Instrument No.33 of 1994

Statement of Principles

concerning

CHOLELITHIASIS

icd code 574

Veterans’ Entitlements Act 1986
subsection 196B(2)

1.         Being of the view that there is sound medical-scientific evidence that indicates that cholelithiasis and death from cholelithiasis can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans’ Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cholelithiasis or death from cholelithiasis with the circumstances of that service, are:

(a)       having a course of treatment with clofibrate where:

(i)        the course of treatment had continued for at least 90 days before the clinical onset of signs or symptoms of cholesterol stones; and

(ii)       the clinical onset of signs or symptoms of cholesterol stones occured either while that treatment was continuing or within 180 days of cessation of that treatment; or

(b)       suffering from hepatic cirrhosis before the clinical onset of signs or symptoms of pigment stones; or

(c)       suffering from chronic haemolysis before the clinical onset of signs or symptoms of pigment stones; or

(d)       suffering from ileal disease, or having had an ileal resection, at least 90 days before the clinical onset of signs or symptoms of cholesterol stones; or

(e)       suffering from mature onset diabetes mellitus before the clinical onset of signs or symptoms of cholesterol stones; or

(f)        having  had total parenteral nutrition (TPN) where:

(i)        TPN occured for at least three weeks before the clinical onset of signs or symptoms of cholesterol stones; and

(ii)       the clinical onset of signs or symptoms of cholesterol stones occured either while TPN was continuing or within four weeks of its cessation; or

(g)       having had treatment with oestrogen therapy where:

(i)        the treatment occured for at least 90 days before the clinical onset of signs or symptoms of cholesterol stones; and

(ii)       the clinical onset of signs or symptoms of cholesterol stones occured either while treatment was continuing or within 180 days of cessation of treatment; or

(h)       having had obesity where:

(i)        the obesity was present for at least 90 days before the clinical onset of signs or symptoms of cholesterol stones; and

(ii)       the clinical onset of signs or symptoms of cholesterol stones occured either while obese or within 180 days of ceasing to be obese; or

(j)        inability to obtain appropriate clinical management for cholelithiasis.

2.         Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(j) must be related to any service rendered by a person.

3.         The factor set out in paragraph 1(j) applies only where:

(a)       the person’s cholelithiasis was contracted before a period, or part of a period, of service to which the factor is related; and

(b)       the relationship suggested between the cholelithiasis and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), 70(5)(d), or 70(5A)(d) of the Act

4.         For the purposes of this Statement of Principles:

“cholesterol stones” means gallstones that consist predominantly of cholesterol;

“chronic haemolysis” means continuing or long lasting abnormal breakdown of red blood cells;

“ICD code” means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472;

“mature onset diabetes mellitus” means an endocrine disease characterised by a fasting venous plasma glucose concentration of equal to or greater than 7.8 millimoles per litre on at least two separate occasions and a venous plasma glucose concentration equal to or greater than 11.1 millimoles per litre both within two hours and at two hours after ingestion of 75 grams of glucose, attracting ICD code 250, but does not include juvenile types;

“obesity” means having a Body Mass Index (BMI) greater than 30, where:

and where:

W is the person’s weight in kilograms; and

H is the person’s height in metres;

(for example, a person would be obese if the person weighed 120kg and was 1.8 metres in height: BMI = 120¸(1.8×1.8) = 37.04);

“pigment stones” means gallstones that are dark black to brown in colour, consisting predominantly of calcium bilirubinate;

“total parenteral nutrition” means continuous intravenous drip feeding with no other feeding via mouth or gut.

Dated this Twenty-Second  day of  September   1994

The Common Seal of the                              )

Repatriation Medical Authority                   )

was affixed to this instrument                      )

in the presence of:                                        )

KEN DONALD

CHAIRMAN