REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 56 of 2012

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. 3 of 2001, determined under subsection 196B(2) of the VEA concerning pulmonary thromboembolism.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that pulmonary thromboembolism and death from pulmonary thromboembolism 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. 56 of 2012 concerning pulmonary thromboembolism.  This Instrument will in effect replace the revoked Statement 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;

 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 pulmonary thromboembolism or death from pulmonary thromboembolism, with the circumstances of that service.

5.             This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 4 November 2009 concerning pulmonary thromboembolism 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.

6.             The contents of this Instrument are in similar terms as the revoked Instrument.  Comparing this Instrument and the revoked Instrument, 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 'pulmonary thromboembolism' in clause 3;
• revising factor 6(a) concerning 'deep vein thrombosis';
• revising factor 6(b) concerning 'venous thrombosis';
• new factor 6(c) concerning 'a cardiac disease from the specified list';
• revising factor 6(d) concerning 'smoking';
• new factor 6(e) concerning 'a neurological disease causing motor impairment';
• new factor 6(f) concerning 'restricted mobility';
• new factor 6(g) concerning 'being an inpatient in a hospital or a resident in a nursing home';
• new factor 6(h) concerning 'surgery requiring a general, spinal or epidural anaesthetic';
• new factor 6(i) concerning 'having a central venous catheter, indwelling cardiac pacemaker or defibrillator leads, or implantation of another intravenous device';
• new factor 6(j) concerning 'an injury or illness as specified';
• new factor 6(k) concerning 'immobilisation of the upper or lower limb';
• new factor 6(l) concerning 'a malignant neoplasm';
• new factor 6(m) concerning 'being treated with a drug or a drug from a class of drugs from the specified list';
• new factor 6(n) concerning 'using hormone replacement therapy or using combined oestrogen-progestin contraception';
• new factor 6(o) concerning 'an autoimmune disease or inflammatory vasculitis from the specified list';
• new factor 6(p) concerning 'having a hypercoagulable state';
• new factor 6(q) concerning 'being obese';
• new factor 6(r) concerning 'being pregnant or being within the three months postpartum';
• new factor 6(s) concerning 'being infected with human immunodeficiency virus';
• new factor 6(t) concerning 'having cytomegalovirus infection of new onset';
• new factor 6(u) concerning 'chronic bronchitis or emphysema';
• new factor 6(v) concerning 'nephrotic syndrome, or any acute or chronic renal disease requiring dialysis or renal transplantation';
• new factor 6(w) concerning 'being at an altitude of at least 3000 metres';
• new factor 6(x) concerning 'having an aneurysm of a vein in the deep venous system';
• new factor 6(y) concerning 'depressive disorder with severe psychomotor retardation';
• new factor 6(z) concerning 'animal envenomation';
• deleting the factor concerning 'thrombus within the right atrium or right ventricle' as it is now covered by factor 6(c) concerning 'a cardiac disease from the specified list';
• new definitions of 'a cardiac disease from the specified list', 'a drug or a drug from a class of drugs from the specified list', 'a hypercoagulable state', 'a neurological disease causing motor impairment', 'an autoimmune disease or inflammatory vasculitis from the specified list', 'an injury or illness as specified', 'being obese', 'having restricted mobility', 'hormone replacement therapy', 'pack-year of cigarettes, or the equivalent thereof in other tobacco products' and 'psychomotor retardation' in clause 9;
• revising the definitions of 'ICD-10-AM code', 'relevant service' and 'venous thrombosis' in clause 9;
• deleting the definition of 'deep vein thrombosis'; 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 pulmonary thromboembolism in the Government Notices Gazette of 4 November 2009, 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.             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.

10.         The determining of this Instrument finalises the investigation in relation to pulmonary thromboembolism as advertised in the Government Notices Gazette of 4 November 2009.

11.         A list of references relating to the above condition is available to any person or organisation referred to in subsection 196E(1)(a) to (c) of the VEA.  Any such request must be made in writing to the Repatriation Medical Authority at the following address:

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. 56 of 2012

Kind of Injury, Disease or Death: Pulmonary thromboembolism

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(8) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

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 pulmonary thromboembolism;
• 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 pulmonary thromboembolism with the circumstances of eligible service rendered by a person, as set out in clause 4 of the Explanatory Notes;
• replaces Instrument No. 3 of 2001; and
• reflects developments in the available sound medical-scientific evidence concerning pulmonary thromboembolism 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; and
• the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD).

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.