos fibres in an enclosed space may be a factor in the development of the condition under consideration.
32281 the condition under consideration is malignant neoplasm of the colon.
32257 the veteran has established the causal connection between inhaling respirable asbestos fibres in an enclosed space and operational service for the clinical onset of malignant neoplasm of the colorectum.
32260 the veteran inhaled respirable asbestos fibres in an enclosed space for a cumulative period of at least 2000 hours at the time material containing such fibres was being applied, removed, dislodged, cut or drilled.
32261 the veteran inhaled respirable asbestos fibres in an enclosed space for a cumulative period of at least 2000 hours at the time material containing such fibres was being applied, removed, dislodged, cut or drilled before the clinical onset of the condition under consideration.
32262 where the veteran inhaled respirable asbestos fibres in an enclosed space for a cumulative period of at least 2000 hours at the time material containing such fibres was being applied, removed, dislodged, cut or drilled before the clinical onset of the condition under consideration, the first such inhalation occurred at least 10 years before the clinical onset of the condition under consideration.
33923 the veteran's inhalation of respirable asbestos fibres on operational service made a material contribution to the inhalation required by the Statement of Principles for malignant neoplasm of the colorectum.
In the case of colorectal cancer appropriate clinical management involves surgical resection of the tumour, colonoscopy of the entire large bowel to identify all cancers or polyps, and a search for metastases [secondary spread of the cancer to other parts of the body]. In some cases radiation and chemotherapy may also be appropriate.
Inability to obtain appropriate clinical management
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Medical Report | Inability to Obtain Appropriate Clinical Management | GQACM.pdf [36] | GQACM.docx [37] |
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.
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.
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.
If there is a history of pipe smoking it will be necessary to obtain information about:
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 [6].
NB The SOP factor dealing with pipe smoking covers only the smoking of tobacco. It does not include non-tobacco products such as marijuana or hashish. This is because the RMA SOP factors refer to "cigarettes or the equivalent thereof in other tobacco products".
Type | Title | PDF Format | Word Format |
---|---|---|---|
Claimant Report | Smoking | CRD905.pdf [22] | CRD905.docx [23] |
Claimant Report | Smoking | CRV905.pdf [24] | CRV905.docx [25] |
22895 there is some evidence that pipe smoking may be a factor in the development of the condition under consideration.
4880 the veteran has ever smoked pipe tobacco.
13805 the veteran has established the causal connection between the pipe smoking and VEA service for the clinical onset of malignant neoplasm of the colorectum.
13806 the veteran has established the causal connection between the pipe smoking and operational service for the clinical onset of malignant neoplasm of the colorectum.
or
13807 the veteran has established the causal connection between the pipe smoking and eligible service for the clinical onset of malignant neoplasm of the colorectum.
32276 the veteran has smoked at least 15 pack years of pipe tobacco before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 30 years of cessation.
32277 the veteran's service related smoking of pipe tobacco commenced at least 20 years before the clinical onset of the condition under consideration.
4911 the veteran has some period or periods of pipe smoking that are causally related to operational service.
32278 the veteran has smoked at least 25 pack years of pipe tobacco before the clinical onset of the condition under consideration and, where smoking has ceased, the clinical onset of the condition under consideration occurred within 15 years of cessation.
32279 the veteran's service related smoking of pipe tobacco commenced at least 35 years before the clinical onset of the condition under consideration.
4913 the veteran has some period or periods of pipe smoking that are causally related to eligible service.
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:
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.
Type | Title | PDF Format | Word Format |
---|---|---|---|
Claimant Report | Smoking | CRD905.pdf [22] | CRD905.docx [23] |
Claimant Report | Smoking | CRV905.pdf [24] | CRV905.docx [25] |
30303 the veteran has smoked cigarettes, cigars or pipe tobacco at some time.
33888 the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of malignant neoplasm of colorectum.
33891 the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of malignant neoplasm of colorectum.
or
33892 the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of malignant neoplasm of colorectum.
33958 the veteran has smoked at least fifteen pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of malignant neoplasm of colorectum and, where smoking has ceased, the clinical onset of malignant neoplasm of colorectum occurred within 30 years of cessation.
33959 the veteran's smoking of at least fifteen pack years of cigarettes or the equivalent thereof in other tobacco products commenced at least 20 years before the clinical onset of malignant neoplasm of colorectum.
33960 smoking as a causal result of operational service made a material contribution to the SOP requirements for malignant neoplasm of colorectum and smoking tobacco products.
33961 the veteran has smoked at least 25 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of malignant neoplasm of colorectum and, where smoking has ceased, the clinical onset of malignant neoplasm of colorectum occurred within 15 years of cessation.
33962 the veteran's smoking of at least 25 pack years of cigarettes or the equivalent thereof in other tobacco products commenced at least 35 years before the clinical onset of malignant neoplasm of colorectum.
33963 smoking as a causal result of eligible service made a material contribution to the SOP requirements for malignant neoplasm of colorectum and smoking tobacco products.
The therapeutic radiation would only be relevant if it was given for a condition other than the one now being considered.
The abdomen is that part of the body between the thorax [the chest] and the pelvis.
The pelvis is the basin formed by the hip bones and the lower portion of the vertebral column constituting the lowest part of the trunk.
Therapeutic radiation
14825 there is some evidence that a course of therapeutic radiation involving the abdominal or pelvic region may be a factor in the development of the condition under consideration.
14826 the veteran has had a course of therapeutic radiation involving the abdominal or pelvic region at some time.
14827 the course of therapeutic radiation involving the abdominal or pelvic region was given for treatment of an illness or injury which is identifiable.
14829 the veteran has established the causal connection between the identified illness or injury for which the course of therapeutic radiation involving the abdominal or pelvic region was given and VEA service for the clinical onset of malignant neoplasm of the colorectum.
14831 the veteran has established the causal connection between the identified illness or injury for which the course of therapeutic radiation involving the abdominal or pelvic region was given and eligible service for the clinical onset of malignant neoplasm of the colorectum.
or
14830 the veteran has established the causal connection between the identified illness or injury for which the course of therapeutic radiation involving the abdominal or pelvic region was given and operational service for the clinical onset of malignant neoplasm of the colorectum.
32282 the veteran received the course of therapeutic radiation involving the abdominal or pelvic region for treatment of the identified illness or injury 10 years or more before the clinical onset of malignant neoplasm of the colorectum.
14832 the identified illness or injury requiring therapeutic radiation involving the abdominal or pelvic region is causally related to operational service.
32283 the veteran received the course of therapeutic radiation involving the abdominal or pelvic region for treatment of the identified illness or injury 15 years or more before the clinical onset of malignant neoplasm of the colorectum.
14833 the identified illness or injury requiring therapeutic radiation involving the abdominal or pelvic region is causally related to eligible service.
Ulcerative colitis is an inflammatory bowel disease in which the mucous membrane lining the large bowel becomes diffusely inflamed and may ulcerate. Diagnosis is by barium enema and sigmoidoscopy. Treatment may include drug therapy [often corticosteroids] or surgery. Significant medical attention would have been needed at some time although possibly not until symptoms had been present for some time.
Signs and symptoms
17601 there is some evidence that ulcerative colitis may be a factor in the development of the condition under consideration.
806 the veteran has had ulcerative colitis.
3709 the veteran has established the causal connection between the ulcerative colitis and VEA service for the clinical onset of malignant neoplasm of the colorectum.
3713 the veteran has established the causal connection between the ulcerative colitis and eligible service for the clinical onset of malignant neoplasm of the colorectum.
or
3712 the veteran has established the causal connection between the ulcerative colitis and operational service for the clinical onset of malignant neoplasm of the colorectum.
32252 the veteran was suffering from ulcerative colitis for at least five years before the clinical onset of malignant neoplasm of the colorectum.
809 the ulcerative colitis is causally related to operational service.
32253 the veteran was suffering from ulcerative colitis for at least ten years before the clinical onset of malignant neoplasm of the colorectum.
3715 the ulcerative colitis is causally related to eligible service.
Links
[1] http://www.rma.gov.au/assets/SOP/2022/9f02e649a3/019.pdf
[2] http://www.rma.gov.au/assets/SOP/2022/467175df81/020.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20228.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63760%23comment-form
[5] http://www.rma.gov.au/SOP/alpha_ind/m.htm
[6] https://clik.dva.gov.au/compensation-and-support-reference-library/commission-guidelines/cm5030-guideline-claims-assessors-smoking-and-alcohol-related-conditions-and-military-service
[7] https://clik.dva.gov.au/compensation-and-support-reference-library/advisory-notes/2000/an02-alcohol-habituation
[8] https://clik.dva.gov.au/system/files/media/CRD904_1.pdf
[9] https://clik.dva.gov.au/system/files/media/CRD904_0.docx
[10] https://clik.dva.gov.au/system/files/media/CRV904_1.pdf
[11] https://clik.dva.gov.au/system/files/media/CRV904_1.docx
[12] https://clik.dva.gov.au/system/files/media/MR9244_1.pdf
[13] https://clik.dva.gov.au/system/files/media/MR9244_1.docx
[14] https://clik.dva.gov.au/system/files/media/CR9212.pdf
[15] https://clik.dva.gov.au/system/files/media/CR9212.docx
[16] https://clik.dva.gov.au/system/files/media/CR9171_0.pdf
[17] https://clik.dva.gov.au/system/files/media/CR9171_0.docx
[18] https://clik.dva.gov.au/system/files/media/CR9230_2.pdf
[19] https://clik.dva.gov.au/system/files/media/CR9230_2.docx
[20] https://clik.dva.gov.au/system/files/media/MR9305_2.pdf
[21] https://clik.dva.gov.au/system/files/media/MR9305_2.docx
[22] https://clik.dva.gov.au/system/files/media/CRD905_6.pdf
[23] https://clik.dva.gov.au/system/files/media/CRD905_5.docx
[24] https://clik.dva.gov.au/system/files/media/CRV905_6.pdf
[25] https://clik.dva.gov.au/system/files/media/CRV905_8.docx
[26] http://www.betterhealth.vic.gov.au
[27] https://clik.dva.gov.au/system/files/media/CR9237.pdf
[28] https://clik.dva.gov.au/system/files/media/CR9237.docx
[29] http://www.gograins.grdc.com.au
[30] https://clik.dva.gov.au/system/files/media/CR9213.pdf
[31] https://clik.dva.gov.au/system/files/media/CR9213.docx
[32] https://clik.dva.gov.au/system/files/media/MR9321.pdf
[33] https://clik.dva.gov.au/system/files/media/MR9321.docx
[34] https://clik.dva.gov.au/system/files/media/CR9236.pdf
[35] https://clik.dva.gov.au/system/files/media/CR9236.docx
[36] https://clik.dva.gov.au/system/files/media/GQACM_13.pdf
[37] https://clik.dva.gov.au/system/files/media/GQACM_13.docx