Statement of Principles concerning gout No. 11 of 2000

Statement of Principles

concerning

GOUT

Instrument No. 11 of 2000 as amended

made under section 196B(2) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 21 November 2005
taking into account Amendment of Statement of Principles concerning GOUT (Instrument No. 43 of 2003)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane

Revocation and Determination

of

Statement of Principles

concerning

GOUT

ICD-10-AM CODE: M10

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.88 of 1997; 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 gout and death from gout.

(b) For the purposes of this Statement of Principles, “gout” means a metabolic condition characterised by hyperuricaemia, tissue deposition of urate crystals and clinical manifestations, which manifestations include acute inflammatory arthritis, tenosynovitis, bursitis, cellulitis, chronic erosive arthritis, or periarticular or subcutaneous urate deposits, attracting ICD-10-AM code M10.

Basis for determining the factors

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

(a) suffering from one of the diseases in the specified list of diseases within the 180 days immediately before the clinical onset of gout; or

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

(c) being obese at the time of the clinical onset of gout; or

(d) suffering from lead nephropathy before the clinical onset of gout; or

(e)               undergoing chemotherapy for a malignant tumour within the seven days immediately before the clinical onset of gout; or

(f) drinking at least 150kg of alcohol (contained within alcoholic drinks) within the ten years immediately before the clinical onset of gout; or

(g) suffering from one of the diseases in the specified list of diseases within the 180 days immediately before the clinical worsening of gout; or

(h) being treated with a specified drug before the clinical worsening of gout; or

(j) being obese at the time of the clinical worsening of gout; or

(k) suffering from lead nephropathy before the clinical worsening of gout; or

(m) undergoing chemotherapy for a malignant tumour within the seven days immediately before the clinical worsening of gout; or

(n) drinking at least 150kg of alcohol (contained within alcoholic drinks) within the ten years immediately before the clinical worsening of gout; or

(o) inability to obtain appropriate clinical management for gout.

Factors that apply only to material contribution or aggravation

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

“alcohol (contained within alcoholic drinks)” is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;

“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres.

“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 drug has ceased);

Table of Drugs

* Abbreviations:  IV = intravenous;  IM = intramuscular; O = oral

“chemotherapy” means systemic treatment of a malignant disease with a chemical agent which can lead to the breakdown of cells, examples of which include vincristine, busulphan, thiotepa, cytarabine, 6‑mercaptopurine and chlorambucil;

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

“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), effective date of 1 July 1998, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86451 340 3;

“lead nephropathy” means chronic tubulointerstitial renal disease caused by exposure to lead;

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

(c) hazardous service;

“specified list of diseases” means the following:

(i) active systemic leukaemia; or

(ii) myeloid metaplasia; or

(iii)           polycythaemia vera; or

(iv)            secondary polycythaemia; or

(v)              multiple myeloma;

“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.

Application

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

Notes to Statement of Principles concerning gout (Instrument No. 11 of 2000)

The Statement of Principles concerning gout (Instrument No. 11 of 2000) in force under section 196B(2) of the Veterans’ Entitlements Act 1986 as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments