Statement of Principles concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022)

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EXPLANATORY STATEMENT

 

STATEMENT OF PRINCIPLES CONCERNING

GRAVES DISEASE

(REASONABLE HYPOTHESIS) (NO. 7 OF 2022)

 

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

 

  1. This is the Explanatory Statement to the Statement of Principles concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022).

Background

2.             The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 33 of 2013 (Federal Register of Legislation No. F2013L00736) determined under subsections 196B(2) and (8) of the VEA concerning Graves' disease.

3.             The Authority is of the view that there is sound medical-scientific evidence that indicates that Graves disease and death from Graves 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 concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022).  This Instrument will in effect replace the repealed Statement of Principles.

Purpose and Operation

4.             The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

5.             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;

 British nuclear test defence 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 Graves disease or death from Graves disease, with the circumstances of that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

6.             This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 5 January 2021 concerning Graves' disease in accordance with section 196G of the VEA.  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.

7.             The contents of this Instrument are in similar terms as the repealed Instrument.  Comparing this Instrument and the repealed Instrument, the differences include:

  • adopting the latest revised Instrument format, which commenced in 2015;
  • revising the name of the condition from 'Graves' disease' to 'Graves disease' with removal of the apostrophe;
  • specifying a day of commencement for the Instrument in section 2;
  • revising the definition of 'Graves disease' in subsection 7(2);
  • revising ICD-10-AM codes for 'Graves disease' in subsection 7(3);
  • revising the reference to 'ICD-10-AM code' in subsection 7(4);
  • revising the factors in subsections 9(1) and 9(12) concerning having iodine excess;
  • revising the factors in subsections 9(2) and 9(13) concerning taking a drug from the specified list of drugs;
  • new factors in subsections 9(3) and 9(14) concerning being treated with alemtuzumab or antithymocyte globulin;
  • new factor in subsection 9(4) concerning taking amiodarone, for clinical onset;
  • revising the factors in subsections 9(5) and 9(16) concerning undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation;
  • revising the factors in subsections 9(6) and 9(17) concerning having received iodine-131 (radioactive iodine) for the treatment of nodular goitre;
  • revising the factors in subsections 9(7) and 9(18) concerning having smoked tobacco products;
  • new factors in subsections 9(8) and 9(19) concerning being pregnant or within the 18 months postpartum;
  • new factors in subsections 9(9) and 9(20) concerning having ethanol injection into the thyroid gland for the treatment of a thyroid adenoma;
  • new factors in subsections 9(10) and 9(21) concerning having trauma to the eye;
  • new factors in subsections 9(11) and 9(22) concerning having an acute precipitating event, for thyrotoxic crisis only;
  • revising the factor in subsection 9(15) concerning taking amiodarone, for clinical worsening;
  • deleting the factors concerning having received ionising radiation, as these are covered by the factors in subsections 9(5) and 9(16) concerning undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation;
  • new definitions of 'acute precipitating event', 'iodine excess', 'MRCA', 'one pack-year', 'specified list of drugs', 'thyrotoxic crisis' and 'VEA' in Schedule 1 - Dictionary;
  • revising the definition of 'relevant service' in Schedule 1 - Dictionary; and
  • deleting the definitions of 'a drug or a drug from a class of drugs from the specified list', 'cumulative equivalent dose', 'having iodine excess' and 'pack-years of cigarettes, or the equivalent thereof in other tobacco products'.

Consultation

8.             Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to Graves' disease in the Government Notices Gazette of 5 January 2021, 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, the Military Rehabilitation and Compensation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  No submissions were received for consideration by the Authority in relation to the investigation.

Human Rights

9.             This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.  A Statement of Compatibility with Human Rights follows.

Finalisation of Investigation

10.         The determining of this Instrument finalises the investigation in relation to Graves' disease as advertised in the Government Notices Gazette of 5 January 2021.

References

11.         A list of references relating to the above condition is available on the Authority’s website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:

              

Email:    info@rma.gov.au

Post:      The Registrar

Repatriation Medical Authority

GPO Box 1014

BRISBANE    QLD    4001


Statement of Compatibility with Human Rights

(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)

 

Instrument No.:   Statement of Principles No. 7 of 2022

Kind of Injury, Disease or Death: Graves disease

 

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

1. This Legislative Instrument is determined pursuant to subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).  Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.

2. This Legislative Instrument:-

  • facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have Graves disease;
  • facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
  • outlines the factors which the current sound medical-scientific evidence indicates must as a minimum exist, before it can be said that a reasonable hypothesis has been raised, connecting Graves disease with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
  • replaces Instrument No. 33 of 2013; and
  • reflects developments in the available sound medical-scientific evidence concerning Graves disease which have occurred since that earlier instrument was determined. 

3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA. 

Human Rights Implications

4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:

  • the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
  • the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
  • the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
  • the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
  • ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).

Conclusion

This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.

 

Repatriation Medical Authority

 

 

 

 

 

 

 

[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.

Overview

The Statement of Principles concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022) was introduced to address the gap in the recognition of the relationship between Graves disease and specific kinds of military service, as determined by the Repatriation Medical Authority (the Authority) under subsection 196B(8) of the Veterans' Entitlements Act 1986. The Act, along with the Military Rehabilitation and Compensation Act 2004, provides the legislative framework for determining veterans' claims for medical treatment and compensation. This Statement of Principles outlines the minimum factors required to establish a reasonable hypothesis connecting Graves disease with service rendered by a person, and replaces the previous Instrument No. 33 of 2013. The policy objective of this legislative instrument is to facilitate the assessment of claims and the review of decisions under the Acts by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons with Graves disease, thereby promoting the human rights of veterans and their dependents. The Repatriation Medical Authority, acting under the authority vested in it by the Parliament, determined this Statement of Principles following an investigation into Graves disease, as advertised in the Government Notices Gazette of 5 January 2021. The Instrument has been designed to reflect the latest sound medical-scientific evidence concerning the disease and its connection to military service. It is compatible with human rights, ensuring that the rights of veterans, current and former Defence Force members, and their dependents are promoted and exercised without discrimination. The Instrument facilitates the assessment and determination of social security benefits and compensation, ensuring accessibility and promoting the right to the highest attainable standard of physical and mental health.

Scope and Application

The Statement of Principles concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022) applies to claims made under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It sets out the minimum circumstances in which a reasonable hypothesis can be raised that Graves disease or death from Graves disease is connected to specific types of military service, including operational, peacekeeping, hazardous, British nuclear test defence service, warlike, and non-warlike service. The Instrument outlines factors such as iodine excess, specified drug intake, treatment with alemtuzumab or antithymocyte globulin, therapeutic radiation, radioactive iodine treatment, tobacco use, pregnancy, thyroid gland ethanol injections, eye trauma, and acute precipitating events that must be considered in assessing claims. This Instrument replaces the previously repealed Statement of Principles No. 33 of 2013, reflecting updated medical-scientific evidence. The scope of the Act is national, applying across Australia, and it facilitates the assessment and determination of benefits and compensation for veterans and Defence Force members, thereby promoting their rights to social security, an adequate standard of living, and the highest attainable standard of physical and mental health.

Key Provisions

The main operative sections of the Statement of Principles concerning Graves disease (Reasonable Hypothesis) (No. 7 of 2022) (the Instrument) are sections 5, 7, and 9, which detail the circumstances under which Graves disease can be reasonably connected to specific service types and the factors that must exist for such a hypothesis. Section 5 outlines the service types that must be considered, including operational service, peacekeeping service, hazardous service, British nuclear test defence service, warlike service, and non-warlike service. Section 7 provides the definition of Graves disease and the relevant ICD-10-AM codes. Section 9 lists the factors that must exist for a reasonable hypothesis, such as iodine excess, certain drug use, therapeutic radiation, radioactive iodine treatment, tobacco use, pregnancy, ethanol injections into the thyroid gland, trauma to the eye, and acute precipitating events for thyrotoxic crisis. The Instrument imposes obligations on claimants, the Repatriation Commission, the Military Rehabilitation and Compensation Commission, and the Veterans' Review Board. Claimants must provide evidence of the factors listed in Section 9 to support their claims that Graves disease is related to their service. The Repatriation and Military Rehabilitation and Compensation Commissions are required to assess claims based on the criteria outlined in the Instrument. The Veterans' Review Board must review decisions made by these Commissions, ensuring they align with the principles set out in the Instrument. There are no direct offences, penalties, or civil/criminal consequences specified for breach of the Instrument itself. However, the Instrument's provisions are integral to the assessment of claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). Failure to comply with the criteria set out in the Instrument may result in the denial of claims for benefits and compensation. Claimants who provide false information or evidence may face consequences under the respective Acts, which could include financial penalties, fines, or other legal repercussions. The Acts themselves provide for various penalties and enforcement mechanisms, but these are not detailed within the Instrument.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.