REPATRIATION MEDICAL AUTHORITY
INSTRUMENT NO. 94 of 2007
VETERANS’ ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
EXPLANATORY NOTES FOR TABLING
- The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans’ Entitlements Act 1986 (the VEA) revokes Instrument No. 14 of 1994, as amended by Instrument No. 222 of 1995, determined under subsection 196B(3) of the VEA concerning ingrown toenail and death from ingrown toenail.
2. The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that ingrowing nail and death from ingrowing nail can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles, Instrument No. 94 of 2007 concerning ingrowing nail. This Instrument will in effect replace the revoked Statements 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 exist, and which of those factors must be related to the following kinds of service rendered by a person:
eligible war service (other than operational service) under the VEA;
defence service (other than hazardous service) under the VEA;
peacetime service under the MRCA,
before it can be said that, on the balance of probabilities, ingrowing nail or death from ingrowing nail is connected 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 ingrown toenail in accordance with section 196G of the Act. 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 Instruments. 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;
- defining 'ingrrowing ail' in clause 3;
- revising factor 6(a) concerning 'deformity of the affected digit or the affected nail bed';
- new factors 6(b) and 6(e) concerning 'injury';
- new factors 6(c) and 6(f) concerning 'receiving treatment';
- revising factors 6(d) and 6(g) concerning 'ingrowing toenail only';
- deleting the onset factor concerning 'poor foot hygiene';
- deleting the worsening factor concerning 'deformity of the toe or toenail';
- revising definitions of 'ill-fitting footwear' and 'poor foot hygiene' in clause 9;
- new definitions of 'death from ingrowing nail'; 'deformity of the affected digit or the affected nail bed'; 'ICD-10-AM code'; 'poor nail care'; 'relevant service' and 'terminal event' in clause 9;
- deleting definitions of 'deformity of the toe'; ' deformity of the toenail'; 'ICD code' and 'ingrown toenail'; 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 ingrown toenail 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. On 8 June 2007, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority. This letter emphasised the deletion of the onset factor relating to poor foot hygiene and the worsening factor relating to deformity of the toe or toenail. The Authority provided an opportunity to the organisations to make representations in relation to the proposed instrument prior to its determination. No submissions were received for consideration by the Authority.
10. The determining of this new instrument finalises the investigation in relation to ingrown toenail as advertised in the Government Notices Gazette of 28 June 2006.
11. A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.
Overview
The Repatriation Medical Authority Instrument No. 94 of 2007 is an instrument made under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) to address the medical-scientific evidence surrounding the connection between ingrown toenails and military service. This legislative instrument was enacted to replace the previous Statements of Principles concerning ingrown toenail and aims to provide a comprehensive framework for assessing claims related to ingrown toenails and deaths resulting from ingrown toenails in the context of military service. The Authority, acting under subsection 196B(3) of the VEA, determined this new Statement of Principles after considering the latest medical-scientific evidence, which indicated a probable connection between certain types of service and ingrown toenails. The instrument sets out the necessary factors that must exist for a claim to be accepted, and it clarifies the circumstances under which ingrown toenails or deaths from ingrown toenails can be considered connected to military service.
Scope and Application
The Repatriation Medical Authority Instrument No. 94 of 2007, issued under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA), replaces previous instruments concerning ingrown toenail and death from ingrown toenail. This instrument applies to veterans and service personnel who have contracted ingrown toenails or died from such conditions as a result of their service, specifically eligible war service, defence service, or peacetime service. The geographic reach of this instrument is national, as it pertains to individuals who have served in the Australian Defence Force. The instrument sets out the conditions and factors that must be met for the Authority to determine a connection between service and the onset or worsening of ingrown toenails. The Authority determined this instrument based on the latest medical-scientific evidence, with revisions including the adoption of a new format, clarification of definitions, and the deletion of certain factors such as poor foot hygiene and deformity of the toe or toenail. The instrument is effective as of the date specified in clause 11 and is applicable to claims for compensation made on or after 1 July 2004.
Key Provisions
The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans’ Entitlements Act 1986 (VEA), has revoked Instrument No. 14 of 1994, as amended by Instrument No. 222 of 1995, concerning ingrown toenail and death from ingrown toenail. This revocation has been made to replace the existing statements of principles with a new Instrument No. 94 of 2007, based on the latest medical-scientific evidence available (section 2). This new instrument outlines the factors that must exist, and which must be related to specific types of service rendered by a person, before it can be said that, on the balance of probabilities, ingrowing nail or death from ingrowing nail is connected with the circumstances of that service (section 4). The new instrument also adopts a revised Instrument format, clarifies definitions, and specifies a date of effect, all of which are aimed at providing a more comprehensive and updated set of guidelines (section 6).
The obligations imposed by the new Instrument No. 94 of 2007 primarily concern the determination of claims for compensation for ingrown toenail and death from ingrown toenail under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). Claims for compensation for service injuries sustained, service diseases contracted, or service deaths on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to the Statements of Principles issued by the Authority (section 3). The Authority must ensure that the claims are assessed in accordance with the specified factors and service-related criteria outlined in the new instrument, thus providing a clear framework for determining eligibility for compensation.
The new Instrument No. 94 of 2007 does not explicitly state any offences, penalties, or civil/criminal consequences for breach. However, it is implicit that non-compliance with the criteria and factors set out in the instrument could lead to disputes or challenges in the determination of claims for compensation. The Authority, in determining the instrument, has provided a comprehensive and updated set of guidelines to ensure that claims are assessed fairly and accurately. This helps to mitigate potential disputes and ensures that claimants receive the appropriate compensation based on the sound medical-scientific evidence available.
The Authority undertook an investigation concerning ingrown toenail, as notified in the Government Notices Gazette of 28 June 2006, and invited submissions from relevant organisations and individuals. Despite these efforts, no submissions were received for consideration during the investigation (sections 5 and 9). This lack of submissions may reflect a consensus or agreement with the Authority's findings and the new instrument's provisions. The Authority further communicated with organisations representing veterans, service personnel, and their dependants regarding the proposed instrument and provided an opportunity for them to make representations prior to its determination (section 9). Again, no submissions were received, indicating a likely acceptance of the Authority's determination.
The determination of the new Instrument No. 94 of 2007 finalises the investigation concerning ingrown toenail, which was advertised in the Government Notices Gazette of 28 June 2006 (section 10). This finalisation ensures that the updated guidelines are in place and that claims for compensation can be assessed according to the latest medical-scientific evidence. Additionally, a list of references relating to the condition is available upon written request from the Repatriation Medical Authority Secretariat, providing further resources for those involved in the claims process (section 11).