REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 58 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. 22 of 1999 of 25 February 1999 determined under subsection 196B(3) of the VEA concerning peptic ulcer disease and death from peptic ulcer disease.

2.             The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that gastric ulcer or duodenal ulcer and death from gastric ulcer or duodenal ulcer 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. 58 of 2006 concerning gastric ulcer and duodenal ulcer. 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 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, gastric ulcer or duodenal ulcer, or death from gastric ulcer or duodenal ulcer 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 23 June 2004 concerning peptic ulcer disease 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 Statements of Principles 'gastric ulcer and duodenal ulcer', which was previously known as 'peptic ulcer disease';
• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• including the definition of ‘gastric ulcer and duodenal ulcer’ in clause 3 in lieu of the definition for 'peptic ulcer disease';
• rewording factors 6(a) & 6(g) concerning Helicobacter pylori;
• rewording and expanding factors 6(b) & 6(h) concerning anti-inflammatory drug;
• rewording and expanding factors 6(c) & 6(i) concerning smoking;
• new factors 6(d) & 6(j) concerning gastrin-secreting tumour;
• new factors 6(e) & 6(k) concerning critical illness or injury;
• new factors 6(f) & 6(l) concerning drug treatment;
• rewording factor 6(m) concerning inability to obtain appropriate clinical management;
• revising the definition of 'relevant service' in clause 9;
• deleting definitions of 'death from peptic ulcer disease'; 'Helicobacter pylori infection'; and 'ICD-9-CM code', from clause 9;
• including new definitions of 'a drug from specified list 1'; 'a drug from specified list 2'; 'critical illness or injury'; 'death from gastric ulcer or duodenal ulcer'; 'ICD-10-AM code'; and 'pack year of cigarettes, or the equivalent thereof in other tobacco products', 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 peptic ulcer disease in the Government Notices Gazettes of 23 June 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, 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. Two submissions were received for consideration by the Authority during the investigation.

10.         The determining of this new instrument finalises the investigation in relation to gastric ulcer and duodenal ulcer as advertised in the Government Notices Gazettes of 23 June 2004.

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