Osteomyelitis — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 23 of 2024

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

1. (1)
   having a wound, laceration, other injury or disease disrupting the skin or mucosa at the site or adjacent to the site of osteomyelitis, within the 2 years before the clinical onset of osteomyelitis;

   Note: Examples of injuries that disrupt the skin include penetrative injuries, compound fractures, burns or pressure ulcers. Examples of diseases that disrupt the skin include chronic ischaemia or diabetes mellitus.

2. (2)
   having a dental, medical or surgical procedure which breaches the skin or mucosa at the site or adjacent to the site of osteomyelitis within the 2 years before the clinical onset of osteomyelitis;

   Note: Examples of procedures that breach the skin or mucosa include lumbar puncture, epidural anaesthesia and tooth extraction.

3. (3)
   having septicaemia, bacteraemia, systemic fungal infection or parasitic infection with Echinococcus granulosus, Trichinella spiralis, or Schistosoma species within the 2 years before the clinical onset of osteomyelitis;

   Note: Echinococcus granulosus, Trichinella spiralis, and Schistosoma species are types of parasitic worms.

4. (4)
   having a foreign body at the site or adjacent to the site of osteomyelitis at the time of the clinical onset of osteomyelitis;

   Note: Examples of foreign bodies associated with osteomyelitis include internal fixation devices, joint replacements, vascular grafts, shrapnel and bullets.

5. (5)
   having diabetes mellitus at the time of the clinical onset or clinical worsening of osteomyelitis;
6. (6)
   having one of the following chronic medical conditions before the clinical onset or clinical worsening of osteomyelitis: (a) chronic renal failure; (b) cirrhosis of the liver; (c) Crohn disease; or (d) sickle cell disorder;

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

7. (7)
   having chronic ischaemia of the affected lower limb from chronic venous insufficiency or atherosclerotic peripheral vascular disease at the time of the clinical onset or clinical worsening of osteomyelitis;
8. (8)
   having a substantially compromised immune system due to: (a) chronic renal failure; (b) haematological malignancy; (c) infection with human immunodeficiency virus; (d) severe malnutrition; (e) solid organ, stem cell or bone marrow transplantation; or (f) taking an immunosuppressive drug; at the time of the clinical onset or clinical worsening of osteomyelitis;

   Note: chronic renal failure and immunosuppressive drug and severe malnutrition are defined in the Schedule -1 Dictionary.

9. (9)
   undergoing a course of radiotherapy for cancer, where the affected site was in the field of radiation, before the clinical onset of osteomyelitis;
10. (10)
    having osteonecrosis at the site of osteomyelitis before the clinical onset of osteomyelitis;
11. (11)
    inability to obtain appropriate clinical management for osteomyelitis before the clinical worsening of osteomyelitis;