Statement of Principles concerning endometriosis No. 8 of 2004

Overview

The Statement of Principles concerning Endometriosis was determined in 2004 by the Repatriation Medical Authority under the Veterans’ Entitlements Act 1986. This legislative instrument addresses the gap in recognising endometriosis as a condition potentially linked to the service of veterans, thereby ensuring that affected individuals can access appropriate benefits. The policy objective is to establish a framework for determining when endometriosis or death from endometriosis can be considered related to the relevant service of veterans, providing a basis for entitlement claims. The determination relies on sound medical-scientific evidence to link endometriosis to specific service-related factors, ensuring that those who meet the criteria receive the necessary support and recognition for their condition.

Scope and Application

This Statement of Principles is a legislative instrument under the Veterans’ Entitlements Act 1986 and is specifically concerned with endometriosis and death resulting from endometriosis among veterans. The Act applies to veterans and members of the Forces who have rendered relevant service, which includes eligible war service and defence service but excludes operational and hazardous service. The Statement of Principles defines endometriosis as a condition involving the ectopic occurrence of endometrial tissue, resulting in clinical symptoms or requiring treatment. The determination is based on the premise that it is more probable than not that endometriosis and death from endometriosis can be related to relevant service rendered by veterans or members of the Forces. Certain factors must be related to relevant service for a connection to be established, such as hormone replacement therapy or continuous tamoxifen therapy for postmenopausal women, surgery or trauma involving the site of endometriosis, or inability to obtain appropriate clinical management for endometriosis. These factors apply to both the onset and worsening of endometriosis, as well as material contribution or aggravation where the condition was present before or during service. The Statement of Principles incorporates other relevant medical conditions if they are mentioned in other existing statements of principles, thereby extending its application through reference to those conditions.

Key Provisions

The Statement of Principles, determined by the Repatriation Medical Authority under section 196B(3) of the Veterans’ Entitlements Act 1986, addresses endometriosis and death from endometriosis, as outlined in clause 2. Endometriosis is defined as a condition where endometrial tissue is present ectopically, causing symptoms or necessitating treatment, as per clause 2(b). This condition is assigned the ICD-10-AM code N80, and this definition applies throughout the Statement of Principles. The Authority has determined, based on available medical-scientific evidence, that it is more probable than not that endometriosis and death from endometriosis can be linked to relevant service rendered by veterans or members of the Forces. Clause 5 details the factors that must be related to relevant service for a connection to be established between endometriosis or death from endometriosis and the circumstances of a person's service. These factors include specific medical treatments or conditions, such as hormone replacement therapy or tamoxifen therapy for postmenopausal women, or surgery or trauma involving the site of endometriosis for certain locations, all occurring before the clinical onset of endometriosis. Additionally, these factors must also apply before the clinical worsening of endometriosis. The inability to obtain appropriate clinical management for endometriosis is also considered. Clause 6 specifies that paragraphs 5(d) to 5(f) apply only to material contribution to, or aggravation of, endometriosis where the condition was suffered or contracted before or during relevant service but not arising out of that service. In accordance with clause 7, if a relevant factor applies and includes an injury or disease for which there is a Statement of Principles, the factors in that Statement of Principles apply as per its terms. Clause 8 provides additional definitions necessary for the interpretation of this Statement of Principles, including definitions for "death from endometriosis," "hormone replacement therapy," "ICD-10-AM code," "relevant service," and "terminal event." The Statement of Principles imposes obligations on the parties by establishing clear criteria for determining the relationship between endometriosis, death from endometriosis, and relevant service. It mandates that at least one of the specified factors must be related to relevant service for a connection to be recognised. Additionally, the definitions and requirements set out in clauses 2, 5, and 8 must be adhered to when assessing claims. Failure to comply with the provisions of this Statement of Principles may result in civil or criminal consequences, although the specific offences, penalties, or consequences are not detailed in the provided text. However, the Veterans’ Entitlements Act 1986 may include provisions for penalties in cases of non-compliance or fraudulent claims. The maximum penalties for such offences would be determined in accordance with the relevant provisions of the Act.