REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 17 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. 97 of 1996 of 16 August 1996 and Instrument No. 16 of 2002 of 9 January 2002, each of which were determined under subsection 196B(2) of the VEA concerning impotence and death from impotence.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that erectile dysfunction and death from erectile dysfunction 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. 17 of 2005 concerning erectile dysfunction.  This Instrument will in effect replace the revoked Statements of Principles concerning impotence and death from impotence.

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 erectile dysfunction or death from erectile dysfunction, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 22 December 2004 concerning impotence 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 Instrument.  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;
• rewording factors 5(a) and (y) relating to mood disorder or anxiety disorder, requiring the disorder to be clinically significant;
• rewording factors 5(b) and (z) relating to smoking cigarettes or equivalent tobacco products, requiring smoking of at least ten pack years before clinical onset or worsening;
• new factors 5(c) and (za) relating to hypertension;
• new factors 5(d) and (zb) relating to obesity;
• new factors 5(e) and (zc) relating to physical activity;
• new factors 5(f) and (zd) relating to ischaemic heart disease;
• a new factor 5(ze) relating to atherosclerotic peripheral vascular disease (at the time of the clinical worsening);
• a new factor 5(zf) relating to non-aneurysmal aortic atherosclerotic disease (at the time of the clinical worsening);
• a new factor 5(zg) relating to diabetes mellitus (at the time of the clinical worsening);
• a new factor 5(zh) relating to therapeutic radiation (immediately before the clinical worsening);
• a new factor 5(zi) relating to endocrinological disorders (at the time of the clinical worsening);
• a new factor 5(zj) relating to trauma to the external genitals, perineum or pelvis (at the time of the clinical worsening);
• rewording factors 5(m) and (zk) relating to traumatic injury involving the  spinal cord or cauda equina within the ninety days immediately before the clinical onset or worsening, and including trauma to the brain and surgical trauma;
• a new factor 5(zl) relating to neurological disorders (at the time of the clinical worsening);
• a new factor 5(zm) relating to cirrhosis of the liver (at the time of the clinical worsening);
• a new factor 5(zn) relating to chronic renal failure (at the time of the clinical worsening);
• a new factor 5(zo) relating to alcohol dependence or alcohol abuse (at the time of the clinical worsening);
• rewording factors 5(r), (s), (zp) and (zq) relating to being treated with a drug, differentiating between treatment with certain classes of drugs and certain drugs;
• rewording factors 5(t) and (zr) relating to low-flow priapism, requiring the condition to be present for a continuous period of four hours or more immediately before the clinical onset or worsening;
• a new factor 5(zs) relating to Peyronie’s disease (before the clinical worsening);
• a new factor 5(zt) relating to haemochromatosis (before the clinical worsening);
• a new factor 5(zu) relating to malignant neoplasm of the reproductive organs (at the time of the clinical worsening);
• new factors 5(x) and (zv) relating to organic solvents;
• deleting the definitions of ‘alcoholic liver disease’, ‘aortic atherosclerotic disease’, ‘a specified psychiatric condition’, ‘atherosclerotic peripheral vascular disease’, ‘course of therapeutic radiation’, ‘damage to the spinal cord or cauda equina’, ‘DSM-IV’, ‘haemochromatosis’, ‘ICD code’, ‘pack-year’, ‘priapism’,’psychoactive substance abuse or dependence involving alcohol’, ‘suffering from blunt or penetrating trauma’, ‘therapeutic radiation’ and ‘undergoing a course of treatment with drugs identified in the Schedule’ in clause 8;
• revising the definitions of ‘a specified endocrinological disorder’, ‘a specified neurological disorder’, ‘chronic renal failure’, ‘malignant neoplasm of the reproductive organs’, ‘Peyronie’s disease’ and ‘relevant service’ in clause 8;
• including new definitions of  ‘a class of drug in Specified List 1’, ‘a course of therapeutic radiation’, ‘being obese’, ‘blunt or penetrating trauma’, ‘clinically significant’, ‘death from erectile dysfunction’, ‘drug in Specified List 2’, ‘low-flow priapism’, ‘MET’, ‘pack years of cigarettes, or the equivalent thereof in other tobacco products’, ‘specified organic solvents’ 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 impotence in the Government Notices Gazettes of 22 December 2004, 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. 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 impotence as advertised in the Government Notices Gazettes of 22 December 2004.

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