SoP LibraryChronic pruritus ani

Statement of Principles

Chronic pruritus ani — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Chronic pruritus ani. DVA can only accept a claim for Chronic pruritus ani if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

Chronic pruritus ani

RH No. 31 of 2019 · BoP No. 32 of 201950 factors

Meaning of chronic pruritus ani: For the purposes of this Statement of Principles, chronic pruritus ani means intense itching of more than six weeks duration affecting the perianal skin.

Reasonable Hypothesis (RH) — Statement of Principles No. 31 of 2019

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 chronic pruritus ani or death from chronic pruritus ani with the circumstances of a person's relevant service:

  1. (1)
    an inability to maintain adequate anal hygiene for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary.

  2. (2)
    undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary.

  3. (3)
    having daily episodes of diarrhoea for at least the seven days before the clinical onset of chronic pruritus ani;

    Note: diarrhoea is defined in the Schedule 1 - Dictionary.

  4. (4)
    having faecal incontinence for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: faecal incontinence is defined in the Schedule 1 - Dictionary.

  5. (5)
    having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary.

  6. (6)
    having a perianal or anal infection from the specified list of infections, at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of infections is defined in the Schedule 1 - Dictionary.

  7. (7)
    having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of infestations is defined in the Schedule 1 - Dictionary.

  8. (8)
    having a pathological vaginal discharge at the time of the clinical onset of chronic pruritus ani;

    Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.

  9. (9)
    having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.

  10. (10)
    having a systemic disease from the specified list of systemic diseases at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.

  11. (11)
    undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical onset of chronic pruritus ani;
  12. (12)
    having corticosteroid-related atrophy of the perianal skin at the time of the clinical onset of chronic pruritus ani;
  13. (13)
    an inability to maintain adequate anal hygiene for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary.

  14. (14)
    undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary.

  15. (15)
    having daily episodes of diarrhoea for at least the seven days before the clinical worsening of chronic pruritus ani;

    Note: diarrhoea is defined in the Schedule 1 - Dictionary.

  16. (16)
    having faecal incontinence for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: faecal incontinence is defined in the Schedule 1 - Dictionary.

  17. (17)
    having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary.

  18. (18)
    having a perianal or anal infection from the specified list of infections, at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of infections is defined in the Schedule 1 - Dictionary.

  19. (19)
    having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of infestations is defined in the Schedule 1 - Dictionary.

  20. (20)
    having a pathological vaginal discharge at the time of the clinical worsening of chronic pruritus ani;

    Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.

  21. (21)
    having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.

  22. (22)
    having a systemic disease from the specified list of systemic diseases at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.

  23. (23)
    undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical worsening of chronic pruritus ani;
  24. (24)
    having corticosteroid-related atrophy of the perianal skin at the time of the clinical worsening of chronic pruritus ani;
  25. (25)
    inability to obtain appropriate clinical management for chronic pruritus ani;

Aggravation-only factors: the factors in subsections 9(13) to 9(25) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

Balance of Probabilities (BoP) — Statement of Principles No. 32 of 2019

25 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, chronic pruritus ani or death from chronic pruritus ani is connected with the circumstances of a person's relevant service:

  1. (1)
    an inability to maintain adequate anal hygiene for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary.

  2. (2)
    undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary.

  3. (3)
    having daily episodes of diarrhoea for at least the seven days before the clinical onset of chronic pruritus ani;

    Note: diarrhoea is defined in the Schedule 1 - Dictionary.

  4. (4)
    having faecal incontinence for at least the four weeks before the clinical onset of chronic pruritus ani;

    Note: faecal incontinence is defined in the Schedule 1 - Dictionary.

  5. (5)
    having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary.

  6. (6)
    having a perianal or anal infection from the specified list of infections, at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of infections is defined in the Schedule 1 - Dictionary.

  7. (7)
    having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of infestations is defined in the Schedule 1 - Dictionary.

  8. (8)
    having a pathological vaginal discharge at the time of the clinical onset of chronic pruritus ani;

    Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.

  9. (9)
    having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.

  10. (10)
    having a systemic disease from the specified list of systemic diseases at the time of the clinical onset of chronic pruritus ani;

    Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.

  11. (11)
    undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical onset of chronic pruritus ani;
  12. (12)
    having corticosteroid-related atrophy of the perianal skin at the time of the clinical onset of chronic pruritus ani;
  13. (13)
    an inability to maintain adequate anal hygiene for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: adequate anal hygiene is defined in the Schedule 1 - Dictionary.

  14. (14)
    undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary.

  15. (15)
    having daily episodes of diarrhoea for at least the seven days before the clinical worsening of chronic pruritus ani;

    Note: diarrhoea is defined in the Schedule 1 - Dictionary.

  16. (16)
    having faecal incontinence for at least the four weeks before the clinical worsening of chronic pruritus ani;

    Note: faecal incontinence is defined in the Schedule 1 - Dictionary.

  17. (17)
    having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary.

  18. (18)
    having a perianal or anal infection from the specified list of infections, at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of infections is defined in the Schedule 1 - Dictionary.

  19. (19)
    having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of infestations is defined in the Schedule 1 - Dictionary.

  20. (20)
    having a pathological vaginal discharge at the time of the clinical worsening of chronic pruritus ani;

    Note: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.

  21. (21)
    having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.

  22. (22)
    having a systemic disease from the specified list of systemic diseases at the time of the clinical worsening of chronic pruritus ani;

    Note: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.

  23. (23)
    undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical worsening of chronic pruritus ani;
  24. (24)
    having corticosteroid-related atrophy of the perianal skin at the time of the clinical worsening of chronic pruritus ani;
  25. (25)
    inability to obtain appropriate clinical management for chronic pruritus ani;

Aggravation-only factors: the factors in subsections 9(13) to 9(25) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

A VHC Diagnostic Assessment addresses each of these factors one by one against your service record and clinical history. See how a VHC DVA claim works, see all fees ($600 + GST per stage) or book an appointment.

About Dr Thomas Perkins

One doctor. Every report.

Founding doctor of the Veterans Health Centre in Ipswich, Queensland, and one of Australia's most experienced practitioners in veterans' medicolegal medicine.

Dr Perkins has spent more than thirteen years working exclusively with current and former ADF members — treating their conditions, writing their reports and navigating the DVA system alongside them. With over 100,000 claims submitted and 2,000 Permanent Impairment Assessments completed, he has seen precisely what separates an accepted claim from a rejected one at every level, from initial liability to the Veterans' Review Board.

Every chart review, diagnostic assessment, impairment rating and appeal that leaves this clinic is personally overseen by Dr Perkins. No template, no locum, no hand-off.

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