Statement of Principles concerning blepharitis (Balance of Probabilities) (No. 30 of 2019) (Cth)

Statement of Principles

concerning

BLEPHARITIS
(Balance of Probabilities)

(No. 30 of 2019)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated    1 March 2019

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO
Chairperson

Contents

1Name........................................................................................................................................... 3

2Commencement........................................................................................................................ 3

3Authority..................................................................................................................................... 3

4Repeal......................................................................................................................................... 3

5Application................................................................................................................................. 3

6Definitions.................................................................................................................................. 3

7Kind of injury, disease or death to which this Statement of Principles relates............... 3

8Basis for determining the factors........................................................................................... 4

9Factors that must exist............................................................................................................. 4

10Relationship to service............................................................................................................. 6

11Factors referring to an injury or disease covered by another Statement of Principles. 6

Schedule 1 - Dictionary............................................................................................. 7

1Definitions.................................................................................................................................. 7

1. Name

This is the Statement of Principles concerning blepharitis (Balance of Probabilities) (No. 30 of 2019).

1. Commencement

This instrument commences on 25 March 2019.

1. Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

1. Repeal

The Statement of Principles concerning blepharitis No. 64 of 2010 (Federal Register of Legislation No. F2010L02303) made under subsection 196B(3) of the VEA is repealed.

1. Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

1. Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

1. Kind of injury, disease or death to which this Statement of Principles relates

(1)This Statement of Principles is about blepharitis and death from blepharitis.

Meaning of blepharitis

(2)For the purposes of this Statement of Principles, blepharitis:

(a)means inflammation of the eyelid margins or glands of the eyelid; and

(b)includes acute blepharitis, chronic blepharitis, chalazion (Meibomian cyst) and hordeolum (stye); and

(c)excludes orbital or periorbital cellulitis, dacryoadenitis and dacryocystitis.

Note 1: Blepharitis typically presents with itchiness, redness, flaking and crusting of the eyelids.

Note 2: Chalazion typically presents as a painless, localised eyelid swelling or cyst.

Note 3: Hordeolum typically presents as an abscess or cyst of the eyelid, with localised, painful, red swelling of the eyelid.

Death from blepharitis

(3)For the purposes of this Statement of Principles, blepharitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's blepharitis.

Note: terminal event is defined in the Schedule 1 – Dictionary.

1. Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that blepharitis and death from blepharitis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

1. Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, blepharitis or death from blepharitis is connected with the circumstances of a person's relevant service:

(1)having an infection of the affected eyelid at the time of the clinical onset of blepharitis;

Note: infection of the affected eyelid is defined in the Schedule 1 - Dictionary.

(2)having an infestation of the affected eyelid region, due to a parasite from the specified list of parasites, at the time of the clinical onset of blepharitis;

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

(3)having a smallpox immunisation within the two weeks before the clinical onset of blepharitis;

(4)having seborrhoeic dermatitis of the periocular region at the time of the clinical onset of blepharitis;

(5)having rosacea of the periocular region at the time of the clinical onset of blepharitis;

(6)having psoriasis of the periocular region at the time of the clinical onset of blepharitis;

(7)having discoid lupus erythematosus of the periocular region at the time of the clinical onset of blepharitis;

(8)having ocular or periocular exposure to an allergen within the 48 hours before the clinical onset of blepharitis;

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

(9) having an irritant substance exposure to the region of the affected eye at the time of the clinical onset of blepharitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(10)having mustard gas exposure to the region of the affected eye at the time of the clinical onset of blepharitis;

(11)undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical onset of blepharitis;

(12)having a benign or malignant neoplasm affecting the affected eyelid at the time of the clinical onset of blepharitis;

(13)having dry eye disease at the time of the clinical onset of blepharitis;

Note: dry eye disease is defined in the Schedule 1 - Dictionary.

(14)being in an immunocompromised state as specified at the time of the clinical onset of blepharitis;

Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.

(15)taking oral isotretinoin or oral acitretin for a continuous period of at least one year before the clinical onset of blepharitis, and where treatment has ceased, the clinical onset of blepharitis has occurred within 30 days of cessation;

(16)having an infection of the affected eyelid at the time of the clinical worsening of blepharitis;

Note: infection of the affected eyelid is defined in the Schedule 1 - Dictionary.

(17)having an infestation of the affected eyelid region, due to a parasite from the specified list of parasites, at the time of the clinical worsening of blepharitis;

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

(18)having seborrhoeic dermatitis of the periocular region at the time of the clinical worsening of blepharitis;

(19)having rosacea of the periocular region at the time of the clinical worsening of blepharitis;

(20)having psoriasis of the periocular region at the time of the clinical worsening of blepharitis;

(21)having discoid lupus erythematosus of the periocular region at the time of the clinical worsening of blepharitis;

(22)having ocular or periocular exposure to an allergen within the 48 hours before the clinical worsening of blepharitis;

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

(23) having an irritant substance exposure to the region of the affected eye at the time of the clinical worsening of blepharitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(24)having mustard gas exposure to the region of the affected eye at the time of the clinical worsening of blepharitis;

(25)undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical worsening of blepharitis;

(26)having a benign or malignant neoplasm affecting the affected eyelid at the time of the clinical worsening of blepharitis;

(27)having dry eye disease at the time of the clinical worsening of blepharitis;

Note: dry eye disease is defined in the Schedule 1 - Dictionary.

(28)being in an immunocompromised state as specified at the time of the clinical worsening of blepharitis;

Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.

(29)inability to obtain appropriate clinical management for blepharitis.

1. Relationship to service

(1)The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)The factors set out in subsections 9(16) to 9(29) apply only to material contribution to, or aggravation of, blepharitis where the person's blepharitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.

1. Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)if a factor referred to in section 9 applies in relation to a person; and

(2)that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary

Note: See Section 6

1. Definitions

In this instrument:

allergen means an antigenic substance capable of producing an immune response leading to allergic contact dermatitis.

blepharitis—see subsection 7(2).

chronic renal failure means:

(a)having a glomerular filtration rate of less than 15 mL/min/1.73 m² for a period of at least three months; or

(b)a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or

(c)undergoing chronic dialysis.

dry eye disease means a disease caused by a chronic lack of sufficient lubrication and moisture on the surface of the affected eye.

Note: Examples of conditions associated with a chronic lack of sufficient lubrication and moisture on the surface of the eye include, but are not limited to:

(a)    dysfunctional tear syndrome;

(b)   keratitis sicca;

(c)    keratoconjunctivitis sicca;

(d)   Meibomian gland dysfunction; 

(e)    Sjögren syndrome;

(f)    vitamin A deficiency; or

(g)   xerophthalmia.

immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:

(a)being treated with an immunosuppressive drug;

(b)having a haematological or solid organ malignancy;

(c)having chronic renal failure;

(d)having infection with human immunodeficiency virus;

(e)having severe malnutrition; or

(f)undergoing solid organ, stem cell or bone marrow transplantation.

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

immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.

Note: Examples of an immunosuppressive drug include, but are not limited to:

(a)     chemotherapeutic agents used for the treatment of cancer;

(b)     corticosteroids, other than inhaled or topical corticosteroids;

(c)     drugs used to prevent transplant rejection; or

(d)     tumour necrosis factor-α inhibitors.

infection of the affected eyelid means a bacterial, viral or fungal infection involving the skin, hair follicles or glands of the affected eyelid.

irritant substance means a chemical which causes an inflammatory effect on living tissue by chemical action at the site of contact, leading to irritant contact dermatitis.

MRCAmeans the Military Rehabilitation and Compensation Act 2004.

relevant service means:

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

(b)defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

specified list of parasites means:

(a)Demodex folliculorum or Demodex brevis mites; or

(b)Phthirus pubis lice.

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

(a) pneumonia;

(b) respiratory failure;

(c) cardiac arrest;

(d) circulatory failure; or

(e) cessation of brain function.

VEA means the Veterans' Entitlements Act 1986.