REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 65 of 2010

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:

(i)            Instrument No. 178 of 1995 determined under subsection 196B(2) of the VEA concerning nephrolithiasis and death from nephrolithiasis; and

(ii)         Instrument No. 180 of 1995 determined under subsection 196B(2) of the VEA concerning ureteric calculus and death from ureteric calculus.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that renal stone disease and death from renal stone disease 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. 65 of 2010 concerning renal stone disease.  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 renal stone disease or death from renal stone disease, with the circumstances of that service.

5.             This new Instrument results from investigations notified by the Authority in the Government Notices Gazette of 2 May 2007 concerning nephrolithiasis and ureteric calculus in accordance with section 196G of the VEA.  The investigations 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;
• changing the name of the Instrument to 'renal stone disease';
• new definition of 'renal stone disease' in clause 3;
• revising factor 6(a) concerning 'being a prisoner of war of the Japanese';
• revising factor 6(k) concerning 'chronic urinary tract infection with urease-producing bacteria for magnesium ammonium phosphate stones only';
• revising factor 6(l) concerning 'acquired narrowing or acquired obstruction of the affected ureter or the affected renal calyx';
• revising factor 6(p) concerning 'ileal resection or ileal bypass surgery';
• revising factor 6(u) concerning 'being treated with a drug or a drug from a class of drugs';
• revising factor 6(v) concerning 'urinary diversion procedure';
• new factor 6(b) concerning 'primary hyperparathyroidism';
• new factor 6(c) concerning 'hyperthyroidism';
• new factor 6(d) concerning 'a malignant neoplasm';
• new factor 6(e) concerning 'gout';
• new factor 6(f) concerning 'a myeloproliferative disorder';
• new factor 6(g) concerning 'haemolytic anaemia';
• new factor 6(h) concerning 'chemotherapy-induced tumour lysis';
• new factor 6(i) concerning 'diarrhoea';
• new factor 6(j) concerning 'hypokalaemia';
• new factor 6(m) concerning 'inflammatory bowel disease';
• new factor 6(n) concerning 'chronic pancreatitis';
• new factor 6(o) concerning 'biliary cirrhosis';
• new factor 6(q) concerning 'Roux-en-Y gastric bypass surgery';
• new factor 6(r) concerning 'type 2 diabetes mellitus';
• new factor 6(s) concerning 'sarcoidosis';
• new factor 6(t) concerning 'Sjogren’s syndrome';
• new factor 6(w) concerning 'neurogenic bladder dysfunction';
• new factor 6(x) concerning 'paraplegia or quadriplegia';
• new factor 6(y) concerning 'being bed-bound';
• new factor 6(z) concerning 'low dietary intake of calcium';
• new factor 6(aa) concerning 'being obese';
• new factor 6(bb) concerning 'anorexia nervosa';
• new factor 6(cc) concerning 'a heat-stressed, dehydrating environment and  inadequate fluid intake';
• new factor 6(dd) concerning 'renal transplantation';
• new factor 6(ee) concerning 'ingesting ethylene glycol or diethylene glycol';
• new factor 6(ff) concerning 'inhaling cadmium fumes';
• new factor 6(gg) concerning 'spaceflight';
• deleting onset factors concerning 'hypercalcaemia', 'Type 1 renal tubular acidosis', 'cystinuria', 'caliceal diverticulum', 'retrocaval ureter', 'horseshoe kidney', 'nephrolithiasis' and 'polycystic kidney disease';
• previous factors concerning 'hypercalciuria', 'hyperoxaluria', 'hyperuricaemia' and 'hyperuricosuria' are now redundant as they are covered by new factors contained within the Instrument;
• new definitions of 'a drug or a drug from a class of drugs from the specified list', 'bed-bound', 'being obese', 'death from renal stone disease', 'ICD-10-AM code', 'inadequate fluid intake', 'relevant service', 'terminal event' and 'urease-producing bacteria' in clause 9;
• deleting definitions of 'caliceal diverticulum', 'cystinuria', 'horseshoe kidney', 'hypercalcaemia', 'hypercalciuria', 'hyperoxaluria', 'hyperuricaemia', 'hyperuricosuria', 'ICD code', 'ileal resection', 'nephrolithiasis', 'other drugs known to play a role in calculogenesis in the urinary tract', 'polycystic kidney disease', 'retrocaval ureter', 'Type 1 renal tubular acidosis', 'ureteral obstruction', 'ureteric calculus', 'ureteropelvic junction obstruction' and 'urinary tract infection involving the bacterial enzyme urease'; 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 investigations in relation to nephrolithiasis and ureteric calculus in the Government Notices Gazette of 2 May 2007, and circulated a copy of the notices 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.  Two submissions were received for consideration by the Authority during the investigations.

9.             On 3 June 2010, 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 hypercalcaemia, Type 1 renal tubular acidosis, cystinuria, caliceal diverticulum, retrocaval ureter, horseshoe kidney, polycystic kidney disease and nephrolithiasis. 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.

10.         The determining of this new Instrument finalises the investigations in relation to nephrolithiasis and ureteric calculus as advertised in the Government Notices Gazette of 2 May 2007.

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 Secretariat

GPO Box 1014

BRISBANE    QLD    4001