Statement of Principles concerning endometriosis (Reasonable Hypothesis) (No. 51 of 2021) (Cth)

Statement of Principles

concerning

ENDOMETRIOSIS
(Reasonable Hypothesis)

(No. 51 of 2021)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated    23 April 2021

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............................................................................................................. 5

11Factors referring to an injury or disease covered by another Statement of Principles. 5

Schedule 1 - Dictionary............................................................................................. 6

1Definitions.................................................................................................................................. 6

1. Name

This is the Statement of Principles concerning endometriosis (Reasonable Hypothesis) (No. 51 of 2021).

1. Commencement

This instrument commences on 24 May 2021.

1. Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

1. Repeal

The Statement of Principles concerning endometriosis No. 41 of 2012 (Federal Register of Legislation No. F2012L01355) made under subsection 196B(2) of the VEA is repealed.

1. Application

This instrument applies to a claim to which section 120A of the VEA or section 338 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 endometriosis and death from endometriosis.

Meaning of endometriosis

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

(a)means a condition in females in which functional endometrial tissue occurs outside the uterus, resulting in clinical symptoms and signs or warranting treatment; and

(b)excludes adenomyosis.

Note: Endometriosis commonly manifests with abdominal pain, a pelvic mass or infertility.

(3)While endometriosis attracts ICD‑10‑AM code N80, in applying this Statement of Principles the meaning of endometriosis is that given in subsection (2).

(4)For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from endometriosis

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

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

1. Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that endometriosis and death from endometriosis can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting endometriosis or death from endometriosis with the circumstances of a person's relevant service:

(1)having penetrating trauma or surgery involving the site of subsequent endometriosis before the clinical onset of endometriosis;

(2)having a caesarean section within the five years before the clinical onset of endometriosis;

(3)being underweight for a period of at least one year while aged 18 years or younger before the clinical onset of endometriosis;

Note: being underweight is defined in the Schedule 1 - Dictionary.

(4)taking estrogen only menopausal hormone therapy for the three months before the clinical onset of endometriosis;

Note: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.

(5)taking tamoxifen for the six months before the clinical onset of endometriosis;

(6)for parous women only, inability to breast feed for a cumulative period of at least three months before the clinical onset of endometriosis;

Note: The period of breastfeeding could be cumulative over a number of pregnancies.

(7)experiencing severe childhood abuse before the clinical onset of endometriosis;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(8)having pelvic inflammatory disease or endometritis before the clinical onset of endometriosis;

(9)taking estrogen only menopausal hormone therapy for the three months before the clinical worsening of endometriosis;

Note: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.

(10)taking tamoxifen for the six months before the clinical worsening of endometriosis;

(11)for parous women only, inability to breast feed for a cumulative period of at least three months before the clinical worsening of endometriosis;

Note: The period of breastfeeding could be cumulative over a number of pregnancies.

(12)having pelvic inflammatory disease or endometritis before the clinical worsening of endometriosis;

(13)inability to obtain appropriate clinical management for endometriosis.

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(9) to 9(13) apply only to material contribution to, or aggravation of, endometriosis where the person's endometriosis 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(2) 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:

being underweight means having a Body Mass Index (BMI) of 18.5 or less.

Note: BMI is also defined in the Schedule 1 - Dictionary.

BMI means W/H² where:

(a)W is the person's weight in kilograms; and

(b)H is the person's height in metres.

endometriosis—see subsection 7(2).

menopausal hormone therapy means administration of hormone preparations to offset a hormone deficiency following surgically induced or naturally occurring menopause.

MRCAmeans the Military Rehabilitation and Compensation Act 2004.

relevant service means:

(a)operational service under the VEA;

(b)peacekeeping service under the VEA;

(c)hazardous service under the VEA;

(d)British nuclear test defence service under the VEA;

(e)warlike service under the MRCA; or

(f)non-warlike service under the MRCA.

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

severe childhood abuse means:

(a)serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or

(b)neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;

where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.

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.