Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Inability to Obtain Appropriate Clincal Management	GQACM.pdf [21]	GQACM.docx [22]

Preliminary questions [6488]

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.

Gastro-oesophageal reflux disease - Scleroderma Factor

RMA definition

"scleroderma" means a multisystem disorder characterised by the association of vascular abnormalities, connective tissue sclerosis and atrophy, and autoimmune changes.

General information

Scleroderma is a rare disease and varies in severity and progression.  A person with scleroderma almost certainly would have sought significant medical attention at some time.  Scleroderma may also be called progressive systemic sclerosis.

Scleroderma is a chronic disease characterised by diffuse fibrosis, degenerative changes and vascular abnormalities in the skin, articular structures, and internal organs.  The most common initial complaints are Raynaud's phenomenon and insidious swelling of the extremities with gradual thickening of the skin of the fingers.  Polyarthralgia is also a prominent early symptom.  Gastro-intestinal disturbances [eg heartburn and dysphagia] or respiratory complaints [eg dyspnoea] occasionally are the first manifestations of the disease.

Medical treatment for this condition would normally be recorded in doctors' notes and/or hospital records.  If these records cannot be obtained, a reliable history of appropriate medical treatment or symptoms at a particular time, will generally be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to scleroderma rather than to some other condition.

See also: Connective tissue disease

Last reviewed for CCPS 18 July 2005.

Preliminary questions [6486]

21959 there is some evidence that scleroderma may be a factor in the development or worsening of the condition under consideration.

6563     the veteran has had scleroderma at some time.

32390  the veteran has established the causal connection between the scleroderma and VEA service for gastro-oesophageal reflux disease.

6564     the veteran had scleroderma at the time of the clinical onset of the condition under consideration.

6565     the veteran has established the causal connection between the scleroderma and VEA service for the clinical onset of gastro-oesophageal reflux disease.

6566     the veteran has established the causal connection between the scleroderma and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

6567     the veteran has established the causal connection between the scleroderma and eligible service for the clinical onset of gastro-oesophageal reflux disease.

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.

32395 the veteran had scleroderma at the time of the clinical worsening of the condition under consideration.

32397   the veteran has established the causal connection between the scleroderma and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

32398  the veteran has established the causal connection between the scleroderma and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

32399  the veteran has established the causal connection between the scleroderma and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [6566]

6568     the scleroderma is causally related to operational service.

Clinical onset and eligible service [6567]

6569     the scleroderma is causally related to eligible service.

Clinical worsening and operational service [32398]

6568     the scleroderma is causally related to operational service.

21687 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the scleroderma is causally related.

Clinical worsening and eligible service [32399]

6569     the scleroderma is causally related to eligible service.

21688 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the scleroderma is causally related.

Gastro-oesophageal reflux disease - Sjogren's syndrome Factor

The RMA has defined Sjogren’s syndrome to mean “a chronic autoimmune disorder characterised by xerostomia (dry mouth), xerophthalmia (dry eyes) and lymphocytic infiltration of the exocrine glands”.

Sjogren's syndrome (SS) is a chronic systemic inflammatory disorder characterised by dryness of the mouth, eyes and other mucous membranes and often associated with rheumatic disorders sharing certain autoimmune features (eg rheumatoid arthritis, scleroderma and systemic lupus erythematosus).  In some, SS affects only the eyes or mouth (primary SS; sicca complex; sicca syndrome) but in others there is an associated generalised collagen-vascular disease (secondary SS).  In advanced cases, the cornea is severely damaged and epithelial strands hang from the corneal surface.

If a person had Sjogren's syndrome, he or she would almost certainly 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 medical treatment or symptoms at a particular time will be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to Sjogren's syndrome rather than to some other condition.

See also: Connective tissue disease

Last reviewed for CCPS 18 July 2005.

Preliminary questions [34887]

34888 there is some evidence that Sjogren's syndrome may be a factor in the development or worsening of the condition under consideration.

8615     the veteran has had Sjogren's syndrome at some time.

34889  the veteran has established the causal connection between Sjogren's syndrome and VEA service for gastro-oesophageal reflux disease.

34896 the veteran had Sjogren's syndrome at the time of the clinical onset of the condition under consideration.

34890   the veteran has established the causal connection between Sjogren's syndrome and VEA service for the clinical onset of gastro-oesophageal reflux disease.

34892  the veteran has established the causal connection between Sjogren's syndrome and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

34893  the veteran has established the causal connection between Sjogren's syndrome and eligible service for the clinical onset of gastro-oesophageal reflux disease.

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.

34897   the veteran had Sjogren's syndrome at the time of the clinical worsening of the condition under consideration.

34891   the veteran has established the causal connection between Sjogren's syndrome and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

34894  the veteran has established the causal connection between Sjogren's syndrome and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

34895  the veteran has established the causal connection between Sjogren's syndrome and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [34892]

34898  the Sjogren's syndrome is causally related to operational service.

Clinical onset and eligible service [34893]

34899  the Sjogren's syndrome is causally related to eligible service.

Clinical worsening and operational service [34894]

34898  the Sjogren's syndrome is causally related to operational service.

34900  the clinical onset of the condition under consideration occurred prior to that part of operational service to which the Sjogren's syndrome is causally related.

Clinical worsening and eligible service [34895]

34899  the Sjogren's syndrome is causally related to eligible service.

34901  the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the Sjogren's syndrome is causally related.

Gastro-oesophageal reflux disease - Smoking cigarettes or other tobacco products Factor

This is the only smoking factor in CCPS as the specific smoking requirements for gastro-oesophageal reflux disease are incompatible with the smoking module. If considering this factor, you will be required to combine all types of smoking (Cigarette smoking, Cigar smoking and Pipe smoking) to calculate the quantity of tobacco products smoked during the relevant period. This factor also provides the appropriate questions for considering material contribution by VEA service to the veteran’s smoking history, in accordance with the FC decision in Kattenberg.

Cigarette smoking

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. [6]

Cigar smoking

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

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

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

Before a causal link between a smoking habit and service may be established, consideration must be given to Repatriation Commission Guideline CM5030 - Guideline for claims assessors on smoking and alcohol related conditions and military service. [6]

Pipe smoking

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. [6]

NB  The SOP factor dealing with pipe smoking covers only the smoking of tobacco.  It does not include non-tobacco products such as marijuana or hashish.  This is because the RMA SOP factors refer to "cigarettes or the equivalent thereof in other tobacco products".

Last reviewed for CCPS 18 July 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking cigarettes or other tobacco products	CRD905.pdf [23]	CRD905.docx [24]
Claimant Report	Smoking cigarettes or other tobacco products	CRV905.pdf [25]	CRV905.docx [26]

Preliminary questions [34107]

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

34110  the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and VEA service for gastro-oesophageal reflux disease.

34111   the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and VEA service for the clinical onset of gastro-oesophageal reflux disease.

34113  the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

34114  the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and eligible service for the clinical onset of gastro-oesophageal reflux disease.

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.

34112   the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

34115  the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

34116  the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [34113]

34131 the veteran smoked at least 10 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical onset of the condition under consideration.

34133 smoking as a causal result of operational service made a material contribution to the requirements of the Statement of Principles for the clinical onset of gastro-oesophageal reflux disease.

Clinical onset and eligible service [34114]

34134 the veteran smoked at least 20 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical onset of the condition under consideration.

34136 smoking as a causal result of eligible service made a material contribution to the requirements of the Statement of Principles for the clinical onset of gastro-oesophageal reflux disease.

Clinical worsening and operational service [34115]

34137 the veteran smoked at least 10 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical worsening of the condition under consideration.

34222 the veteran's smoking of at least 10 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical worsening of the condition under consideration took place after the clinical onset of gastro-oesophageal reflux disease.

34105 smoking as a causal result of operational service made a material contribution to the requirements of the Statement of Principles for the clinical worsening of gastro-oesophageal reflux disease.

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 [34116]

34140 the veteran smoked at least 20 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical worsening of the condition under consideration.

34223 the veteran's smoking of at least 20 cigarettes per day or the equivalent thereof in other tobacco products for a continuous period of at least six months immediately before the clinical worsening of the condition under consideration took place after the clinical onset of gastro-oesophageal reflux disease.

34106 smoking as a causal result of eligible service made a material contribution to the requirements of the Statement of Principles for the clinical worsening of gastro-oesophageal reflux disease.

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

Gastro-oesophageal reflux disease - Treatment with a drug reported to have caused acute erosive oesophagitis Factor

This factor applies only to worsening reasonable hypothesis cases.

The veteran must have been treated with a drug which has been reported in a peer-reviewed medical or scientific publication to have caused acute erosive oesophagitis, for a condition for which the drug cannot be ceased or substituted, at the time of clinical worsening of gastro-oesophageal reflux disease.  There is no requirement that the veteran has ever suffered from acute erosive oesophagitis, only that he was treated with such a drug at the time of permanent worsening of gastro-oesophageal reflux disease.

Internet Medline search for published peer-reviewed literature

Last reviewed for CCPS 18 July 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Drugs treatment - Gastro-Oesophageal Reflux Disease	MR9316.pdf [27]	MR9316.docx [28]

Preliminary questions [34910]

34911 there is some evidence that treatment with a drug reported to have caused acute erosive oesophagitis 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.

34912 the veteran was being treated with a drug reported to have caused acute erosive oesophagitis at the time of the clinical worsening of the condition under consideration.

34913 the veteran was being treated with a drug reported to have caused acute erosive oesophagitis, at the time of the clinical worsening of the condition under consideration, for an illness or injury which is identifiable.

34914 the identified illness or injury, for which the veteran was being treated with a drug reported to have caused acute erosive oesophagitis at the time of the clinical worsening of the condition under consideration, is a condition for which the drug cannot be ceased or substituted.

34915  the veteran has established the causal connection between the treatment with a drug reported to have caused acute erosive oesophagitis and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical worsening and operational service [34915]

34916  the identified illness or injury which required treatment with a drug reported to have caused acute erosive oesophagitis is causally related to operational service.

34917 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 reported to have caused acute erosive oesophagitis is causally related.

Gastro-oesophageal reflux disease - Treatment with a nonsteroidal anti-inflammatory drug Factor

NSAIDs are any anti-inflammatory drugs that do not contain steroids.  Most commonly they are treatment for arthritic conditions but may also be used for muscle strains associated with sporting injuries.  Examples of non-steroidal anti-inflammatory drugs include:

• Aspirin
• Phenylbutazone (Butazolidine - BTZ)
• Indomethacin (Indocid, Hicin, Indomed)
• Naproxen (Naprosyn, Naprogesic)
• Ibuprofen (Brufen, Nurofen, Rafen)
• Piroxicam (Feldene, Fensaid, Mobilis)
• Ketoprofen (Orudis, Oruvail)
• Sulindac (Clusinol, Clinoril)
• Tenoxicam (Tilcotil)
• Diclofenac sodium (Voltaren, Fenac)

With the exception of aspirin, these are usually prescribed medications, but some, such as Nurofen and Naprogesic, are available without a doctor’s prescription.

Last reviewed for CCPS 18 July 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Non-steroidal Anti-inflammatory Drugs and/or Doxycycline - Gastro-Oesophageal Reflux Disease	MR9282.pdf [29]	MR9282.docx [30]

Preliminary questions [32439]

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.

32447 the veteran was being treated with a nonsteroidal anti-inflammatory drug at the time of the clinical worsening of the condition under consideration.

32440 the veteran was being treated with a nonsteroidal anti-inflammatory drug, at the time of the clinical worsening of the condition under consideration, for an illness or injury which is identifiable.

32441 the identified illness or injury, for which the veteran was being treated with a nonsteroidal anti-inflammatory drug at the time of the clinical worsening of the condition under consideration, is a condition for which the drug cannot be ceased or substituted.

32423  the veteran has established the causal connection between the treatment with the nonsteroidal anti-inflammatory drug and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical worsening and operational service [32423]

32425  the identified illness or injury which required treatment with the nonsteroidal anti-inflammatory drug is causally related to operational service.

32445 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 the nonsteroidal anti-inflammatory drug is causally related.

Gastro-oesophageal reflux disease - Treatment with a smooth muscle relaxant drug Factor

In the SOP for gastro-oesophageal reflux disease the Repatriation Medical Authority defines a smooth muscle relaxant drug as “an anti-cholinergic drug, a beta-adrenergic drug, a nitrate drug, a calcium channel blocker drug, theophylline or aminophylline”.  Information about these drugs is contained in the hotwords below:

• Aminophylline
• Anti-cholinergic drugs
• Beta-adrenergic drugs are also known as beta blockers
• Calcium channel blockers
• Nitrates
• Theophylline

A history of ingestion of a drug may be documented in the medical evidence.  However, if these cannot be obtained, a statement that a particular drug was taken at a particular time will generally be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed treatment with the drug is medically feasible.

Last reviewed for CCPS 18 July 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Smooth Muscle Relaxant Drugs - Gastro-Oesophageal Reflux Disease	MR9218.pdf [31]	MR9218.docx [32]

Preliminary questions [6483]

29294 there is some evidence that treatment with a smooth muscle relaxant drug may be a factor in the development or worsening of the condition under consideration.

6523     the veteran was being treated with a smooth muscle relaxant drug for an illness or injury which is identifiable.

29295 the identified illness or injury, for which the veteran was being treated with a smooth muscle relaxant drug, is a condition for which the drug cannot be ceased or substituted.

6524     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and VEA service for gastro-oesophageal reflux disease.

6527     for the identified illness or injury, the veteran was being treated with a smooth muscle relaxant drug, which could not be ceased or substituted, at the time of the clinical onset of the condition under consideration.

6525     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and VEA service for the clinical onset of gastro-oesophageal reflux disease.

6529     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and operational service for the clinical onset of gastro-oesophageal reflux disease.Ê

or

6530     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and eligible service for the clinical onset of gastro-oesophageal reflux disease.

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.

6528     for the identified illness or injury, the veteran was being treated with a smooth muscle relaxant drug, which could not be ceased or substituted, at the time of the clinical worsening of the condition under consideration.

6526     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

6531     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

6532     the veteran has established the causal connection between the treatment with the smooth muscle relaxant drug and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [6529]

6534     the identified illness or injury which required treatment with the smooth muscle relaxant drug is causally related to operational service.

Clinical onset and eligible service [6530]

6535     the identified illness or injury which required treatment with the smooth muscle relaxant drug is causally related to eligible service.

Clinical worsening and operational service [6531]

6534     the identified illness or injury which required treatment with the smooth muscle relaxant drug is causally related to operational service.

6537     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 the smooth muscle relaxant drug is causally related.

Clinical worsening and eligible service [6532]

6535     the identified illness or injury which required treatment with the smooth muscle relaxant drug is causally related to eligible service.

6538     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 the smooth muscle relaxant drug is causally related.

Gastro-oesophageal reflux disease - Treatment with doxycycline Factor

Doxycycline belongs to the tetracycline class of antibiotics.

Common Australian brand names include Doxycycline, Doxsig, Doryx, Doxylin and Vibramycin.

Within the ADF, doxycycline is often prescribed as a malaria prophylactic.  It provides for specific coverage against malaria caused by P. vivax.  However, there are relatively few locations where P. vivax does not coexist to some extent with P. falciparum, it is generally recommended that doxycycline be taken in conjunction with other antimalarial agents such as chloroquine.  If a person served in an area of malarial transmission it is very unlikely that the provision of anti-malarials would be recorded in the service medical records.  Therefore, the absence of such documentation should not be regarded as evidence that anti-malarial drugs were not provided.

The drug is otherwise prescribed for infections due to susceptible organisms including primary atypical pneumonia, typhus fever, Q fever, psittacosis, granuloma inguinale, relapsing fever, trachoma, cholera, brucellosis, plague, venereal diseases and severe acne.  It may also be prescribed for other recalcitrant medical conditions such as tonsillitis or rheumatoid arthritis.

Last reviewed for CCPS 18 July 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Treatment with doxycycline - Gastro-Oesophageal Reflux Disease	CR9243.pdf [33]	CR9243.docx [34]
Medical Report	Non-steroidal Anti-inflammatory Drugs and/or Doxycycline -Gastro-Oesophageal Reflux Disease	MR9282.pdf [35]	MR9282.docx [36]

Preliminary questions [34902]

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.

34907  the veteran has established the causal connection between the treatment with doxycycline and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical worsening and operational service [34907]

35134 as a consequence of operational service, the veteran was treated with doxycycline.

35135 as a consequence of operational service, the veteran was treated with doxycycline at the time of the clinical worsening of the condition under consideration.

or

34905 the veteran was treated with doxycycline for treatment of an illness or injury which is identifiable.

34904 for treatment of the identified illness or injury, the veteran was treated with doxycycline at the time of the clinical worsening of the condition under consideration.

34906 the identified illness or injury, for which the veteran was being treated with doxycycline at the time of the clinical worsening of the condition under consideration, is a condition for which the drug cannot be ceased or substituted.

34908  the identified illness or injury which required treatment with doxycycline is causally related to operational service.

34909 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 doxycycline is causally related.

Gastro-oesophageal reflux disease - Zollinger-Ellison syndrome Factor

Zollinger-Ellison syndrome is a rare and serious condition and a veteran or member would have needed significant medical attention.

RMA Definition

"a condition characterised by gastric hypersecretion of acid, ulceration of the upper gastro-intestinal mucosa and usually the presence of a gastrinoma or a diffuse hyperplasia of the gastrin secreting beta cells of the pancreas”.

Medical treatment for this condition would normally be recorded in doctors' notes and/or hospital records.  However, if these records cannot be obtained a reliable history of appropriate medical treatment and symptoms at a particular time will generally be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to Zollinger-Ellison rather than to some other condition.

Last reviewed for CCPS 18 July 2005.

Preliminary questions [6487]

7611     there is some evidence that Zollinger-Ellison syndrome may be a factor in the development or worsening of the condition under consideration.

6579     the veteran has had Zollinger-Ellison syndrome at some time.

6570     the veteran has established the causal connection between the Zollinger-Ellison syndrome and VEA service for gastro-oesophageal reflux disease.

6580     the veteran had Zollinger-Ellison syndrome at the time of the clinical onset of the condition under consideration.

6571     the veteran has established the causal connection between the Zollinger-Ellison syndrome and VEA service for the clinical onset of gastro-oesophageal reflux disease.

6575     the veteran has established the causal connection between the Zollinger-Ellison syndrome and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

6576     the veteran has established the causal connection between the Zollinger-Ellison syndrome and eligible service for the clinical onset of gastro-oesophageal reflux disease.

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.

6584     the veteran had Zollinger-Ellison syndrome at the time of the clinical worsening of the condition under consideration.

6574     the veteran has established the causal connection between the Zollinger-Ellison syndrome and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

6577     the veteran has established the causal connection between the Zollinger-Ellison syndrome and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

6578     the veteran has established the causal connection between the Zollinger-Ellison syndrome and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [6575]

6581     the Zollinger-Ellison syndrome is causally related to operational service.

Clinical onset and eligible service [6576]

6583     the Zollinger-Ellison syndrome is causally related to eligible service.

Clinical worsening and operational service [6577]

6581     the Zollinger-Ellison syndrome is causally related to operational service.

<hotword "zzz 00903/06487/06585-0016">6585     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the Zollinger-Ellison syndrome is causally related.

Clinical worsening and eligible service [6578]

6583     the Zollinger-Ellison syndrome is causally related to eligible service.

6587     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the Zollinger-Ellison syndrome is causally related.