REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 15 of 2007

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. 263 of 1995 of 21 June 1995, determined under subsection 196B(2) of the VEA concerning myasthenia gravis and death from myasthenia gravis.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that myasthenia gravis and death from myasthenia gravis 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. 15 of 2007 concerning myasthenia gravis.  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 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 myasthenia gravis or death from myasthenia gravis, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 15 June 2005 concerning myasthenia gravis 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;
• revising the definition of 'myasthenia gravis' in clause 3;
• new factor 6(a) concerning systemic treatment with a specified drug at the time of the clinical onset of myasthenia gravis ;
• new factor 6(b) concerning treatment with a drug from a class of drugs relating to the clinical worsening of myasthenia gravis;
• new factor 6(c) concerning treatment with a specified drug relating to the clinical worsening of myasthenia gravis;
• new factor 6(d) concerning injection of iothalamic acid, diatrizoate meglumine, or diatrizoate sodium relating to the clinical worsening of myasthenia gravis;
• new factor 6(e) concerning pregnancy relating to the clinical worsening of myasthenia gravis;
• new factor 6(f) concerning bone marrow transplantation relating to the clinical worsening of myasthenia gravis
• deleting the definition of 'ICD code';
• including new definitions of "a drug from Specified List 1", "a drug from Specified List 2", "death from myasthenia gravis", "drug from a class of drugs in the Specified List", "ICD-10-AM code", "relevant service", and "terminal event", in clause 9; 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 myasthenia gravis in the Government Notices Gazette of 15 June 2005, 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.  One submission was received for consideration by the Authority during the investigation.

9.             The determining of this new instrument finalises the investigation in relation to myasthenia gravis as advertised in the Government Notices Gazette of 15 June 2005.

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