Instrument No.3 of 2002
Determination
of
Statement of Principles
concerning
GINGIVITIS
ICD-10-AM codeS: K05.0, K05.1
Veterans’ Entitlements Act 1986
1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act).
Kind of injury, disease or death
2. (a) This Statement of Principles is about gingivitis and death from gingivitis.
(b) For the purposes of this Statement of Principles, “gingivitis” means inflammation of the gingiva (gums), including acute gingivitis, acute necrotising ulcerative gingivitis, chronic gingivitis and gingival abscess attracting ICD-10-AM code K05.0 or K05.1. This definition excludes:
(i) oral aphthae;
(ii) gingivitis associated with stomatitis including herpesviral gingivostomatitis;
(iii) gingival recession;
(iv) gingival enlargement; and
(v) inflammation extending beyond the gums into the underlying supporting structures of the teeth.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that gingivitis and death from gingivitis can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting gingivitis or death from gingivitis with the circumstances of a person’s relevant service are:
(a) undertaking no cleaning of the teeth for a period of at least the seven days before the clinical onset of gingivitis; or
(b) suffering from diabetes mellitus at the time of the clinical onset of gingivitis; or
(c) having a microscopic or macroscopic foreign body embedded in the affected region of the gums at the time of the clinical onset of gingivitis; or
(d) suffering physical, chemical or thermal injury to the affected region of the gums within the 48 hours before the clinical onset of gingivitis; or
(e) being pregnant at the time of the clinical onset of gingivitis; or
(f) being infected with human immunodeficiency virus (HIV) at the time of the clinical onset of gingivitis; or
(g) suffering from leukaemia at the time of the clinical onset of gingivitis; or
(h) undergoing a course of the combined oral contraceptive pill or a progesterone oral contraceptive pill, for a period of at least the four weeks before the clinical onset of gingivitis; or
(i) for acute necrotising ulcerative gingivitis only,
(i) smoking at least 20 cigarettes per day or the equivalent thereof in other tobacco products for at least one year before the clinical onset of gingivitis, and where smoking has ceased, the clinical onset has occurred within six months of cessation; or
(ii) experiencing a severe psychosocial stressor within the seven days before the clinical onset of gingivitis; or
(iii) suffering from a severe nutritional deficiency at the time of the clinical onset of gingivitis; or
(j) inability to obtain appropriate clinical management for gingivitis.
Factors that apply only to material contribution or aggravation
6. Paragraph 5(j) applies only to material contribution to, or aggravation of, gingivitis where the person’s gingivitis was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
7. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.
Other definitions
8. For the purposes of this Statement of Principles:
“acute necrotising ulcerative gingivitis” means a painful and rapidly progressive inflammation of the gums characterised by gingival bleeding with interdental soft tissue necrosis and ulceration, and is also known as Vincent’s disease and trenchmouth;
“cigarettes per day or the equivalent thereof, in other tobacco products” means either cigarettes, pipe tobacco or cigars, alone or in any combination where one tailor made cigarette approximates one gram of tobacco; or one gram of cigar, pipe or other smoking tobacco by weight;
“death from gingivitis” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s gingivitis;
“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“severe psychosocial stressor” means an identifiable occurrence that evokes feelings of substantial distress in an individual, for example, being shot at, death or serious injury in a close friend or relative, assault (including sexual assault), severe illness or injury, experiencing a loss such as divorce or separation, loss of employment, major financial problems or legal problems;
“suffering from a severe nutritional deficiency” means suffering from scurvy or having clinical or biochemical evidence of a severe protein-energy malnutrition due to starvation, being a prisoner of war, systemic disease or chronic gastrointestinal malabsorption;
“terminal event” means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Dated this Ninth day of January 2002
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN