EXPLANATORY STATEMENT
STATEMENT OF PRINCIPLES CONCERNING
OPEN-ANGLE GLAUCOMA
(REASONABLE HYPOTHESIS) (NO. 49 OF 2021)
VETERANS' ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
- This is the Explanatory Statement to the Statement of Principles concerning
open-angle glaucoma (Reasonable Hypothesis) (No. 49 of 2021).
Background
2. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 27 of 2012 (Federal Register of Legislation No. F2012L00457) determined under subsections 196B(2) and (8) of the VEA concerning open-angle glaucoma.
3. The Authority is of the view that there is sound medical-scientific evidence that indicates that open-angle glaucoma and death from open-angle glaucoma 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 open-angle glaucoma (Reasonable Hypothesis) (No. 49 of 2021). This Instrument will in effect replace the repealed Statement of Principles.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 open-angle glaucoma or death from open-angle glaucoma, 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 7 May 2019 concerning open-angle glaucoma 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 The contents of this Instrument are in similar terms as the repealed Instrument. Comparing this Instrument and the repealed Instrument, the differences include: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;
- specifying a day of commencement for the Instrument in section 2;
- revising the definition of 'open-angle glaucoma' in subsection 7(2);
- including ICD-10-AM codes for 'open-angle glaucoma' in subsection 7(3);
- revising the factors in subsections 9(1) and 9(12) concerning having glucocorticoid therapy as specified, by the inclusion of a note;
- new factors in subsections 9(2) and 9(13) concerning having uveitis, scleritis or episcleritis;
- new factors in subsections 9(3) and 9(14) concerning having a benign or malignant neoplasm or a non-neoplastic lesion of the affected eye;
- revising the factors in subsections 9(4) and 9(15) concerning having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures;
- revising the factors in subsections 9(5) and 9(16) concerning having trauma to the affected eye;
- revising the factors in subsections 9(6) and 9(17) concerning having sympathetic ophthalmia, by the inclusion of a note;
- new factors in subsections 9(9) and 9(20) concerning having a disease from the specified list of endocrine diseases;
- new factors in subsections 9(10) and 9(21) concerning having hypertension;
- new factors in subsections 9(11) and 9(22) concerning having dyslipidaemia;
- deleting the factors concerning having a specified disorder of the affected eye or orbit, as these are now covered by the factors in subsections 9(2) and 9(13) concerning having uveitis, scleritis or episcleritis and the factors in subsections 9(3) and 9(14) concerning having a benign or malignant neoplasm or a non-neoplastic lesion of the affected eye;
- deleting the factors concerning having Cushing's syndrome, as these are now covered by the factors in subsections 9(9) and 9(20) concerning having a disease from the specified list of endocrine diseases;
- deleting the factors concerning having Graves' disease, as these are now covered by the factors in subsections 9(9) and 9(20) concerning having a disease from the specified list of endocrine diseases;
- deleting the factors concerning having hypothyroidism, as these are now covered by the factors in subsections 9(9) and 9(20) concerning having a disease from the specified list of endocrine diseases;
- deleting the factors concerning having non-intraocular surgery to the affected eye;
- deleting the factors concerning having received ionising radiation;
- new definitions of 'episcleritis', 'glucocorticoid therapy as specified', 'dyslipidaemia', 'MRCA', 'scleritis', 'specified list of conditions or procedures', 'specified list of endocrine diseases', 'trauma' and 'VEA' in
Schedule 1 - Dictionary; - revising the definitions of 'equivalent glucocorticoid therapy', 'equivalent inhaled glucocorticoid', 'high or very high potency topical glucocorticoid', 'relevant service', 'sympathetic ophthalmia' and 'uveitis' in
Schedule 1 - Dictionary; and - deleting the definitions of 'a specified condition or procedure', 'a specified disorder', 'cumulative equivalent dose', 'having glucocorticoid therapy as specified' and 'trauma as specified'.
Consultation
8. Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to open-angle glaucoma in the Government Notices Gazette of 7 May 2019, 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.
9. On 24 December 2020, 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 factors relating to having non-intraocular surgery to the affected eye in the one month before the clinical onset of open-angle glaucoma and having non-intraocular surgery to the affected eye in the one month before the clinical worsening of open-angle glaucoma. 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. No changes were made to the proposed Instrument following this consultation process.
Human Rights
10. 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
11. The determining of this Instrument finalises the investigation in relation to
open-angle glaucoma as advertised in the Government Notices Gazette of 7 May 2019.
References
12. 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. 49 of 2021
Kind of Injury, Disease or Death: Open-angle glaucoma
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 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 open-angle glaucoma;
- 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 open-angle glaucoma with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
- replaces Instrument No. 27 of 2012; and
- reflects developments in the available sound medical-scientific evidence concerning open-angle glaucoma 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, ICSECR; 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, ICSECR 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.