Statement of Principles

concerning

PILONIDAL SINUS
(Reasonable Hypothesis)

(No. 27 of 2019)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated                                           1 March 2019

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning pilonidal sinus (Reasonable Hypothesis) (No. 27 of 2019).

2               Commencement

              This instrument commences on 25 March 2019.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4               Repeal

The Statement of Principles concerning pilonidal sinus No. 71 of 2010 (Federal Register of Legislation No. F2010L02310) made under subsection 196B(2) of the VEA is repealed.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about pilonidal sinus and death from pilonidal sinus.

Meaning of pilonidal sinus

(2)          For the purposes of this Statement of Principles, pilonidal sinus:

(a)          means an inflammatory tissue reaction of the skin to an embedded hair which is manifested by the development of a sinus or fistula; and

(b)           includes pilonidal cyst and pilonidal fistula; and

(c)           excludes ingrown hair.

Note:  Pilonidal sinus principally occurs in the sacrococcygeal region, but can also occur in the interdigital webs of the hands and in other regions of the body.

(3)          While pilonidal sinus attracts ICD‑10‑AM code L05, in applying this Statement of Principles the meaning of pilonidal sinus is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from pilonidal sinus

(5)          For the purposes of this Statement of Principles, pilonidal sinus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pilonidal sinus.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that pilonidal sinus and death from pilonidal sinus can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting pilonidal sinus or death from pilonidal sinus with the circumstances of a person's relevant service:

(1)          for pilonidal sinus of the hand or foot only:

(a)          working as a hairdresser or barber within the six months before the clinical onset of pilonidal sinus; or

(b)          having cutaneous exposure to animal hair within the six months before the clinical onset of pilonidal sinus;

Note: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary.             

(2)          for pilonidal sinus of the sacrococcygeal region only:

(a)          driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical onset of pilonidal sinus; or

(b)          being overweight or obese within the six months before the clinical onset of pilonidal sinus;

Note: being overweight or obese is defined in the Schedule 1 - Dictionary.             

(3)          for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical onset of pilonidal sinus;

(4)          for pilonidal sinus of the hand or foot only:

(a)          working as a hairdresser or barber within the six months before the clinical worsening of pilonidal sinus; or

(b)          having cutaneous exposure to animal hair within the six months before the clinical worsening of pilonidal sinus;

Note: having cutaneous exposure to animal hair is defined in the Schedule 1 - Dictionary.             

(5)          for pilonidal sinus of the sacrococcygeal region only:

(a)          driving or being a seated passenger in a motorised vehicle for an average of at least 20 hours per week for a period of at least three months, within the six months before the clinical worsening of pilonidal sinus; or

(b)          being overweight or obese within the six months before the clinical worsening of pilonidal sinus;

Note: being overweight or obese is defined in the Schedule 1 - Dictionary.             

(6)          for pilonidal sinus of the sacrococcygeal and umbilical regions only, inability to shower or bathe more than two times per week for a period of at least four weeks, within the six months before the clinical worsening of pilonidal sinus;

(7)          inability to obtain appropriate clinical management for pilonidal sinus.

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(4) to 9(7) apply only to material contribution to, or aggravation of, pilonidal sinus where the person's pilonidal sinus was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.

Note: BMI is also defined in the Schedule 1 - Dictionary.

                               BMI means W/H2 where:

W is the person's weight in kilograms; and

H is the person's height in metres.

                               having cutaneous exposure to animal hair means milking, shearing, grooming, clipping or slaughtering animals.

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               pilonidal sinus—see subsection 7(2).

                               relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                               VEA means the Veterans' Entitlements Act 1986.