Cirrhosis of the liver

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.

RH No. 1 of 2017 · BoP No. 2 of 2017106 factors

Meaning of cirrhosis of the liver: For the purposes of this Statement of Principles, cirrhosis of the liver means a chronic condition of the hepatic parenchyma involving severe fibrosis in association with the formation of regenerative nodules. (3) While cirrhosis of the liver attracts ICD-10-AM code K70.3, K71.7 or K74.3-K74.6, in applying this Statement of Principles the meaning of cirrhosis of the liver 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-020-5.

Reasonable Hypothesis (RH) — Statement of Principles No. 1 of 2017

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 cirrhosis of the liver or death from cirrhosis of the liver with the circumstances of a person's relevant service:

(1)
for males, consuming at least 110 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(2)
for females, consuming at least 55 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(3)
having received a cumulative equivalent dose of at least 0.4 sievert of ionising radiation to the liver before the clinical onset of cirrhosis of the liver;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
(4)
having chronic infection with the hepatitis B virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.
(5)
having chronic infection with the hepatitis C virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.
(6)
having chronic infection with the hepatitis D virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.
(7)
having infection with the hepatitis E virus before the clinical onset of cirrhosis of the liver;
Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.
(8)
having chronic hepatitis before the clinical onset of cirrhosis of the liver;
Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.
(9)
having autoimmune chronic active hepatitis before the clinical onset of cirrhosis of the liver;
Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.
(10)
having steatohepatitis before the clinical onset of cirrhosis of the liver;
(11)
being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.
(12)
having evidence of chronic infection with schistosomiasis involving the liver before the clinical onset of cirrhosis of the liver;
(13)
having granulomatous liver disease before the clinical onset of cirrhosis of the liver;
Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.
(14)
having severe right-sided cardiac failure for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;
Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.
(15)
having veno-occlusive disease for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;
Note: veno-occlusive disease is defined in the Schedule 1 - Dictionary.
(16)
having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical onset of cirrhosis of the liver;
(17)
having iron overload involving the liver at the time of the clinical onset of cirrhosis of the liver;
Note: iron overload is defined in the Schedule 1 - Dictionary.
(18)
having alpha-1 antitrypsin deficiency before the clinical onset of cirrhosis of the liver;
(19)
having Gaucher's disease before the clinical onset of cirrhosis of the liver;
(20)
having Wilson's disease before the clinical onset of cirrhosis of the liver;
(21)
having Budd-Chiari syndrome for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;
Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.
(22)
consuming a daily average of at least 7.5 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least four grams, within the ten years before the clinical onset of cirrhosis of the liver;
(23)
being treated with methotrexate: (a) for at least the six months; or (b) to a cumulative dose of methotrexate of at least 500 milligrams taken over at least a three month period, before the clinical onset of cirrhosis of the liver;
(24)
being treated with dideoxynucleoside-analogue drugs as specified for at least six months before the clinical onset of cirrhosis of the liver;
Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.
(25)
inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 500 hours within the five years before the clinical onset of cirrhosis of the liver;
(26)
inhaling a cumulative dose of at least 500 ppm-years of gaseous vinyl chloride before the clinical onset of cirrhosis of the liver;
Note: ppm-years is defined in the Schedule 1 - Dictionary.
(27)
inhaling gaseous vinyl chloride for a cumulative period of at least 1 000 hours while working in the production or processing of vinyl chloride monomer or polyvinyl chloride before the clinical onset of cirrhosis of the liver;
(28)
for males, consuming at least 110 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(29)
for females, consuming at least 55 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(30)
having received a cumulative equivalent dose of at least 0.4 sievert of ionising radiation to the liver before the clinical worsening of cirrhosis of the liver;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
(31)
having chronic infection with the hepatitis B virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.
(32)
having chronic infection with the hepatitis C virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.
(33)
having chronic infection with the hepatitis D virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.
(34)
having infection with the hepatitis E virus before the clinical worsening of cirrhosis of the liver;
Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.
(35)
having chronic hepatitis before the clinical worsening of cirrhosis of the liver;
Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.
(36)
having autoimmune chronic active hepatitis before the clinical worsening of cirrhosis of the liver;
Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.
(37)
having steatohepatitis before the clinical worsening of cirrhosis of the liver;
(38)
being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.
(39)
having evidence of chronic infection with schistosomiasis involving the liver before the clinical worsening of cirrhosis of the liver;
(40)
having granulomatous liver disease before the clinical worsening of cirrhosis of the liver;
Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.
(41)
having severe right-sided cardiac failure for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.
(42)
having veno-occlusive disease for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: veno-occlusive disease is defined in the Schedule 1 - Dictionary.
(43)
having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical worsening of cirrhosis of the liver;
(44)
having iron overload involving the liver at the time of the clinical worsening of cirrhosis of the liver;
Note: iron overload is defined in the Schedule 1 - Dictionary.
(45)
having alpha-1 antitrypsin deficiency before the clinical worsening of cirrhosis of the liver;
(46)
having Gaucher's disease before the clinical worsening of cirrhosis of the liver;
(47)
having Wilson's disease before the clinical worsening of cirrhosis of the liver;
(48)
having Budd-Chiari syndrome for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.
(49)
consuming a daily average of at least 7.5 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least four grams, within the ten years before the clinical worsening of cirrhosis of the liver;
(50)
being treated with methotrexate: (a) for at least the six months; or (b) to a cumulative dose of methotrexate of at least 500 milligrams taken over at least a three month period, before the clinical worsening of cirrhosis of the liver;
(51)
being treated with dideoxynucleoside-analogue drugs as specified for at least six months before the clinical worsening of cirrhosis of the liver;
Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.
(52)
inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 500 hours within the five years before the clinical worsening of cirrhosis of the liver;
(53)
inhaling a cumulative dose of at least 500 ppm-years of gaseous vinyl chloride before the clinical worsening of cirrhosis of the liver;
Note: ppm-years is defined in the Schedule 1 - Dictionary.
(54)
inhaling gaseous vinyl chloride for a cumulative period of at least 1 000 hours while working in the production or processing of vinyl chloride monomer or polyvinyl chloride before the clinical worsening of cirrhosis of the liver;
(55)
inability to obtain appropriate clinical management for cirrhosis of the liver;

Aggravation-only factors: the factors in subsections 9(28) to 9(55) 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. 2 of 2017

51 factors

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

(1)
for males, consuming at least 150 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(2)
for females, consuming at least 75 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(3)
having received a cumulative dose of at least 0.4 sievert of ionising radiation to the liver, from internal deposition of a substance which emits alpha particles, before the clinical onset of cirrhosis of the liver;
(4)
having chronic infection with the hepatitis B virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.
(5)
having chronic infection with the hepatitis C virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.
(6)
having chronic infection with the hepatitis D virus before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.
(7)
having infection with the hepatitis E virus before the clinical onset of cirrhosis of the liver;
Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.
(8)
having chronic hepatitis before the clinical onset of cirrhosis of the liver;
Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.
(9)
having autoimmune chronic active hepatitis before the clinical onset of cirrhosis of the liver;
Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.
(10)
having steatohepatitis before the clinical onset of cirrhosis of the liver;
(11)
being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical onset of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.
(12)
having evidence of chronic infection with schistosomiasis involving the liver before the clinical onset of cirrhosis of the liver;
(13)
having granulomatous liver disease before the clinical onset of cirrhosis of the liver;
Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.
(14)
having severe right-sided cardiac failure for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;
Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.
(15)
having veno-occlusive disease for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;
Note: veno-occlusive disease is defined in the Schedule 1 - Dictionary.
(16)
having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical onset of cirrhosis of the liver;
(17)
having iron overload involving the liver at the time of the clinical onset of cirrhosis of the liver;
Note: iron overload is defined in the Schedule 1 - Dictionary.
(18)
having alpha-1 antitrypsin deficiency before the clinical onset of cirrhosis of the liver;
(19)
having Gaucher's disease before the clinical onset of cirrhosis of the liver;
(20)
having Wilson's disease before the clinical onset of cirrhosis of the liver;
(21)
having Budd-Chiari syndrome for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;
Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.
(22)
consuming a daily average of at least 15 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least eight grams, within the ten years before the clinical onset of cirrhosis of the liver;
(23)
being treated with methotrexate: (a) for at least the 12 months; or (b) to a cumulative dose of methotrexate of at least one gram taken over at least a six month period, before the clinical onset of cirrhosis of the liver;
(24)
being treated with dideoxynucleoside-analogue drugs as specified for at least 12 months before the clinical onset of cirrhosis of the liver;
Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.
(25)
inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 1 000 hours within the five years before the clinical onset of cirrhosis of the liver;
(26)
for males, consuming at least 150 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(27)
for females, consuming at least 75 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;
Note: alcohol is defined in the Schedule 1 - Dictionary.
(28)
having received a cumulative dose of at least 0.4 sievert of ionising radiation to the liver, from internal deposition of a substance which emits alpha particles, before the clinical worsening of cirrhosis of the liver;
(29)
having chronic infection with the hepatitis B virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.
(30)
having chronic infection with the hepatitis C virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.
(31)
having chronic infection with the hepatitis D virus before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.
(32)
having infection with the hepatitis E virus before the clinical worsening of cirrhosis of the liver;
Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.
(33)
having chronic hepatitis before the clinical worsening of cirrhosis of the liver;
Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.
(34)
having autoimmune chronic active hepatitis before the clinical worsening of cirrhosis of the liver;
Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.
(35)
having steatohepatitis before the clinical worsening of cirrhosis of the liver;
(36)
being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical worsening of cirrhosis of the liver;
Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.
(37)
having evidence of chronic infection with schistosomiasis involving the liver before the clinical worsening of cirrhosis of the liver;
(38)
having granulomatous liver disease before the clinical worsening of cirrhosis of the liver;
Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.
(39)
having severe right-sided cardiac failure for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.
(40)
having veno-occlusive disease for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: veno-occlusive disease is defined in the Schedule 1 - Dictionary.
(41)
having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical worsening of cirrhosis of the liver;
(42)
having iron overload involving the liver at the time of the clinical worsening of cirrhosis of the liver;
Note: iron overload is defined in the Schedule 1 - Dictionary.
(43)
having alpha-1 antitrypsin deficiency before the clinical worsening of cirrhosis of the liver;
(44)
having Gaucher's disease before the clinical worsening of cirrhosis of the liver;
(45)
having Wilson's disease before the clinical worsening of cirrhosis of the liver;
(46)
having Budd-Chiari syndrome for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;
Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.
(47)
consuming a daily average of at least 15 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least eight grams, within the ten years before the clinical worsening of cirrhosis of the liver;
(48)
being treated with methotrexate: (a) for at least the 12 months; or (b) to a cumulative dose of methotrexate of at least one gram taken over at least a six month period, before the clinical worsening of cirrhosis of the liver;
(49)
being treated with dideoxynucleoside-analogue drugs as specified for at least 12 months before the clinical worsening of cirrhosis of the liver;
Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.
(50)
inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 1 000 hours within the five years before the clinical worsening of cirrhosis of the liver;
(51)
inability to obtain appropriate clinical management for cirrhosis of the liver;

Aggravation-only factors: the factors in subsections 9(26) to 9(51) 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.

Cirrhosis of the liver — DVA SoP factors