REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 53 of 2006

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. 11 of 1994 of 8 September 1994, as amended by Instrument No. 219 of 1995 of 1 June 1995, determined under subsection 196B(2) of the VEA concerning fracture and death from fracture.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that fracture and death from fracture 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. 53 of 2006 concerning fracture.  This Instrument will in effect replace the revoked Statements 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 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 fracture or death from fracture, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 19 November 2003 concerning fracture 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:

• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• revising the definition of ‘fracture’ in clause 3;
• rewording factors 6(a) & 6(j) concerning trauma;
• rewording factor 6(b) concerning Paget's disease;
• rewording and including separate factors 6(c) & 6(d) concerning osteoporosis and osteomalacia;
• new factor 6(e) & 6(k)concerning osteonecrosis;
• rewording factors 6(f) & 6(l)concerning infection;
• rewording factor 6(g) concerning malignant neoplasm;
• rewording factor 6(h) concerning benign neoplasm;
• rewording 6(i) concerning stress fracture;
• new factor 6(m) concerning stress fracture;
• deleting the factors concerning Paget's disease; osteoporosis or osteomalacia; malignant neoplasm; and benign tumour, relating to the clinical worsening of fracture;
• revising the definition of 'osteomalacia' in clause 9;
• deleting definitions of 'benign tumour of the bone'; 'ICD code'; 'malignant neoplasm'; mycotic, suppurative or syphilitic infection'; 'osteoporosis'; and 'Paget's disease', from clause 9;
• including new definitions of 'death from fracture'; 'osteonecrosis'; 'relevant service'; 'repetitive loading stress'; and 'terminal event', in clause 9; and
• specifying a date of effect for the Instrument in clause 11.

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 fracture in the Government Notices Gazettes of 19 November 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. No submissions were received for consideration by the Authority during the investigation.

10.         On 18 August 2006, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument, the medical-scientific material considered by the Authority. This letter emphasised the deletion of factors relating to 'Paget's disease', 'osteoporosis or osteomalacia', 'malignant neoplasm affecting the bone' and 'benign tumour of the bone’. The Authority provided an opportunity to the organisations to make representations in relation to the proposed instrument prior to its determination. No submissions were received for consideration by the Authority.

11.         The determining of this new instrument finalises the investigation in relation to fracture as advertised in the Government Notices Gazettes of 19 November 2003.

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