REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 72 of 2008

VETERANS’ ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

EXPLANATORY NOTES FOR TABLING

1. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) revokes Instrument No. 19 of 1997 determined under subsection 196B(2) of the VEA concerning idiopathic thrombocytopaenic purpura and death from idiopathic thrombocytopaenic purpura.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that immune thrombocytopaenic purpura and death from immune thrombocytopaenic purpura 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, Instrument No. 72 of 2008 concerning immune thrombocytopaenic purpura.  This Instrument will in effect replace the revoked Statement of Principles.

3.             The provisions of the Military Rehabilitation and Compensation Act 2004 (the MRCA) relating to claims for compensation commenced on 1 July 2004.  Claims under section 319 of the MRCA for acceptance of liability for a service injury sustained, a service disease contracted or service death on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to Statements of Principles issued by the Authority pursuant to the VEA.

4.             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;

 warlike service under the MRCA;

 non-warlike service under the MRCA,

before it can be said that a reasonable hypothesis has been raised connecting immune thrombocytopaenic purpura or death from immune thrombocytopaenic purpura, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 28 June 2006 concerning idiopathic thrombocytopaenic purpura 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.

6.             The contents of the new Instrument are in similar terms as the revoked Instrument.  Comparing the new and the revoked Instruments, the differences include:

• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• change of name from "idiopathic thrombocytopaenic purpura" to "immune thrombocytopaenic purpura";
• new definition for 'immune thrombocytopaenic purpura' in clause 3 which replaces the previous definition of 'idiopathic thrombocytopaenic purpura';
• new factors 6(a) & 6(i) concerning 'a specified viral infection';
• new factors 6(b) & 6(j) concerning 'a specified bacterial infection';
• new factors 6(c) & 6(k) concerning 'a drug or a drug from a class of drugs, from the specified list';
• new factor 6(d) concerning 'measles-mumps-rubella, hepatitis B or influenza vaccine';
• new factors 6(e) & 6(l) concerning 'being pregnant';
• new factors 6(f) & 6(m) concerning 'haematological malignancy or lymphoproliferative disorder';
• new factors 6(g) & 6(n) concerning 'graft-versus-host disease complicating allogeneic stem cell transplantation';
• new factors 6(h) & 6(o) concerning 'an autoimmune or inflammatory disease from the specified list';
• new definitions of 'a drug or a drug from a class of drugs, from the specified list', 'a haematological malignancy or lymphoproliferative disorder', 'a specified bacterial infection', 'a specified viral infection', 'an autoimmune or inflammatory disease from the specified list', 'death from immune thrombocytopaenic purpura', 'graft-versus-host disease', 'ICD-10-AM code' and 'terminal event' in clause 9;
• revising definition of 'relevant service' in clause 9;
• deleting definition of 'ICD code'; and
• specifying a date of effect for the Instrument in clause 11.

7.             Further changes to the format of the Instrument reflect the commencement of the MRCA and clarify that pursuant to subsection 196B(3A) of the VEA, the Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

8.             Prior to determining this instrument, the Authority advertised its intention to undertake an investigation in relation to idiopathic thrombocytopaenic purpura in the Government Notices Gazette of 28 June 2006, 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, 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 during the investigation.

9.             The determining of this new instrument finalises the investigation in relation to immune thrombocytopaenic purpura as advertised in the Government Notices Gazette of 28 June 2006.

10.         A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.