Instrument No. 32 of 2004
Revocation and Determination
of
Statement of Principles
concerning
RHEUMATOID ARTHRITIS
for the purposes of the
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
1. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 126 of 1996; 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 rheumatoid arthritis and death from rheumatoid arthritis.
(b) For the purposes of this Statement of Principles, “rheumatoid arthritis” means an adult chronic multisystem disease primarily of the joints, characterised by inflammatory synovitis, symmetrical joint involvement, muscle atrophy, and bone rarefaction.
(c) Rheumatoid arthritis attracts ICD-10-AM code M05 or M06.
(d) In the application of this Statement of Principles, the definition of “rheumatoid arthritis” is that given at paragraph 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 rheumatoid arthritis and death from rheumatoid arthritis can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
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 the relevant service rendered by the person.
Factors
5. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting rheumatoid arthritis or death from rheumatoid arthritis with the circumstances of a person’s relevant service is:
(a) for seropositive rheumatoid arthritis only, smoking at least five cigarettes per day, or the equivalent thereof in other tobacco products, for a period of at least fifteen years before the clinical onset of rheumatoid arthritis, and where smoking has ceased, the clinical onset has occurred within twenty years of cessation; or
(b) inhaling respirable crystalline silica dust, at the time material containing crystalline silica was being:
(i) produced, or
(ii) excavated, or
(iii) drilled, or
(iv) used in manufacturing, cleaning or blasting,
for a period or periods of time totalling at least 370 days before the clinical onset of rheumatoid arthritis; or
(c) taking a drug which has been reported in a peer reviewed medical or scientific publication to have caused rheumatoid arthritis, which cannot be ceased or substituted, at the time of the clinical onset of rheumatoid arthritis; or
(d) being treated with the drug interferon-α at the time of the clinical onset of rheumatoid arthritis; or
(e) smoking at least fifteen pack years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of rheumatoid arthritis; or
(f) taking a drug which has been reported in a peer reviewed medical or scientific publication to have caused a worsening of rheumatoid arthritis, which cannot be ceased or substituted, at the time of the clinical worsening of rheumatoid arthritis; or
(g) inability to obtain appropriate clinical management for rheumatoid arthritis.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(e) to (g) apply only to material contribution to, or aggravation of, rheumatoid arthritis where the person’s rheumatoid arthritis was suffered or contracted before or during (but not arising out of) the person’s relevant service.
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 rheumatoid arthritis” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s rheumatoid arthritis;
“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), Fourth Edition, effective date of 1 July 2004, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 594 1;
“pack years of cigarettes, or the equivalent thereof in other tobacco products” means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7300 cigarettes. One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack year of tailor made cigarettes equates to 7300 cigarettes, or 7.3kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;
“relevant service” means:
(a) operational service under the VEA; or
(b) peacekeeping service under the VEA; or
(c) hazardous service under the VEA; or
(d) warlike service under the MRCA; or
(e) non-warlike service under the MRCA;
“seropositive rheumatoid arthritis” means rheumatoid arthritis accompanied by serological evidence of an elevated level of rheumatoid factor;
“terminal event” means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(f) cessation of brain function.
Application
9. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Dated this seventh day of October 2004
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN