Instrument No.2 of 2002
Revocation
of
Statement of Principles
concerning
INFLAMMATORY PERIODONTAL DISEASE
and
Determination
of
Statement of Principles
concerning
PERIODONTITIS
ICD-10-AM CODES: K04.4, K04.5, K05.2, K05.3, K05.4
Veterans’ Entitlements Act 1986
1. The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.369 of 1995; 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 periodontitis and death from periodontitis.
(b) For the purposes of this Statement of Principles, “periodontitis” means an inflammatory disease of the bony and ligamentous supporting tissues of the teeth, accompanied by destruction of the periodontal ligament or alveolar bone, attracting ICD-10-AM code K04.4, K04.5, K05.2, K05.3 or K05.4. This definition includes acute periodontitis, chronic periodontitis, necrotising periodontitis, aggressive periodontitis and early-onset periodontitis but excludes gingivitis.
Basis for determining the factors
3. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that periodontitis and death from periodontitis can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, periodontitis or death from periodontitis is connected with the circumstances of a person’s relevant service are:
(a) suffering from gingivitis at the time of the clinical onset of periodontitis, where the periodontitis has occurred adjacent to the gingivitis; or
(b) smoking at least 20 cigarettes per day or the equivalent thereof in other tobacco products for a period of at least 15 years before the clinical onset of periodontitis, and where smoking has ceased the clinical onset has occurred within five years of cessation; or
(c) suffering from diabetes mellitus at the time of the clinical onset of periodontitis; or
(d) suffering from a severe nutritional deficiency at the time of the clinical onset of periodontitis; or
(e) being infected with human immunodeficiency virus (HIV) at the time of the clinical onset of periodontitis; or
(f) suffering from dental pulp disease of a tooth in the affected region of the periodontium at the time of the clinical onset of periodontitis; or
(g) for periodontal abscess only,
(i) having a microscopic or macroscopic foreign body embedded in the affected region of the periodontium at the time of the clinical onset of periodontitis; or
(ii) suffering penetrating trauma (including surgery or open fracture) to the affected region of the periodontium within the seven days before the clinical onset of periodontitis; or
(h) suffering from gingivitis at the time of the clinical worsening of periodontitis, where the periodontitis has occurred adjacent to the gingivitis; or
(i) suffering from diabetes mellitus at the time of the clinical worsening of periodontitis; or
(j) being infected with human immunodeficiency virus (HIV) at the time of the clinical worsening of periodontitis; or
(k) suffering from dental pulp disease of a tooth in the affected region of the periodontium at the time of the clinical worsening of periodontitis; or
(l) for periodontal abscess only,
(i) having a microscopic or macroscopic foreign body embedded in the affected region of the periodontium at the time of the clinical worsening of periodontitis; or
(ii) suffering penetrating trauma (including surgery or open fracture) to the affected region of the periodontium within the seven days before the clinical worsening of periodontitis; or
(m) inability to obtain appropriate clinical management for periodontitis.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(h) to 5(m) apply only to material contribution to, or aggravation of, periodontitis where the person’s periodontitis was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(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:
“cigarettes per day or the equivalent thereof, in other tobacco products” means either cigarettes, pipe tobacco or cigars, alone or in any combination where one tailor made cigarette approximates one gram of tobacco; or one gram of cigar, pipe or other smoking tobacco by weight;
“death from periodontitis” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s periodontitis;
“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), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“periodontal abscess” means a rapidly developing, destructive inflammatory disease with local accumulation of pus within the bony and ligamentous supporting structures of the teeth;
“relevant service” means:
(a) eligible war service (other than operational service); or
(b) defence service (other than hazardous service);
“suffering from a severe nutritional deficiency” means suffering from scurvy or having clinical or biochemical evidence of a severe protein-energy malnutrition due to starvation, being a prisoner of war, systemic disease or chronic gastrointestinal malabsorption;
“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 120B of the Act applies.
Dated this Ninth day of January 2002
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN