Reasonable Hypothesis SOP [1] | 39 of 2021 |
Balance of Probabilities SOP [2] | 40 of 2021 |
SOP Bulletin 220 [3]
This is an uncommon, chronic, progressive, systemic, inflammatory condition which mainly affects the spine (spondylitis) and sacroiliac joints and causes chronic back pain. There can also be manifestations outside the spine, see note below.
Confirming the diagnosis
The diagnosis is based on a combination of clinical findings, laboratory results and imaging. The diagnosis is often difficult to establish and specialist opinion will be needed. Testing will typically include HLA-B27 (a genetic marker) testing and plain X-rays or MRI of involved joints. There is no one single finding that will confirm the diagnosis.
The appropriate medical specialist is a rheumatologist.
* another SOP applies
Onset is typically insidious and before the age of 45 (peak is between 20 and 30 years). The most common presentation is with chronic dull pain in the lower back or buttock.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. There is no curative treatment but there are medications that can slow or stop the progress of the disease. The clinical course is variable.
This systemic disease may have other manifestations:
There may also be complications arising from the spinal pathology such as: spinal stenosis with radiculopathy and myelopathy; localised osteoporosis; and spinal compression fractures.
Place holder node for Rulebase for ankylosing spondylitis
Ankylosing spondylitis - Inability to obtain appropriate clinical management for ankylosing spondylitis Factor
Last reviewed for CCPS 05 October 2005.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [13852] 11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7334 [6] the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service. the condition under consideration permanently worsened. the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 [9] 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] or 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. [14] [15] Clinical worsening and eligible service [11236] or 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. [14] [15]
Links
[1] http://www.rma.gov.au/assets/SOP/2021/86f5b72217/039.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/91640b48b8/040.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20220.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63270%23comment-form
[5] https://clik.dva.gov.au/ccpsother-31
[6] https://clik.dva.gov.au/node/70390
[7] clikpopup://CCPS/Reject/OnsetAfterService
[8] clikpopup://CCPS/Reject/NoPermanentWorsening
[9] https://clik.dva.gov.au/11109-inability-obtain-appropriate-clinical-management-condition-under-consideration
[10] clikpopup://CCPS/ACM/NoContribution
[11] clikpopup://CCPS/ACM/NotOpService
[12] clikpopup://CCPS/ACM/NotOperDuties
[13] clikpopup://CCPS/rejectwilful
[14] clikpopup://CCPS/ACM/NoIllness
[15] clikpopup://CCPS/reject7390,7391No
[16] clikpopup://CCPS/Ankylosing spondylitis/ACM - onset prior to operational service
[17] clikpopup://CCPS/ACM/OnsetFailOper
[18] clikpopup://CCPS/ACM/NotEligService
[19] clikpopup://CCPS/ACM/NotEligDuties
[20] clikpopup://CCPS/Ankylosing spondylitis/ACM - onset prior to eligible service
[21] clikpopup://CCPS/ACM/OnsetFailElig