<p> DDECISIONECISION SSUPPORTUPPORT UUNITNIT 8th Floor, 259 Queen St, Brisbane 3rd Floor Blackburn House, 199 Grenfell St, Adelaide Intranet site: http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm</p><p>SOP Bulletin No. 89</p><p>2004 年 12 月 17 日</p><p>THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 22 DECEMBER, 2004</p><p>New SOPs Epicondylitis Leptospirosis</p><p>Revocations & Non-melanotic malignant neoplasm of the skin Replacements Malignant neoplasm of the salivary gland</p><p>Amendments Nil</p><p>IMPORTANT OPERATIONAL FEATURES</p><p>Non-melanotic malignant neoplasm of the skin Revocation – 48 & 49 of ‘04 Replaces: 43, 44, 51 and 52 of '01 and: 340 & 341 of ’95 + 27 & 28 of ‘96</p><p> Coverage of this SOP has been extended to now specifically include anogenital skin. This includes penile skin and as a result, the MN of the penis SOP has been revoked and subsumed into this SOP (except for the exceedingly rare soft tissue sarcoma of the penis – covered by the soft tissue sarcoma SOP). Several new factors have been added that are specific to anogenital/penile skin.</p><p>00f04ebc4ebe2cb8c7102346102e861d.doc Page 1 of 4 Decision Support Unit Business Development, Monitoring and Support Section Disability Compensation Branch Australian Government Department of Veterans’ Affairs  A major change to this SOP is the inclusion of a new sunlight exposure factor. This factor is in addition to the existing solar UV exposure factor. The existing factor involves calculating how much extra UV exposure a person had as a result of service. The new factor requires only a total dose (in hours) of sun exposure. </p><p> This new factor should be able to be used in many cases as a screening factor, with a fairly simple calculation made, based on limited detail, to see if the dose requirement is comfortably met, or clearly not met. A more thorough assessment of exposure should only be needed in a proportion of cases, where more detailed information, or use of the UV risk calculator to determine a UV exposure factor ratio, may be required. </p><p> Note that the new factor is expressed in terms of hours of exposure to unprotected skin at the affected site. As with the existing UV factor, it will be necessary to consider and determine different body sites separately (see Advisory Note No. 4 of ’04), to account for different exposure at the different sites.</p><p> Note also the definition of “unprotected skin” in the SOP. If the person is exposed to sunlight, but the site being considered is protected at any time by sunscreen or clothing, or is in shade from any source, including another body part, or is facing away from the sun, then it is not “unprotected skin” at that time. </p><p> For screening purposes, it would be reasonable to calculate hours of exposure on service using the following approach: Number of days of service in each latitude zone (as defined in the SOP). multiplied by Estimated average hours/day of exposure outside in the sun in that zone (if the body site being considered was covered by clothing or protected by sunscreen then hours spent outside would not be included in the estimate for that site). divided by A correction factor to account for shading from all sources (other physical barriers, body part facing away from the sun, shading by other body parts, partial shading by e.g. a hat, etc). The suggested correction factor for screening purposes is 2 (ie. a 50% deduction), but this can be altered to suit individual case circumstances. then</p><p>00f04ebc4ebe2cb8c7102346102e861d.doc Page 2 of 4 Decision Support Unit Business Development, Monitoring and Support Section Disability Compensation Branch Australian Government Department of Veterans’ Affairs The total for each latitude zone is adjusted using the latitude weighting factor in the SOP definition and the result for each zone is added together.</p><p> The solar keratosis SOP is currently under review by the RMA. A similar new sunlight exposure factor is likely to be incorporated in that SOP, in March 2005.</p><p> A number of other factors have been changed or added:  The arsenic exposure factors have been reorganised and amalgamated.  The immunosuppressive drugs factor is no longer limited to organ transplant recipients.  There are new factors for HIV infection, paraquat or bipyridine exposure and having lichen sclerosis.</p><p>Malignant neoplasm of the salivary gland Revocation – 46 & 47 of ‘04 Replaces 25 and 26 of '97</p><p>. The conditions covered by the SOP are unchanged. The ICD codes have been removed from the definition, because the available codes are based on anatomy and not disease, causing an overlap with the MN oral cavity and hypopharynx SOP. [Reliance on the codes and not the words in the definition (which take precedence) has led to the wrong SOP being applied in a previous MN salivary gland case at the AAT - see Cody and Repatriation Commission [2001] AATA 995.]</p><p> The atomic radiation factor has been updated in the RH SOP and added to the BOP SOP.</p><p> There are new factors for diagnostic radiation, radioiodine therapy and mustard gas exposure, in both RH and BOP SOPs.</p><p>Epicondylitis New – 52 & 53 of ‘04</p><p> This SOP covers both lateral epicondylitis (tennis elbow) and medial epicondylitis. </p><p> Claims on hold due to the non-SOP investigation into lateral epicondylitis can now be determined.</p><p>00f04ebc4ebe2cb8c7102346102e861d.doc Page 3 of 4 Decision Support Unit Business Development, Monitoring and Support Section Disability Compensation Branch Australian Government Department of Veterans’ Affairs Leptospirosis New – 50 & 51 of ‘04</p><p> This SOP covers an uncommon bacterial infection. It can be contracted worldwide and throughout Australia but is most common in north Queensland. Infection typically occurs via skin contact with water, wet soil or vegetation that is contaminated with urine from domestic or wild animals, particularly rats. Infection typically presents 10 days after contact. The common features are fever, rash, vomiting and jaundice. </p><p>Contact Officers for this bulletin: Maureen Anderson x 50365 Dr Bev Grehan x 48376 Dr Jon Kelley x 48412</p><p>00f04ebc4ebe2cb8c7102346102e861d.doc Page 4 of 4 Decision Support Unit Business Development, Monitoring and Support Section Disability Compensation Branch Australian Government Department of Veterans’ Affairs</p>