Multiple sclerosis — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 11 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 multiple sclerosis or death from multiple sclerosis with the circumstances of a person's relevant service:

1. (1)
   having acute infectious mononucleosis before the clinical onset of multiple sclerosis;
2. (2)
   smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of multiple sclerosis, and where smoking has ceased, the clinical onset of multiple sclerosis has occurred within five years of cessation;

   Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

3. (3)
   being exposed to second-hand smoke for at least 10 000 hours before the clinical onset of multiple sclerosis;

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

4. (4)
   inhaling an organic solvent or having cutaneous contact with an organic solvent on more days than not for a continuous period of at least one year before the clinical onset of multiple sclerosis;

   Note: organic solvent is defined in the Schedule 1 - Dictionary.

5. (5)
   undergoing a course of treatment with a tumour necrosis factor alpha antagonist within the two years before the clinical onset of multiple sclerosis;
6. (6)
   in the absence of supplemental ultraviolet light exposure, having an inability to meet the specified sunlight exposure levels for at least one year before the clinical onset of multiple sclerosis, and where this inability to meet the specified sunlight exposure levels occurred more than two years before the clinical onset of multiple sclerosis;

   Note: specified sunlight exposure levels is defined in the Schedule 1 - Dictionary.

7. (7)
   having vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 50 nanomoles per litre for a continuous period of at least one year before the clinical onset of multiple sclerosis, and where this vitamin D deficiency occurred more than two years before the clinical onset of multiple sclerosis;
8. (8)
   undergoing a course of treatment with an immune checkpoint inhibitor within the four months before the clinical onset of multiple sclerosis;

   Note: Immune checkpoint inhibitors include, but are not limited to, ipilimumab, nivolumab, atezolizumab and pembrolizumab.

9. (9)
   being overweight for at least five years when aged less than 30 years before the clinical onset of multiple sclerosis, and where this five year period occurred within the 15 years before the clinical onset of multiple sclerosis;

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

10. (10)
    having type 1 diabetes mellitus before the clinical onset of multiple sclerosis;
11. (11)
    having onset of a viral or bacterial infection within the five weeks before, or the two weeks after, the clinical worsening of multiple sclerosis;
12. (12)
    smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of multiple sclerosis, and where smoking has ceased, the clinical worsening of multiple sclerosis has occurred within five years of cessation;

    Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

13. (13)
    being exposed to second-hand smoke for at least 10 000 hours before the clinical worsening of multiple sclerosis;

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

14. (14)
    undergoing a course of treatment with a tumour necrosis factor alpha antagonist within the two years before the clinical worsening of multiple sclerosis;
15. (15)
    undergoing a course of treatment with granulocyte colony-stimulating factor or interferon within the one year before the clinical worsening of multiple sclerosis;
16. (16)
    undergoing a course of treatment with an immune checkpoint inhibitor within the four months before the clinical worsening of multiple sclerosis;

    Note: Immune checkpoint inhibitors include, but are not limited to, ipilimumab, nivolumab, atezolizumab and pembrolizumab.

17. (17)
    experiencing the death of a significant other within the six months before the clinical worsening of multiple sclerosis;

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

18. (18)
    experiencing a category 1A stressor within the six months before the clinical worsening of multiple sclerosis;

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

19. (19)
    experiencing a category 1B stressor within the six months before the clinical worsening of multiple sclerosis;

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

20. (20)
    experiencing a category 2 stressor within the six months before the clinical worsening of multiple sclerosis;

    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.

21. (21)
    having a medical illness or injury, other than multiple sclerosis, which is life-threatening or which results in serious physical or cognitive disability, within the six months before the clinical worsening of multiple sclerosis;
22. (22)
    for women only, using hormonal assisted reproductive therapy within the three months before the clinical worsening of multiple sclerosis;

    Note: hormonal assisted reproductive therapy is defined in the Schedule 1 - Dictionary.

23. (23)
    undergoing a course of therapeutic radiation for cancer, where the affected site was in the field of radiation, before the clinical worsening of multiple sclerosis;
24. (24)
    having received a cumulative equivalent dose of at least 10 sieverts of ionising radiation to the affected site before the clinical worsening of multiple sclerosis;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

25. (25)
    having dyslipidaemia at the time of the clinical worsening of multiple sclerosis;

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

26. (26)
    inability to obtain appropriate clinical management for multiple sclerosis;

Aggravation-only factors: the factors in subsections 9(11) to 9(26) 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.