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Gastro-oesophageal Reflux Disease J002

Date published 
Tuesday, June 2, 2015
Last amended 
Thursday, June 3, 2021
Current RMA Instruments
Reasonable Hypothesis SOP [1]
61 of 2021
Balance of Probabilities SOP [2]
62 of 2021
Changes from previous instruments

SOP Bulletin 222 [3]

ICD Coding
  • ICD-9-CM:  530.11,530.2,530.81
  • ICD-10-AM: K21
   Brief description

This SOP covers gastric reflux of sufficient severity to either cause chronic inflammation of the oesophagus (with histological evidence), or to result in symptoms sufficient to warrant regular medical treatment. Minor symptomatic reflux without oesophagitis is very common, but is not a disease.

Confirming the diagnosis

The diagnosis is based on the clincial presentation (significantly symptomatic reflux) and is preferrably confirmed by upper gastrointestinal endoscopy, with histology.  Symptoms may involve the oesophagus (particularly heart burn) but may also include manifestations in the larynx and pharynx (regurgitation, cough, hoarseness).

The relevant medical specialist is a gastroenterologist.

Additional diagnoses covered by SOP
  • Reflux oesophagitis
  • Reflux with oseophageal ulceration
Related conditions that may be covered by SOP (further information required)
  • Heartburn
  • Waterbrash
  • Oesophagitis unspecified
Conditions not covered by SOP
  • Barrett’s oesophagus*
  • Oesophagitis due to radiation, infectious agents or corrosive agents#
  • Oesophageal varices#

* Another SOP applies

# non-SOP condition

Clinical onset

An accurate clinical onset may be difficult to establish.  Once the diagnosis has been confirmed and other causes of heartburn-type symptoms have been excluded, clinical onset can be backdated to when reflux symptoms of sufficient severity to warrant treatment first developed.

Clinical worsening

Permanent clinical worsening could be manifest by a persisting increase in the level of symptoms or the development of oesophageal ulcer, bleeding or stricture.  Barrett's oesophagus is a separate condition, not a worsening of GORD.

 

Factors in CCPS as at 18 JULY 2005

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Last amended 
29 May 2015

Important Information

  • The investigation questions displayed here are based on factors that were current at the time that they were incorporated into the CCPS application.
  • There may have been new instruments for this SOP condition issued after they were added to the CCPS application.
  • Please ensure that you refer to and use the latest instruments for this SOP condition (gastro-oesophageal reflux disease).

 

Current Statements of Principles
  • Please refer to the Repatriation Medical Authority (RMA) Website to confirm the most recent instruments for this SOP condition (gastro-oesophageal reflux disease).
  • This page at the Repatriation Medical Authority [5]  will contain the latest Gastro Oesophageal Reflux Disease instruments.
 
The following gastro-oesophageal reflux disease factors were last reviewed for CCPS on 18 July 2005.

A partial or total gastrectomy

Date published 
Thursday, May 21, 2015
Last amended 
Friday, May 29, 2015

Gastro-oesophageal reflux disease - A partial or total gastrectomy Factor

A complete gastrectomy (also known as a total gastrectomy) is the surgical removal of all of the stomach.  A partial gastrectomy (also known as a subtotal gastrectomy) is surgical removal of part of the stomach.  It may also be referred to as a gastric resection.  The most common reasons for undergoing this procedure are stomach malignancies or peptic ulcer disease.

Last reviewed for CCPS 18 July 2005.

Preliminary questions [34854]

34855 there is some evidence that a partial or total gastrectomy may be a factor in the development or worsening of the condition under consideration.

34856 the veteran has had a partial or total gastrectomy at some time.

34857 the veteran has established the causal connection between the partial or total gastrectomy and VEA service for gastro-oesophageal reflux disease.

34858   the veteran has established the causal connection between the partial or total gastrectomy and VEA service for the clinical onset of gastro-oesophageal reflux disease.

34860  the veteran has established the causal connection between the partial or total gastrectomy and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

34861  the veteran has established the causal connection between the partial or total gastrectomy 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.

34859   the veteran has established the causal connection between the partial or total gastrectomy and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

34863  the veteran has established the causal connection between the partial or total gastrectomy and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

or

34862  the veteran has established the causal connection between the partial or total gastrectomy and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [34860]

34866 on operational service, the veteran underwent a partial or total gastrectomy.

34867 on operational service, the veteran underwent a partial or total gastrectomy within the three months before the clinical onset of the condition under consideration.

or

34865 the veteran underwent a partial or total gastrectomy for treatment of an illness or injury which is identifiable.

34868 as a consequence of the identified illness or injury, the veteran underwent a partial or total gastrectomy within the three months before the clinical onset of the condition under consideration.

34872 the identified illness or injury for which the veteran underwent a partial or total gastrectomy is causally related to operational service.

Clinical onset and eligible service [34861]

34865 the veteran underwent a partial or total gastrectomy for treatment of an illness or injury which is identifiable.

34869 as a consequence of the identified illness or injury, the veteran underwent a partial or total gastrectomy within the four weeks before the clinical onset of the condition under consideration.

34873 the identified illness or injury for which the veteran underwent a partial or total gastrectomy is causally related to eligible service.

Clinical worsening and operational service [34862]

34870 as a consequence of the identified illness or injury, the veteran underwent a partial or total gastrectomy within the three months before the clinical worsening of the condition under consideration.

34872 the identified illness or injury for which the veteran underwent a partial or total gastrectomy is causally related to operational service.

34874 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 the veteran underwent a partial or total gastrectomy is causally related.

Clinical worsening and eligible service [34863]

34871 as a consequence of the identified illness or injury, the veteran underwent a partial or total gastrectomy within the four weeks before the clinical worsening of the condition under consideration.

34873 the identified illness or injury for which the veteran underwent a partial or total gastrectomy is causally related to eligible service.

34875 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 the veteran underwent a partial or total gastrectomy is causally related.

 

A surgical procedure to the region of the oesophageal hiatus of the diaphragm

Date published 
Thursday, May 21, 2015
Last amended 
Friday, May 29, 2015

Gastro-oesophageal reflux disease - A surgical procedure to the region of the oesophageal hiatus of the diaphragm Factor

For this factor to apply, it is necessary that the surgical procedure involve the actual region of the oesophageal hiatus of the diaphragm.  Gastrectomy (a separate factor in gastro-oesophageal reflux disease (GORD)) or other surgery to the oesophagus or upper parts of the stomach would meet this criterion.  This may involve treatment for cancer, ulcers or GORD.  Nissen fundoplication (for GORD) would be a common example of a relevant surgical procedure.  An endoscopy is not surgery; it is an investigative procedure only.

Last reviewed for CCPS 18 July 2005.

Preliminary questions [6485]

33713 there is some evidence that a surgical procedure to the region of the oesophageal hiatus of the diaphragm may be a factor in the development or worsening of the condition under consideration.

33714 the veteran has undergone a surgical procedure to the region of the oesophageal hiatus of the diaphragm at some time.

32373  the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and VEA service for gastro-oesophageal reflux disease.

6554     the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and VEA service for the clinical onset of gastro-oesophageal reflux disease.

6555     the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

6557     the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm 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.

32375   the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

32378  the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

or

32377  the veteran has established the causal connection between the surgical procedure to the region of the oesophageal hiatus of the diaphragm and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [6555]

32438 on operational service, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm.

6561     on operational service, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm within the three months before the clinical onset of the condition under consideration.

or

33715 the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm for treatment of an illness or injury which is identifiable.

25974 as a consequence of the identified illness or injury, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm within the three months before the clinical onset of the condition under consideration.

33724  the identified illness or injury for which the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related to operational service.

Clinical onset and eligible service [6557]

33715 the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm for treatment of an illness or injury which is identifiable.

25975 as a consequence of the identified illness or injury, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm within the four weeks before the clinical onset of the condition under consideration.

33725  the identified illness or injury for which the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related to eligible service.

Clinical worsening and operational service [32377]

34852 as a consequence of the identified illness or injury, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm within the three months before the clinical worsening of the condition under consideration.

33724  the identified illness or injury for which the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related to operational service.

33727 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 the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related.

Clinical worsening and eligible service [32378]

34853 as a consequence of the identified illness or injury, the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm within the four weeks before the clinical worsening of the condition under consideration.

33725  the identified illness or injury for which the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related to eligible service.

33730 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 the veteran underwent a surgical procedure to the region of the oesophageal hiatus of the diaphragm is causally related.

 

Alcohol consumption

Date published 
Thursday, May 21, 2015
Last amended 
Wednesday, June 10, 2015

Gastro-oesophageal reflux disease - Alcohol consumption Factor

The alcohol factors for gastro-oesophageal reflux disease (GORD) require consumption of average amounts of alcohol (300 grams per week RH / 500 grams per week BOP) for at least the twelve months before the clinical onset/worsening of GORD.  As part of the investigation of this factor, you will be asked to consider whether VEA service made a material contribution to the specified amounts for the relevant period.  In considering this question you should have regard to:

  • Guideline for claims assessors on smoking and alcohol related conditions and military service [6] and, also
  • AN02/2000, an Advisory Note concerning Alcohol Habituation [7]

A material contribution by service can be made in a number of ways:

  • an amount was consumed during service, as a causal result of service;
  • an amount was consumed because of a service related medical condition, either during service or after service, or both.  For example, as part of alcohol dependence or alcohol abuse; or, as part of another psychiatric condition; or, as "self medication" for a medical condition.

The Repatriation Commission also agreed that arguments put to delegates that are outside the Guideline must still be considered for substance and medical and scientific support.  However, the Commission did not agree that the temporal connection of service life with alcohol consumption is enough to establish ‘habit’ as the cause of alcohol use.

“Habituation” is often an argument advanced to connect service conditions with post service alcohol consumption.

A search by the Repatriation Medical Authority (RMA) for sound medical scientific evidence bearing on "habituation" revealed only one epidemiological study (as at April 2000) that bears on the ‘habituation’ issue, that is, whether a “habit” of alcohol drinking continues from the service environment into the community after discharge from service.  In fact, that paper suggested that not only was there no association with military service there is some evidence that military service produces the opposite effect.

Last reviewed for CCPS 18 July 2005.

Investigative Documents
Type Title PDF Format Word Format
Claimant Report
Alcohol Consumption
CRD904.pdf [8]
CRD901.docx [9]
Claimant Report
Alcohol Consumption
CRV904.pdf [10]
CRV904.docx [11]
Medical Report
Alcohol Consumption
MR9164.pdf [12]
MR9164.docx [13]
Preliminary questions [8941]

25686 the veteran has consumed alcohol at some time.

8955   the veteran has established the causal connection between the alcohol consumption and VEA service for gastro-oesophageal reflux disease.

8956     the veteran has established the causal connection between the alcohol consumption and VEA service for the clinical onset of gastro-oesophageal reflux disease.

8962     the veteran has established the causal connection between the alcohol consumption and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

8963     the veteran has established the causal connection between the alcohol consumption 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.

8957     the veteran has established the causal connection between the alcohol consumption and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

8964     the veteran has established the causal connection between the alcohol consumption and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

8965     the veteran has established the causal connection between the alcohol consumption and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [8962]

34842 the veteran consumed an average of at least 300 grams of alcohol per week for at least the 12 months before the clinical onset of the condition under consideration.

34844 operational service made a material contribution to the requirements of the Statement of Principles for alcohol consumption before the clinical onset of gastro-oesophageal reflux disease.

Clinical onset and eligible service [8963]

34843 the veteran consumed an average of at least 500 grams of alcohol per week for at least the 12 months before the clinical onset of the condition under consideration.

34845 eligible service made a material contribution to the requirements of the Statement of Principles for alcohol consumption before the clinical onset of gastro-oesophageal reflux disease.

Clinical worsening and operational service [8964]

34846 the veteran consumed an average of at least 300 grams of alcohol per week for at least 12 months after the clinical onset and immediately before the clinical worsening of the condition under consideration.

34848 operational service made a material contribution to the requirements of the Statement of Principles for alcohol consumption before the clinical worsening of gastro-oesophageal reflux disease.

34850 the material contribution by operational service to the consumption of alcohol for a continuous period of at least 12 months immediately before the clinical worsening of the condition under consideration relates to operational service rendered after the clinical onset of the condition under consideration.

Clinical worsening and eligible service [8965]

34847 the veteran consumed an average of at least 500 grams of alcohol per week for at least 12 months after the clinical onset and immediately before the clinical worsening of the condition under consideration.

34849 eligible service made a material contribution to the requirements of the Statement of Principles for alcohol consumption before the clinical worsening of gastro-oesophageal reflux disease.

34851 the material contribution by eligible service to the consumption of alcohol for a continuous period of at least 12 months immediately before the clinical worsening of the condition under consideration relates to eligible service rendered after the clinical onset of the condition under consideration.

 

Being obese

Date published 
Thursday, May 21, 2015
Last amended 
Wednesday, June 10, 2015

Gastro-oesophageal reflux disease - Being obese Factor

The gastro-oesophageal reflux disease Statement of Principles (SOP) 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 gastro-oesophageal reflux disease 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 SOP, the RMA 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 18 July 2005.

Investigative Documents
Type Title PDF Format Word Format
Claimant Report
Obesity
CR9230.pdf [14]
CR9230.docx [15]
Medical Report
Obesity
MR9305.pdf [16]
MR9305.docx [17]
Preliminary questions [30056]

17512 there is some evidence that obesity may be a factor in the development or worsening of the condition under consideration.

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.

 

Eradication of Helicobacter pylori

Date published 
Thursday, May 21, 2015
Last amended 
Wednesday, June 10, 2015

Gastro-oesophageal reflux disease - Eradication of Helicobacter pylori Factor

Pathology testing for Helicobacter pylori (H. pylori) has only been available since 1983.

Helicobacter pylori infection is a risk factor for conditions such as peptic ulcer and stomach cancer, and if detected, eradication will generally be attempted.  Not all treatment for H. pylori infection will result in the eradication of Helicobacter pylori, particularly if the treatment regime is not adhered to properly.  Therefore, it is necessary to establish:

  • The veteran had a H. pylori infection
  • The veteran was treated for this H. pylori infection
  • The eradication exercise was successful (this needs to be proven either via urea breath test, stool antigen test or repeat endoscopy and biopsy)

See Advisory Note No 6/99 Military Service and infection with Helicobacter pylori [18]

Last reviewed for CCPS 18 July 2005.

Investigative Documents
Type Title PDF Format Word Format
Medical Report
Eradication of Helicobacter pylori
- Gastro-Oesophageal Reflux Disease
MR9317.pdf [19]
MR9317.docx [20]
Preliminary questions [34876]

34877 there is some evidence that eradication of Helicobacter pylori may be a factor in the development or worsening of the condition under consideration.

34878 the veteran has had chronic gastritis of the stomach body at some time.

35531 while suffering from chronic gastritis of the stomach body, the veteran underwent eradication of Helicobacter pylori.

34879 the veteran underwent eradication of Helicobacter pylori for treatment of an illness or injury which is identifiable.

34880 the veteran has established the causal connection between eradication of Helicobacter pylori and operational service for gastro-oesophageal reflux disease.

34883 the veteran had chronic gastritis of the stomach body and eradication of Helicobacter pylori for treatment of the identified illness or injury within the six months before the clinical onset of the condition under consideration.

34881 the veteran has established the causal connection between eradication of Helicobacter pylori and operational 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.

34884 the veteran had chronic gastritis of the stomach body and eradication of Helicobacter pylori for treatment of the identified illness or injury within the six months before the clinical worsening of the condition under consideration.

34882 the veteran has established the causal connection between eradication of Helicobacter pylori and operational service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [34881]

34885  the identified illness or injury, which required eradication of Helicobacter pylori, is causally related to operational service.

Clinical worsening and operational service [34882]

34885  the identified illness or injury, which required eradication of Helicobacter pylori, is causally related to operational service.

34886  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 eradication of Helicobacter pylori, is causally related.

 

Hiatus hernia

Date published 
Wednesday, May 13, 2015
Last amended 
Friday, May 29, 2015

Gastro-oesophageal reflux disease - Hiatus hernia Factor

General information

More than half the elderly population of the western world would have some degree of hiatus hernia if submitted to a barium meal examination.  Most (greater than 85%) hiatal hernias are of the sliding type.  The lower oesophageal sphincter and a portion of the stomach in the sliding type of hiatal hernia moves into the chest, above the diaphragmatic hiatus.

Establishing the presence of an hiatus hernia

Most patients are asymptomatic unless the hernia becomes incarcerated or strangulated in which case there is acute chest pain, dysphagia and a mediastinal mass, requiring prompt operative treatment.

The presence of an hiatus hernia is demonstrated by radiography or endoscopy.  However, doctors' and hospitals' records may have been destroyed or can no longer be obtained.

Therefore, a statement that an hiatus hernia was demonstrated at a particular time will generally be accepted, unless there is contradictory evidence.  You may wish to seek medical advice.

Last reviewed for CCPS 18 July 2005.

Preliminary questions [6484]

6539    the veteran has had hiatus hernia at some time.

32357  the veteran has established the causal connection between the hiatus hernia and VEA service for gastro-oesophageal reflux disease.

6541     the veteran had a hiatus hernia at the time of the clinical onset of the condition under consideration.

6540     the veteran has established the causal connection between the hiatus hernia and VEA service for the clinical onset of gastro-oesophageal reflux disease.

6545     the veteran has established the causal connection between the hiatus hernia and operational service for the clinical onset of gastro-oesophageal reflux disease.

or

6546     the veteran has established the causal connection between the hiatus hernia 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.

32358    the veteran had a hiatus hernia at the time of the clinical worsening of the condition under consideration.

32359    the veteran has established the causal connection between the hiatus hernia and VEA service for the clinical worsening of gastro-oesophageal reflux disease.

32360  the veteran has established the causal connection between the hiatus hernia and operational service for the clinical worsening of gastro-oesophageal reflux disease.

or

32362  the veteran has established the causal connection between the hiatus hernia and eligible service for the clinical worsening of gastro-oesophageal reflux disease.

Clinical onset and operational service [6545]

6549     the hiatus hernia is causally related to operational service.

Clinical onset and eligible service [6546]

6550     the hiatus hernia is causally related to eligible service.

Clinical worsening and operational service [32360]

6549     the hiatus hernia is causally related to operational service.

32363   the clinical onset of the condition under consideration occurred prior to that part of operational service to which the hiatus hernia is causally related.

Clinical worsening and eligible service [32362]

6550     the hiatus hernia is causally related to eligible service.

32364   the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the hiatus hernia is causally related.

 

No appropriate clinical management for gastro-oesophageal reflux disease

Date published 
Wednesday, May 13, 2015
Last amended 
Wednesday, June 10, 2015

Gastro-oesophageal reflux disease - No appropriate clinical management for gastro-oesophageal reflux disease Factor

Appropriate clinical management may include a variety of drugs designed to neutralise the refluxed material or improve the clearance of material from the oesophagus and protect its mucosa, elevation of the head of the bed with blocks, and avoidance of certain drugs such as smooth muscle relaxant drugs. In severe cases, surgery may be performed.

Inability to obtain appropriate clinical management

Last reviewed for CCPS 18 July 2005.

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.

Scleroderma

Last amended 
Friday, May 29, 2015

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.

 

Sjogren's syndrome

Last amended 
Monday, June 1, 2015

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.

 

Smoking cigarettes or other tobacco products

Last amended 
Wednesday, June 10, 2015

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.

 

Treatment with a drug reported to have caused acute erosive oesophagitis

Last amended 
Wednesday, June 10, 2015

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.

 

Treatment with a nonsteroidal anti-inflammatory drug

Last amended 
Wednesday, June 10, 2015

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.

 

Treatment with a smooth muscle relaxant drug

Last amended 
Thursday, June 11, 2015

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.

 

Treatment with doxycycline

Last amended 
Thursday, June 11, 2015

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.

 

Zollinger-Ellison syndrome

Last amended 
Monday, June 1, 2015

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.

 


Source URL (modified on 18/06/2021 - 1:37pm): https://clik.dva.gov.au/ccps-medical-research-library/sops-grouped-icd-body-system/e-g/gastro-oesophageal-reflux-disease-j002-k21

Links
[1] http://www.rma.gov.au/assets/SOP/2021/30405db5ac/061.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/801748a64b/062.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20222.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63551%23comment-form
[5] http://www.rma.gov.au/SOP/alpha_ind/g.htm
[6] https://clik.dva.gov.au/compensation-and-support-reference-library/commission-guidelines/cm5030-guideline-claims-assessors-smoking-and-alcohol-related-conditions-and-military-service
[7] https://clik.dva.gov.au/compensation-and-support-reference-library/advisory-notes/2000/an02-alcohol-habituation
[8] https://clik.dva.gov.au/system/files/media/CRD904_0.pdf
[9] https://clik.dva.gov.au/system/files/media/CRD901.docx
[10] https://clik.dva.gov.au/system/files/media/CRV904_0.pdf
[11] https://clik.dva.gov.au/system/files/media/CRV904_0.docx
[12] https://clik.dva.gov.au/system/files/media/MR9164.pdf
[13] https://clik.dva.gov.au/system/files/media/MR9164.docx
[14] https://clik.dva.gov.au/system/files/media/CR9230_1.pdf
[15] https://clik.dva.gov.au/system/files/media/CR9230_1.docx
[16] https://clik.dva.gov.au/system/files/media/MR9305_1.pdf
[17] https://clik.dva.gov.au/system/files/media/MR9305_1.docx
[18] https://clik.dva.gov.au/compensation-and-support-reference-library/advisory-notes/1999/an06-military-service-and-infection-helicobacter-pylori
[19] https://clik.dva.gov.au/system/files/media/MR9317.pdf
[20] https://clik.dva.gov.au/system/files/media/MR9317.docx
[21] https://clik.dva.gov.au/system/files/media/GQACM_13.pdf
[22] https://clik.dva.gov.au/system/files/media/GQACM_13.docx
[23] https://clik.dva.gov.au/system/files/media/CRD905_5.pdf
[24] https://clik.dva.gov.au/system/files/media/CRD905_4.docx
[25] https://clik.dva.gov.au/system/files/media/CRV905_5.pdf
[26] https://clik.dva.gov.au/system/files/media/CRV905_7.docx
[27] https://clik.dva.gov.au/system/files/media/MR9316.pdf
[28] https://clik.dva.gov.au/system/files/media/MR9316.docx
[29] https://clik.dva.gov.au/system/files/media/MR9282.pdf
[30] https://clik.dva.gov.au/system/files/media/MR9282.docx
[31] https://clik.dva.gov.au/system/files/media/MR9218.pdf
[32] https://clik.dva.gov.au/system/files/media/MR9218.docx
[33] https://clik.dva.gov.au/system/files/media/CR9243.pdf
[34] https://clik.dva.gov.au/system/files/media/CR9243.docx
[35] https://clik.dva.gov.au/system/files/media/MR9282_1.pdf
[36] https://clik.dva.gov.au/system/files/media/MR9282_1.docx