Statement of Principles concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb (Reasonable Hypothesis) (No. 7 of 2021)

Administered by Department of Veterans' Affairs

Legislation au F2021L00020 In force Legislative Instrument

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EXPLANATORY STATEMENT

 

STATEMENT OF PRINCIPLES CONCERNING

CHRONIC VENOUS INSUFFICIENCY OF THE LOWER LIMB AND VARICOSE VEINS OF THE LOWER LIMB

(REASONABLE HYPOTHESIS) (NO. 7 OF 2021)

 

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

 

  1. This is the Explanatory Statement to the Statement of Principles concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb (Reasonable Hypothesis) (No. 7 of 2021).

Background

2.             The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 29 of 2012 (Federal Register of Legislation No. F2012L00460) determined under subsection 196B(2) of the VEA concerning chronic venous insufficiency of the lower limb. 

3.             The Authority, under subsection 196B(8) of the VEA, repeals Instrument No. 120 of 2011 (Federal Register of Legislation No. F2011L02137) determined under subsection 196B(2) of the VEA concerning varicose veins of the lower limb.

4.             The Authority is of the view that there is sound medical-scientific evidence that indicates that chronic venous insufficiency of the lower limb or varicose veins of the lower limb and death from chronic venous insufficiency of the lower limb or varicose veins of the lower limb 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 concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb (Reasonable Hypothesis) (No. 7 of 2021).  This Instrument will in effect replace the repealed Statements of Principles.

Purpose and Operation

5.             The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

6.             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;

 British nuclear test defence 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 venous insufficiency of the lower limb or varicose veins of the lower limb or death from chronic venous insufficiency of the lower limb or varicose veins of the lower limb, with the circumstances of that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

7.             This new Instrument results from two discrete investigations notified by the Authority in the Government Notices Gazette of 7 May 2019 concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb, respectively, in accordance with section 196G of the VEA.  These investigations involved an examination of the available sound medical-scientific evidence for each condition.  The Authority concluded that it would determine Statements of Principles that cover both chronic venous insufficiency of the lower limb and varicose veins of the lower limb for two reasons.  Firstly, since chronic venous insufficiency of the lower limb and varicose veins of the lower limb are part of the continuum of chronic venous disease of the lower limb, the ease of use of the Statements of Principles is facilitated by having Instruments that cover both conditions rather than separate Instruments.  Secondly, the sound medical-scientific evidence demonstrates substantial overlap in the risk factors for the clinical onset and clinical worsening of these conditions.

8.             The contents of this Instrument are in similar terms as the repealed Instruments.  Comparing this Instrument and the repealed Instruments, 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 'chronic venous insufficiency of the lower limb' in subsection 7(2);
  • revising the definition of 'varicose veins of the lower limb' in subsection 7(3);
  • revising the reference to 'ICD-10-AM code' in subsection 7(5);
  • revising the factors in subsections 9(1) and 9(12) concerning having deep vein thrombosis within a deep vein that drains the affected lower limb;
  • revising the factors in subsections 9(2) and 9(13) concerning having chronic complete or partial obstruction of a vein that drains the affected lower limb;
  • revising the factors in subsections 9(4) and 9(15) concerning continuous standing;
  • revising the factors in subsections 9(5) and 9(16) concerning having chronic dysfunction of the calf muscle pump in the affected lower limb;
  • revising the factors in subsections 9(6) and 9(17) concerning being obese, by the inclusion of a note;
  • new factors in subsections 9(9) and 9(20) concerning having tricuspid valve regurgitation, in the presence of a pulsatile greater saphenous vein;
  • new factors in paragraphs 9(10)(b) and 9(21)(b) concerning having heart failure, for chronic venous insufficiency of the lower limb only;
  • new definitions of 'BMI', 'MRCA' and 'VEA' in Schedule 1 - Dictionary; and
  • revising the definitions of 'being obese' , 'deep vein that drains the affected lower limb' and 'relevant service' in Schedule 1 - Dictionary.

Consultation

9.             Prior to determining this Instrument, the Authority advertised its intention to undertake investigations in relation to chronic venous insufficiency of the lower limb and varicose veins of the lower limb, respectively, in the Government Notices Gazette of 7 May 2019, 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.  One submission was received for consideration by the Authority in relation to the investigation concerning varicose veins of the lower limb.

Human Rights

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.

Finalisation of Investigation

11.         The determining of this Instrument finalises the investigations in relation to chronic venous insufficiency of the lower limb and varicose veins of the lower limb, respectively, as advertised in the Government Notices Gazette of 7 May 2019.

References

12.         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. 7 of 2021

Kind of Injury, Disease or Death: Chronic venous insufficiency of the lower limb and varicose veins of the lower limb

 

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(2) 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 chronic venous insufficiency of the lower limb or varicose veins of the lower limb;
  • 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 as a minimum exist, before it can be said that a reasonable hypothesis has been raised, connecting chronic venous insufficiency of the lower limb or varicose veins of the lower limb with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
  • replaces Instrument No. 29 of 2012 and Instrument No. 120 of 2011; and
  • reflects developments in the available sound medical-scientific evidence concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb which have occurred since that 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;
  • 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.

Overview

The Statement of Principles concerning Chronic Venous Insufficiency of the Lower Limb and Varicose Veins of the Lower Limb (Reasonable Hypothesis) (No. 7 of 2021) was enacted in 2021 under the authority of the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. This legislative instrument was introduced to address the gap left by the repealed Instruments No. 29 of 2012 and No. 120 of 2011, which previously outlined the factors connecting chronic venous insufficiency of the lower limb and varicose veins of the lower limb with particular kinds of service. The Repatriation Medical Authority, acting under subsection 196B(2) of the Veterans' Entitlements Act 1986, determined this new Statement of Principles to ensure that veterans and current or former Defence Force members receive the appropriate medical treatment and compensation for these conditions when connected to their service. The policy objective is to facilitate claims and assessments by specifying the minimum factors that must exist, as supported by sound medical-scientific evidence, to establish a reasonable hypothesis of connection between the conditions and the service rendered. The Statement of Principles serves to outline the necessary factors for consideration in claims under both the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004, ensuring that the qualifying conditions for benefits are reasonable, proportionate, and transparent. By replacing the previous instruments and reflecting updated medical-scientific evidence, the new Statement of Principles aims to improve the quality of outcomes and promote the human rights of veterans, Defence Force members, and their dependents, including their rights to social security, an adequate standard of living, and the highest attainable standard of physical and mental health.

Scope and Application

The Statement of Principles concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb (Reasonable Hypothesis) (No. 7 of 2021) applies to claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). It outlines the factors that must exist for a reasonable hypothesis to be raised connecting these conditions with particular kinds of service rendered by a person, such as operational, peacekeeping, hazardous, British nuclear test defence, warlike, or non-warlike service. The instrument is designed to facilitate claimants in making and assessing claims and to replace the previously repealed Statements of Principles No. 29 of 2012 and No. 120 of 2011. The Statement of Principles applies on a Commonwealth level, affecting veterans and current or former Defence Force members across Australia. The instrument does not specify any exclusions, exemptions, or thresholds, but its application can be extended or restricted through subordinate instruments. This legislative instrument has been determined to be compatible with human rights and does not derogate from any, but rather promotes the human rights of veterans, current and former Defence Force members, and their dependents.

Key Provisions

The Statement of Principles concerning chronic venous insufficiency of the lower limb and varicose veins of the lower limb (Reasonable Hypothesis) (No. 7 of 2021) (the Statement of Principles) sets out the circumstances in which a reasonable hypothesis may be raised that chronic venous insufficiency of the lower limb or varicose veins of the lower limb is related to certain kinds of service (subsection 9(1)). The Statement of Principles applies to claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) (subsection 5(1)). The Statement of Principles sets out the factors that must, as a minimum, exist before it can be said that a reasonable hypothesis has been raised connecting chronic venous insufficiency of the lower limb or varicose veins of the lower limb with the circumstances of particular kinds of service rendered by a person (subsection 5(2)). The Statement of Principles also includes definitions of certain terms used in the Statement (Schedule 1 Dictionary). The Statement of Principles imposes obligations on the parties to claims under the VEA and the MRCA, and the entities responsible for assessing and determining such claims, to consider the factors set out in the Statement of Principles in making and assessing claims for treatment and compensation related to chronic venous insufficiency of the lower limb or varicose veins of the lower limb. The Statement of Principles does not impose any new obligations on parties or entities beyond those already imposed by the VEA and the MRCA. There are no offences, penalties, or civil/criminal consequences for breach of the Statement of Principles itself. However, failure to comply with the VEA or the MRCA, or with any determination or direction made under those Acts, may result in civil or criminal penalties. For example, under section 196D of the VEA, a person who knowingly makes a false or misleading statement in a claim for a benefit under the VEA may be liable to a penalty of up to 200 penalty units ($42,000) for an individual and up to 10,000 penalty units ($2,100,000) for a body corporate. Similarly, under section 196D of the MRCA, a person who knowingly makes a false or misleading statement in a claim for a benefit under the MRCA may be liable to a penalty of up to 200 penalty units ($42,000) for an individual and up to 10,000 penalty units ($2,100,000) for a body corporate. These penalties are in addition to any other civil or criminal penalties that may apply.

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