REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 9 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. 209 of 1995, as amended by Instrument No. 328 of 1995, determined under subsection 196B(2) of the VEA concerning acute sinusitis and death from acute sinusitis; and

(ii)         Instrument No. 21 of 2003 determined under subsection 196B(2) of the VEA concerning chronic sinusitis and death from chronic sinusitis.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that sinusitis and death from sinusitis 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. 9 of 2010 concerning sinusitis.  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 sinusitis or death from sinusitis, with the circumstances of that service.

5.             This new instrument results from investigations notified by the Authority in the Government Notices Gazette of 27 June 2007 concerning acute sinusitis, and the Gazette of 14 November 2007 concerning chronic sinusitis and chronic rhinosinusitis.  These notices were done 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;
• revising the definition of 'sinusitis' in clause 3;
• revising factors 6(a) & 6(m) concerning 'a viral respiratory tract infection';
• revising factors 6(b) & 6(n) concerning 'impaired drainage of the sinus';
• revising factors 6(c) & 6(o) concerning 'human immunodeficiency virus';
• revising factors 6(d) & 6(p) concerning 'immunocompromised state';
• revising factors 6(e) & 6(q) concerning 'diabetes mellitus';
• revising factors 6(f) & 6(r) concerning 'inhaling a specified substance';
• revising factors 6(g) & 6(s) concerning 'a specified dental condition';
• revising factors 6(h) & 6(t) concerning 'allergic rhinitis';
• revising factors 6(i) & 6(u) concerning 'sinus barotrauma';
• revising factor 6(j) concerning 'therapeutic radiation';
• revising factors 6(k) & 6(w) concerning 'smoking';
• new factors 6(l) & 6(x) concerning 'gastroesophageal reflux disease';
• new factor 6(v) concerning 'therapeutic radiation';
• previous factor concerning 'being intubated with a nasal tracheal or nasal gastric tube' is now redundant as it is covered by the revised factor concerning 'impaired drainage of the sinus';
• previous factor concerning 'head trauma' is now redundant as it is covered by the revised factor concerning 'impaired drainage of the sinus';
• previous factor concerning 'suffering from acute sinusitis' is now redundant as 'acute sinusitis' is included in the definition of 'sinusitis' in clause 3;
• new definitions of 'a specified substance', 'acute nasal symptoms or signs', 'an immunocompromised state' and 'death from sinusitis' in clause 9;
• revising definitions of 'a specified dental condition', 'ICD-10-AM code' and 'relevant service' in clause 9;
• deleting definitions of 'acute sinusitis', 'acute upper respiratory symptoms or signs', 'being infected with HIV', 'chronic invasive fungal sinusitis', 'death from chronic sinusitis', 'ICD-code', 'immuno-compromised state', 'muco-ciliary transport abnormality', 'one of the specified substances' and 'sinus barotrauma'; 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 acute sinusitis, chronic sinusitis and chronic rhinosinusitis in the Government Notices Gazettes as detailed in paragraph 5 above. The Authority circulated a copy of the notices 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.  One submission was received for consideration by the Authority during the investigations.

9.             On 23 October 2009, 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 "muco-ciliary transport abnormality". 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 investigation in relation to acute sinusitis as advertised in the Government Notices Gazette of 27 June 2007, and the investigations in relation to chronic sinusitis and chronic rhinosinusitis as advertised on 14 November 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