Statement of Principles concerning secondary parkinsonism No. 39 of 2002

Administered by Department of Veterans' Affairs

Legislation au F2005B03586 Not in force Legislative Instrument

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Instrument No.39 of 2002

Revocation and Determination

Statement of Principles

concerning

SECONDARY PARKINSONISM

ICD-10-AM CODE: G21

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.71 of 1999; 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 secondary parkinsonism and death from secondary parkinsonism.

(b) For the purposes of this Statement of Principles, “secondary parkinsonism” means a neurological syndrome of identifiable aetiology, characterised by the presence of any two of the features of bradykinesia, muscular rigidity or a rest tremor of 4-5 Hz, but excludes Parkinson’s disease and parkinsonism associated with other forms of extra pyramidal, basal ganglia or striatopallidal disease including multiple system atrophy, progressive supranuclear palsy, Huntington’s disease, Alzheimer’s disease, syphilis, dementia pugilistica, benign essential tremor or arteriosclerotic pseudoparkinsonism. Secondary parkinsonism attracts ICD-10-AM code G21.

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 secondary parkinsonism and death from secondary parkinsonism 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, secondary parkinsonism or death from secondary parkinsonism is connected with the circumstances of a person’s relevant service are:

(a) suffering from encephalitis lethargica before the clinical onset of secondary parkinsonism; or

(b) suffering from encephalitis within the 45 days before the clinical onset of secondary parkinsonism; or

(c) being exposed to manganese as specified at least weekly for a period of at least six months within the 10 years before the clinical onset of secondary parkinsonism; or

(d) being exposed to carbon disulphide as specified at least weekly for a period of at least five years within the 10 years before the clinical onset of secondary parkinsonism; or

(e) consuming methyl alcohol (methanol) resulting in plasma levels greater than 60 mmol/L (200mg/dL) and clinical manifestations of convulsions or coma, within the 90 days before the clinical onset of secondary parkinsonism; or

(f) suffering from an hypoxic-ischaemic cerebral insult within the 90 days before the clinical onset of secondary parkinsonism; or

(g) receiving an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 90 days before the clinical onset of secondary parkinsonism; or

(h) suffering from a lesion affecting the brain stem within the 90 days before the clinical onset of secondary parkinsonism; or

(i) undergoing treatment with a drug from the specified list, which cannot be ceased or substituted, at the time of the clinical onset of secondary parkinsonism; or

(j) undergoing treatment with a neuroleptic (antipsychotic) drug, which cannot be ceased or substituted, at the time of the clinical onset of secondary parkinsonism; or

(k) suffering from encephalitis lethargica before the clinical worsening of secondary parkinsonism; or

(l) suffering from encephalitis within the 45 days before the clinical worsening of secondary parkinsonism;

(m) being exposed to manganese as specified at least weekly for a period of at least six months within the 10 years before the clinical worsening of secondary parkinsonism; or

(n) being exposed to carbon disulphide as specified at least weekly for a period of at least five years within the 10 years before the clinical worsening of secondary parkinsonism; or

(o) consuming methyl alcohol (methanol) resulting in plasma levels greater than 60 mmol/L (200mg/dL) and clinical manifestations of convulsions or coma, within the 90 days before the clinical worsening of secondary parkinsonism; or

(p) suffering from an hypoxic-ischaemic cerebral insult within the 90 days before the clinical worsening of secondary parkinsonism; or

(q) receiving an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 90 days before the clinical worsening of secondary parkinsonism; or

(r) suffering from a lesion affecting the brain stem within the 90 days before the clinical worsening of secondary parkinsonism; or

(s) undergoing treatment with a drug from the specified list, which cannot be ceased or substituted, at the time of the clinical worsening of secondary parkinsonism; or

(t) undergoing treatment with a neuroleptic (antipsychotic) drug, which cannot be ceased or substituted, at the time of the clinical worsening of secondary parkinsonism; or

(u) inability to obtain appropriate clinical management for secondary parkinsonism.

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(k) to 5(u) apply only to material contribution to, or aggravation of, secondary parkinsonism where the person’s secondary parkinsonism 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:

“a lesion affecting the brain stem” means an insult or injury that destroys the nigrostriatal pathway of the brain stem, and which is caused by:

(a) an intracranial space occupying lesion that impinges directly on the brainstem or which causes signs or symptoms of brainstem dysfunction, and which is due to neoplasm, abscess, tuberculoma, or cyst; or

(b) an episode of cerebral ischaemia or intracerebral haemorrhage that directly impinges on the brainstem or that causes signs or symptoms of brainstem dysfunction; or

(c) a direct penetrating injury to the brainstem or blunt trauma to the head that produces unconsciousness or causes signs or symptoms of brainstem dysfunction;

“being exposed to manganese as specified” means

(a) working in the mining or smelting of ores containing manganese; or

(b) welding with rods containing manganese; or

(d) handling fungicides containing manganese;

“being exposed to carbon disulphide as specified” means working in the manufacture of viscose rayon, cellophane or carbon tetrachloride, or working in close contact with grain fumigants containing carbon disulphide;

“death from secondary parkinsonism” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s secondary parkinsonism;

“hypoxic-ischaemic cerebral insult” means acute cerebral anoxia due to cardiorespiratory failure or carbon monoxide poisoning;

“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. Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

“relevant service” means:

(a) eligible war service (other than operational service); or

(b) defence service (other than hazardous service);

“terminal event” means the proximate or ultimate cause of death and includes:

(a) pneumonia;

(b) respiratory failure;

(d) circulatory failure; or

(e) cessation of brain function;

“undergoing treatment with a drug from the specified list” means therapeutic administration of one of the following drugs:

amiodarone

amoxapine

amphotericin B

aprindine

amlodipine

bethanechol

buphormine

captopril

cephaloridine

cimetidine

cinnarizine

cisapride

clebopride

clopamide-pindolol combination

cyclosporine

cytosine arabinoside

diazepam

diltiazem

disulfiram

flunarizine

5-fluorouracil

fluoxetine

hexamethylmelamine

interferon-a

lithium

manidipine

meperidine

a-methyldopa

metoclopramide

paroxetine

perhexiline

phenelzine

phenytoin

prenylamine

procaine

pyridostigmine

reserpine

sertraline

tetrabenazine

trazodone

valproate

verapamil

Application

9. This Instrument applies to all matters to which section 120B of the Act applies.

Dated this Sixteenth day of April 2002

The Common Seal of the )

Repatriation Medical Authority )

was affixed to this instrument )

in the presence of: )

KEN DONALD

CHAIRMAN

Overview

The Veterans’ Entitlements Act 1986 was enacted by the Parliament of Australia to provide for the payment of pensions and other benefits to veterans and their dependants. The Act was introduced to address the need for a comprehensive legislative framework that recognises the sacrifices made by individuals who have served in the Australian Defence Force and to provide them with necessary support and care. The Repatriation Medical Authority, established under the Act, plays a crucial role in determining the medical conditions and injuries that qualify for benefits. In April 2002, the Authority issued Instrument No.39 of 2002, revoking a previous instrument and determining a new Statement of Principles concerning secondary parkinsonism and death from secondary parkinsonism. This new instrument aims to provide clear guidelines for medical professionals and claimants regarding the factors that must be considered in determining the connection between secondary parkinsonism and relevant service rendered by veterans. The Repatriation Medical Authority, under the authority conferred by subsection 196B(3) of the Veterans’ Entitlements Act 1986, revoked Instrument No.71 of 1999 and established the new Statement of Principles. This legislation outlines the specific factors that must be present for secondary parkinsonism or death from secondary parkinsonism to be considered connected with a veteran's service. The policy objective is to ensure that the criteria for establishing such a connection are based on sound medical-scientific evidence, thereby providing a fair and consistent approach to the assessment of claims related to secondary parkinsonism. The new instrument applies to all matters to which section 120B of the Act applies, ensuring that the updated guidelines are incorporated into the broader legislative framework for veterans' entitlements.

Scope and Application

The Statement of Principles concerning Secondary Parkinsonism ICD-10-AM Code: G21, issued under the Veterans’ Entitlements Act 1986, applies to all matters governed by section 120B of the Act, including the eligibility criteria for veterans or members of the Defence Forces who have contracted secondary parkinsonism or have died from it. This Statement of Principles delineates the medical and scientific basis for linking secondary parkinsonism and its resultant deaths to relevant service rendered by veterans, outlining specific causative factors such as exposure to certain chemicals, specific medical treatments, and particular injuries or diseases contracted during service. Notably, the Statement of Principles excludes Parkinson's disease and other forms of parkinsonism associated with extra pyramidal, basal ganglia, or striatopallidal diseases. The geographical reach of this legislation is primarily within the Commonwealth of Australia, affecting those who served in the Defence Forces and are now seeking benefits related to their service-connected health conditions. The Act does not specify exclusions beyond the defined scope of secondary parkinsonism but refers to other Statements of Principles for additional factors where relevant. The application of this Statement of Principles can be extended or refined through subordinate instruments as necessary.

Key Provisions

The legislative instrument, numbered 39 of 2002, under the Veterans' Entitlements Act 1986, primarily serves to revoke an earlier instrument (Instrument No. 71 of 1999) and establish a new Statement of Principles regarding secondary parkinsonism (section 1). The instrument defines secondary parkinsonism as a neurological syndrome identifiable by two specific features: bradykinesia, muscular rigidity, or a rest tremor of 4-5 Hz, excluding Parkinson’s disease and other related conditions (section 2). The Repatriation Medical Authority has concluded, based on medical-scientific evidence, that secondary parkinsonism and related deaths are likely linked to relevant service rendered by veterans or members of the armed forces (section 3). The Act imposes certain obligations on the parties involved, stipulating that at least one of the specified factors must relate to the relevant service of the individual for a connection to be established between secondary parkinsonism or its related death and the service (section 4). The factors that need to be present or have occurred before the clinical onset or worsening of secondary parkinsonism include suffering from encephalitis, exposure to certain chemicals, consuming methanol, suffering from specific cerebral insults, receiving certain injections, suffering from brain stem lesions, or undergoing treatment with specific drugs (section 5). Certain factors also apply to material contribution to, or aggravation of, secondary parkinsonism under specific circumstances (section 6). The instrument also includes definitions for terms used within the Statement of Principles, such as "a lesion affecting the brain stem," "being exposed to manganese as specified," "being exposed to carbon disulphide as specified," "death from secondary parkinsonism," "hypoxic-ischaemic cerebral insult," "ICD-10-AM code," "relevant service," and "terminal event" (section 8). There are no specific offences, penalties, or civil/criminal consequences outlined in the instrument for breach of the provisions. The primary focus is on establishing a clear framework for determining the eligibility of veterans for benefits related to secondary parkinsonism. The instrument provides a structured approach for assessing claims based on the defined factors and their relation to relevant service, ensuring that the benefits are awarded based on sound medical-scientific evidence.

Area of Law: Veterans’ Law
Instrument: Legislative Instrument
Concepts: Definitions & Interpretation; Offence Provisions; Reporting & Disclosure Obligations

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.

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