REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 2 of 2005

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. 82 of 1996 of 21 May 1996, determined under subsection 196B(3) of the VEA concerning seizures and death from seizures.

2.             The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that epileptic seizure and death from epileptic seizure can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles, Instrument No. 2 of 2005 concerning epileptic seizure. 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 exist, and which of those factors must be related to the following kinds of service rendered by a person:

 eligible war service (other than operational service) under the VEA;

 defence service (other than hazardous service) under the VEA;

 peacetime service under the MRCA,

before it can be said that, on the balance of probabilities, epileptic seizure or death from epileptic seizure is connected with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 5 March 2003 concerning seizures in accordance with section 196G of the Act. 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 Instruments.  Comparing the new and the revoked Instruments, the differences include:

• renaming the Instrument;
• adopting the latest revised Instrument format, which commenced in 2003;
• deleting the ICD code from the Instrument header;
• a new definition of ‘epileptic seizure’ in clause 2;
• factor 5(a) relating to cerebral trauma requires cerebral trauma to have occurred within the ten years before clinical onset;
• factor 5(b) relating to cerebrovascular accident or subarachnoid haemorrhage requires the cerebrovascular accident or subarachnoid haemorrhage to have occurred within the ten years before clinical onset;
• factor 5(c) relating to hypoxic cerebral insult requires the insult to have occurred within the twenty-four hours before clinical onset;
• a new factor 5(e) relating to carbon monoxide poisoning;
• factor 5(f) relating to intracranial space-occupying lesion requires the lesion within the ten years before clinical onset;
• a new factor 5(g) relating to an infection of the brain or meninges;
• a new factor 5(i) relating to the use of a range of specified drugs;
• a new factor 5(k) relating to Cruetzfeldt-Jakob disease;
• a new factor 5(l) relating to exposure to a stimulus;
• factor 5(m) relating to alcohol dependence or alcohol abuse includes alcohol withdrawal and requires one of the conditions to be present at the time of clinical onset;
• a new factor 5(o) relating to hypoglycaemia;
• a new factor 5(p) relating to non-ketotic hyperglycaemia;
• rewording factor 5(q) relating to acute liver failure;
• factor 5(r) relating to renal failure includes chronic renal failure;
• a new factor 5(t) relating to liver or kidney transplantation;
• factor 5(u) relating to being treated with a specified drug enlarges the number and classes of drugs specified;
• factor 5(v) relating to a chronically administered sedative drug includes reference to suddenly reducing the intake of the drug;
• factor 5(w) relating to malignant hypertension includes reference to hypertensive encephalopathy and eclampsia;
• a new factor 5(x) relating to multiple sclerosis;
• a new factor 5(y) relating to being exposed to partial pressures of oxygen above 1.2 atmospheres absolute;
• a new factor 5(z) relating to being exposed to an abrupt reduction in the pressure of air;
• a new factor 5(za) relating to organochlorine insecticide;
• deleting the definitions of ‘acute necrosis of the liver’, ‘a disorder of glucose metabolism’, Alzheimer’s disease’, ‘bacterial meningitis’, ‘central nervous system (CNS) systemic lupus erythematosus (SLE)’, cerebral cysticercosis’, ‘cerebral echinococcosis’, ‘cerebral malaria’, cerebral schistosomiasis’, cerebral toxoplasmosis’, ‘dialysis’, human immunodeficiency virus (HIV)’, hypoxic-ischaemic cerebral insult’, ‘ICD code’, ‘psychoactive substance abuse or dependence involving alcohol’, ‘specified list of cerebrovascular diseases’, ‘specified list of drugs’, ‘viral encephalitis’ and ‘withdrawal of a chronically administered sedative drug’ in clause 8;
• revising the definitions of ‘acute renal failure’, ‘an electrolyte imbalance’, ‘cerebral trauma’, ‘intracranial space-occupying lesion’, malignant hypertension’ and ‘relevant service’ in clause 8;
• including new definitions of ‘a class of drug from Specified List 2’, ‘a drug from Specified List 1’, ‘alcohol withdrawal’, ‘chronic renal failure’, ‘death from epileptic seizure’, ‘eclampsia’, ‘infection of the brain or meninges’, ‘reflex epilepsy’,  ‘sedative drug’, ‘status epilepticus’ and ‘terminal event’ in clause 8; and
• specifying a date of effect for the Instrument in clause 10.

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 seizures in the Government Notices Gazettes of 5 March 2003, 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.

9.             Following the commencement of the MRCA, the Authority published a “Further Notice of Investigations” in the Government Notices Gazette of 14 July 2004, extending the closing date for submissions in relation to the above mentioned investigation until 10 September 2004. The Authority again invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA (who include persons eligible to make a claim under the MRCA), as well as the Military Rehabilitation and Compensation Commission and any person having expertise in the field. One submission was received and considered by the Authority during the investigation

10.         The determining of this new instrument finalises the investigation in relation to seizures as advertised in the Government Notices Gazettes of 5 March 2003.

11.         A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.