REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 75 of 2010

VETERANS’ ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

EXPLANATORY NOTES FOR TABLING

1. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), revokes Instrument No. 41 of 1996, determined under subsection 196B(2) of the VEA concerning pruritus ani.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that chronic pruritus ani and death from chronic pruritus ani can be related to particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles, Instrument No. 75 of 2010 concerning chronic pruritus ani.  This Instrument will in effect replace the revoked Statement 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 as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:

 operational service under the VEA;

 peacekeeping service under the VEA;

 hazardous service under the VEA;

 warlike service under the MRCA;

 non-warlike service under the MRCA,

before it can be said that a reasonable hypothesis has been raised connecting chronic pruritus ani or death from chronic pruritus ani, with the circumstances of that service.

5.             This new Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 25 June 2008 concerning pruritus ani 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.

6.             The contents of the new Instrument are in similar terms as the revoked Instrument.  Comparing the new and the revoked Instruments, the differences include:

• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• changing the name of the Instrument from 'pruritus ani' to 'chronic pruritus ani';
• new definition of 'chronic pruritus ani' in clause 3;
• revising factors 6(a) & 6(m) concerning 'adequate anal hygiene';
• revising factors 6(b) & 6(n) concerning 'diarrhoea';
• revising factors 6(c) & 6(o) concerning 'a rectal or anal condition';
• revising factors 6(d) & 6(p) concerning 'a perianal or anal infection';
• revising factors 6(e) & 6(q) concerning 'a local perianal or anal infestation';
• revising factors 6(f) & 6(r) concerning 'a pathological vaginal discharge';
• revising factors 6(g) & 6(s) concerning 'a dermatological disease';
• revising factors 6(h) & 6(t) concerning 'therapeutic radiation';
• revising factors 6(i) & 6(u) concerning 'corticosteroid related atrophy of the perianal skin';
• revising factors 6(j) & 6(v) concerning 'being systemically treated with water-soluble corticosteroid phosphates';
• revising factors 6(k) & 6(w) concerning 'being treated with nicosamide, clioquinol or mineral oil';
• new factors 6(l) & 6(x) concerning 'a systemic disease';
• new definitions of 'a rectal or anal condition from the specified list', 'a systemic disease from the specified list', 'adequate anal hygiene', 'an agent from the specified list of infections', 'an agent from the specified list of infestations', 'death from chronic pruritus ani' and 'terminal event' in clause 9;
• revising definitions of 'a course of therapeutic radiation', 'a dermatological disease from the specified list', 'a pathological vaginal discharge', 'diarrhoea', and 'relevant service' in clause 9;
• deleting definitions of 'anal hygiene', 'dermatological disease from the specified list', 'high potency topical corticosteroid-containing preparations', 'ICD code', 'malignant lesion of the anal or perianal region', 'perianal area', 'pruritus ani', 'specified list of colorectal or anal conditions', 'specified list of infections and infestations' and 'therapeutic radiation'; 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 pruritus ani in the Government Notices Gazette of 25 June 2008, 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, 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.             The determining of this new Instrument finalises the investigation in relation to pruritus ani as advertised in the Government Notices Gazette of 25 June 2008.

10.         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 Secretariat

GPO Box 1014

BRISBANE    QLD    4001