REPATRIATION MEDICAL AUTHORITY
INSTRUMENT NO. 50 of 2014
VETERANS’ ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
EXPLANATORY NOTES FOR TABLING
- The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans’ Entitlements Act 1986 (the VEA), revokes Instrument No. 20 of 2003 determined under subsection 196B(3) of the VEA concerning atrial fibrillation, and Instrument No. 72 of 2002 determined under subsection 196B(3) of the VEA concerning atrial flutter.
2. The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that atrial fibrillation and atrial flutter and death from atrial fibrillation and atrial flutter 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, Instrument No. 50 of 2014 concerning atrial fibrillation and atrial flutter. This Instrument will in effect replace the revoked Statements of Principles.
3. The provisions of the Military Rehabilitation and Compensation Act 2004 (the MRCA) relating to claims for compensation commenced on 1 July 2004. Claims under section 319 of the MRCA for acceptance of liability for a service injury sustained, a service disease contracted or service death on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to Statements of Principles issued by the Authority pursuant to the VEA.
4. 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, atrial fibrillation and atrial flutter or death from atrial fibrillation and atrial flutter is connected with the circumstances of that service.
5. This Instrument results from investigations notified by the Authority in the Government Notices Gazette of 18 May 2011 concerning atrial fibrillation and in the Government Notices Gazette of 30 June 2010 concerning atrial flutter, in accordance with section 196G of the VEA. The investigations involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.
6. The contents of this Instrument are in similar terms as the revoked Instruments. Comparing this Instrument and the revoked Instruments, the differences include:
- combining the separate Instruments for atrial fibrillation and atrial flutter into an Instrument entitled 'atrial fibrillation and atrial flutter';
- adopting the latest revised Instrument format, which commenced in 2005;
- new definition of 'atrial fibrillation and atrial flutter' in clause 3;
- revising factor 6(a) concerning 'valvular heart disease';
- revising factor 6(b) concerning 'ischaemic heart disease';
- revising factor 6(c) concerning 'myocarditis';
- revising factor 6(d) concerning 'cardiomyopathy';
- new factor 6(e) concerning 'familial hypertrophic cardiomyopathy', for clinical onset only;
- revising factor 6(f) concerning 'cardiac failure';
- new factors 6(g) & 6(dd) concerning 'hypertension';
- new factors 6(h) & 6(ee) concerning 'pericarditis';
- revising factor 6(i) concerning 'hyperthyroidism, thyrotoxicosis, Graves' disease or thyrotoxic goitre';
- new factors 6(j) & 6(gg) concerning 'subclinical hyperthyroidism';
- revising factor 6(k) concerning 'alcohol';
- revising factor 6(l) concerning 'cardiac or thoracic surgery';
- new factors 6(m) & 6(jj) concerning 'a surgical procedure';
- revising factor 6(n) concerning 'chronic obstructive pulmonary disease';
- new factor 6(o) concerning 'physical activity';
- new factors 6(p) & 6(ll) concerning 'sick sinus syndrome';
- new factors 6(q) & 6(mm) concerning 'a benign or malignant neoplasm';
- new factors 6(r) & 6(nn) concerning 'a non-neoplastic mass lesion';
- new factors 6(s) & 6(oo) concerning 'diabetes mellitus';
- new factors 6(t) & 6(pp) concerning 'penetrating trauma';
- new factors 6(u) & 6(qq) concerning 'non-penetrating blow to the chest';
- new factors 6(v) & 6(rr) concerning 'a spinal cord injury';
- new factors 6(w) & 6(ss) concerning 'an injury or illness';
- new factors 6(x) & 6(tt) concerning 'being obese';
- new factor 6(y) concerning 'valvular heart disease', for clinical worsening;
- new factor 6(z) concerning 'ischaemic heart disease', for clinical worsening;
- new factor 6(aa) concerning 'myocarditis', for clinical worsening;
- new factor 6(bb) concerning 'cardiomyopathy', for clinical worsening;
- new factor 6(cc) concerning 'cardiac failure', for clinical worsening;
- new factor 6(ff) concerning 'hyperthyroidism, thyrotoxicosis, Graves' disease or thyrotoxic goitre', for clinical worsening;
- new factor 6(hh) concerning 'alcohol', for clinical worsening;
- new factor 6(ii) concerning 'cardiac or thoracic surgery', for clinical worsening;
- new factor 6(kk) concerning 'chronic obstructive pulmonary disease', for clinical worsening;
- deleting the factor concerning 'congenital heart disease' as it is now covered by factor 6(e) concerning 'familial hypertrophic cardiomyopathy';
- deleting the factor concerning 'emphysema' as it is now covered by factors 6(n) & 6(kk) concerning 'chronic obstructive pulmonary disease';
- deleting the factor concerning 'atrial fibrillation';
- new definitions of 'alcohol', 'being obese', 'death from atrial fibrillation and atrial flutter', 'ICD-10-AM code', 'MET', 'spinal cord injury', 'subclinical hyperthyroidism' and 'valvular heart disease' in clause 9;
- revising the definition of 'relevant service' in clause 9;
- deleting the definitions of 'chronic bronchitis with pulmonary obstruction', 'death from atrial fibrillation', 'death from atrial flutter' and 'hyperthyroidism'; and
- specifying a date of effect for the Instrument in clause 11.
7. Further changes to the format of the Instrument reflect the commencement of the MRCA and clarify that pursuant to subsection 196B(3A) of the VEA, the Statement of Principles has been determined for the purposes of both the VEA and the MRCA.
8. Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to atrial fibrillation in the Government Notices Gazette of 18 May 2011 and its intention to undertake an investigation in relation to atrial flutter in the Government Notices Gazette of 30 June 2010, and circulated a copy of the notices 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, 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 during the investigation.
9. On 9 January 2014, 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 a factor relating to atrial fibrillation in respect of the clinical onset of atrial flutter. 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 typographical changes were made to the proposed Instrument following this consultation process.
10. 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.
11. The determining of this Instrument finalises the investigations in relation to atrial fibrillation as advertised in the Government Notices Gazette of 18 May 2011 and in relation to atrial flutter as advertised in the Government Notices Gazette of 30 June 2010.
12. A list of references relating to the above condition is available to any person or organisation referred to in subsection 196E(1)(a) to (c) of the VEA. Any such request must be made in writing to the Repatriation Medical Authority at the following address:
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. 50 of 2014
Kind of Injury, Disease or Death: Atrial fibrillation and atrial flutter
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(8) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).
2. This Legislative Instrument:-
- facilitates claimants in making, and the Repatriation 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 atrial fibrillation or atrial flutter;
- 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, atrial fibrillation or atrial flutter is connected with the circumstances of eligible service rendered by a person, as set out in clause 4 of the Explanatory Notes;
- replaces Instrument No. 20 of 2003 concerning atrial fibrillation and Instrument No. 72 of 2002 concerning atrial flutter; and
- reflects developments in the available sound medical-scientific evidence concerning atrial fibrillation and atrial flutter which have occurred since those earlier instruments were 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, ICSECR; 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, ICSECR 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; and
- the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD).
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.