Statement of Principles concerning myasthenia gravis No. 15 of 2007 (Cth)

Statement of Principles

concerning

MYASTHENIA GRAVIS

No. 15 of 2007

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 myasthenia gravis No. 15 of 2007.

Determination

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

(a)       revokes Instrument No. 263 of 1995 concerning myasthenia gravis; and

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

Kind of injury, disease or death

1. (a)        This Statement of Principles is about myasthenia gravis and death from myasthenia gravis.

(b)For the purposes of this Statement of Principles, "myasthenia gravis" means an autoimmune neuromuscular disorder characterised by weakness and fatigability of skeletal muscles.  This definition excludes myasthenic syndromes.

(c)Myasthenia gravis attracts ICD-10-AM code G70.0.

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

Basis for determining the factors

1. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that myasthenia gravis and death from myasthenia gravis 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 Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

1. 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

1. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting myasthenia gravis or death from myasthenia gravis with the circumstances of a person’s relevant service is:

(a)having systemic treatment with a drug from Specified List 1 at the time of the clinical onset of myasthenia gravis; or

(b)being treated with a drug from a class of drugs in the Specified List at the time of the clinical worsening of myasthenia gravis; or

(c)being treated with a drug from Specified List 2 at the time of the clinical worsening of myasthenia gravis; or

(d)having an injection of iothalamic acid, diatrizoate meglumine, or diatrizoate sodium, within the 24 hours before the clinical worsening of myasthenia gravis; or

(e)being pregnant at the time of the clinical worsening of myasthenia gravis; or

(f)having bone marrow transplantation before the clinical worsening of myasthenia gravis; or

(g)inability to obtain appropriate clinical management for myasthenia gravis.

Factors that apply only to material contribution or aggravation

1. Paragraphs 6(b) to 6(g) apply only to material contribution to, or aggravation of, myasthenia gravis where the person’s myasthenia gravis was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

1. 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

1. For the purposes of this Statement of Principles:

"a drug from Specified List 1" means:

(a)chloroquine;

(b)lithium carbonate;

(c)penicillamine;

(d)phenytoin; or

(e)trimethadione;

"a drug from Specified List 2" means any of the drugs (including where those drugs are contained in preparations) listed in the following Table of Drugs:

Table of Drugs

acetazolamide	erythromycin	phenytoin
ampicillin	interferon alpha	polymyxin B
atracurium	kanamycin	practolol
bacitracin	lidocaine	procainamide
chloroquine	lithium carbonate	procaine
cilastin sodium	mefloquine	propranolol
ciprofloxacin	nitrofurantoin	proguanil
colistin sulphate	norfloxacin	quinine
diphenylhydantoin	oxprenolol	streptomycin
doxycycline	penicillamine	trimethadione

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

"drug from a class of drugs in the Specified List" means:

(a)anticholinergic agent;

(b)beta-blocking agent;

(c)calcium channel blocker; or

(d)systemic corticosteroid;

"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), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;

"relevant service" means:

(a)     operational service under the VEA;

(b)     peacekeeping service under the VEA;

(c)     hazardous service under the VEA;

(d)     warlike service under the MRCA; or

(e)     non-warlike 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.

Application

1. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.

Date of effect

1. This Instrument takes effect from 10 January 2007.

Dated this   eighteenth         day of              December    2006

The Common Seal of the    )

Repatriation Medical Authority                   )

was affixed to this instrument   )

in the presence of:   )

KEN DONALD

CHAIRPERSON