EXPLANATORY STATEMENT
STATEMENT OF PRINCIPLES CONCERNING
AORTIC STENOSIS
(BALANCE OF PROBABILITIES) (NO. 14 OF 2022)
VETERANS' ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
- This is the Explanatory Statement to the Statement of Principles concerning aortic stenosis (Balance of Probabilities) (No. 14 of 2022).
Background
2. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 22 of 2013 (Federal Register of Legislation No. F2013L00719) determined under subsections 196B(3) and (8) of the VEA concerning aortic stenosis.
3. The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that aortic stenosis and death from aortic stenosis can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles concerning aortic stenosis (Balance of Probabilities) (No. 14 of 2022). This Instrument will in effect replace the repealed Statement of Principles.
Purpose and Operation
4. The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).
5. The Statement of Principles sets out the factors that must exist, and which of those factors must be related to the following kinds of service rendered by a person:
eligible war service (other than operational service) under the VEA;
defence service (other than hazardous service and British nuclear test defence service) under the VEA;
peacetime service under the MRCA,
before it can be said that, on the balance of probabilities, aortic stenosis or death from aortic stenosis is connected with the circumstances of that service. The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.
6. This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 5 January 2021 concerning aortic stenosis in accordance with section 196G of the VEA. The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.
7. The contents of this Instrument are in similar terms as the repealed Instrument. Comparing this Instrument and the repealed Instrument, the differences include:
- adopting the latest revised Instrument format, which commenced in 2015;
- specifying a day of commencement for the Instrument in section 2;
- revising the definition of 'aortic stenosis' in subsection 7(2);
- revising the reference to 'ICD-10-AM code' in subsection 7(4);
- new factors in subsections 9(2) and 9(12) concerning having a systemic autoimmune connective tissue disease;
- new factors in subsections 9(3) and 9(13) concerning having chronic kidney disease;
- new factors in subsections 9(4) and 9(14) concerning having hypertension;
- revising the factors in subsections 9(5) and 9(15) concerning having dyslipidaemia, by the inclusion of a note;
- new factors in subsections 9(6) and 9(16) concerning having diabetes mellitus;
- new factors in subsections 9(7) and 9(17) concerning being overweight or obese;
- new factors in subsections 9(8) and 9(18) concerning having smoked tobacco products;
- revising the factors in subsections 9(9) and 9(19) concerning having received ionising radiation to the heart, by the inclusion of a note;
- new factors in subsections 9(10) and 9(20) concerning undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation;
- new factor in subsection 9(21) concerning being pregnant, for clinical worsening only;
- new factor in subsection 9(22) concerning having surgery requiring a general, spinal or epidural anaesthetic, for clinical worsening only and for symptomatic or severe aortic stenosis only;
- deleting the factors concerning having systemic lupus erythematosus or rheumatoid arthritis, as these are now covered by the factors in subsections 9(2) and 9(12) concerning having a systemic autoimmune connective tissue disease;
- deleting the factors concerning having chronic renal disease requiring renal transplantation or dialysis, as these are now covered by the factors in subsections 9(3) and 9(13) concerning having chronic kidney disease;
- new definitions of 'albuminuria', 'being overweight or obese', 'BMI', 'chronic kidney disease', 'MRCA', 'one pack-year', 'severe aortic stenosis' and 'VEA' in Schedule 1 - Dictionary;
- revising the definitions of 'dyslipidaemia' and 'relevant service' in
Schedule 1 - Dictionary; and - deleting the definition of 'infective endocarditis'.
Incorporation
8. The definition of "cumulative equivalent dose" contained in the Schedule 1 – Dictionary incorporates the Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017. This writing is incorporated pursuant to subsection 14(b) of the Legislation Act 2003.
9. A copy of this document is available to any person on the website of the Repatriation Medical Authority at www.rma.gov.au or from the Repatriation Medical Authority, Level 8, 480 Queen St, Brisbane, Queensland 4000, by contacting the Registrar on telephone (07) 3815 9404.
Consultation
10. Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to aortic stenosis in the Government Notices Gazette of 5 January 2021, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants. The Authority invited submissions from the Repatriation Commission, the Military Rehabilitation and Compensation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field. No submissions were received for consideration by the Authority in relation to the investigation.
11. On 6 August 2021, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority. This letter emphasised the deletion of factors relating to having alkaptonuria before the clinical onset of aortic stenosis and having alkaptonuria before the clinical worsening of aortic stenosis from the reasonable hypothesis Statement of Principles. The Authority provided an opportunity to the organisations to make representations in relation to the proposed Instrument prior to its determination. No submissions were received for consideration by the Authority. Minor changes were made to the proposed Instrument following this consultation process.
Human Rights
12. This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. A Statement of Compatibility with Human Rights follows.
Finalisation of Investigation
13. The determining of this Instrument finalises the investigation in relation to aortic stenosis as advertised in the Government Notices Gazette of 5 January 2021.
References
14. A list of references relating to the above condition is available on the Authority’s website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:
Email: info@rma.gov.au
Post: The Registrar
Repatriation Medical Authority
GPO Box 1014
BRISBANE QLD 4001
Statement of Compatibility with Human Rights
(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)
Instrument No.: Statement of Principles No. 14 of 2022
Kind of Injury, Disease or Death: Aortic stenosis
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
1. This Legislative Instrument is determined pursuant to subsection 196B(3) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA). Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.
2. This Legislative Instrument:-
- facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have aortic stenosis;
- facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
- outlines the factors which the current sound medical-scientific evidence indicates must exist before it can be said that, on the balance of probabilities, aortic stenosis is connected with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
- replaces Instrument No. 22 of 2013 and
- reflects developments in the available sound medical-scientific evidence concerning aortic stenosis which have occurred since that earlier instrument was determined.
3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA.
Human Rights Implications
4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:
- the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
- the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
- the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
- the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
- ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).
Conclusion
This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.
Repatriation Medical Authority
[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.