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Statement of Principles

concerning

ANAL FISSURE

ICD CODES: 565.0

Veterans’ Entitlements Act 1986

subsection 196B(2)

1. Being of the view that there is sound medical-scientific evidence that indicates that anal fissure and death from anal fissure can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping Forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act), that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting anal fissure or death from anal fissure with the circumstances of that service, are:

(a) undergoing anal surgery immediately before the clinical onset of anal fissure; or

(b) suffering trauma to the perineum immediately before the clinical onset of anal fissure; or

(c) being infected with HIV before the clinical onset of anal fissure; or

(d) suffering Crohn's disease before the clinical onset of anal fissure; or

(e) suffering constipation immediately before the clinical onset of anal fissure; or

(f) suffering from ulcerative colitis before the clinical onset of anal fissure; or

(g) inability to obtain appropriate clinical management for the anal fissure.

2. Subject to clause 3 (below) at least one of the factors set out in paragraph 1(a) to 1(g) must be related to any service rendered by a person.

3. The factor set out in paragraph 1(g) applies only where:

(a) the person's anal fissure developed before a period, or part of a period, of service to which the factor is related; and

(b) the relationship suggested between the anal fissure and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act.

4. For the purposes of this Statement of Principles:

“anal fissure” means a longitudinal, elliptical or rounded defect in the anoderm, extending part or all of the way from the anal verge to the pectinate line, attracting ICD code 565.0;

“being infected with HIV” means serological evidence of infection with Human Immunodeficiency Virus, attracting an ICD code in the range 042 - 044;

“constipation” means infrequent or difficult evacuation of the faeces that leads to straining at stool, attracting ICD code 564.0;

“Crohn's disease” means an inflammatory disease of the digestive system, involving the bowel wall, characterised by the presence of epithelioid cell granuloma, often with giant cells, attracting ICD code 555;