Instrument No.18 of 1997
Determination
of
Statement of Principles
concerning
COELIAC DISEASE
ICD CODE: 579.0
Veterans’ Entitlements Act 1986
1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act).
Kind of injury, disease or death
2. (a) This Statement of Principles is about coeliac disease and death from coeliac disease.
(b) For the purposes of this Statement of Principles, “coeliac disease” means a chronic malabsorption syndrome due to inflammation in the small intestine precipitated in susceptible individuals by the ingestion of gluten, and which is characterised clinically by a range of gastrointestinal and extraintestinal manifestations which improve upon withdrawal of gluten from the diet, and by specific biopsy-demonstrated histological changes in the small intestine which improve upon withdrawal of gluten from the diet. Coeliac disease is also known as coeliac crisis, gluten sensitive enteropathy or nontropical sprue, attracting ICD code 579.0.
Basis for determining the factors
3. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that coeliac disease and death from coeliac disease can be related to relevant service rendered by veterans or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, the factor set out in the paragraph in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factor that must exist before it can be said that, on the balance of probabilities, coeliac disease or death from coeliac disease is connected with the circumstances of a person’s relevant service is:
(a) inability to obtain appropriate clinical management for coeliac disease, for example, consumption of a gluten containing diet where gluten containing products could not be ceased or substituted at the time of the clinical worsening of coeliac disease.
Factors that apply only to material contribution or aggravation
6. Paragraph 5(a) applies only to material contribution to, or aggravation of, coeliac disease where the person’s coeliac disease was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(d) of the Act refers.
Other definitions
7. For the purposes of this Statement of Principles:
“gluten” means a protein containing an alcohol soluble gliadin fraction which is toxic to the small intestine mucosa of patients with coeliac disease and which is found in wheat, rye and barley cereal grains and in processed food products containing these cereal grains;
“ICD code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;
“relevant service” means:
(a) eligible war service (other than operational service); or
(b) defence service (other than hazardous service).
Dated this Twentieth day of February 1997
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of )
KEN DONALD
CHAIRMAN
Overview
The Statement of Principles concerning Coeliac Disease, determined under the Veterans’ Entitlements Act 1986, was enacted in 1997 to address the gap in recognition of coeliac disease as a service-related condition for veterans. The Repatriation Medical Authority, as the enacting body, established this legislative instrument to provide a clear pathway for veterans suffering from coeliac disease to seek recognition and entitlements. The policy objective is to ensure that veterans who are unable to obtain appropriate clinical management for coeliac disease due to their service circumstances can be compensated appropriately. This determination acknowledges that coeliac disease, a chronic malabsorption syndrome, can be linked to the conditions and exposures encountered during military service, thus warranting consideration for veteran benefits.
Scope and Application
The Statement of Principles concerning Coeliac Disease under the Veterans’ Entitlements Act 1986 applies to veterans and members of the Australian Defence Forces who suffer from coeliac disease or have died from the condition. This legislation seeks to establish a connection between coeliac disease and the service rendered by these individuals. The scope of this determination is specifically tailored to veterans who were unable to obtain appropriate clinical management for coeliac disease during their service, such as instances where a gluten-free diet could not be implemented due to circumstances during their service. The geographic reach of this Act is nationwide as it pertains to all veterans and members of the Defence Forces across Australia. Notably, this Statement of Principles does not extend to operational or hazardous service, as defined within the Act. The application of the Act may be further defined or expanded through subordinate instruments, though the primary focus remains on establishing a link between coeliac disease and relevant service, particularly in terms of access to necessary medical management during service.
Key Provisions
The main operative sections of this Statement of Principles pertain to the recognition of coeliac disease and death from coeliac disease as conditions that may be related to the service of veterans or members of the Forces (section 2). The determination is based on the view that it is more probable than not that these conditions can be connected to relevant service (section 3). Specifically, the Statement identifies the inability to obtain appropriate clinical management for coeliac disease as a factor that must exist before it can be said that, on the balance of probabilities, the disease or death from the disease is connected with the circumstances of a person’s relevant service (section 5(a)).
The Act imposes obligations on parties by establishing the criteria for the connection of coeliac disease and death from coeliac disease to relevant service. It specifies that these conditions are recognised as service-related if the individual was unable to obtain appropriate clinical management for coeliac disease, such as when they were unable to cease or substitute gluten-containing products at the time of the clinical worsening of the disease (section 5(a)). This requirement is particularly pertinent to cases where the coeliac disease was suffered or contracted before or during the person’s relevant service but not arising out of that service (section 6). The definition of "relevant service" is also clarified within the Statement to include eligible war service or defence service, but excluding operational or hazardous service (section 7).
The Statement of Principles does not explicitly outline specific offences, penalties, or civil/criminal consequences for breach. Instead, it serves to guide the assessment and recognition of service-related coeliac disease and death from coeliac disease for the purposes of veterans’ entitlements. The implications of these provisions are primarily administrative, ensuring that eligible veterans receive appropriate recognition and support for conditions that may be linked to their service.