REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 14 of 2005

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. 40 of 1997 of 2 May 1997, determined under subsection 196B(3) of the VEA concerning sleep apnoea and death from sleep apnoea.

2.             The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that sleep apnoea and death from sleep apnoea can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles, Instrument No. 14 of 2005 concerning sleep apnoea.  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 exist, and which of those factors must be related to the following kinds of service rendered by a person:

 eligible war service (other than operational service) under the VEA;

 defence service (other than hazardous service) under the VEA;

 peacetime service under the MRCA,

before it can be said that, on the balance of probabilities, sleep apnoea or death from sleep apnoea is connected with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 11 June 2003 concerning sleep apnoea in accordance with section 196G of the Act. 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 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 2003;
• deleting the ICD code from the Instrument header;
• changing the definition of ‘sleep apnoea’ in clause 2;
• new factors 5(i) and (r) relating to end stage renal failure;
• new factor 5(s) relating to consuming alcohol immediately before the clinical worsening;
• deleting the definition of ‘a central nervous system disorder involving the upper or mid cervical cord, brain stem, cerebrum or extrapyramidal system’, ‘being infected with human immunodeficiency virus (HIV)’ and ‘ICD code’ in clause 8;
• revising the definition of ‘acromegaly’, ‘autonomic neuropathy’, ‘being obese’, ‘chronic obstruction of the upper airways’, ‘congestive cardiac failure’, ‘hypothyroidism’ and ‘relevant service’ in clause 8;
• including new definitions of ‘a central nervous system disorder’, ‘alcohol’, ‘death from sleep apnoea’, ‘end stage renal disease’, ‘ICD-10-AM code’ and ‘terminal event’ in clause 8; and
• specifying a date of effect for the Instrument in clause 10.

7.             Further changes to the format and wording 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.             The Instrument refers to, but does not incorporate by reference, The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), effective date of 1 July 2004, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 594 1. This publication is available for purchase from the National Centre for Classification in Health, The University of Sydney, PO Box 170, Lidcombe NSW 1825.

9.             Prior to determining this instrument, the Authority advertised its intention to undertake an investigation in relation to sleep apnoea in the Government Notices Gazettes of 11 June 2003, 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.

10.         Following the commencement of the MRCA, the Authority published a “Further Notice of Investigations” in the Government Notices Gazette of 14 July 2004, extending the closing date for submissions in relation to the above mentioned investigation until 10 September 2004. The Authority again invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA (who include persons eligible to make a claim under the MRCA), as well as the Military Rehabilitation and Compensation Commission and any person having expertise in the field. No submissions were received by the Authority during the investigation

11.         The determining of this new instrument finalises the investigation in relation to sleep apnoea as advertised in the Government Notices Gazettes of 11 June 2003.

12.         A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.