Instrument No.55 of 2003
Revocation and Determination
of
Statement of Principles
concerning
MYELOMA
Veterans’ Entitlements Act 1986
1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.72 of 1999; and
(b) determines in its place the following Statement of Principles.
Kind of injury, disease or death
2. (a) This Statement of Principles is about myeloma and death from myeloma.
(b) For the purposes of this Statement of Principles, “myeloma” means a malignant disease of plasma cells, in which a single line of plasma cells accumulates and produces a monoclonal immunoglobulin. This definition includes plasma cell leukaemia, multiple myeloma and solitary plasmacytoma of bone or extramedullary plasmacytoma, but excludes monoclonal gammopathy of undetermined significance.
(c) Myeloma attracts ICD-10-AM code C90.
(d) In the application of this Statement of Principles, the definition of “myeloma” is that given at para 2(b) above.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that myeloma and death from myeloma can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting myeloma or death from myeloma with the circumstances of a person’s relevant service are:
(a) having received a cumulative equivalent dose of 0.05 Sievert of atomic radiation to the bone marrow where this dose was accumulated at least five years before the clinical onset of myeloma; or
(b) working as a painter for a period or periods of time totalling at least 312 days before the clinical onset of myeloma, and where the work as a painter has ceased, the clinical onset of myeloma has occurred within 20 years of cessation; or
(c) spraying or decanting a herbicide containing 2,4-dichloro-phenoxyacetic acid (2,4-D) or 2,4,5- trichlorophenoxyacetic acid (2,4,5-T), in circumstances likely to result in inhalation or absorption of the herbicide, at least five years before the clinical onset of myeloma; or
(d) being:
(i) on land in Vietnam, or
(ii) at sea in Vietnamese waters, or
(iii) on board a vessel and consuming potable water supplied on that vessel, when the water supply had been produced by evaporative distillation of estuarine Vietnamese waters,
for a cumulative period of at least 30 days, at least five years before the clinical onset of myeloma; or
(e) being infected with Human Immunodeficiency Virus (HIV) at the time of the clinical onset of myeloma; or
(f) inability to obtain appropriate clinical management for myeloma.
Factors that apply only to material contribution or aggravation
6. Paragraph 5(f) applies only to material contribution to, or aggravation of, myeloma where the person’s myeloma was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
7. 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.
Other definitions
8. For the purposes of this Statement of Principles:
“atomic radiation” means ionising radiation excluding;
(i) natural background radiation;
(ii) therapeutic radiation; and
(iii) radiation from diagnostic procedures;
“being infected with Human Immunodeficiency Virus (HIV)” means serological evidence of infection with Human Immunodeficiency Virus;
“being:
(i) on land in Vietnam, or
(ii) at sea in Vietnamese waters,” means service in at least one of the areas and at the times described in Items 4 and 8 of Schedule 2 of the Veterans’ Entitlements Act 1986;
“cumulative equivalent dose” means the total equivalent dose of atomic radiation from all types of radiation (eg alpha, gamma). It accounts for the differences in biological effectiveness of various types of radiation and allows doses from different radiations to be combined. Each component is calculated by multiplying the absorbed dose in a particular tissue or organ for a given type of radiation by the radiation weighting factor for that radiation. The unit of equivalent dose is the Sievert (Sv);
“death from myeloma” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s myeloma;
“estuarine Vietnamese waters” means at least one of the waterways or harbours in the relevant areas described in Items 4 and 8 of Schedule 2 of the Veterans’ Entitlements Act 1986;
“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), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9;
“potable water” means water used for drinking water, food preparation and beverage production;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“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.
Application
9. This Instrument applies to all matters to which section 120A of the Act applied.
Dated this Seventh day of November 2003
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN