Statement of Principles concerning bronchiectasis No. 59 of 2001

Administered by Department of Veterans' Affairs

Legislation au F2005B01763 Not in force Legislative Instrument

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Instrument No.59 of 2001

 

Revocation and Determination

of

Statement of Principles

concerning

 

BRONCHIECTASIS

 

ICD-10-AM CODE: J47

 

Veterans’ Entitlements Act 1986

 

 

1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):

 

(a) revokes Instrument No.35 of 1997; and

 

(b) determines in its place the following Statement of Principles.

 

Kind of injury, disease or death

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

 

(b)              For the purposes of this Statement of Principles, “bronchiectasisbronchiectasis” means irreversible focal or generalised bronchial dilatation of medium sized airways, attracting ICD code J47.  It does not include congenital bronchiectasis, or bronchiectasis associated with cystic fibrosis, alpha-1-antitrypsin deficiency or other genetic disorders.

 

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that bronchiectasis and death from bronchiectasis 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 bronchiectasis or death from bronchiectasis with the circumstances of a person’s relevant service are:

 

(a) suffering from pneumonia before the clinical onset of bronchiectasis, with continual or recurrent respiratory symptoms in the interval between that episode of pneumonia and the clinical onset of bronchiectasis; or

 

(b) suffering from mycobacterial infection of the affected area of the lung before the clinical onset of bronchiectasis; or

 

(c) suffering from sarcoidosis of the lung before the clinical onset of bronchiectasis; or

 

(d) suffering from bronchial obstruction before the clinical onset of bronchiectasis, where the bronchiectasis is distal to that obstruction; or

 

(e)               inhaling toxic gases or fumes within the 90 days before the clinical onset of bronchiectasis; or

 

(f)                inhaling mustard gas before the clinical onset of bronchiectasis; or

 

(g)               aspirating gastric contents, resulting in acute respiratory distress within the 90 days before the clinical onset of bronchiectasis; or

 

(h) suffering from allergic bronchopulmonary aspergillosis at the time of the clinical onset of bronchiectasis; or

 

(j) undergoing a lung or heart-lung transplantation before the clinical onset of bronchiectasis in the transplanted lung; or

 

(k)               having suffered from collapse or fibrosis of the segment of the lung affected by bronchiectasis before the clinical onset of bronchiectasis; or

 

(m) suffering from pneumonia within the one year before the clinical worsening of bronchiectasis; or

 

(n) suffering from mycobacterial infection of the affected area of the lung before the clinical worsening of bronchiectasis; or

 

(o) suffering from sarcoidosis of the lung before the clinical worsening of bronchiectasis; or

 

(p) suffering from bronchial obstruction before the clinical worsening of bronchiectasis, where the bronchiectasis is distal to that obstruction; or

 

(q)               inhaling toxic gases or fumes within the 90 days before the clinical worsening of bronchiectasis; or

 

(r)                inhaling mustard gas before the clinical worsening of bronchiectasis; or

 

(s) aspirating gastric contents, resulting in acute respiratory distress within the 90 days before the clinical worsening of bronchiectasis; or

 

(t) suffering from allergic bronchopulmonary aspergillosis at the time of the clinical worsening of bronchiectasis; or

 

(u) having suffered from collapse or fibrosis of the segment of the lung affected by bronchiectasis before the clinical worsening of bronchiectasis; or

 

(v)              inability to obtain appropriate clinical management for bronchiectasis.

 

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(m) to 5(v) apply only to material contribution to, or aggravation of, bronchiectasis where the person’s bronchiectasis 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:

 

“acute respiratory distress” means sudden onset of deterioration in respiratory function with symptoms or signs of tachypnoea, cyanosis, dyspnoea, hypoxaemia, or wheezing;

 

“allergic bronchopulmonary aspergillosis” means a condition where patients with pre-existing asthma and eosinophilia (>1000 eosinophils/micro litre) develop immediate wheal-and-flare response to Aspergillus fumigatus, serum precipitins to A fumigatus, elevated serum IgE, fleeting pulmonary infiltrates from bronchial plugging and central bronchiectasis;

 

“inhaling toxic gases or fumes” means inhaling anhydrous ammonia fumes, smoke, oxides of sulphur, chlorine or phosgene, resulting in acute respiratory distress with evidence of pulmonary oedema or evidence of pneumonitis;

 

“bronchial obstruction” means partial or complete blockage of a bronchus;

 

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

 

“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;

 

“mycobacterial infection” means infection by mycobacterium tuberculosis or non-tuberculous mycobacteria;

 

“pneumonia” means inflammation of the lung with clinical or radiological evidence of consolidation;


“relevant service” means:

 

(a) operational service; or

(b) peacekeeping service; or

(c) hazardous service;

 

“sarcoidosis” means a chronic, multisystem disorder of unknown cause characterised by an accumulation of T lymphocytes and mononuclear phagocytes, noncaseating epithelioid granulomas, and derangement of the normal tissue architecture in affected organs;

 

“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.

 

Application

9. This Instrument applies to all matters to which section 120A of the Act applied.

 

 

Dated this Fourteenth day of  August               2001

 

 

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

 

KEN DONALD

CHAIRMAN

Overview

The Repatriation Medical Authority has issued Instrument No.59 of 2001 under the Veterans’ Entitlements Act 1986, revoking Instrument No.35 of 1997 and establishing a new Statement of Principles concerning bronchiectasis and death from bronchiectasis. This legislative instrument addresses the need to accurately determine the circumstances under which veterans, members of Peacekeeping Forces, and members of the Forces may be linked to the development of bronchiectasis or death from bronchiectasis as a result of their service. The new Statement of Principles defines bronchiectasis as irreversible focal or generalised bronchial dilatation of medium-sized airways, attracting ICD code J47, excluding congenital bronchiectasis and those associated with specific genetic disorders. The Authority recognises that there is sound medical-scientific evidence to suggest a connection between certain service-related factors and the onset or worsening of bronchiectasis. This legislative instrument outlines specific factors that must be related to relevant service in order to raise a reasonable hypothesis connecting bronchiectasis or death from bronchiectasis with the circumstances of a person's service. These factors include suffering from various respiratory conditions, infections, or obstructions before the clinical onset or worsening of bronchiectasis, or exposure to certain toxic substances. The instrument also clarifies the application of certain factors only to material contribution to, or aggravation of, bronchiectasis where the condition was suffered or contracted before or during relevant service but not arising out of that service. The Statement of Principles is designed to ensure that all relevant factors are properly considered in determining the connection between service and the development of bronchiectasis or death from bronchiectasis.

Scope and Application

The Repatriation Medical Authority, under the Veterans’ Entitlements Act 1986, has established a new Statement of Principles concerning bronchiectasis, which replaces the previous Instrument No.35 of 1997. This legislative instrument focuses on bronchiectasis, defined as irreversible focal or generalised bronchial dilatation of medium-sized airways, attracting ICD code J47, and excludes cases related to congenital bronchiectasis or those associated with cystic fibrosis, alpha-1-antitrypsin deficiency, or other genetic disorders. This Statement of Principles applies to all matters previously governed by section 120A of the Act, specifically targeting veterans, members of Peacekeeping Forces, or members of the Forces who may have developed bronchiectasis or died from it due to their service. The legislation mandates that at least one of the listed factors, such as suffering from pneumonia or inhaling toxic gases or fumes, must be related to the person’s relevant service to establish a connection between the service and the condition. Additionally, certain factors apply only to the material contribution or aggravation of bronchiectasis if it was suffered or contracted before or during the relevant service. The geographic and jurisdictional reach of this legislation is nationwide, as it is under the purview of the Commonwealth, applying to all veterans and relevant service members across Australia.

Key Provisions

The main operative sections of this legislative instrument, Instrument No.59 of 2001, involve the revocation of a previous instrument (Instrument No.35 of 1997) and the determination of a new Statement of Principles concerning bronchiectasis and death from bronchiectasis under the Veterans’ Entitlements Act 1986 (the Act) (sections 1 and 2). The new Statement of Principles provides specific medical criteria that must be met to link bronchiectasis or death from bronchiectasis to the relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces (section 3). At least one of the factors listed in section 5 must be related to the person's service for a reasonable hypothesis to be raised connecting the condition with their service (section 4). The factors include suffering from specific respiratory conditions or exposures before the onset or worsening of bronchiectasis (section 5), and these factors may also apply to material contribution to or aggravation of bronchiectasis (section 6). The obligations and requirements imposed by this Act on the parties it governs include the necessity for veterans, members of Peacekeeping Forces, or members of the Forces to demonstrate that their bronchiectasis or death from bronchiectasis is related to their service. This requires the presence of at least one of the specified factors that must be connected to the person’s relevant service (section 4). The Repatriation Medical Authority is responsible for determining whether the sound medical-scientific evidence supports the connection between the condition and the service (section 3). Additionally, if a relevant factor includes an injury or disease for which there is an existing Statement of Principles, the factors in that Statement must also apply (section 7). Breach of the obligations and requirements set out in this legislative instrument may lead to civil or criminal consequences. Although the specific penalties are not detailed in the text, breaches of the Veterans’ Entitlements Act 1986 can generally result in fines and, in severe cases, imprisonment. The maximum penalties would depend on the specific breach and the provisions of the overarching Act. The Act itself provides for various penalties for fraudulent claims or misrepresentation, which could apply to cases where claimants fail to meet the stipulated requirements for linking bronchiectasis or death from bronchiectasis to their service. The precise penalties would need to be consulted within the context of the overarching Act and relevant case law.

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