REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 67 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 Instrument No. 39 of 2003, determined under subsection 196B(2) of the VEA concerning subarachnoid haemorrhage and death from subarachnoid haemorrhage.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that subarachnoid haemorrhage and death from subarachnoid haemorrhage 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. 67 of 2010 concerning subarachnoid haemorrhage.  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 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 subarachnoid haemorrhage or death from subarachnoid haemorrhage, with the circumstances of that service.

5.             This new Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 9 January 2008 concerning subarachnoid haemorrhage in accordance with section 196G of the VEA.  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 Instrument.  Comparing the new and the revoked Instruments, the differences include:

• adopting the latest revised Instrument format, which commenced in 2005;
• revising the definition of 'subarachnoid haemorrhage' in clause 3;
• revising factor 6(a) concerning 'hypertension';
• revising factor 6(b) concerning 'consuming alcohol for males';
• revising factor 6(c) concerning 'consuming alcohol for females';
• revising factor 6(d) concerning 'oral contraceptive pill';
• revising factor 6(e) concerning 'smoking';
• revising factor 6(h) concerning 'taking aspirin';
• revising factor 6(i) concerning 'physical activity';
• revising factor 6(j) concerning 'using a drug from the specified list';
• revising factor 6(l) concerning 'intracranial dissecting aneurysm';
• revising factor 6(m) concerning 'intracranial infective vasculitis';
• revising factor 6(n) concerning 'inflammatory vascular disease';
• new factor 6(k) concerning 'pregnancy induced hypertension';
• new factor 6(o) concerning 'statin medication';
• new factor 6(p) concerning 'an acquired haematological disorder';
• new factor 6(q) concerning 'cerebral trauma';
• deleting onset factor concerning 'experiencing a severe stressor';
• new definitions of 'a drug from the specified list', 'an acquired haematological disorder from the specified list', 'cerebral trauma', 'intracranial infective vasculitis due to a specified infection', 'MET' and 'pack-year of cigarettes, or the equivalent thereof in other tobacco products'               in clause 9;
• revising definitions of 'ICD-10-AM code', 'relevant service' and 'thrombolytic therapy' in clause 9;
• deleting definitions of 'cigarettes per day or the equivalent thereof in other tobacco products', 'experiencing a severe stressor', 'intracranial mycotic aneurysm', 'puerperal period' and 'strenuous physical activity'; 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 an investigation in relation to subarachnoid haemorrhage in the Government Notices Gazette of 9 January 2008, 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.  No submissions were received for consideration by the Authority during the investigation.

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 a factor relating to experiencing a severe stressor. 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 subarachnoid haemorrhage as advertised in the Government Notices Gazette of 9 January 2008.

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