Statement of Principles concerning Graves’ disease No. 34 of 2013

Statement of Principles concerning Graves' disease No. 34 of 2013

made under subsection 196B(3) of the

Veterans' Entitlements Act 1986

Compilation No. 1  

Compilation date:   18 September 2017

Includes amendments up to: Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017) (F2017L01067)

The day of commencement of this Amendment Determination is 18 September 2017.

About this compilation

This compilation

This is a compilation of the Statement of Principles concerning Graves' disease No. 34 of 2013 that shows the text of the law as amended and in force on 18 September 2017.

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Statement of Principles

concerning

GRAVES' DISEASE

No. 34 of 2013

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

Title

1. This Instrument may be cited as Statement of Principles concerning Graves' disease No. 34 of 2013.

Determination

2. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the VEA).

Kind of injury, disease or death

3. (a) This Statement of Principles is about Graves' disease and death from Graves' disease.

(b) For the purposes of this Statement of Principles, "Graves' disease" means a chronic autoimmune disease of the thyroid gland, in which thyroid autoantibodies (thyroid-stimulating immunoglobulins) activate the thyroid stimulating hormone receptor, causing thyroid hyperplasia and stimulating excessive thyroid hormone synthesis and secretion. Typical presenting features include a diffuse goitre, hyperthyroidism, a characteristic ophthalmopathy and, less commonly, a characteristic dermopathy. This definition excludes acute thyroiditis, subacute thyroiditis, Hashimoto's thyroiditis, postpartum thyroiditis, non-autoimmune chronic thyroiditis and secondary hyperthyroidism.

(c) Graves' disease attracts ICD-10-AM code E05.0.

(d) In the application of this Statement of Principles, the definition of "Graves' disease" is that given at paragraph 3(b) above.

Basis for determining the factors

4. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that Graves' disease and death from Graves' disease can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

Factors

6. The factor that must exist before it can be said that, on the balance of probabilities, Graves' disease or death from Graves' disease is connected with the circumstances of a person’s relevant service is:

(a)                having iodine excess from consuming foods, dietary supplements or medications with a high content of iodine, within the three months before the clinical onset of Graves' disease; or

(b)               being treated with a drug or a drug from a class of drugs from the specified list for a continuous period of at least six weeks, within the one year before the clinical onset of Graves' disease; or

(c)                undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the ten years before the clinical onset of Graves' disease; or

(d)               having received a cumulative equivalent dose of at least 20 sieverts of ionising radiation to the thyroid gland, within the ten years before the clinical onset of Graves' disease; or

(e)                receiving radioactive iodine (131I) for the treatment of multinodular goitre within the ten years before the clinical onset of Graves' disease; or

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

(g)               having iodine excess from consuming foods, dietary supplements or medications with a high content of iodine, within the three months before the clinical worsening of Graves' disease; or

(h)               being treated with a drug or a drug from a class of drugs from the specified list for a continuous period of at least six weeks, within the one year before the clinical worsening of Graves' disease; or

(i)                 being treated with amiodarone for a continuous period of at least six weeks, within the one year before the clinical worsening of Graves' disease; or

(j)                 undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the ten years before the clinical worsening of Graves' disease; or

(k)               having received a cumulative equivalent dose of at least 20 sieverts of ionising radiation to the thyroid gland, within the ten years before the clinical worsening of Graves' disease; or

(l)                 receiving radioactive iodine (131I) for the treatment of multinodular goitre within the ten years before the clinical worsening of Graves' disease; or

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

(n)               inability to obtain appropriate clinical management for Graves' disease.

Factors that apply only to material contribution or aggravation

7. Paragraphs 6(g) to 6(n) apply only to material contribution to, or aggravation of, Graves' disease where the person’s Graves' disease was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

8. 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 as in force from time to time.

Other definitions

9. For the purposes of this Statement of Principles:

"a drug or a drug from a class of drugs from the specified list" means:

(a)                alemtuzumab (Campath-1H);

(b)               highly active antiretroviral therapy; or

(c)                interferon alpha;

"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017;

Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.

Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.

"death from Graves' disease" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s Graves' disease;

"having iodine excess" means having an average dietary intake of more than 1500 micrograms of iodine per day for a continuous period of three months, or having a urinary iodine excretion rate of greater than 800 micrograms per 24 hours;

"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), Seventh Edition, effective date of 1 July 2010, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 154 5;

"pack-years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7300 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 7.3 kilograms of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars, smoked alone or in any combination;

"relevant service" means:

(a)                eligible war service (other than operational service) under the VEA;

(b)               defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)                peacetime service under the MRCA;

"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.

Date of effect

10. This Instrument takes effect from 8 May 2013.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history. 

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history