REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 11 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. 52 of 2002 of 6 August 2002, determined under subsection 196B(2) of the VEA concerning gastro-oesophageal reflux disease and death from gastro-oesophageal reflux disease.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that gastro-oesophageal reflux disease and death from gastro-oesophageal reflux disease 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. 11 of 2005 concerning gastro-oesophageal reflux disease.  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 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 gastro-oesophageal reflux disease or death from gastro-oesophageal reflux disease, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 18 December 2002 concerning gastro-oesophageal reflux 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:

• adopting the latest revised Instrument format, which commenced in 2003;
• deleting the ICD code from the Instrument header;
• changing the definition of ‘gastro-oesophageal reflux disease’ in clause 2;
• factors 5(c) and (n) relating to smoking cigarettes or equivalent tobacco products requires at least ten cigarettes per day for a continuous period of at least six months immediately before clinical onset or worsening;
• factors 5(d) and (o) relating to alcohol consumption requires an average of at least 300 grams of alcohol per week for a continuous period of at least twelve months immediately before clinical onset or worsening;
• factors 5(e) and (p) relating to surgery requires a procedure to the region of the oesophageal hiatus of the diaphragm within the three months before clinical onset or worsening;
• new factors 5(f) and (q) relating to gastrectomy;
• new factors 5(j) and (u) relating to eradication of Helicobacter pylori in a person with chronic gastritis;
• new factors 5(k) and (v) relating to Sjögren’s syndrome;
• new factor 5(x) relating to being treated with doxycycline at the time of clinical worsening;
• new factor 5(y) relating to being treated with a drug reported to have caused acute erosive oesophagitis at the time of clinical worsening;
• deleting the previously included factor relating to being treated with a nonsteroidal anti-inflammatory drug at the time of the clinical onset;
• deleting the definition of ‘area of the lower oesophageal sphincter’, ‘pack years of cigarettes or the equivalent thereof in other tobacco products’ and ‘smooth muscle relaxant drug’ in clause 8;
• revising the definition of ‘ICD-10-AM code’, ‘relevant service’ and ‘Zollinger-Ellison syndrome’ in clause 8;
• including new definitions of ‘a smooth muscle relaxant drug’ and ‘Sjögren’s syndrome’ in clause 8; and
• specifying a date of effect for the Instrument in clause 10.

7.             Further changes to the format and wording 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.             The Instrument refers to, but does not incorporate by reference, The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), effective date of 1 July 2004, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 594 1. This publication is available for purchase from the National Centre for Classification in Health, The University of Sydney, PO Box 170, Lidcombe NSW 1825.

9.             Prior to determining this instrument, the Authority advertised its intention to undertake an investigation in relation to gastro-oesophageal reflux disease in the Government Notices Gazettes of 18 December 2002, 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.

10.         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.

11.         On 12 November 2004, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument, the medical-scientific material considered by the Authority and emphasising the deletion of the factor relating to being treated with a nonsteroidal anti-inflammatory drug at the time of the clinical onset. The Authority provided an opportunity to the organisations to make representations in relation to the proposed instrument prior to its determination. No representations were received.

12.         The determining of this new instrument finalises the investigation in relation to gastro-oesophageal reflux disease as advertised in the Government Notices Gazettes of 18 December 2002.

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