Statement of Principles concerning goitre No. 21 of 2000

Instrument No.21 of 2000

Revocation and Determination

of

Statement of Principles

concerning

GOITRE

ICD-10-AM codeS: E01.0, E01.1, E01.2, E04, E05.1, E05.2

Veterans’ Entitlements Act 1986

1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):

(a) revokes Instrument No.29 of 1998; and

(b) determines in its place the following Statement of Principles.

Kind of injury, disease or death

2. (a) This Statement of Principles is about goitre and death from goitre.

(b) For the purposes of this Statement of Principles, “goitre” means a generalised or focal enlargement of the thyroid gland, causing a palpable or visible swelling in the front part of the neck or a thyroid gland volume greater than the 97th centile by ultrasound assessment, attracting ICD-10-AM code E01.0, E01.1, E01.2, E04, E05.1 or E05.2, but excluding congenital goitre, and goitre due to malignant neoplasm of the thyroid, benign neoplasm of the thyroid, thyroiditis or Graves’ disease.

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that goitre and death from goitre 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 goitre or death from goitre with the circumstances of a person’s relevant service are:

(a) suffering from iodine deficiency within the 12 months immediately before the clinical onset of goitre; or

(b) being treated with a specified drug before the clinical onset of goitre; or

(c) smoking at least three pack-years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of goitre, and where smoking has ceased, the clinical onset has occurred within five years of cessation; or

(d)              having received a cumulative equivalent dose of at least 0.2 Sievert of atomic radiation to the thyroid gland where this dose was accumulated at least one year before the clinical onset of goitre; or

(e) suffering from hypothyroidism at the time of the clinical onset of goitre; or

(f) suffering from hyperthyroidism at the time of the clinical onset of goitre; or

(g) suffering from thyroiditis at the time of the clinical onset of goitre; or

(h) suffering from amyloidosis at the time of the clinical onset of goitre; or

(j) suffering from iodine deficiency within the 12 months immediately before the clinical worsening of goitre; or

(k) being treated with a specified drug before the clinical worsening of goitre; or

(m) smoking at least three pack-years of cigarettes or the equivalent thereof in other tobacco products before the clinical worsening of goitre, and where smoking has ceased, the clinical worsening has occurred within five years of cessation; or

(n) suffering from hypothyroidism at the time of the clinical worsening of goitre; or

(o) suffering from hyperthyroidism at the time of the clinical worsening of goitre; or

(p) suffering from thyroiditis at the time of the clinical worsening of goitre; or

(q) suffering from amyloidosis at the time of the clinical worsening of goitre; or

(r) being treated with an anti-thyroid drug before the clinical worsening of goitre, and, where administration of the anti-thyroid drug has ceased the clinical worsening occurred within 28 days of cessation; or

(s) inability to obtain appropriate clinical management for goitregoitre.

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(j) to 5(s) apply only to material contribution to, or aggravation of, goitre where the person’s goitre 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:

“amyloidosis” means the accumulation of insoluble fibrillar proteins (amyloid) in organs or tissues of the body such that vital function is compromised;

“atomic radiation” means ionising radiation excluding:

(i)                natural background radiation;

(ii)              therapeutic radiation; and

(iii)           radiation from diagnostic procedures;

“being treated with an anti-thyroid drug” means treatment with carbimazole, methimazole, propylthiouracil or perchlorate on at least a daily basis for two weeks;

“being treated with a specified drug” means being treated with any of the drugs (including where those drugs are contained in preparations) listed in the following Table of Drugs, under the circumstances as specified in the Table, with regard to the mode of administration, dose level, minimum duration of treatment, and temporality (time relationship between the last administration of the drug and the onset or worsening of the disease, as the case may be, where the administration of the drug has ceased).

Table of Drugs

* Abbreviations:  IV = intravenous;  IM = intramuscular; O = oral, T = topical

“cumulative equivalent dose” means the total equivalent dose of atomic radiation from all types of radiation (eg alpha, gamma).  It accounts for the differences in biological effectiveness of various types of radiation and allows doses from different radiations to be combined.  Each component is calculated by multiplying the absorbed dose in a particular tissue or organ for a given type of radiation by the radiation weighting factor for that radiation.  The unit of equivalent dose is the Sievert (Sv);

“death from goitre” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s goitre;

“hyperthyroidism” means hyperactivity of the thyroid gland involving overproduction of thyroid hormone by the thyroid gland itself;

“hypothyroidism” means the functional state of the body resulting from insufficiency of thyroid hormones;

“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;

“iodine deficiency” means an average dietary intake of iodine of less than 150 g/day for a continuous period of 30 days or a urinary iodine level of less than 100 g/L;

“pack years of cigarettes or the equivalent thereof in other tobacco products” means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes (being the “standard” cigarette pack contents) per day for a period of one calendar year, or

7 300 cigarettes.  One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack year of tailor made cigarettes equates to 7 300 cigarettes, or 7.3kg of smoking tobacco by weight.  Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

(c) hazardous service;

“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.

“thyroiditis” means inflammation of the thyroid gland.

Application

9. This Instrument applies to all matters to which section 120A of the Act applies.

Dated thisTwenty-seventh  day of    September    2000

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN