Reasonable Hypothesis [1] | 103 of 2021 |
Balance of Probabilities [2] | 104 of 2013 |
SOP Bulletin 225 [3]
This is a primary malignant neoplasm of the exocrine pancreas. The SOP does not cover benign neoplasms or secondary neoplasms arising from other sources.
The pancreas is composed of: exocrine glands which supply enzymes to the gastrointestinal tract via the pancreatic ducts; and, islands (islets) of endocrine tissue scattered through the pancreas, which secrete hormones (insulin, glucagon, somatostatin) into the blood stream. This SOP only applies to a cancer of the exocrine tissue and not the endocrine tissue.
This diagnosis requires histological confirmation from a biopsy or surgical resection of pancreatic tissue. A range of other tests and imaging may be performed.
The relevant medical specialist is a gastroenterologist, general surgeon or oncologist.
* another SOP applies
# non-SOP condition
The condition most commonly presents clinically, with symptoms of pain (abdominal or epigastric), jaundice, and weight loss. A range of other non-specific symptoms may also occur. Pain is usually of insidious onset and has been present for some time at the time of first presentation. The condition is occassionally first uncovered as an incidental finding on CT or MRI scan.
The only SOP worsening factor is for inability to obtain appropriate clinical management. The condition often presents late and has a poor prognosis. Surgical resection is not possible in most cases.
Place holder node for Rulebase for malignant neoplasm of the pancreas
Malignant neoplasm of the pancreas - A partial gastrectomy Factor
Last reviewed for CCPS 30 November 2013.
Preliminary questions [35669]
7628 [5] there is some evidence that a partial gastrectomy may be a factor in the development of the condition under consideration.
1385 [5] the veteran has undergone a partial gastrectomy at some time.
35691 [6] the veteran underwent a partial gastrectomy at least twenty years before the clinical onset of malignant neoplasm of the pancreas. 35692 — the veteran has established the causal connection between the partial gastrectomy and operational service for the clinical onset of malignant neoplasm of the pancreas. Clinical onset and operational service [35692] or
1389 — the identified illness or injury for which the partial gastrectomy was performed is causally related to operational service. [11]
Malignant neoplasm of the pancreas - Being obese Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Obesity [CR9230] [12] Medical Report - Obesity [MR9305] Preliminary questions [35668]
587 [13] the veteran has a history of obesity. 35680 — the veteran has established the causal connection between being obese and VEA service for the clinical onset of malignant neoplasm of the pancreas. 35681 — the veteran has established the causal connection between being obese and operational service for the clinical onset of malignant neoplasm of the pancreas. or 35682 — the veteran has established the causal connection between being obese and eligible service for the clinical onset of malignant neoplasm of the pancreas. Clinical onset and operational service [35681] or
35688 [19] the veteran was morbidly obese for a period of at least ten years, within the twenty years before the clinical onset of malignant neoplasm of the pancreas.
9005 — the morbid obesity is causally related to operational service. [20] Clinical onset and eligible service [35682] or
35690 [25] the veteran was morbidly obese for a period of at least twenty years, within the thirty years before the clinical onset of malignant neoplasm of the pancreas.
9006 — the morbid obesity is causally related to eligible service. [26] [27]
Malignant neoplasm of the pancreas - Chronic pancreatitis Factor
Last reviewed for CCPS 30 November 2013.
Preliminary questions [1359]
7613 [28] there is some evidence that chronic pancreatitis may be a factor in the onset of malignant neoplasm of the pancreas.
1360 [28] the veteran has had chronic pancreatitis at some time. 1363 — the veteran has established the causal connection between the chronic pancreatitis and VEA service for malignant neoplasm of the pancreas. 5041 — the veteran has established the causal connection between the chronic pancreatitis and eligible service for malignant neoplasm of the pancreas. or 1364 — the veteran has established the causal connection between the chronic pancreatitis and operational service for malignant neoplasm of the pancreas. Clinical onset and operational service [1364] 1365 — the chronic pancreatitis is causally related to operational service. [30] [31] Clinical onset and eligible service [5041]
5042 — the chronic pancreatitis is causally related to eligible service. [34] [31]
Malignant neoplasm of the pancreas - Cigar smoking Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Smoking [CRD905] [35] Claimant Report - Smoking [CRV905] Preliminary questions [23782]
4915 [37] the veteran has ever smoked cigars. [38]
23783 — the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of malignant neoplasm of the pancreas.
23784 — the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of malignant neoplasm of the pancreas.
or
23785 — the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of malignant neoplasm of the pancreas.
Clinical onset and operational service [23784]
23786 — the veteran had smoked at least ten pack-years of cigars prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within twenty years of cessation. [39]
4921 — the veteran has some period or periods of cigar smoking that are causally related to operational service. [40]
Clinical onset and eligible service [23785]
23787 — the veteran had smoked at least fifteen pack-years of cigars prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within fifteen years of cessation. [41]
4922 — the veteran has some period or periods of cigar smoking that are causally related to eligible service. [42]
Malignant neoplasm of the pancreas - Cigarette smoking Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Smoking [CRD905] [35] Claimant Report - Smoking [CRV905] Preliminary questions [882]
23779 — the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical onset of malignant neoplasm of the pancreas.
4027 — the veteran has established the causal connection between the cigarette smoking and operational service for the clinical onset of malignant neoplasm of the pancreas.
or
23780 — the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical onset of malignant neoplasm of the pancreas.
Clinical onset and operational service [4027]
5037 — the veteran had smoked at least ten pack-years of cigarettes prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within twenty years of cessation. [45]
3116 — the veteran has some period or periods of cigarette smoking that are causally related to operational service. [46]
Clinical onset and eligible service [23780]
23781 — the veteran had smoked at least fifteen pack-years of cigarettes prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within fifteen years of cessation. [47]
3521 — the veteran has some period or periods of cigarette smoking that are causally related to eligible service. [48]
Malignant neoplasm of the pancreas - Diabetes mellitus Factor
Last reviewed for CCPS 30 November 2013.
Preliminary questions [5049]
489 — the veteran has diabetes mellitus.
10547 [49] the veteran has insulin dependent diabetes mellitus (type 1). or 30263 — the veteran has established the causal connection between the diabetes mellitus and VEA service for the clinical onset of the condition under consideration. 30265 — the veteran has established the causal connection between the diabetes mellitus and eligible service for the clinical onset of the condition under consideration. or 30264 — the veteran has established the causal connection between the diabetes mellitus and operational service for the clinical onset of the condition under consideration. Clinical onset and operational service [30264] 17527 — the identified illness or injury, a type of diabetes mellitus, is causally related to operational service. [52] [53] Clinical onset and eligible service [30265]
17528 — the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service. [56] [53]
Malignant neoplasm of the pancreas - Exposure to DDT Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Spraying or Decanting of DDT - Malignant Neoplasm of the Pancreas [CR9016] Preliminary questions [5054]
5056 — the veteran has established the causal connection between exposure to DDT and operational service for the clinical onset of malignant neoplasm of the pancreas.
Clinical onset and operational service [5056]
23802 [58] the veteran experienced inhalation, ingestion or cutaneous contact with DDT on more days than not for a cumulative period of at least 12 months at some time. the veteran experienced inhalation, ingestion or cutaneous contact with DDT on more days than not for a cumulative period of at least 12 months at least 10 years before the clinical onset of malignant neoplasm of the pancreas. operational service made a material contribution to the veteran's inhalation, ingestion or cutaneous contact with DDT on more days than not for a cumulative period of at least 12 months at least 10 years before the clinical onset of malignant neoplasm of the pancreas. [61]
Malignant neoplasm of the pancreas - No appropriate clinical management for malignant neoplasm of the pancreas Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [5061] 11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7334 [63] 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 [66] 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. [70] [71] 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. [70] [71]
Malignant neoplasm of the pancreas - Pipe smoking Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Smoking [CRD905] [35] Claimant Report - Smoking [CRV905] Preliminary questions [23789]
4880 [79] the veteran has ever smoked pipe tobacco. [80]
23791 — the veteran has established the causal connection between the pipe smoking and VEA service for the clinical onset of malignant neoplasm of the pancreas.
23792 — the veteran has established the causal connection between the pipe smoking and operational service for the clinical onset of malignant neoplasm of the pancreas.
or
23793 — the veteran has established the causal connection between the pipe smoking and eligible service for the clinical onset of malignant neoplasm of the pancreas.
Clinical onset and operational service [23792]
23794 — the veteran had smoked at least ten pack-years of pipe tobacco prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within twenty years of cessation. [81]
4911 — the veteran has some period or periods of pipe smoking that are causally related to operational service. [82]
Clinical onset and eligible service [23793]
23795 — the veteran had smoked at least fifteen pack-years of pipe tobacco prior to the clinical onset of the malignant neoplasm of the pancreas, and where smoking has ceased the clinical onset of malignant neoplasm of the pancreas occurred within fifteen years of cessation. [83]
4913 — the veteran has some period or periods of pipe smoking that are causally related to eligible service. [84]
Malignant neoplasm of the pancreas - Smoking tobacco products - material contribution Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Smoking [CRD905] [35] Claimant Report - Smoking [CRV905] Preliminary questions [35189] 35190 — the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of malignant neoplasm of the pancreas. 35191 — the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of malignant neoplasm of the pancreas. or 35192 — the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of malignant neoplasm of the pancreas. Clinical onset and operational service [35191] Clinical onset and eligible service [35192]
Malignant neoplasm of the pancreas - Using smokeless tobacco Factor
Last reviewed for CCPS 30 November 2013.
Investigative Documents
Claimant Report - Use of Smokeless Tobacco - Malignant Neoplasm of the Pancreas [CR9256] Preliminary questions [35667]
35671 [92] the veteran has engaged in the use of smokeless tobacco on more days than not for an extended period at some time. 35672 — the veteran has established the causal connection between the use of smokeless tobacco and VEA service for the clinical onset of malignant neoplasm of the pancreas. 35673 — the veteran has established the causal connection between the use of smokeless tobacco and operational service for the clinical onset of malignant neoplasm of the pancreas. or 35674 — the veteran has established the causal connection between the use of smokeless tobacco and eligible service for the clinical onset of malignant neoplasm of the pancreas. Clinical onset and operational service [35673] Clinical onset and eligible service [35674]
Links
[1] http://www.rma.gov.au/assets/SOP/2021/4f211df748/103.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/47b505c3f7/104.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20225.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63800%23comment-form
[5] https://clik.dva.gov.au/partial-gastrectomy
[6] clikpopup://CCPS/Partial gastrectomy 20 years before onset of MN pancreas
[7] clikpopup://CCPS/reject35691No
[8] clikpopup://CCPS/reject35693No
[9] clikpopup://CCPS/rejectwilful
[10] clikpopup://CCPS/reject35695No
[11] clikpopup://CCPS/reject1389No
[12] https://clik.dva.gov.au/ccpsclaimant-78
[13] https://clik.dva.gov.au/ccpsb001rc-4
[14] clikpopup://CCPS/reject587No
[15] clikpopup://CCPS/reject35683No
[16] clikpopup://CCPS/reject35684No
[17] clikpopup://CCPS/reject591No
[18] clikpopup://CCPS/reject9004No
[19] clikpopup://CCPS/Morbidly obese for 10 years in 20 years before onset of MN pancreas
[20] clikpopup://CCPS/reject9005No
[21] clikpopup://CCPS/Obese for 20 years at some time
[22] clikpopup://CCPS/reject35685No
[23] clikpopup://CCPS/reject35686No
[24] clikpopup://CCPS/reject3407No
[25] clikpopup://CCPS/Morbidly obese for 20 years in 30 years before onset of MN pancreas
[26] clikpopup://CCPS/reject9006No
[27] clikpopup://CCPS/reject9005,9006No
[28] https://clik.dva.gov.au/chronic-pancreatitis
[29] clikpopup://CCPS/reject1360No
[30] clikpopup://CCPS/reject23800No
[31] clikpopup://CCPS/reject1365,5042No
[32] clikpopup://CCPS/Chronic pancreatitis present at least 5 years before onset of MN pancreas
[33] clikpopup://CCPS/reject23801No
[34] clikpopup://CCPS/reject5042No
[35] https://clik.dva.gov.au/ccpsclaimant-115
[36] clikpopup://CCPS/Cigar smoking
[37] clikpopup://CCPS/Ever smoked cigars
[38] clikpopup://CCPS/reject4915No
[39] clikpopup://CCPS/reject23786No
[40] clikpopup://CCPS/reject4921No
[41] clikpopup://CCPS/reject23787No
[42] clikpopup://CCPS/reject4922No
[43] clikpopup://CCPS/Cigarette smoking
[44] clikpopup://CCPS/reject5803No
[45] https://clik.dva.gov.au/reasons-decision-190
[46] clikpopup://CCPS/reject3116No
[47] clikpopup://CCPS/reject23781No
[48] clikpopup://CCPS/reject3521No
[49] https://clik.dva.gov.au/ccpsc002rc-20
[50] https://clik.dva.gov.au/reasons-decision-197
[51] clikpopup://CCPS/reject10548No
[52] clikpopup://CCPS/reject30266No
[53] clikpopup://CCPS/reject17527,17528No
[54] clikpopup://CCPS/Diabetes mellitus for 10 years immediately before onset of malignant neoplasm of the pancreas
[55] clikpopup://CCPS/reject30267No
[56] clikpopup://CCPS/reject17528No
[57] https://clik.dva.gov.au/ccpsclaimant-0
[58] clikpopup://CCPS/Exposure to DDT at some time
[59] clikpopup://CCPS/reject23802No
[60] clikpopup://CCPS/reject24031No
[61] clikpopup://CCPS/reject23805No
[62] https://clik.dva.gov.au/ccpsother-31
[63] https://clik.dva.gov.au/node/71008
[64] clikpopup://CCPS/Reject/OnsetAfterService
[65] clikpopup://CCPS/Reject/NoPermanentWorsening
[66] clikpopup://CCPS/MN pancreas/ACM - contributed to worsening
[67] clikpopup://CCPS/ACM/NoContribution
[68] clikpopup://CCPS/ACM/NotOpService
[69] clikpopup://CCPS/ACM/NotOperDuties
[70] clikpopup://CCPS/ACM/NoIllness
[71] clikpopup://CCPS/reject7390,7391No
[72] clikpopup://CCPS/MN pancreas/ACM - onset prior to operational service
[73] clikpopup://CCPS/ACM/OnsetFailOper
[74] clikpopup://CCPS/ACM/NotEligService
[75] clikpopup://CCPS/ACM/NotEligDuties
[76] clikpopup://CCPS/MN pancreas/ACM - onset prior to eligible service
[77] clikpopup://CCPS/ACM/OnsetFailElig
[78] clikpopup://CCPS/Pipe smoking
[79] clikpopup://CCPS/Ever smoked pipe tobacco
[80] clikpopup://CCPS/reject4880No
[81] clikpopup://CCPS/reject23794No
[82] clikpopup://CCPS/reject4911No
[83] clikpopup://CCPS/reject23795No
[84] clikpopup://CCPS/reject4913No
[85] clikpopup://CCPS/Smoked cigarettes, pipe tobacco or cigars at some time
[86] clikpopup://CCPS/reject30303No
[87] clikpopup://CCPS/reject35193No
[88] clikpopup://CCPS/reject35195No
[89] clikpopup://CCPS/reject35194No
[90] clikpopup://CCPS/reject35196No
[91] https://clik.dva.gov.au/ccpsclaimant-66
[92] clikpopup://CCPS/Used smokeless tobacco a lot at some time
[93] clikpopup://CCPS/reject35671No
[94] clikpopup://CCPS/reject35675No
[95] clikpopup://CCPS/reject35677No
[96] clikpopup://CCPS/reject35676No
[97] clikpopup://CCPS/reject35678No