Diabetes mellitus — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 48 of 2020

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 diabetes mellitus or death from diabetes mellitus with the circumstances of a person's relevant service: Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022

1. (1)
   having an endocrine disorder from the specified list of endocrine disorders before the clinical onset of diabetes mellitus;

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

2. (2)
   having a solid organ transplant or bone marrow transplant before the clinical onset of diabetes mellitus;
3. (3)
   having glucocorticoid therapy as specified, before the clinical onset of diabetes mellitus, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the 30 days before the clinical onset of diabetes mellitus;

   Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

4. (4)
   being treated with a drug from the Specified List 1 of drugs, which cannot be ceased or substituted, for at least the seven days before the clinical onset of diabetes mellitus;

   Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

5. (5)
   being treated with a drug from the antidepressant or antipsychotic classes of drugs, which cannot be ceased or substituted, for at least the six weeks before the clinical onset of diabetes mellitus;
6. (6)
   for type 1 diabetes mellitus only: (a) undergoing surgery to the pancreas before the clinical onset of diabetes mellitus; (b) undergoing splenectomy for trauma before the clinical onset of diabetes mellitus; (c) undergoing a course of therapeutic radiation for cancer, where the pancreas was in the field of radiation, before the clinical onset of diabetes mellitus; (d) having a specified pathological condition involving the pancreas before the clinical onset of diabetes mellitus; (e) having haemolytic uraemic syndrome before the clinical onset of diabetes mellitus; (f) ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical onset of diabetes mellitus; Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022 (g) taking an immune checkpoint inhibitor or an interferon within the one year before the clinical onset of diabetes mellitus; or (h) having infection with a Coxsackie B virus within the three years before the clinical onset of diabetes mellitus;

   Note: specified pathological condition involving the pancreas is defined in the Schedule 1 - Dictionary.

   Note: haemolytic uraemic syndrome is defined in the Schedule 1 - Dictionary.

   Note: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.

7. (7)
   for type 2 diabetes mellitus only: (a) having smoked at least five pack-years of tobacco products before the clinical onset of diabetes mellitus, and where smoking has permanently ceased, the clinical onset of diabetes mellitus has occurred within 15 years of cessation; (b) being exposed to second-hand smoke for at least 5,000 hours before the clinical onset of diabetes mellitus, and where exposure to second-hand smoke has permanently ceased, the clinical onset of diabetes mellitus has occurred within 15 years of cessation; (c) being overweight or obese for at least five years before the clinical onset of diabetes mellitus; (d) an inability to undertake moderate physical activity of at least four METs for at least the five years before the clinical onset of diabetes mellitus; (e) having cirrhosis of the liver at the time of the clinical onset of diabetes mellitus; (f) having non-alcoholic steatohepatitis at the time of the clinical onset of diabetes mellitus; (g) having infection with human immunodeficiency virus before the clinical onset of diabetes mellitus; (h) having infection with hepatitis C virus before the clinical onset of diabetes mellitus; (i) having hypertension at the time of the clinical onset of diabetes mellitus; Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022 (j) having chronic renal failure at the time of the clinical onset of diabetes mellitus; (k) having gout or hyperuricaemia at the time of the clinical onset of diabetes mellitus; (l) having posttraumatic stress disorder at the time of the clinical onset of diabetes mellitus; (m) having depressive disorder at the time of the clinical onset of diabetes mellitus; (n) having bipolar disorder at the time of the clinical onset of diabetes mellitus; (o) having schizophrenia at the time of the clinical onset of diabetes mellitus; (p) having bilateral orchiectomy before the clinical onset of diabetes mellitus; (q) having anti-androgen therapy as specified for at least the one year before the clinical onset of diabetes mellitus; (r) being exposed to arsenic as specified before the clinical onset of diabetes mellitus; (s) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD): (i) for a cumulative period of at least 500 hours, within a consecutive period of ten years before the clinical onset of diabetes mellitus; and (ii) where the first exposure occurred at least five years before the clinical onset of diabetes mellitus; and (iii) where that exposure has ceased, the clinical onset of diabetes mellitus has occurred within 25 years of cessation; or Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022 (t) for parous women only, inability to breast feed for a cumulative period of at least six months before the clinical onset of diabetes mellitus;

   Note: one pack-year is defined in the Schedule 1 - Dictionary.

   Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

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

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

   Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

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

   Note: anti-androgen therapy as specified is defined in the Schedule 1 - Dictionary.

   Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

   Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

   Note: The period of breastfeeding could be cumulative over a number of pregnancies.

8. (8)
   for gestational diabetes mellitus and type 2 diabetes mellitus only, being pregnant at the time of the clinical onset of diabetes mellitus;
9. (9)
   having an endocrine disorder from the specified list of endocrine disorders before the clinical worsening of diabetes mellitus;

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

10. (10)
    having a solid organ transplant or bone marrow transplant before the clinical worsening of diabetes mellitus;
11. (11)
    having glucocorticoid therapy as specified, before the clinical worsening of diabetes mellitus, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the 30 days before the clinical worsening of diabetes mellitus;

    Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

12. (12)
    being treated with a drug from the Specified List 1 of drugs, which cannot be ceased or substituted, for at least the seven days before the clinical worsening of diabetes mellitus;

    Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

13. (13)
    being treated with a drug from the antidepressant or antipsychotic classes of drugs, which cannot be ceased or substituted, for at least the six weeks before the clinical worsening of diabetes mellitus; (13a) taking an immune checkpoint inhibitor or an interferon within the one year before the clinical worsening of diabetes mellitus;

    Note: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.

14. (14)
    undergoing surgery to the pancreas before the clinical worsening of diabetes mellitus;
15. (15)
    undergoing splenectomy for trauma before the clinical worsening of diabetes mellitus;
16. (16)
    undergoing a course of therapeutic radiation for cancer, where the pancreas was in the field of radiation, before the clinical worsening of diabetes mellitus;
17. (17)
    having a specified pathological condition involving the pancreas before the clinical worsening of diabetes mellitus; Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022;

    Note: specified pathological condition involving the pancreas is defined in the Schedule 1 - Dictionary.

18. (18)
    having haemolytic uraemic syndrome before the clinical worsening of diabetes mellitus;

    Note: haemolytic uraemic syndrome is defined in the Schedule 1 - Dictionary.

19. (19)
    ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical worsening of diabetes mellitus;
20. (20)
    having depressive disorder at the time of the clinical worsening of diabetes mellitus;
21. (21)
    having bipolar disorder at the time of the clinical worsening of diabetes mellitus;
22. (22)
    having schizophrenia at the time of the clinical worsening of diabetes mellitus;
23. (23)
    for type 2 diabetes mellitus only: (a) having smoked at least five pack-years of tobacco products before the clinical worsening of diabetes mellitus, and where smoking has permanently ceased, the clinical worsening of diabetes mellitus has occurred within 15 years of cessation; (b) being exposed to second-hand smoke for at least 5,000 hours before the clinical worsening of diabetes mellitus, and where exposure to second-hand smoke has permanently ceased, the clinical worsening of diabetes mellitus has occurred within 15 years of cessation; (c) being overweight or obese for at least five years before the clinical worsening of diabetes mellitus; (d) an inability to undertake moderate physical activity of at least four METs for at least the five years before the clinical worsening of diabetes mellitus; (e) having cirrhosis of the liver at the time of the clinical worsening of diabetes mellitus; (f) having non-alcoholic steatohepatitis at the time of the clinical worsening of diabetes mellitus; Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022 (g) having infection with human immunodeficiency virus before the clinical worsening of diabetes mellitus; (h) having infection with hepatitis C virus before the clinical worsening of diabetes mellitus; (i) having hypertension at the time of the clinical worsening of diabetes mellitus; (j) having chronic renal failure at the time of the clinical worsening of diabetes mellitus; (k) having gout or hyperuricaemia at the time of the clinical worsening of diabetes mellitus; (l) having posttraumatic stress disorder at the time of the clinical worsening of diabetes mellitus; (m) having bilateral orchiectomy before the clinical worsening of diabetes mellitus; (n) having anti-androgen therapy as specified for at least the one year before the clinical worsening of diabetes mellitus; (o) being exposed to arsenic as specified before the clinical worsening of diabetes mellitus; or (p) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD): (i) for a cumulative period of at least 500 hours, within a consecutive period of ten years before the clinical worsening of diabetes mellitus; and (ii) where the first exposure occurred at least five years before the clinical worsening of diabetes mellitus; and (iii) where that exposure has ceased, the clinical worsening of diabetes mellitus has occurred within 25 years of cessation; Compilation No. 3 Compilation date: 19/09/2022 Authorised Version F2022C00898 registered 19/09/2022;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

    Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

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

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

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

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

    Note: anti-androgen therapy as specified is defined in the Schedule 1 - Dictionary.

    Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

    Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

24. (24)
    for gestational diabetes mellitus and type 2 diabetes mellitus only, being pregnant at the time of the clinical worsening of diabetes mellitus;
25. (25)
    inability to obtain appropriate clinical management for diabetes mellitus;

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