DECLARATION UNDER SUBSECTION 196B(9)
OF THE VETERANS’ ENTITLEMENTS ACT 1986
The Repatriation Medical Authority (the Authority), under subsection 196B(9) of the Veterans' Entitlements Act 1986 (the Act), makes the following declaration in respect of the review of the contents of the Statements of Principles in force under the Act concerning migraine, Nos. 7 and 8 of 2018.
The investigation related to "head trauma". The Notice of Investigation was published in the Government Notices Gazette of 3 July 2018.
The Authority proposes to amend Statement of Principles concerning migraine (Reasonable Hypothesis) (No. 7 of 2018), by inserting new factors in subsections 9(2a) and 9(4a) concerning head trauma. In regard to Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018), the Authority declares that it does not propose to amend the existing Statements of Principles, by inclusion of a factor relating to head trauma. The reason is that the new sound medical-scientific evidence available is insufficient to justify an amendment to that Statement of Principles.
Based on biological plausibility and consistent associations of headache with head trauma, there is a reasonable hypothesis that head trauma may be a causal factor for persistent headaches, including migraine headaches. However, the sound medical-scientific evidence is insufficient to establish a probable causal association between head trauma and migraine. The evidence does not clarify the extent to which persistent headaches reported after head injury are due to the injury itself, or to other factors. Limitations of the evidence concerning persistent posttraumatic headache do not allow the factors that may contribute to headaches following head trauma to be individually identified. These limitations include recall and selection bias, variable definitions of head injury and persistent posttraumatic headache, lack of assessment of pre-injury headaches and previous head injuries, lack of consideration of time since head injury, insufficient control for confounding by other injuries or psychosocial factors, lack of prospective follow up after head injuries to identify headache trajectories, and lack of evidence of a dose-response effect by severity of head injury.
In conclusion, the Authority is of the view that the new sound medical-scientific evidence available raises a reasonable hypothesis that migraine can be related to service involving head trauma. However, the new sound medical-scientific evidence does not establish that such a relationship is more probable than not and does not enable the Authority to determine a factor concerning head trauma for inclusion in the Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018), already determined pursuant to subsection 196B(3) of the Act.
The Common Seal of the ) Repatriation Medical Authority ) was affixed at the direction of: ) | |
| PROFESSOR NICHOLAS SAUNDERS AO CHAIRPERSON 26 / 10 / 2018 |
Overview
The Veterans' Entitlements Act 1986 was enacted to provide various benefits to veterans and their families, addressing issues such as income support, health care, and rehabilitation. This legislation was introduced to ensure that veterans who have served in the Australian Defence Force receive the necessary support and care due to their service. The Act was enacted by the Parliament of Australia with the policy objective of acknowledging and compensating for the sacrifices made by veterans and their families. The Repatriation Medical Authority, under subsection 196B(9) of the Act, has recently reviewed the Statements of Principles concerning migraine, specifically Nos. 7 and 8 of 2018, to address the potential causal relationship between head trauma and migraines among veterans. The Authority found that while there is a reasonable hypothesis that head trauma may contribute to persistent headaches, including migraines, the available evidence is insufficient to establish a probable causal association, thus not warranting an amendment to the existing Statements of Principles.
Scope and Application
The Veterans' Entitlements Act 1986 applies to veterans and their dependants who are eligible for Commonwealth pensions or benefits under the Act. The Act's provisions govern the authority's responsibility to review and amend the Statements of Principles concerning veterans' health conditions, ensuring that these principles accurately reflect the latest medical and scientific evidence. The Repatriation Medical Authority, as established under the Act, has the authority to make declarations and amendments to these Statements of Principles. The Authority's recent declaration focuses on the review of Statements of Principles concerning migraine, specifically addressing the potential causal link between migraine and head trauma experienced during service. The Authority proposes to amend one of the Statements of Principles to include new factors regarding head trauma, while deciding against amending the other due to insufficient evidence to establish a probable causal association. The Authority's decision is based on the current limitations in medical-scientific evidence, including issues such as recall bias and lack of prospective follow-up data. This declaration underscores the Authority's commitment to ensuring that the Statements of Principles reflect the most accurate and current understanding of veterans' health conditions.
Key Provisions
The key operative sections of this declaration under subsection 196B(9) of the Veterans' Entitlements Act 1986 relate to the proposed amendments to the Statements of Principles concerning migraine. Specifically, section 9(2a) and section 9(4a) of the respective Statements of Principles are proposed for amendment to include new factors concerning head trauma. The Authority has decided not to amend the Statement of Principles concerning migraine (Balance of Probabilities) (No. 8 of 2018) as the sound medical-scientific evidence available is deemed insufficient to establish a probable causal association between head trauma and migraine (subsection 196B(3)). This decision is based on a thorough review of the available evidence and the limitations identified therein.
The obligations imposed on the Repatriation Medical Authority by this Act include conducting investigations into the contents of the Statements of Principles, such as the review of the link between head trauma and migraine. This involves assessing new sound medical-scientific evidence to determine if it warrants an amendment to the Statements of Principles. Additionally, the Authority must publish notices of investigations in the Government Notices Gazette, as seen in the Notice of Investigation published on 3 July 2018 (subsection 196B(9)). The Authority is also required to make a declaration regarding the proposed amendments and the reasons for not amending the Statements of Principles if the evidence is deemed insufficient.
Any breaches of the obligations or requirements imposed by the Act may result in civil or criminal consequences. Although specific penalties are not detailed in the declaration, under the general provisions of the Veterans' Entitlements Act 1986, penalties for breaches can include fines and, in severe cases, imprisonment. The maximum penalties would depend on the nature and severity of the breach, as well as any specific provisions outlined in other sections of the Act. The Authority's decisions must be made in good faith and based on sound medical-scientific evidence, failure to adhere to these requirements could potentially lead to legal repercussions.