Parkinson's disease and secondary parkinsonism — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 55 of 2016

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 Parkinson's disease or secondary parkinsonism or death from Parkinson's disease or secondary parkinsonism with the circumstances of a person's relevant service:

1. (1)
   for Parkinson's disease only: (a) inhaling, ingesting or having cutaneous contact with a pesticide from the specified list of pesticides, for a cumulative period of at least 1 000 hours, before the clinical onset of Parkinson's disease; (b) having moderate to severe traumatic brain injury more than 15 years before the clinical onset of Parkinson's disease; (c) inhaling trichloroethylene vapour in an enclosed space, or having cutaneous contact with trichloroethylene, for a cumulative period of at least 2 000 hours, at least 20 years before the clinical onset of Parkinson's disease; (d) an inability to undertake any physical activity greater than three METs for at least ten years within the 20 years before the clinical onset of Parkinson's disease; (e) consuming an average of at least one litre of milk per day for at least the 15 years before the clinical onset of Parkinson's disease; (f) consuming an average of at least 150 grams of cheese per day for at least the 15 years before the clinical onset of Parkinson's disease; (g) having clinically significant depressive disorder or generalised anxiety disorder at least 15 years before the clinical onset of Parkinson's disease; or (h) in a person with a history of a regular smoking habit as specified, having not smoked for at least the five years before the clinical onset of Parkinson's disease; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986;

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

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

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

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

2. (2)
   for secondary parkinsonism only: (a) having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the three months before the clinical onset of secondary parkinsonism; (b) having moderate to severe traumatic brain injury within the one year before the clinical onset of secondary parkinsonism; (c) having an intracranial space occupying lesion within the three months before the clinical onset of secondary parkinsonism; (d) having hydrocephalus, or draining of hydrocephalus, within the three months before the clinical onset of secondary parkinsonism; (e) having a cerebrovascular accident, excluding transient ischaemic attack, within the five years before the clinical onset of secondary parkinsonism; (f) having a disease from the specified list of diseases involving the cerebral vessels, in the presence of neuroimaging findings of brain stem or cerebral white matter lesions, haemorrhage or infarction, at the time of the clinical onset of secondary parkinsonism; (g) having a subarachnoid haemorrhage within the three months before the clinical onset of secondary parkinsonism; (h) having an acquired cerebrovascular malformation or dural arteriovenous fistula at the time of the clinical onset of secondary parkinsonism; (i) having an hypoxic cerebral insult within the two years before the clinical onset of secondary parkinsonism; (j) having influenza within the three months before the clinical onset of secondary parkinsonism; (k) having encephalitis within the three months before the clinical onset of secondary parkinsonism; (l) being infected with the human immunodeficiency virus before the clinical onset of secondary parkinsonism; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986 (m) having neurosyphilis at the time of the clinical onset of secondary parkinsonism; (n) having neurocysticercosis at the time of the clinical onset of secondary parkinsonism; (o) inhaling carbon disulphide vapour in an enclosed space, or having cutaneous contact with carbon disulphide, for a cumulative period of at least 500 hours, within the ten years before the clinical onset of secondary parkinsonism; (p) inhaling trichloroethylene vapour in an enclosed space, or having cutaneous contact with trichloroethylene, for a cumulative period of at least 2 000 hours, within the 20 years before the clinical onset of secondary parkinsonism; (q) inhaling or ingesting methanol or ethylene glycol, and having clinical, haematological or biochemical evidence of methanol or ethylene glycol intoxication, within the three months before the clinical onset of secondary parkinsonism; (r) being exposed to manganese as specified for a cumulative period of at least 250 hours, within the ten years before the clinical onset of secondary parkinsonism; (s) having clinical or biochemical evidence of manganese intoxication while receiving total parenteral nutrition or maintenance haemodialysis, at the time of the clinical onset of secondary parkinsonism; (t) inhaling, ingesting or having cutaneous contact with cyanide, and having clinical, haematological or biochemical evidence of cyanide intoxication, within the three months before the clinical onset of secondary parkinsonism; (u) having an injection containing 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP) within the three months before the clinical onset of secondary parkinsonism; (v) using khat (Catha edulis), Ecstasy (3,4- methylenedioxymethamphetamine) or the drug methcathinone (ephedrone) within the three months before the clinical onset of secondary parkinsonism; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986 (w) taking a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days within the three months before the clinical onset of secondary parkinsonism; (x) having a disorder of calcium metabolism from the specified list of disorders of calcium metabolism at the time of the clinical onset of secondary parkinsonism; (y) having cirrhosis of the liver at the time of the clinical onset of secondary parkinsonism; (z) having chronic renal failure at the time of the clinical onset of secondary parkinsonism; (aa) having a disease from the specified list of autoimmune diseases at the time of the clinical onset of secondary parkinsonism; or (bb) having a paraneoplastic encephalomyelitis at the time of the clinical onset of secondary parkinsonism;

   Note: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 - Dictionary.

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

   Note: specified list of diseases involving the cerebral vessels is defined in the Schedule 1 - Dictionary.

   Note: hypoxic cerebral insult is defined in the Schedule 1 - Dictionary.

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

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

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

   Note: total parenteral nutrition is defined in the Schedule 1 - Dictionary.

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

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

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

   Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

3. (3)
   inhaling, ingesting or having cutaneous contact with a pesticide from the specified list of pesticides, for a cumulative period of at least 1 000 hours, within the ten years before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

4. (4)
   having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;

   Note: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 - Dictionary.

5. (5)
   having moderate to severe traumatic brain injury within the one year before the clinical worsening of Parkinson's disease or secondary parkinsonism;
6. (6)
   having an intracranial space occupying lesion within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986;
7. (7)
   having hydrocephalus, or draining of hydrocephalus, within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

8. (8)
   having a cerebrovascular accident, excluding transient ischaemic attack, within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
9. (9)
   having a disease from the specified list of diseases involving the cerebral vessels, in the presence of neuroimaging findings of brain stem or cerebral white matter lesions, haemorrhage or infarction, at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

   Note: specified list of diseases involving the cerebral vessels is defined in the Schedule 1 - Dictionary.

10. (10)
    having a subarachnoid haemorrhage within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
11. (11)
    having an acquired cerebrovascular malformation or dural arteriovenous fistula at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;
12. (12)
    having an hypoxic cerebral insult within the two years before the clinical worsening of Parkinson's disease or secondary parkinsonism;

    Note: hypoxic cerebral insult is defined in the Schedule 1 - Dictionary.

13. (13)
    having influenza within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
14. (14)
    having encephalitis within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

15. (15)
    being infected with the human immunodeficiency virus before the clinical worsening of Parkinson's disease or secondary parkinsonism;
16. (16)
    having neurosyphilis at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

17. (17)
    having neurocysticercosis at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;
18. (18)
    inhaling carbon disulphide vapour in an enclosed space, or having cutaneous contact with carbon disulphide, for a cumulative period of at least 500 hours, within the ten years before the clinical worsening of Parkinson's disease or secondary parkinsonism; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986;
19. (19)
    inhaling trichloroethylene vapour in an enclosed space, or having cutaneous contact with trichloroethylene, for a cumulative period of at least 2 000 hours, within the 20 years before the clinical worsening of Parkinson's disease or secondary parkinsonism;
20. (20)
    inhaling or ingesting methanol or ethylene glycol, and having clinical, haematological or biochemical evidence of methanol or ethylene glycol intoxication, within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
21. (21)
    being exposed to manganese as specified for a cumulative period of at least 250 hours, within the ten years before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

22. (22)
    having clinical or biochemical evidence of manganese intoxication while receiving total parenteral nutrition or maintenance haemodialysis, at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

    Note: total parenteral nutrition is defined in the Schedule 1 - Dictionary.

23. (23)
    inhaling, ingesting or having cutaneous contact with cyanide, and having clinical, haematological or biochemical evidence of cyanide intoxication, within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
24. (24)
    having an injection containing 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP) within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
25. (25)
    using khat (Catha edulis), Ecstasy (3,4- methylenedioxymethamphetamine) or the drug methcathinone (ephedrone) within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;
26. (26)
    taking a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days within the three months before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

27. (27)
    having a disorder of calcium metabolism from the specified list of disorders of calcium metabolism at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

28. (28)
    having cirrhosis of the liver at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism; Parkinson's Disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) Veterans' Entitlements Act 1986;
29. (29)
    having chronic renal failure at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

30. (30)
    an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

31. (31)
    having a disease from the specified list of autoimmune diseases at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

32. (32)
    consuming an average of at least one litre of milk per day for at least the five years before the clinical worsening of Parkinson's disease or secondary parkinsonism;
33. (33)
    consuming an average of at least 150 grams of cheese per day for at least the five years before the clinical worsening of Parkinson's disease or secondary parkinsonism;
34. (34)
    having a paraneoplastic encephalomyelitis at the time of the clinical worsening of Parkinson's disease or secondary parkinsonism;
35. (35)
    having clinically significant depressive disorder or generalised anxiety disorder for at least the five years before the clinical worsening of Parkinson's disease or secondary parkinsonism;

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

36. (36)
    in a person with a history of a regular smoking habit as specified, having not smoked within the ten years before the clinical worsening of Parkinson's disease and secondary parkinsonism;

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

37. (37)
    inability to obtain appropriate clinical management for Parkinson's disease or secondary parkinsonism;

Aggravation-only factors: the factors in subsections 9(3) to 9(37) 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.