Statement of Principles concerning secondary parkinsonism No. 39 of 2002 (Cth)
Instrument No.39 of 2002
Revocation and Determination
of
Statement of Principles
concerning
SECONDARY PARKINSONISM
ICD-10-AM CODE: G21
Veterans’ Entitlements Act 1986
The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.71 of 1999; and
(b) determines in its place the following Statement of Principles.
Kind of injury, disease or death
(a) This Statement of Principles is about secondary parkinsonism and death from secondary parkinsonism.
(b)For the purposes of this Statement of Principles, “secondary parkinsonism” means a neurological syndrome of identifiable aetiology, characterised by the presence of any two of the features of bradykinesia, muscular rigidity or a rest tremor of 4-5 Hz, but excludes Parkinson’s disease and parkinsonism associated with other forms of extra pyramidal, basal ganglia or striatopallidal disease including multiple system atrophy, progressive supranuclear palsy, Huntington’s disease, Alzheimer’s disease, syphilis, dementia pugilistica, benign essential tremor or arteriosclerotic pseudoparkinsonism. Secondary parkinsonism attracts ICD-10-AM code G21.
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 secondary parkinsonism and death from secondary parkinsonism can be related to relevant service rendered by veterans or members of the Forces.
Factors that must be related to service
Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
The factors that must exist before it can be said that, on the balance of probabilities, secondary parkinsonism or death from secondary parkinsonism is connected with the circumstances of a person’s relevant service are:
(a)suffering from encephalitis lethargica before the clinical onset of secondary parkinsonism; or
(b)suffering from encephalitis within the 45 days before the clinical onset of secondary parkinsonism; or
(c) being exposed to manganese as specified at least weekly for a period of at least six months within the 10 years before the clinical onset of secondary parkinsonism; or
(d) being exposed to carbon disulphide as specified at least weekly for a period of at least five years within the 10 years before the clinical onset of secondary parkinsonism; or
(e) consuming methyl alcohol (methanol) resulting in plasma levels greater than 60 mmol/L (200mg/dL) and clinical manifestations of convulsions or coma, within the 90 days before the clinical onset of secondary parkinsonism; or
(f) suffering from an hypoxic-ischaemic cerebral insult within the 90 days before the clinical onset of secondary parkinsonism; or
(g) receiving an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 90 days before the clinical onset of secondary parkinsonism; or
(h) suffering from a lesion affecting the brain stem within the 90 days before the clinical onset of secondary parkinsonism; or
(i)undergoing treatment with a drug from the specified list, which cannot be ceased or substituted, at the time of the clinical onset of secondary parkinsonism; or
(j) undergoing treatment with a neuroleptic (antipsychotic) drug, which cannot be ceased or substituted, at the time of the clinical onset of secondary parkinsonism; or
(k) suffering from encephalitis lethargica before the clinical worsening of secondary parkinsonism; or
(l) suffering from encephalitis within the 45 days before the clinical worsening of secondary parkinsonism;
(m)being exposed to manganese as specified at least weekly for a period of at least six months within the 10 years before the clinical worsening of secondary parkinsonism; or
(n) being exposed to carbon disulphide as specified at least weekly for a period of at least five years within the 10 years before the clinical worsening of secondary parkinsonism; or
(o) consuming methyl alcohol (methanol) resulting in plasma levels greater than 60 mmol/L (200mg/dL) and clinical manifestations of convulsions or coma, within the 90 days before the clinical worsening of secondary parkinsonism; or
(p) suffering from an hypoxic-ischaemic cerebral insult within the 90 days before the clinical worsening of secondary parkinsonism; or
(q) receiving an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 90 days before the clinical worsening of secondary parkinsonism; or
(r) suffering from a lesion affecting the brain stem within the 90 days before the clinical worsening of secondary parkinsonism; or
(s)undergoing treatment with a drug from the specified list, which cannot be ceased or substituted, at the time of the clinical worsening of secondary parkinsonism; or
(t) undergoing treatment with a neuroleptic (antipsychotic) drug, which cannot be ceased or substituted, at the time of the clinical worsening of secondary parkinsonism; or
(u) inability to obtain appropriate clinical management for secondary parkinsonism.
Factors that apply only to material contribution or aggravation
Paragraphs 5(k) to 5(u) apply only to material contribution to, or aggravation of, secondary parkinsonism where the person’s secondary parkinsonism was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(d) of the Act refers.
Inclusion of Statements of Principles
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.
Other definitions
For the purposes of this Statement of Principles:
“a lesion affecting the brain stem” means an insult or injury that destroys the nigrostriatal pathway of the brain stem, and which is caused by:
(a) an intracranial space occupying lesion that impinges directly on the brainstem or which causes signs or symptoms of brainstem dysfunction, and which is due to neoplasm, abscess, tuberculoma, or cyst; or
(b) an episode of cerebral ischaemia or intracerebral haemorrhage that directly impinges on the brainstem or that causes signs or symptoms of brainstem dysfunction; or
(c) a direct penetrating injury to the brainstem or blunt trauma to the head that produces unconsciousness or causes signs or symptoms of brainstem dysfunction;
“being exposed to manganese as specified” means
(a) working in the mining or smelting of ores containing manganese; or
(b) welding with rods containing manganese; or
(c) inhaling dust containing manganese; or
(d) handling fungicides containing manganese;
“being exposed to carbon disulphide as specified” means working in the manufacture of viscose rayon, cellophane or carbon tetrachloride, or working in close contact with grain fumigants containing carbon disulphide;
“death from secondary parkinsonism” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s secondary parkinsonism;
“hypoxic-ischaemic cerebral insult” means acute cerebral anoxia due to cardiorespiratory failure or carbon monoxide poisoning;
“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), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3. Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;
“relevant service” means:
(a) eligible war service (other than operational service); or
(b)defence service (other than hazardous service);
“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;
“undergoing treatment with a drug from the specified list” means therapeutic administration of one of the following drugs:
amiodarone
amoxapine
amphotericin B
aprindine
amlodipine
bethanechol
buphormine
captopril
cephaloridine
cimetidine
cinnarizine
cisapride
clebopride
clopamide-pindolol combination
cyclosporine
cytosine arabinoside
diazepam
diltiazem
disulfiram
flunarizine
5-fluorouracil
fluoxetine
hexamethylmelamine
interferon-a
lithium
manidipine
meperidine
a-methyldopa
metoclopramide
paroxetine
perhexiline
phenelzine
phenytoin
prenylamine
procaine
pyridostigmine
reserpine
sertraline
tetrabenazine
trazodone
valproate
verapamil
Application
This Instrument applies to all matters to which section 120B of the Act applies.
Dated this Sixteenth day of April 2002
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN
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