Inflammatory bowel disease — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 90 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 inflammatory bowel disease or death from inflammatory bowel disease with the circumstances of a person's relevant service:

1. (1)
   taking a drug from the Specified List 1 of drugs for at least the seven days before the clinical onset of inflammatory bowel disease;

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

2. (2)
   taking a nonsteroidal anti-inflammatory drug on at least ten days per month, for a continuous period of at least two months before the clinical onset of inflammatory bowel disease and the last dose of the drug was taken within the 14 days before the clinical onset of inflammatory bowel disease;
3. (3)
   taking an immune checkpoint inhibitor within the one year before the clinical onset of inflammatory bowel disease;
4. (4)
   taking a combined oral contraceptive pill for a continuous period of at least six months before the clinical onset of inflammatory bowel disease and where taking the combined oral contraceptive pill has ceased, the clinical onset of inflammatory bowel disease has occurred within one year of cessation;
5. (5)
   undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of inflammatory bowel disease;

   Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.

6. (6)
   experiencing a category 1A stressor within the three months before the clinical onset of inflammatory bowel disease;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

7. (7)
   experiencing a category 1B stressor within the three months before the clinical onset of inflammatory bowel disease;

   Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

8. (8)
   experiencing a category 2 stressor within the 30 days before the clinical onset of inflammatory bowel disease;

   Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

   Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

9. (9)
   having a clinically significant depressive disorder or a clinically significant anxiety disorder for at least the one year before the clinical onset of inflammatory bowel disease;

   Note: clinically significant is defined in the Schedule 1 - Dictionary.

10. (10)
    for Crohn disease only: (a) having smoked at least one pack-year of tobacco products before the clinical onset of Crohn disease, and where smoking has permanently ceased, the clinical onset of Crohn disease has occurred within four years of cessation; (b) where exposure to second-hand smoke has not permanently ceased: (i) being exposed to second-hand smoke for at least 5,000 hours before the clinical onset of Crohn disease; and (ii) the first exposure to second-hand smoke commenced at least one year before the clinical onset of Crohn disease; (c) where exposure to second-hand smoke has permanently ceased before the clinical onset of Crohn disease: (i) being exposed to second-hand smoke for at least 5,000 hours; and (ii) the first exposure to second-hand smoke commenced at least one year before the clinical onset of Crohn disease; and (iii) the clinical onset of Crohn disease has occurred within four years of the last exposure to second-hand smoke; (d) taking at least three courses of antibiotics within the five years before the clinical onset of Crohn disease, and the last course of antibiotics was completed at least six months before the clinical onset of Crohn disease; (e) inability to consume an average daily intake of at least ten grams of fibre in food for a period of at least five consecutive years within the ten years before the clinical onset of Crohn disease; (f) consuming an average of at least 100 grams per day of sucrose, for at least two consecutive years within the five years before the clinical onset of Crohn disease; (g) inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of Crohn disease; (h) being obese for at least five years within the 20 years before the clinical onset of Crohn disease;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

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

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

    Note: The consumption of sucrose includes sucrose in soft drinks.

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

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

11. (11)
    for ulcerative colitis only, in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke between one and 20 years before the clinical onset of ulcerative colitis;

    Note: regular smoking habit as specified is defined in the Schedule 1 - Dictionary.

12. (12)
    taking a drug from the Specified List 2 of drugs for at least the seven days before the clinical worsening of inflammatory bowel disease;

    Note: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.

13. (13)
    taking an immune checkpoint inhibitor within the one year before the clinical worsening of inflammatory bowel disease;
14. (14)
    taking a combined oral contraceptive pill for a continuous period of at least six months before the clinical worsening of inflammatory bowel disease and where taking the combined oral contraceptive pill has ceased, the clinical worsening of inflammatory bowel disease has occurred within one year of cessation;
15. (15)
    undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical worsening of inflammatory bowel disease;

    Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.

16. (16)
    having a bowel infection within the 30 days before the clinical worsening of inflammatory bowel disease;
17. (17)
    experiencing a category 1A stressor within the three months before the clinical worsening of inflammatory bowel disease;

    Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

18. (18)
    experiencing a category 1B stressor within the three months before the clinical worsening of inflammatory bowel disease;

    Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

19. (19)
    experiencing a category 2 stressor within the 30 days before the clinical worsening of inflammatory bowel disease;

    Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

    Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

20. (20)
    having a clinically significant depressive disorder or a clinically significant anxiety disorder for at least the one year before the clinical worsening of inflammatory bowel disease;

    Note: clinically significant is defined in the Schedule 1 - Dictionary.

21. (21)
    for Crohn disease only: (a) having smoked at least one pack-year of tobacco products before the clinical worsening of Crohn disease, and where smoking has permanently ceased, the clinical worsening of Crohn disease has occurred within four years of cessation; (b) where exposure to second-hand smoke has not permanently ceased: (i) being exposed to second-hand smoke for at least 5,000 hours before the clinical worsening of Crohn disease; and (ii) the first exposure to second-hand smoke commenced at least one year before the clinical worsening of Crohn disease; (c) where exposure to second-hand smoke has permanently ceased before the clinical worsening of Crohn disease: (i) being exposed to second-hand smoke for at least 5,000 hours; and (ii) the first exposure to second-hand smoke commenced at least one year before the clinical worsening of Crohn disease; and (iii) the clinical worsening of Crohn disease occurs within four years of the last exposure to second-hand smoke; (d) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of Crohn disease;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

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

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

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

22. (22)
    for ulcerative colitis only, in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke between one and 20 years before the clinical worsening of ulcerative colitis;

    Note: regular smoking habit as specified is defined in the Schedule 1 - Dictionary.

23. (23)
    inability to obtain appropriate clinical management for inflammatory bowel disease;

Aggravation-only factors: the factors in subsections 9(12) to 9(23) 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.