Statement of Principles concerning aplastic anaemia No. 1 of 2001

Instrument No.1 of 2001

Determination

of

Statement of Principles

concerning

APLASTIC ANAEMIA

ICD-10-AM codeS: D61.1 – D61.9

Veterans’ Entitlements Act 1986

1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act).

Kind of injury, disease or death

2. (a) This Statement of Principles is about aplastic anaemia and death from aplastic anaemia.

(b) For the purposes of this Statement of Principles, “aplastic anaemia” is a disorder of haematopoiesis characterised by pancytopaenia in the peripheral blood and a hypoplastic bone marrow with no signs of granulomatous disease or malignancy in the bone marrow, attracting an ICD-10-AM code in the range D61.1 to D61.9, but excluding agranulocytosis and congenital aplastic anaemia.

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that aplastic anaemia and death from aplastic anaemia can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.

Factors that must be related to service

4. 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

5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting aplastic anaemia or death from aplastic anaemia with the circumstances of a person’s relevant service are:

(a)               undergoing treatment with a drug from the specified list where that treatment has occurred within the 180 days immediately before the clinical onset of aplastic anaemia; or

(b)              taking a drug which has been reported in a peer reviewed medical or scientific publication to have caused aplastic anaemia as an idiosyncratic reaction, within the 180 days immediately before the clinical onset of aplastic anaemia; or

(c)               suffering from fulminant hepatitis within the 180 days immediately before the clinical onset of aplastic anaemia; or

(d)              receiving a course of therapeutic radiation for ankylosing spondylitis within the 180 days immediately before the clinical onset of aplastic anaemia; or

(e)               undergoing liver transplantation for viral hepatitis within the 180 days immediately before the clinical onset of aplastic anaemia; or

(f)                being exposed to at least 10 ppm of benzene (32 mg/m3) as an 8-hour time-weighted average (TWA) on more days than not for at least 60 days within the 180 days immediately before the clinical onset of aplastic anaemia; or

(g)             handling or inhaling organochlorine or organophosphate pesticides within the 180 days immediately before the clinical onset of aplastic anaemia; or

(h)              inability to obtain appropriate clinical management for aplastic anaemia.

Factors that apply only to material contribution or aggravation

6. Paragraph 5(h) applies only to material contribution to, or aggravation of, aplastic anaemia where the person’s aplastic anaemia was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.

Inclusion of Statements of Principles

7. 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

8. For the purposes of this Statement of Principles:

“a drug from the specified list” means one of the following:

(a)               Acetazolamide;

(b)               Busulfan;

(c)               Carbamazepine;

(d)               Chloramphenicol;

(e)               Cyclophosphamide;

(f)                Daunorubicin;

(g)               Doxorubicin;

(h)               Fluorouracil;

(i)                 Gold Salts;

(j)                 Hydantoins;

(k)               Melphalan;

(l)                 Mercaptopurine;

(m)            Methotrexate;

(n)               Mitoxantrone;

(o)               Nitrogen Mustard;

(p)               Oxyphenbutazone;

(q)               Penicillamine;

(r)                Phenylbutazone; or

(s)                Quinacrine (Atebrine);

“death from aplastic anaemia” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s aplastic anaemia;

“fulminant hepatitis” means massive necrosis of the liver of viral origin characterised by jaundice and hepatic encephalopathy;

“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;

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

(c)               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;

“8-hour time-weighted average (TWA)” means the averaging of different exposure levels to benzene during an average exposure period equivalent to eight hours.

Dated this  Third day of  January 2001

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN