Erectile Dysfunction - Blunt or penetrating trauma to the external genitals, perineum or pelvis Factor

RMA definition

The RMA has defined blunt or penetrating trauma as "an injury that results in pain and swelling or tenderness for at least forty-eight hours and which is of sufficient severity to warrant medical attention".  The RMA has specified that blunt or penetrating trauma includes surgical trauma.

Medical attention may not have been sought but it must have been warranted.  Medical attention does not necessarily mean treatment by a doctor; it may include the provision of pain killing drugs, rest, and hot and cold packs.  Medical attention would be provided in the case of surgical trauma.

The external genitals are the penis and testicles.

The perineum is the region between the anus and the scrotum.

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.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Blunt or Penetrating Trauma to the External Genitals, Perineum or Pelvis - Erectile Dysfunction	CR9141.pdf [6]	CR9141.docx [7]
Medical Report	Blunt or Penetrating Trauma to the External Genitals, Perineum or Pelvis - Erectile Dysfunction	MR9182.pdf [8]	MR9182.docx [9]

Preliminary questions [23002]

23191 there is some evidence that a blunt or penetrating trauma to the external genitals, perineum or pelvis may be a factor in the development or worsening of the condition under consideration.

23003 the veteran has ever experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis as defined in the Statement of Principles.

35402  the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and VEA service for erectile dysfunction.

23004 the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration.

23005   the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and VEA service for the clinical onset of erectile dysfunction.

23006  the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and operational service for the clinical onset of erectile dysfunction.

or

23007  the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and eligible service for the clinical onset of erectile dysfunction.

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.

35406 the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration.

35403   the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and VEA service for the clinical worsening of erectile dysfunction.

35404  the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and operational service for the clinical worsening of erectile dysfunction.

or

35405  the veteran has established the causal connection between the blunt or penetrating trauma to the external genitals, perineum or pelvis and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [23006]

35410 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by an injury.

23008 on operational service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration.

23009 the blunt or penetrating trauma to the external genitals, perineum or pelvis, on operational service, within the 90 days 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.

or

23010  the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35415 the injury which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration was due to an illness or injury which is identifiable.

23011  the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related to operational service.

or

35411 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by surgery.

35416  the surgery, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical onset and eligible service [23007]

35410 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by an injury.

23012 on eligible service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration.

23013 as a causal result of eligible service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration.

23014 the blunt or penetrating trauma to the external genitals, perineum or pelvis, on eligible service, within the 90 days 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.

or

23010  the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35415 the injury which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration was due to an illness or injury which is identifiable.

23015  the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related to eligible service.

or

35411 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by surgery.

35416  the surgery, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical worsening and operational service [35404]

35412 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by an injury.

35417 on operational service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration.

35418 as a causal result of operational service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration.

35423 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the blunt or penetrating trauma to the external genitals, perineum or pelvis on operational service.

35419 the blunt or penetrating trauma to the external genitals, perineum or pelvis, on operational service, within the 90 days immediately before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

23010  the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35425 the injury which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration was due to an illness or injury which is identifiable.

23011  the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related to operational service.

35427 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related.

or

35413 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by surgery.

35426  the surgery, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical worsening and eligible service [35405]

35412 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by an injury.

35420 on eligible service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration.

35421 as a causal result of eligible service, the veteran experienced a blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration.

35424 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the blunt or penetrating trauma to the external genitals, perineum or pelvis on eligible service.

35422 the blunt or penetrating trauma to the external genitals, perineum or pelvis, on eligible service, within the 90 days immediately before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

23010  the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35425 the injury which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration was due to an illness or injury which is identifiable.

23015  the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related to eligible service.

35428 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis, is causally related.

or

35413 the blunt or penetrating trauma to the external genitals, perineum or pelvis which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by surgery.

35426  the surgery, which caused the blunt or penetrating trauma to the external genitals, perineum or pelvis within the 90 days immediately before the clinical worsening of the condition under consideration, was performed for an illness or injury which is identifiable.

Erectile dysfunction - A clinically significant psychiatric condition Factor

The Statement of Principles refers to having a mood disorder with depressive features or an anxiety disorder.

In Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) the section entitled Mood Disorders lists major depressive disorder, dysthymic disorder, bipolar I and bipolar II disorders, cyclothymic disorder, and mood disorder due to a general medical condition, substance-induced mood disorder.  Mood disorders have a disturbance in mood as the predominant feature and whether there are depressive features will depend on the individual.

The section entitled Anxiety Disorders in DSM-IV lists post traumatic stress disorder (PTSD), generalised anxiety disorder, anxiety disorder due to a general medical condition, substance-induced anxiety disorder, panic disorders, agoraphobia, acute stress disorder, phobias, and obsessive-compulsive disorder.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Mood Disorder or Anxiety Disorder- Erectile Dysfunction	MR9181.pdf [10]	MR9181.docx [11]

Preliminary questions [25079]

22874 the veteran has had a mood disorder with depressive features or an anxiety disorder at some time.

27399  the veteran's mood disorder with depressive features or anxiety disorder is an illness or injury which is identifiable.

25235 the identified illness or injury was clinically significant.

35210  the veteran has established the causal connection between the clinically significant psychiatric condition and VEA service for erectile dysfunction.

22877 the identified illness or injury, a psychiatric condition, was clinically significant at the time of the clinical onset of the condition under consideration.

22878   the veteran has established the causal connection between the clinically significant psychiatric condition and VEA service for the clinical onset of erectile dysfunction.

22879  the veteran has established the causal connection between the clinically significant psychiatric condition and operational service for the clinical onset of erectile dysfunction.

or

22880  the veteran has established the causal connection between the clinically significant psychiatric condition and eligible service for the clinical onset of erectile dysfunction.

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.

35214 the identified illness or injury, a psychiatric condition, was clinically significant at the time of the clinical worsening of the condition under consideration.

35211   the veteran has established the causal connection between the clinically significant psychiatric condition and VEA service for the clinical worsening of erectile dysfunction.

35212  the veteran has established the causal connection between the clinically significant psychiatric condition and operational service for the clinical worsening of erectile dysfunction.

or

35213  the veteran has established the causal connection between the clinically significant psychiatric condition and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22879]

6024     the identified illness or injury, a psychiatric condition, is causally related to operational service.

Clinical onset and eligible service [22880]

6026     the identified illness or injury, a psychiatric condition, is causally related to eligible service.

Clinical worsening and operational service [35212]

6024     the identified illness or injury, a psychiatric condition, is causally related to operational service.

35215 the clinical onset of erectile dysfunction occurred prior to that part of operational service to which the identified illness or injury, a psychiatric condition, is causally related.

Clinical worsening and eligible service [35213]

6026     the identified illness or injury, a psychiatric condition, is causally related to eligible service.

35216 the clinical onset of erectile dysfunction occurred prior to that part of eligible service to which the identified illness or injury, a psychiatric condition, is causally related.

Erectile Dysfunction - A specified condition for erectile dysfunction Factor

A number of factors in the Statement of Principles have been grouped together for CCPS purposes.  These are:

• Atherosclerotic peripheral vascular disease
• Non-aneurysmal aortic atherosclerotic disease
• Epilepsy
• Multiple Sclerosis
• Peripheral autonomic neuropathy
• Parkinson's disease
• Secondary parkinsonism
• Guillain-Barre syndrome
• Cirrhosis of the liver
• Chronic renal failure
• Malignant neoplasm of the reproductive organs

Last reviewed for CCPS 5 October 2005.

Preliminary questions [22902]

23188 there is some evidence that a specified condition for erectile dysfunction may be a factor in the development or worsening of the condition under consideration.

35262  the veteran has had a specified condition for erectile dysfunction at some time.

22901 the veteran has had atherosclerotic peripheral vascular disease at some time.

or

22995 the veteran has suffered from non-aneurysmal aortic atherosclerotic disease at some time.

or

22981 the veteran has suffered from epilepsy at some time.

or

8159     the veteran has multiple sclerosis.

or

22982 the veteran has suffered from peripheral autonomic neuropathy at some time.

or

13520 the veteran has had Parkinson's disease at some time.

or

27400 the veteran has had secondary parkinsonism at some time.

or

22983 the veteran has suffered from Guillain-Barre syndrome at some time.

or

22586 the veteran has had cirrhosis of the liver at some time.

or

626        the veteran has chronic renal failure.

or

23178 the veteran has suffered from a malignant neoplasm of the skin of the penis or scrotum at some time.

or

23179 the veteran has suffered from a malignant neoplasm of the testis and paratesticular tissue at some time.

or

23180 the veteran has suffered from a malignant neoplasm of the prostate at some time.

or

23181 the veteran has suffered from a malignant melanoma of the skin of the penis or scrotum at some time.

or

27349 the veteran has suffered from a malignant neoplasm of the seminal vesicle or tunica vaginalis at some time.

or

27350 the veteran has suffered from a malignant neoplasm of the male genital organ (unspecified site) at some time.

35263  the veteran has established the causal connection between the specified condition for erectile dysfunction and VEA service for erectile dysfunction.

35270 the veteran had the identified illness or injury, a specified condition for erectile dysfunction, at the time of the clinical onset of erectile dysfunction.

35264   the veteran has established the causal connection between the specified condition for erectile dysfunction and VEA service for the clinical onset of erectile dysfunction.

35266  the veteran has established the causal connection between the specified condition for erectile dysfunction and operational service for the clinical onset of erectile dysfunction.

or

35267  the veteran has established the causal connection between the specified condition for erectile dysfunction and eligible service for the clinical onset of erectile dysfunction.

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.

35271 the veteran had the identified illness or injury, a specified condition for erectile dysfunction, at the time of the clinical worsening of erectile dysfunction.

35265   the veteran has established the causal connection between the specified condition for erectile dysfunction and VEA service for the clinical worsening of erectile dysfunction.

35268  the veteran has established the causal connection between the specified condition for erectile dysfunction and operational service for the clinical worsening of erectile dysfunction.

or

35269  the veteran has established the causal connection between the specified condition for erectile dysfunction and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35266]

35272  the identified illness or injury, a specified condition for erectile dysfunction, is causally related to operational service.

Clinical onset and eligible service [35267]

35273  the identified illness or injury, a specified condition for erectile dysfunction, is causally related to eligible service.

Clinical worsening and operational service [35268]

35272  the identified illness or injury, a specified condition for erectile dysfunction, is causally related to operational service.

35274 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a specified condition for erectile dysfunction, is causally related.

Clinical worsening and eligible service [35269]

35273  the identified illness or injury, a specified condition for erectile dysfunction, is causally related to eligible service.

35275 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a specified condition for erectile dysfunction, is causally related.

Erectile dysfunction - A specified endocrinological disorder Factor

RMA definition

For the purposes of this Statement of Principles, the RMA states that a specified endocrinological disorder means a disorder of the endocrine system which can result in sexual dysfunction, and includes:

• Cushing's syndrome – ICD code 255.0
• Acromegaly – ICD code 253.0
• Hypogonadism – ICD code 257.2
• Testicular hypofunction – ICD code 257.1, 257.2
• Hypogonadotrophic hypogonadism – ICD code 253.4
• Hyperthyroidism – ICD code 242.4, 242.8, 242.9
• Hypothyroidism – ICD code 244; or
• Hyperprolactinaemia – ICD code 253.1
• Pituitary gland adenoma – covered by the SoP for neoplasm of the pituitary gland ICD code 227.30; or
• Pituitary or hypothalamic dysfunction - ICD code 253.7, 253.8; or
• Panhypopituitarism – ICD code 253.2.

The above list is not exhaustive and there may be other endocrine conditions which result in sexual dysfunction.

Establishing onset

If a veteran or member had such an endocrine disorder he 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 such an endocrine disorder 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 the endocrine disorder rather than to some other condition.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Endocrinological Disorder - Erectile Dysfunction	MR9184.pdf [12]	MR9184.docx [13]

Preliminary questions [23157]

23202 there is some evidence that a specified endocrinological disorder may be a factor in the development or worsening of the condition under consideration.

23158 the veteran has had a specified endocrinological disorder at some time.

25086  the specified endocrinological disorder is an illness which is identifiable.

35283  the veteran has established the causal connection between the endocrinological disorder and VEA service for erectile dysfunction.

23160 the veteran had the identified illness or injury, a specified endocrinological disorder, at the time of the clinical onset of the condition under consideration.

23161   the veteran has established the causal connection between the endocrinological disorder and VEA service for the clinical onset of erectile dysfunction.

23162  the veteran has established the causal connection between the endocrinological disorder and operational service for the clinical onset of erectile dysfunction.

or

23163  the veteran has established the causal connection between the endocrinological disorder and eligible service for the clinical onset of erectile dysfunction.

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.

35287 the veteran had the identified illness or injury, a specified endocrinological disorder, at the time of the clinical worsening of the condition under consideration.

35284   the veteran has established the causal connection between the endocrinological disorder and VEA service for the clinical worsening of erectile dysfunction.

35285  the veteran has established the causal connection between the endocrinological disorder and operational service for the clinical worsening of erectile dysfunction.

or

35286  the veteran has established the causal connection between the endocrinological disorder and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [23162]

23164  the identified illness or injury, a specified endocrinological disorder, is causally related to operational service.

Clinical onset and eligible service [23163]

23165  the identified illness or injury, a specified endocrinological disorder, is causally related to eligible service.

Clinical worsening and operational service [35285]

23164  the identified illness or injury, a specified endocrinological disorder, is causally related to operational service.

35288 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a specified endocrinological disorder, is causally related.

Clinical worsening and eligible service [35286]

23165  the identified illness or injury, a specified endocrinological disorder, is causally related to eligible service.

35289 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a specified endocrinological disorder, is causally related.

Erectile dysfunction - A specified neurological disorder for erectile dysfunction Factor

For the purposes of CCPS this factor covers:

• A lesion of the temporal lobe; or
• Compression, neoplasm, infection or inflammation of the brain, spinal cord, thoracolumbar nerve roots or cauda equina.

Medical advice is essential to establish if there is a lesion in the temporal lobe, or compression, neoplasm, infection or inflammation of the brain, spinal cord, thoracolumbar nerve roots or cauda equina.

A lesion in the temporal lobe is a structural or functional abnormality of that structure, eg traumatic damage, tumour, infection, haemorrhage, degenerative process etc.  A lesion of the temporal lobe might be associated with diseases such as Systemic lupus erythematosus and Creutzfeldt-Jakob disease.  However not all cases of SLE or CJD would involve a lesion of the temporal lobe.  Some forms of dementia may involve atrophy of the temporal lobe.

Compression of the spinal cord, thoracolumbar nerve roots or cauda equina could be caused by spinal conditions such as intervertebral disc prolapse or spondylolisthesis. Meningitis and Encephalitis can be the cause of infection and inflammation of the spinal cord and brain.  A neoplasm could be benign or malignant.

The spinal cord ends near the first lumbar vertebra and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

Last reviewed for CCPS 05 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Specified Neurological Disorder- Erectile Dysfunction	MR9320.pdf [14]	MR9320.docx [15]

Preliminary questions [22984]

35363 there is some evidence that a specified neurological disorder may be a factor in the development or worsening of the condition under consideration.

35364 the veteran has had a specified neurological disorder at some time.

35365  a specified neurological disorder means a lesion of the temporal lobe or compression, neoplasm, infection or inflammation of the brain, spinal cord, thoracolumbar nerve roots or cauda equina.

35366  the veteran has established the causal connection between a specified neurological disorder and VEA service for erectile dysfunction.

35373 the veteran had the identified illness or injury, a neurological disorder, at the time of the clinical onset of the condition under consideration.

35367   the veteran has established the causal connection between a specified neurological disorder and VEA service for the clinical onset of erectile dysfunction.

35369  the veteran has established the causal connection between a specified neurological disorder and operational service for the clinical onset of erectile dysfunction.

or

35370  the veteran has established the causal connection between a specified neurological disorder and eligible service for the clinical onset of erectile dysfunction.

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.

35374 the veteran had the identified illness or injury, a neurological disorder, at the time of the clinical worsening of the condition under consideration.

35368   the veteran has established the causal connection between a specified neurological disorder and VEA service for the clinical worsening of erectile dysfunction.

35371  the veteran has established the causal connection between a specified neurological disorder and operational service for the clinical worsening of erectile dysfunction.

or

35372  the veteran has established the causal connection between a specified neurological disorder and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35369]

35375  the identified illness or injury, a neurological disorder, is causally related to operational service.

Clinical onset and eligible service [35370]

35376  the identified illness or injury, a neurological disorder, is causally related to eligible service.

Clinical worsening and operational service [35371]

35375  the identified illness or injury, a neurological disorder, is causally related to operational service.

35377 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a neurological disorder, is causally related.

Clinical worsening and eligible service [35372]

35376  the identified illness or injury, a neurological disorder, is causally related to eligible service.

35378 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a neurological disorder, is causally related.

Erectile dysfunction - Alcohol dependence or alcohol abuse Factor

A report from a specialist psychiatrist that conforms with the Guidelines for Psychiatric Compensation Claims [16] is required to confirm whether or not a person has alcohol dependence or alcohol abuse.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [22946]

25223 the veteran has had alcohol dependence or alcohol abuse at some time.

35290  the veteran has established the causal connection between the alcohol dependence or alcohol abuse and VEA service for erectile dysfunction.

35294 the veteran had alcohol dependence or alcohol abuse at the time of the clinical onset of erectile dysfunction.

22948   the veteran has established the causal connection between the alcohol dependence or alcohol abuse and VEA service for the clinical onset of erectile dysfunction.

22949  the veteran has established the causal connection between the alcohol dependence or alcohol abuse and operational service for the clinical onset of erectile dysfunction.

or

22950  the veteran has established the causal connection between the alcohol dependence or alcohol abuse and eligible service for the clinical onset of erectile dysfunction.

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.

35295 the veteran had alcohol dependence or alcohol abuse at the time of the clinical worsening of erectile dysfunction.

35291   the veteran has established the causal connection between the alcohol dependence or alcohol abuse and VEA service for the clinical worsening of erectile dysfunction.

35292  the veteran has established the causal connection between the alcohol dependence or alcohol abuse and operational service for the clinical worsening of erectile dysfunction.

or

35293  the veteran has established the causal connection between the alcohol dependence or alcohol abuse and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22949]

26519  the alcohol dependence or alcohol abuse is causally related to operational service.

Clinical onset and eligible service [22950]

26522  the alcohol dependence or alcohol abuse is causally related to eligible service.

Clinical worsening and operational service [35292]

26519  the alcohol dependence or alcohol abuse is causally related to operational service.

23760 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the alcohol dependence or alcohol abuse is causally related.

Clinical worsening and eligible service [35293]

26522  the alcohol dependence or alcohol abuse is causally related to eligible service.

23761 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the alcohol dependence or alcohol abuse is causally related.

Erectile dysfunction - Being obese Factor

The SOP for erectile dysfunction includes a factor of "being obese".  This term is defined in the SOP.  The RMA has also issued a SOP for morbid obesity.  If there is a history of "being obese" but the claim for erectile dysfunction does not succeed via this factor, you will be asked to consider whether there is a history of morbid obesity, as this is an extreme form of obesity.

RMA definition of being obese

In this Statement of Principles the Repatriation Medical Authority has defined being obese as meaning an increase in body weight by way of fat accumulation which 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 inches2) x 703.1).

This definition excludes weight gain not resulting from fat deposition such as gross oedema, peritoneal or pleural effusion, or muscle hypertrophy.  "Being obese" develops when energy intake is in excess of expenditure for a sustained period of time.

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.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Obesity	CR9230.pdf [17]	CR9230.docx [18]
Medical Report	Obesity	MR9305.pdf [19]	MR9305.docx [20]

Preliminary questions [35245]

587       the veteran has a history of obesity.

17298  the veteran has established the causal connection between the obesity and VEA service for the condition under consideration.

17299   the veteran has established the causal connection between the obesity and VEA service for the clinical onset of the condition under consideration.

17303  the veteran has established the causal connection between the obesity and operational service for the clinical onset of the condition under consideration.

or

17304  the veteran has established the causal connection between the obesity 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.

17300   the veteran has established the causal connection between the obesity and VEA service for the clinical worsening of the condition under consideration.

17305  the veteran has established the causal connection between the obesity and operational service for the clinical worsening of the condition under consideration.

or

17306  the veteran has established the causal connection between the obesity and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [17303]

17307 the veteran was obese at the time of the clinical onset of the condition under consideration.

591       the obesity was caused by operational service.

or

9004     the veteran has a history of morbid obesity.

9007     the veteran was morbidly obese at the time of the clinical onset of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

Clinical onset and eligible service [17304]

17307 the veteran was obese at the time of the clinical onset of the condition under consideration.

3407     the obesity was caused by eligible service.

or

9004     the veteran has a history of morbid obesity.

9007     the veteran was morbidly obese at the time of the clinical onset of the condition under consideration.

9006     the morbid obesity is causally related to eligible service.

Clinical worsening and operational service [17305]

17308 the veteran was obese at the time of the clinical worsening of the condition under consideration.

591       the obesity was caused by operational service.

17309 the clinical onset of the condition under consideration occurred prior to that part of operational service which caused the obesity.

or

9004     the veteran has a history of morbid obesity.

9008     the veteran was morbidly obese at the time of the clinical worsening of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

9009     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the morbid obesity is causally related.

Clinical worsening and eligible service [17306]

17308 the veteran was obese at the time of the clinical worsening of the condition under consideration.

3407     the obesity was caused by eligible service.

17310 the clinical onset of the condition under consideration occurred prior to that part of eligible service which caused the obesity.

or

9004     the veteran has a history of morbid obesity.

9008     the veteran was morbidly obese at the time of the clinical worsening of the condition under consideration.

9006     the morbid obesity is causally related to eligible service.

9010     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the morbid obesity is causally related.

Erectile dysfunction - Cerebrovascular accident Factor

For the purposes of this Statement of Principles, “cerebrovascular accident” means cerebral ischaemia (including vertebrobasilar ischaemia) or intracerebral haemorrhage.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [35532]

35533 there is some evidence that a cerebrovascular accident may be a factor in the development or worsening of the condition under consideration.

35534  the veteran had a cerebrovascular accident for erectile dysfunction at some time.

34783 the veteran has had cerebral ischaemia at some time.

or

34784 the veteran has had an intracerebral haemorrhage at some time.

35535  the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and VEA service for erectile dysfunction.

35542 the veteran had the identified illness or injury, a cerebrovascular accident, at the time of the clinical onset of erectile dysfunction.

35536   the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and VEA service for the clinical onset of erectile dysfunction.

35538  the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and operational service for the clinical onset of erectile dysfunction.

or

35539  the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and eligible service for the clinical onset of erectile dysfunction.

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.

35543 the veteran had the identified illness or injury, a cerebrovascular accident, at the time of the clinical worsening of erectile dysfunction.

35537   the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and VEA service for the clinical worsening of erectile dysfunction.

35540  the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and operational service for the clinical worsening of erectile dysfunction.

or

35541  the veteran has established the causal connection between a cerebrovascular accident for erectile dysfunction and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35538]

15683  the identified illness or injury, a cerebrovascular accident, is causally related to operational service.

Clinical onset and eligible service [35539]

15684  the identified illness or injury, a cerebrovascular accident, is causally related to eligible service.

Clinical worsening and operational service [35540]

15683  the identified illness or injury, a cerebrovascular accident, is causally related to operational service.

35544 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a cerebrovascular accident, is causally related.

Clinical worsening and eligible service [35541]

15684  the identified illness or injury, a cerebrovascular accident, is causally related to eligible service.

35545 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a cerebrovascular accident, is causally related.

Erectile dysfunction - Cigar smoking Factor

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 [21].

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [22]	CRD905.docx [23]
Claimant Report	Smoking	CRV905.pdf [24]	CRV905.docx [25]

Preliminary questions [22882]

26916 there is some evidence that cigar smoking may be a factor in the development or worsening of the condition under consideration.

35223  the veteran has established the causal connection between the cigar smoking and VEA service for erectile dysfunction.

22890   the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of erectile dysfunction.

22892  the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of erectile dysfunction.

or

22891  the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of erectile dysfunction.

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.

35224   the veteran has established the causal connection between the cigar smoking and VEA service for the clinical worsening of erectile dysfunction.

35225  the veteran has established the causal connection between the cigar smoking and operational service for the clinical worsening of erectile dysfunction.

or

35226  the veteran has established the causal connection between the cigar smoking and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22892]

27891  the veteran smoked at least ten pack years of cigars before the clinical onset of erectile dysfunction.

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

Clinical onset and eligible service [22891]

27892  the veteran smoked at least fifteen pack years of cigars before the clinical onset of erectile dysfunction.

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

Clinical worsening and operational service [35225]

22893  the veteran smoked at least ten pack years of cigars before the clinical worsening of erectile dysfunction.

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

9196     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the period or periods of cigar smoking are causally related.

Clinical worsening and eligible service [35226]

22894  the veteran smoked at least fifteen pack years of cigars before the clinical worsening of erectile dysfunction.

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

9197     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the period or periods of cigar smoking are causally related.

Erectile Dysfunction - Cigarette smoking Factor

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 quantity smoked (either tailor-made cigarettes per day or hand-rolled cigarettes in ounces per week or a combination of both);
• 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 [21].

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [22]	CRD905.docx [23]
Claimant Report	Smoking	CRV905.pdf [24]	CRV905.docx [25]

Preliminary questions [22881]

5803     the veteran has ever smoked cigarettes.

35217  the veteran has established the causal connection between the cigarette smoking and VEA service for erectile dysfunction.

22884   the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical onset of erectile dysfunction.

22885  the veteran has established the causal connection between the cigarette smoking and operational service for the clinical onset of erectile dysfunction.

or

22886  the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical onset of erectile dysfunction.

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.

35218   the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical worsening of erectile dysfunction.

35219  the veteran has established the causal connection between the cigarette smoking and operational service for the clinical worsening of erectile dysfunction.

or

35220  the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22885]

27889  the veteran smoked at least ten pack years of cigarettes before the clinical onset of erectile dysfunction.

3116     the veteran has some period or periods of cigarette smoking that are causally related to operational service.

Clinical onset and eligible service [22886]

27890  the veteran smoked at least fifteen pack years of cigarettes before the clinical onset of erectile dysfunction.

3521     the veteran has some period or periods of cigarette smoking that are causally related to eligible service.

Clinical worsening and operational service [35219]

35221  the veteran smoked at least ten pack years of cigarettes before the clinical worsening of erectile dysfunction.

3116     the veteran has some period or periods of cigarette smoking that are causally related to operational service.

9188     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the period or periods of cigarette smoking are causally related.

Clinical worsening and eligible service [35220]

35222  the veteran smoked at least fifteen pack years of cigarettes before the clinical worsening of erectile dysfunction.

3521     the veteran has some period or periods of cigarette smoking that are causally related to eligible service.

9189     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the period or periods of cigarette smoking are causally related.

Erectile dysfunction - 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 5 October 2005.

Preliminary questions [22941]

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.

Erectile dysfunction - Exposure to a specified organic solvent Factor

RMA definition

A specified organic solvent for the purposes of this SoP means:

1. Aromatic hydrocarbon solvents; or
2. Ketones; or
3. Acetates; or
4. Carbon disulphide.

General information

Aromatic hydrocarbon solvents: including benzene; toluene; and xylene. Examples: white spirit and mineral turpentine.

Ketones: including acetone, methyl ethyl ketone (MEK); methyl isobutyl ketone; and methyl n-butyl ketone (MBK). Example: acetone (nail polish remover);

Acetates: including ethyl acetate; methyl formate; and amyl acetate. Example: ethyl acetate (nail polish remover);

Carbon disulphide is highly flammable and toxic.  Full personal protection equipment is required when using this product.

Important uses of these organic solvents (usually in combination with other solvents) include:

• Cleaning agents to remove oils and grease;
• Dry cleaning;
• Constituents of paints, varnishes, thinners, waxes, adhesives, motor fuels;
• Manufacture of artificial rubber, leather, plastics, textiles and explosives;
• Pharmaceutical, pesticide and fumigant formulations.

In some occupational groups within the Australian Defence Forces, there is significant exposure to organic solvents. The largest group of these is aircraft workers who use solvent mixtures such as benzene to clean the jet engines of aircraft.

However, the use of organic solvents is widespread and it is not possible to give an exhaustive list either of the organic solvents themselves, or the type of work that would involve exposure. You may need to take the time to read the information provided below. For example service personnel working with paints (including paint strippers and paint thinners), enamels, varnishes, shellacs and lacquers; fumigants and pesticides; adhesives; resins; printing inks; rubber solvents; or electrical cables, may all have been exposed to these organic solvents – it may depend on the nature of the work or the types of chemicals used.

• Types of organic solvents
• How to identify an organic solvent
• Physical requirements, duties, and workplace hazards of specific military occupations

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Exposure to Specified Organic Solvents - Erectile Dysfunction	CR9253.pdf [26]	CR9253.docx [27]

Preliminary questions [35349]

35350 there is some evidence that exposure to a specified organic solvent may be a factor in the development or worsening of the condition under consideration.

35351 the veteran has experienced inhalation, ingestion or cutaneous contact with a specified organic solvent at some time.

35352  the veteran has established the causal connection between exposure to a specified organic solvent and operational service for erectile dysfunction.

35353   the veteran has established the causal connection between exposure to a specified organic solvent and operational service for the clinical onset of erectile dysfunction.

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.

35354   the veteran has established the causal connection between exposure to a specified organic solvent and operational service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35353]

35355 the veteran experienced inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical onset of the condition under consideration.

35357 operational service made a material contribution to the veteran's inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical onset of the condition under consideration.

35359 the veteran's inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical onset of the condition under consideration, to which operational service made a material contribution, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical worsening and operational service [35354]

35356 the veteran experienced inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical worsening of the condition under consideration.

35361 the clinical onset of the condition under consideration occurred prior to the veteran experiencing inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical worsening of the condition under consideration.

35358 operational service made a material contribution to the veteran's inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical worsening of the condition under consideration.

35360 the veteran's inhalation, ingestion or cutaneous contact with a specified organic solvent on more days than not for a cumulative period of at least 180 days within the two years immediately before the clinical worsening of the condition under consideration, to which operational service made a material contribution, was due to the veteran's serious default, wilful act or serious breach of discipline.

Erectile dysfunction - Haemochromatosis Factor

Definition

The RMA has defined haemochromatosis as meaning “a genetic disorder of iron storage in which an inappropriate increase in intestinal iron absorption results in the deposition of excessive quantities of iron in parenchymal cells, with eventual tissue damage and functional impairment of the organs involved, especially the liver, pancreas, heart and pituitary, and excludes acquired haemosiderosis, attracting ICD code 275.0”.

Signs and symptoms

Haemochromatosis is rarely evident below age 20.  Nearly 70% of patients develop the first symptoms between ages 40 and 60.  Initial symptoms include:

• weakness, lassitude, weight loss, change in skin colour (bronzing), abdominal pain, loss of libido (hypogonadism) and symptoms of diabetes mellitus.

Signs of advanced disease include:

• hepatomegaly, spider angiomas, splenomegaly, arthropathy, ascites, cardiac arrhythmias, congestive heart failure, loss of body hair and testicular atrophy, and jaundice.

Establishing onset

If a person had haemochromatosis, significant medical attention would have been needed at some time, diagnosis and monitoring would involve blood tests and treatment includes phlebotomy (blood letting) and possibly treatment with iron chelating agents; medical advice may not have been sought until symptoms had been present for some time. If doctors' notes and hospitals' records have been destroyed or can no longer be obtained, a statement that haemochromatosis first developed at a particular time will generally be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the symptoms claimed to be due to haemochromatosis at that time were not due to some other condition.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [22967]

21960 there is some evidence that haemochromatosis may be a factor in the development or worsening of the condition under consideration.

8677     the veteran has haemochromatosis.

35296  the veteran has established the causal connection between haemochromatosis and VEA service for erectile dysfunction.

22968 the veteran had haemochromatosis before the clinical onset of the condition under consideration.

22969   the veteran has established the causal connection between haemochromatosis and VEA service for the clinical onset of erectile dysfunction.

22970  the veteran has established the causal connection between haemochromatosis and operational service for the clinical onset of erectile dysfunction.

or

22971  the veteran has established the causal connection between haemochromatosis and eligible service for the clinical onset of erectile dysfunction.

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.

35300 the veteran had haemochromatosis before the clinical worsening of the condition under consideration.

35297   the veteran has established the causal connection between haemochromatosis and VEA service for the clinical worsening of erectile dysfunction.

35298  the veteran has established the causal connection between haemochromatosis and operational service for the clinical worsening of erectile dysfunction.

or

35299  the veteran has established the causal connection between haemochromatosis and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22970]

10698  the haemochromatosis is causally related to operational service.

Clinical onset and eligible service [22971]

10699  the haemochromatosis is causally related to eligible service.

Clinical worsening and operational service [35298]

10698  the haemochromatosis is causally related to operational service.

21000 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the haemochromatosis is causally related.

Clinical worsening and eligible service [35299]

10699  the haemochromatosis is causally related to eligible service.

21001 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the haemochromatosis is causally related.

Erectile dysfunction - Hypertension Factor

Definition

Hypertension is high blood pressure.  Hypertension was also sometimes called hyperpiesia or hyperpiesis up until the 1950's.  Blood pressure is usually recorded as two figures - the top figure records the systolic pressure and the lower figure records the diastolic pressure (eg 130/80 records a systolic pressure of 130 and a diastolic pressure of 80).

Note:  The definition means that hypertension cannot be diagnosed on the basis of one elevated blood pressure reading.  There must be a number of high readings.  When treatment is given, blood pressure readings may return to normal.  However, a person with 'normal' blood pressure readings can still be suffering from hypertension if he or she is undergoing treatment for hypertension.

Establishing the onset of hypertension

This disease is significant and, if it has been detected, it will have been documented by a medical officer.  However, doctors' notes and hospitals' records may have been destroyed or can no longer be obtained.  If this is the case, the person's statement that hypertension was detected at a particular time should generally be accepted, However, if these records cannot be obtained, a reliable history of hypertension at a particular time will generally 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 hypertension rather than to some other condition.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [35237]

317       the veteran has hypertension.

35238  the veteran has established the causal connection between the hypertension and VEA service for erectile dysfunction.

32355 the veteran's hypertension was present at the time of the clinical onset of the condition under consideration.

35239   the veteran has established the causal connection between the hypertension and VEA service for the clinical onset of erectile dysfunction.

35241  the veteran has established the causal connection between the hypertension and operational service for the clinical onset of erectile dysfunction.

or

35242  the veteran has established the causal connection between the hypertension and eligible service for the clinical onset of erectile dysfunction.

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.

32356 the veteran's hypertension was present at the time of the clinical worsening of the condition under consideration.

35240   the veteran has established the causal connection between the hypertension and VEA service for the clinical worsening of erectile dysfunction.

35243  the veteran has established the causal connection between the hypertension and operational service for the clinical worsening of erectile dysfunction.

or

35244  the veteran has established the causal connection between the hypertension and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35241]

334        the hypertension is causally related to operational service.

Clinical onset and eligible service [35242]

934        the hypertension is causally related to eligible service.

Clinical worsening and operational service [35243]

334        the hypertension is causally related to operational service.

7899     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the hypertension is causally related.

Clinical worsening and eligible service [35244]

934        the hypertension is causally related to eligible service.

7900     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the hypertension is causally related.

Erectile dysfunction - Inability to obtain appropriate clinical management for erectile dysfunction Factor

In the case of erectile dysfunction appropriate clinical management entails full examinations to determine and treat the underlying cause, where possible. Treatment may include:

• Androgen therapy [only where hypogonadism is demonstrated].
• Changing medication that might be causing the condition.
• Making lifestyle changes (for example quitting smoking).
• Oral medication with vasoactive substances such as sildenafil citrate (Viagra).
• Direct penile injection of vasoactive substances such as prostaglandin E and papaverine (intracavernosal injections).
• Intraurethral suppositories.
• Penile prostheses, surgically implanted.
• Psychotherapy.

Inability to obtain appropriate clinical management

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Inability to Obtain Appropriate Clinical Management	GQACM.pdf [28]	GQACM.docx [29]

Preliminary questions [24419]

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.

Erectile dysfunction - Inability to undertake any physical activity greater than 3 METs Factor

RMA definition

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:

• The factor requirements are a severe test of a limited capacity for exertion.  The MET ratings for common activities provides guidance for assessing whether or not certain activities meet the RMA SOP factor.
• The SOP factor requires "an inability to undertake any physical activity greater than 3 METs …".  Therefore, there must be a physical or mental incapacity that prevents the person engaging in such activity.  The incapacity must be due a physical inability with a generalised, rather than localised, effect on the level of physical activity able to be undertaken.  For example the person with adhesive capsulitis may not be able to work as a mechanic or play golf, but can readily engage in other activities where the level of energy expended is greater than 3 METs.  Similarly, the person with osteoarthrosis of the knees can undertake upper arm activities and/or swimming at levels easily exceeding 3 METs.
• Lifestyle choices, lack of opportunity, or lack of facilities do not constitute an inability to undertake any physical activity greater than 3 METs.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Inability to Undertake Physical Activity	CR9147.pdf [30]	CR9147.docx [31]
Medical Report	Inability to Undertake Physical Activity	MR9045.pdf [32]	MR9045.docx [33]

Preliminary questions [35246]

33534 there is some evidence that an inability to undertake any physical activity greater than 3 METs may be a factor in the development or worsening of the condition under consideration.

33535 the veteran has been unable to undertake any physical activity greater than 3 METs for at least 5 years at some time.

33536 the veteran was unable to undertake any physical activity greater than 3 METs for at least 5 years as a result of an illness or injury which is identifiable.

35247  the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and operational service for erectile dysfunction.

35248   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 erectile dysfunction.

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.

35249   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 worsening of erectile dysfunction.

Clinical onset and operational service [35248]

33499 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 the five years before the clinical onset of the condition under consideration.

33538  the identified illness or injury which prevented the veteran from undertaking any physical activity greater than 3 METs is causally related to operational service.

Clinical worsening and operational service [35249]

33500 the identified illness or injury made a material contribution to the veteran's inability to undertake any physical activity greater than 3 METs after the clinical onset and for at least the five years before the clinical worsening of the condition under consideration.

33538  the identified illness or injury which prevented the veteran from undertaking any physical activity greater than 3 METs is causally related to operational service.

33539 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 undertaking any physical activity greater than 3 METs is causally related.

Erectile dysfunction - Ischaemic heart disease Factor

Definition

Note that coronary atherosclerosis that has not resulted in angina, an infarct or some other cardiac disability is not covered by the RMA SOP definition.

Establishing a history of ischaemic heart disease

Ischaemic heart disease is a cardiac disability which arises from an imbalance between the supply and myocardial demand for oxygen.  This imbalance results from coronary atheroma [also called coronary atherosclerosis and coronary artery disease] or coronary vasospasm.  NB - the presence of coronary artery disease [as may be shown by an angiogram] does not establish the presence of ischaemic heart disease, unless there is some cardiac disability such as angina.

If a veteran or member had ischaemic heart disease he or she would most likely have sought medical attention at some time.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, if these records cannot be obtained, a reliable history of appropriate symptoms and/or medical treatment at a particular time generally will be accepted, provided this is not negated by other evidence.  Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to ischaemic heart disease rather than to some other illness or injury.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [35250]

19161 the veteran has suffered from ischaemic heart disease at some time.

35251  the veteran has established the causal connection between the ischaemic heart disease and VEA service for erectile dysfunction.

35258 the veteran had ischaemic heart disease at the time of the clinical onset of erectile dysfunction.

35252   the veteran has established the causal connection between the ischaemic heart disease and VEA service for the clinical onset of erectile dysfunction.

35254  the veteran has established the causal connection between the ischaemic heart disease and operational service for the clinical onset of erectile dysfunction.

or

35255  the veteran has established the causal connection between the ischaemic heart disease and eligible service for the clinical onset of erectile dysfunction.

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.

35259 the veteran had ischaemic heart disease at the time of the clinical worsening of erectile dysfunction.

35253   the veteran has established the causal connection between the ischaemic heart disease and VEA service for the clinical worsening of erectile dysfunction.

35256  the veteran has established the causal connection between the ischaemic heart disease and operational service for the clinical worsening of erectile dysfunction.

or

35257  the veteran has established the causal connection between the ischaemic heart disease and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35254]

30360  the ischaemic heart disease is causally related to operational service.

Clinical onset and eligible service [35255]

30361  the ischaemic heart disease is causally related to eligible service.

Clinical worsening and operational service [35256]

30360  the ischaemic heart disease is causally related to operational service.

35260 the clinical onset of erectile dysfunction occurred prior to that part of operational service to which the ischaemic heart disease is causally related.

Clinical worsening and eligible service [35257]

30361  the ischaemic heart disease is causally related to eligible service.

35261 the clinical onset of erectile dysfunction occurred prior to that part of eligible service to which the ischaemic heart disease is causally related.

Erectile dysfunction - Low-flow priapism Factor

RMA definition

Low-flow priapism means ‘persistent abnormal erection of the penis caused by corporeal veno-occlusion’.

Low flow priapism results from blood being unable to leave the erect penis; it is painful and can cause damage to the penis if not treated promptly.

High flow priapism is less common and is caused by too much blood entering the penis; the blood continues to carry oxygen and the condition is not painful and does not cause permanent damage.

Causes of low flow priapism can be either:

Medication: for example, injection therapy for erectile dysfunction; chlorpromazine [eg Largactil]; prazosin [eg Minipress]; certain antihypertensives, anticoagulants, and corticosteroids; or

Medical condition: for example, leukaemia, sickle cell disease; pelvic haematoma or neoplasm; cerebrospinal disease (eg, syphilis, tumour); or genital infection and inflammation (eg, prostatitis, urethritis, cystitis).

Priapism may present as acute episodes lasting up to 2-4 hours which spontaneously subside or as a prolonged episode lasting over 4 hours which requires treatment to avoid permanent damage. Acute episodes may precede a prolonged attack. This is a painful condition and medical treatment would have been sought at the time. Some cases (especially those due to therapy for erectile dysfunction) respond to vasoactive drugs administered directly into the corpora. Other treatments may include continuous caudal or spinal anaesthesia; decompression of the corpora by introduction of large-bore needles with evacuation and irrigation; or therapy for the underlying disease.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [35316]

35317 there is some evidence that low-flow priapism may be a factor in the development or worsening of the condition under consideration.

22952 the veteran has had low-flow priapism for a continuous period of at least four hours at some time.

35319  the veteran has established the causal connection between low-flow priapism and VEA service for erectile dysfunction.

35326 the veteran had low-flow priapism for a continuous period of at least four hours immediately before the clinical onset of the condition under consideration.

35320   the veteran has established the causal connection between low-flow priapism and VEA service for the clinical onset of erectile dysfunction.

35322  the veteran has established the causal connection between low-flow priapism and operational service for the clinical onset of erectile dysfunction.

or

35323  the veteran has established the causal connection between low-flow priapism and eligible service for the clinical onset of erectile dysfunction.

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.

35327 the veteran had low-flow priapism for a continuous period of at least four hours immediately before the clinical worsening of the condition under consideration.

35321   the veteran has established the causal connection between low-flow priapism and VEA service for the clinical worsening of erectile dysfunction.

35324  the veteran has established the causal connection between low-flow priapism and operational service for the clinical worsening of erectile dysfunction.

or

35325  the veteran has established the causal connection between low-flow priapism and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35322]

35328  the low-flow priapism is causally related to operational service.

Clinical onset and eligible service [35323]

35329  the low-flow priapism is causally related to eligible service.

Clinical worsening and operational service [35324]

35328  the low-flow priapism is causally related to operational service.

35330 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the low-flow priapism is causally related.

Clinical worsening and eligible service [35325]

35329  the low-flow priapism is causally related to eligible service.

35331 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the low-flow priapism is causally related.

Erectile dysfunction - Peyronie's disease Factor

RMA definition

Peyronie’s disease means “induration of the corpora cavernosa of the penis, characterised by a circumscribed, firm, painless plaque or band, usually situated on the dorsum of the penis.”

Peyronie's disease is also known as van Buren's disease or penile fibromatosis. The contracture usually results in deviation of the erect penis to the involved side, occasionally causes painful erections and interferes with sexual intercourse. There is no known cause.

Resolution may occur spontaneously over many months so treatment may not be warranted initially. Surgical treatment involving ‘nipping and tucking’ the opposite side is usually effective in countering the effect. Local injections of drugs, such as Verapamil, may also be effective.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [35301]

35302 there is some evidence that Peyronie's disease may be a factor in the development or worsening of the condition under consideration.

22960 the veteran has suffered from Peyronie's disease at some time.

35303  the veteran has established the causal connection between Peyronie's disease and VEA service for erectile dysfunction.

35310 the veteran had Peyronie's disease before the clinical onset of the condition under consideration.

35304   the veteran has established the causal connection between Peyronie's disease and VEA service for the clinical onset of erectile dysfunction.

35306  the veteran has established the causal connection between Peyronie's disease and operational service for the clinical onset of erectile dysfunction.

or

35307  the veteran has established the causal connection between Peyronie's disease and eligible service for the clinical onset of erectile dysfunction.

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.

35311 the veteran had Peyronie's disease before the clinical worsening of the condition under consideration.

35305   the veteran has established the causal connection between Peyronie's disease and VEA service for the clinical worsening of erectile dysfunction.

35308  the veteran has established the causal connection between Peyronie's disease and operational service for the clinical worsening of erectile dysfunction.

or

35309  the veteran has established the causal connection between Peyronie's disease and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35306]

35312  the Peyronie's disease is causally related to operational service.

Clinical onset and eligible service [35307]

35313  the Peyronie's disease is causally related to eligible service.

Clinical worsening and operational service [35308]

35312  the Peyronie's disease is causally related to operational service.

35314 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the Peyronie's disease is causally related.

Clinical worsening and eligible service [35309]

35313  the Peyronie's disease is causally related to eligible service.

35315 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the Peyronie's disease is causally related.

Erectile dysfunction - Pipe smoking Factor

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

• the quantity smoked (ascertain tobacco smoked per week in grams or ounces; 1 ounce = 28 grams);
• 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 [21].

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".

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [22]	CRD905.docx [23]
Claimant Report	Smoking	CRV905.pdf [24]	CRV905.docx [25]

Preliminary questions [22883]

26927 there is some evidence that pipe smoking may be a factor in the development or worsening of the condition under consideration.

35227  the veteran has established the causal connection between the pipe smoking and VEA service for erectile dysfunction.

22896   the veteran has established the causal connection between the pipe smoking and VEA service for the clinical onset of erectile dysfunction.

22897  the veteran has established the causal connection between the pipe smoking and operational service for the clinical onset of erectile dysfunction.

or

22898  the veteran has established the causal connection between the pipe smoking and eligible service for the clinical onset of erectile dysfunction.

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.

35228   the veteran has established the causal connection between the pipe smoking and VEA service for the clinical worsening of erectile dysfunction.

35229  the veteran has established the causal connection between the pipe smoking and operational service for the clinical worsening of erectile dysfunction.

or

35230  the veteran has established the causal connection between the pipe smoking and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22897]

27893  the veteran smoked at least ten pack years of pipe tobacco before the clinical onset of erectile dysfunction.

4911     the veteran has some period or periods of pipe smoking that are causally related to operational service.

Clinical onset and eligible service [22898]

27894  the veteran smoked at least fifteen pack years of pipe tobacco before the clinical onset of erectile dysfunction.

4913     the veteran has some period or periods of pipe smoking that are causally related to eligible service.

Clinical worsening and operational service [35229]

22899  the veteran smoked at least ten pack years of pipe tobacco before the clinical worsening of erectile dysfunction.

4911     the veteran has some period or periods of pipe smoking that are causally related to operational service.

9204     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the period or periods of pipe smoking are causally related.

Clinical worsening and eligible service [35230]

22900  the veteran smoked at least fifteen pack years of pipe tobacco before the clinical worsening of erectile dysfunction.

4913     the veteran has some period or periods of pipe smoking that are causally related to eligible service.

9205     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the period or periods of pipe smoking are causally related.

Erectile dysfunction - Smoking and CCPS Factor

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 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [22]	CRD905.docx [23]
Claimant Report	Smoking	CRV905.pdf [24]	CRV905.docx [25]

Preliminary questions [34261]

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

35231  the veteran has established the causal connection between smoking tobacco products and VEA service for erectile dysfunction.

34262   the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of erectile dysfunction.

34263  the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of erectile dysfunction.

or

34264  the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of erectile dysfunction.

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.

35232   the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical worsening of erectile dysfunction.

35233  the veteran has established the causal connection between smoking tobacco products and operational service for the clinical worsening of erectile dysfunction.

or

35234  the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [34263]

22343 the veteran smoked at least ten pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration.

34268 smoking as a causal result of operational service made a material contribution to 10 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the erectile dysfunction.

Clinical onset and eligible service [34264]

34265 the veteran smoked at least fifteen pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration.

34269 smoking as a causal result of eligible service made a material contribution to 15 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the erectile dysfunction.

Clinical worsening and operational service [35233]

34266 the veteran smoked at least ten pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of the condition under consideration.

35235 the veteran's smoking of at least ten pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of the condition under consideration took place after the clinical onset of erectile dysfunction.

35546 smoking as a causal result of operational service made a material contribution to 10 pack years of cigarettes or the equivalent thereof in other tobacco products after the clinical onset of the erectile dysfunction and before its clinical worsening.

33454 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the smoking is causally related.

Clinical worsening and eligible service [35234]

34267 the veteran smoked at least fifteen pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of the condition under consideration.

35236 the veteran's smoking of at least fifteen pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of the condition under consideration took place after the clinical onset of erectile dysfunction.

35547 smoking as a causal result of eligible service made a material contribution to 15 pack years of cigarettes or the equivalent thereof in other tobacco products after the clinical onset of the erectile dysfunction and before its clinical worsening.

33459 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the smoking is causally related.

Erectile dysfunction - Therapeutic radiation to the lower abdomen, pelvis, penis or perineal region Factor

The abdomen is that part of the body between the thorax [the chest] and the pelvis, and the lower abdomen is that part of the abdomen below the umbilicus (belly button). Right inguinal, left inguinal and pubic, are all terms used to describe areas of the lower abdomen.

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.

The perineal region is the space between the anus and the scrotum.

Therapeutic radiation to the lower abdomen, pelvis, penis or perineal region may have been given for colorectal, prostatic or testicular cancer, Hodgkin’s disease, squamous cell carcinoma of the anus, or ankylosing spondylitis involving the sacroiliac joints.

Last reviewed for CCPS 5 October 2005.

Preliminary questions [22909]

23190 there is some evidence that therapeutic radiation to the lower abdomen, pelvis, penis or perineal region may be a factor in the development or worsening of the condition under consideration.

22910 the veteran has undergone therapeutic radiation to the lower abdomen, pelvis, penis or perineal region at some time.

22912 the veteran underwent therapeutic radiation to the lower abdomen, pelvis, penis or perineal region for an illness or injury which is identifiable.

35276  the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and VEA service for erectile dysfunction.

26652 as a consequence of the identified illness or injury, the veteran underwent therapeutic radiation to the lower abdomen, pelvis, penis or perineal region within the fifteen years immediately before the clinical onset of the condition under consideration.

22913   the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and VEA service for the clinical onset of erectile dysfunction.

22914  the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and operational service for the clinical onset of erectile dysfunction.

or

22915  the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and eligible service for the clinical onset of erectile dysfunction.

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.

35280 as a consequence of the identified illness or injury, the veteran underwent therapeutic radiation to the lower abdomen, pelvis, penis or perineal region within the fifteen years immediately before the clinical worsening of the condition under consideration.

35277   the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and VEA service for the clinical worsening of erectile dysfunction.

35278  the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and operational service for the clinical worsening of erectile dysfunction.

or

35279  the veteran has established the causal connection between the therapeutic radiation to the lower abdomen, pelvis, penis or perineal region and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [22914]

22916  the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was undergone, is causally related to operational service.

Clinical onset and eligible service [22915]

22917  the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was undergone, is causally related to eligible service.

Clinical worsening and operational service [35278]

22916  the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was undergone, is causally related to operational service.

35281 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was given, is causally related.

Clinical worsening and eligible service [35279]

22917  the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was undergone, is causally related to eligible service.

35282 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, for which therapeutic radiation to the lower abdomen, pelvis, penis or perineal region was given, is causally related.

Erectile dysfunction - Traumatic injury involving the brain, spinal cord or cauda equina Factor

The SoP factor for erectile dysfunction requires the traumatic injury to result “in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina”.

Medical advice is essential to establish the presence of a traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, and to establish the cause of the injury.

Traumatic injury could include a blunt impact, penetrating wound or surgery.  Some injuries may allow for almost complete recovery.  Examples neurological sequelae are quadriplegia, paraplegia, various degrees of muscle weakness, and motor and sensory deficits.

The spinal cord ends near the first lumbar vertebra and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Traumatic Injury to the Brain, Spinal Cord or Cauda Equina - Erectile Dysfunction	MR9183.pdf [34]	MR9183.docx [35]

Preliminary questions [23134]

23193 there is some evidence that a traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina may be a factor in the development or worsening of the condition under consideration.

23135 the veteran has experienced a traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina at some time.

35379  the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and VEA service for erectile dysfunction.

23136 the veteran experienced a traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration.

23140   the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and VEA service for the clinical onset of erectile dysfunction.

23141  the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and operational service for the clinical onset of erectile dysfunction.

or

23142  the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and eligible service for the clinical onset of erectile dysfunction.

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.

35383 the veteran experienced a traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration.

35380   the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and VEA service for the clinical worsening of erectile dysfunction.

35381  the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and operational service for the clinical worsening of erectile dysfunction.

or

35382  the veteran has established the causal connection between a traumatic injury to the brain, spinal cord or cauda equina and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [23141]

23137 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by an injury.

23143 on operational service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration.

23144 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on operational service within the 90 days 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.

or

27401  the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

23145 the injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration was due to an illness or injury which is identifiable.

23146  the identified illness or injury which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina is causally related to operational service.

or

23139 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by surgery.

23151  the surgery, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, within the 90 days immediately before the clinical onset of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical onset and eligible service [23142]

23137 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by an injury.

23147 on eligible service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration.

23148 as a causal result of eligible service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration.

23149 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on eligible service within the 90 days 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.

or

27401  the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

23145 the injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset of the condition under consideration was due to an illness or injury which is identifiable.

23150  the identified illness or injury which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina is causally related to eligible service.

or

23139 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical onset of the condition under consideration was caused by surgery.

23151  the surgery, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, within the 90 days immediately before the clinical onset of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical worsening and operational service [35381]

35388 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by an injury.

35390 on operational service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration.

35391 as a causal result of operational service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration.

35392 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on operational service.

35393 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on operational service within the 90 days immediately before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

27401  the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35398 the injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration was due to an illness or injury which is identifiable.

23146  the identified illness or injury which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina is causally related to operational service.

35400 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, is causally related.

or

35389 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by surgery.

35399  the surgery, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, within the 90 days immediately before the clinical worsening of the condition under consideration, was performed for an illness or injury which is identifiable.

Clinical worsening and eligible service [35382]

35388 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by an injury.

35394 on eligible service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration.

35395 as a causal result of eligible service, the veteran experienced the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration.

35396 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on eligible service.

35397 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina on eligible service within the 90 days immediately before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

27401  the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical onset or worsening of the condition under consideration was due to an illness or injury which is identifiable.

35398 the injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina within the 90 days immediately before the clinical worsening of the condition under consideration was due to an illness or injury which is identifiable.

23150  the identified illness or injury which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina is causally related to eligible service.

35401 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, is causally related.

or

35389 the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina which the veteran experienced within the 90 days immediately before the clinical worsening of the condition under consideration was caused by surgery.

35399  the surgery, which caused the traumatic injury resulting in acute and permanent neurological sequelae involving the brain, spinal cord or cauda equina, within the 90 days immediately before the clinical worsening of the condition under consideration, was performed for an illness or injury which is identifiable.

Erectile dysfunction - Treatment with a drug from the specified lists Factor

The RMA has specified the following classes of drugs and included some examples.  (A “class” of drugs only includes drugs whose primary purpose is the purpose of the class. For example, a drug only belongs to the class of antihypertensive agents if the primary purpose of the drug is to treat hypertension.) You can find out whether a particular drug is in one of these classes by looking in a MIMS publication or asking a medical officer or pharmacist.

• Histamine 2 receptor antagonists
• Antihypertensive agents for erectile dysfunction
• Antiandrogens
• Steroid or sex hormones
• Diuretics
• Lipid lowering drugs
• Antiepileptics
• Anticholinergics
• Antidepressants
• Cytotoxic agents
• Antipsychotics
• Tranquillisers
• Antiemetics
• Narcotics
• Ketaconazole (oral)
• Digoxin
• Lithium
• A drug assessed as causing or worsening erectile dysfunction

Last reviewed for CCPS 5 October 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Drug Treatment - Erectile Dysfunction	MR9186.pdf [36]	MR9186.docx [37]

Preliminary questions [35332]

35333 the veteran has been treated with a drug from the lists specified for erectile dysfunction at some time.

35334 the veteran was being treated with a drug from the lists specified for erectile dysfunction for an illness or injury which is identifiable.

35335 the identified illness or injury, for which the veteran was being treated with a drug from the lists specified for erectile dysfunction, is a condition for which the drug cannot be ceased or substituted.

35336  the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and VEA service for erectile dysfunction.

35343 for the identified illness or injury, the veteran was being treated with a drug from the lists specified for erectile dysfunction, which could not be ceased or substituted, at the time of the clinical onset of the condition under consideration.

35337   the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and VEA service for the clinical onset of erectile dysfunction.

35339  the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and operational service for the clinical onset of erectile dysfunction.

or

35340  the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and eligible service for the clinical onset of erectile dysfunction.

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.

35344 for the identified illness or injury, the veteran was being treated with a drug from the lists specified for erectile dysfunction, which could not be ceased or substituted, at the time of the clinical worsening of the condition under consideration.

35338   the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and VEA service for the clinical worsening of erectile dysfunction.

35341  the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and operational service for the clinical worsening of erectile dysfunction.

or

35342  the veteran has established the causal connection between treatment with a drug from the lists specified for erectile dysfunction and eligible service for the clinical worsening of erectile dysfunction.

Clinical onset and operational service [35339]

35345  the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related to operational service.

Clinical onset and eligible service [35340]

35346  the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related to eligible service.

Clinical worsening and operational service [35341]

35345  the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related to operational service.

35347 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related.

Clinical worsening and eligible service [35342]

35346  the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related to eligible service.

35348 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which required treatment with a drug from the lists specified for erectile dysfunction, is causally related.