Statement of Principles concerning acquired cataract No. 40 of 2008 (Cth)

Statement of Principles

concerning

ACQUIRED CATARACT

Instrument No. 40 of 2008 as amended

made under section 196B(3) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 22 July 2011 taking into account Amendment of Statement of Principles concerning ACQUIRED CATARACT (Instrument No. 78 of 2011).

Prepared by the Repatriation Medical Authority Secretariat, Brisbane.

Statement of Principles

concerning

ACQUIRED CATARACT

No. 40 of 2008

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

Title

1.This Instrument may be cited as Statement of Principles concerning acquired cataract No. 40 of 2008.

Determination

2.The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):

(a)       revokes Instrument No. 38 of 2001, as amended by Instrument No. 33 of 2002, concerning acquired cataract; and

(b)       determines in their place this Statement of Principles.

Kind of injury, disease or death

3.         (a)       This Statement of Principles is about acquired cataract and death from acquired cataract.

(b)For the purposes of this Statement of Principles, "acquired cataract" means an opacification of the lens or lens capsule of the eye which causes visual impairment and which is not due to congenital or infantile cataract or lens malformation.

(c)Acquired cataract attracts ICD-10-AM code H25, H26, H28.1 or H28.2.

(d)In the application of this Statement of Principles, the definition of "acquired cataract" is that given at paragraph 3(b) above.

Basis for determining the factors

4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that acquired cataract and death from acquired cataract can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

Factors

6.         The factor that must exist before it can be said that, on the balance of probabilities, acquired cataract or death from acquired cataract is connected with the circumstances of a person’s relevant service is:

(a)having sunlight exposure to the unprotected eye for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of acquired cataract; or

(b)smoking at least 20 pack years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of acquired cataract; or

(c)having diabetes mellitus before the clinical onset of acquired cataract; or

(d)having glaucoma of the affected eye before the clinical onset of acquired cataract; or

(e)having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected eye before the clinical onset of acquired cataract; or

(f)having physical trauma to the affected eye within the 10 years before the clinical onset of acquired cataract; or

(g)being treated with oral, topical or inhalational corticosteroids as specified within the 10 years before the clinical onset of acquired cataract; or

(h)     having a severe thermal or chemical burn to the affected eye before the clinical onset of acquired cataract; or

(i)having an electrical injury within the five years before the clinical onset of acquired cataract; or

(j)being treated with a drug as specified before the clinical onset of acquired cataract; or

(k)having uveitis or iridocyclitis of the affected eye before the clinical onset of acquired cataract; or

(l)for cortical and subcapsular cataract only, having chronic hypocalcaemia at the time of the clinical onset of acquired cataract; or

(m)having sunlight exposure to the unprotected eye for at least 4500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical worsening of acquired cataract; or

(n)smoking at least 20 pack years of cigarettes, or the equivalent thereof in other tobacco products before the clinical worsening of acquired cataract; or

(o)having diabetes mellitus before the clinical worsening of acquired cataract; or

(p)having glaucoma of the affected eye before the clinical worsening of acquired cataract; or

(q)having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected eye before the clinical worsening of acquired cataract; or

(r)having physical trauma to the affected eye within the 10 years before the clinical worsening of acquired cataract; or

(s)being treated with oral, topical or inhalational corticosteroids as specified within the 10 years before the clinical worsening of acquired cataract; or

(t)having a severe thermal or chemical burn to the affected eye before the clinical worsening of acquired cataract; or

(u)having an electrical injury within the five years before the clinical worsening of acquired cataract; or

(v)being treated with a drug as specified before the clinical worsening of acquired cataract; or

(w)having uveitis or iridocyclitis of the affected eye before the clinical worsening of acquired cataract; or

(x)for cortical and subcapsular cataract only, having chronic hypocalcaemia at the time of the clinical worsening of acquired cataract; or

(y)inability to obtain appropriate clinical management for acquired cataract.

Factors that apply only to material contribution or aggravation

7.         Paragraphs 6(m) to 6(y) apply only to material contribution to, or aggravation of, acquired cataract where the person’s acquired cataract was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

8.In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Other definitions

9.For the purposes of this Statement of Principles:

"a severe thermal or chemical burn" means a burn involving at least one of the following clinical features:

(a)greater than 50% involvement of the limbus or conjunctiva; or

(b)corneal anaesthesia; or

(c)a significant degree of corneal opacification; or

(d)for chemical burns only, penetration of the chemical into the anterior chamber;

"a tropical area" means any area between the Tropic of Capricorn (23º 27' South) and the Tropic of Cancer (23º 27' North);

"being treated with a drug as specified" means:

(a)     for anterior subcapsular cataract only, receiving a cumulative dose of at least 1500 grams of phenothiazines; or

(b)     for anterior subcapsular cataract only, receiving amiodarone therapy for a cumulative period of at least 365 days; or

(c)         receiving a cumulative dose of at least 400 grams of allopurinol;

"being treated with oral, topical or inhalational corticosteroids as specified" means:

(a)     applying topical corticosteroids to the cornea of the affected eye equivalent to a cumulative dose of at least 200 drops of 0.1% dexamethasone; or

(b)     applying topical corticosteroids to the skin for a total of at least 730 days; or

(c)     taking oral corticosteroids equivalent to a cumulative dose of at least 1800 mg of prednisone; or

(d)     using inhalational corticosteroids equivalent to a cumulative dose of at least 1000 mg of beclomethasone;

"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents;

"death from acquired cataract" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s acquired cataract;

"equivalent sunlight exposure in other latitude zones" means the cumulative hours of sunlight exposure equivalent to that specified for a tropical area, calculated by multiplying the hours of exposure in each latitude zone by the latitude weighting factor for the zone as per the latitude weighting factor schedule and adding together the result for each zone:

Latitude weighting factor schedule

Latitude zone    Latitude weighting factor

a latitude between 23° 27' S and 23° 27' N                1.0

a latitude from > 23° 27' to 35°    0.75

a latitude from > 35° to 45°    0.5

a latitude from > 45° to 65°   0.25;

"glaucoma" means open-angle glaucoma or angle-closure glaucoma;

"hypocalcaemia" means confirmed findings of serum calcium <8.2 mg/dL (2.05 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L);

"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Sixth Edition, effective date of 1 July 2008, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 016 6;

"pack years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7300 cigarettes. One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack year of tailor made cigarettes equates to 7300 cigarettes, or 7.3 kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;

"physical trauma" means:

(a)     penetrating injury;

(b)    intraocular surgery; or

(c)     blunt trauma resulting in symptoms and signs lasting at least three days;

"relevant service" means:

(a)     eligible war service (other than operational service) under the VEA; or

(b)    defence service (other than hazardous service) under the VEA; or

(c)     peacetime service under the MRCA;

"terminal event" means the proximate or ultimate cause of death and includes:

(a)     pneumonia;

(b)    respiratory failure;

(c)     cardiac arrest;

(d)    circulatory failure; or

(e)     cessation of brain function;

"the unprotected eye" means an eye exposed to sunlight and not

protected by UV screening devices.

Application

10.       This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.

Date of effect

11.       This Instrument takes effect from 2 July 2008.

Notes to Statement of Principles concerning acquired cataract (Instrument No. 40 of 2008)

The Statement of Principles concerning acquired cataract (Instrument No. 40 of 2008) in force under section 196B(3) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title	Date of notification in Gazette or FRLI registration	Date of commencement	Application, saving or transitional provisions
Statement of Principles concerning acquired cataract (Instrument No. 40 of 2008)	25 June 2008 F2008L02191	2 July 2008
Amendment of Statement of Principles concerning acquired cataract (Instrument No. 52 of 2009)	23 June 2009 F2009L02422	1 July 2009
Amendment of Statement of Principles concerning acquired cataract (Instrument No. 78 of 2011)	16 May 2011 F2011L00758	25 May 2011

Table of Amendments

ad. = added or inserted      am. = amended      rep. = repealed      rs. = repealed and substituted
Provision affected	How affected
Clause 6(e)	rs. Instrument No. 78 of 2011
Clause 6(r)	rs. Instrument No. 78 of 2011
Clause 6(f) & (s)	rep. Instrument No. 78 of 2011
Clause 6(g) to (r)	am. Instrument No. 78 of 2011
Clause 6(t) to (aa)	am. Instrument No. 78 of 2011
Clause 7 – '6(n) to 6(aa)…'	am. Instrument No. 78 of 2011
Clause 9 – ' "electrical injury"…'	rep. Instrument  No. 52 of 2009
Clause 9 – ' "cumulative equivalent dose"..'	rs. Instrument No. 78 of 2011
Clause 9 – ' "a course of therapeutic radiation"..'	rep. Instrument No. 78 of 2011
Clause 9 – ' "atomic radiation"..'	rep. Instrument No. 78 of 2011