REPATRIATION MEDICAL AUTHORITY
INSTRUMENT NO. 7 of 2009
VETERANS’ ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
EXPLANATORY NOTES FOR TABLING
- The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) revokes Instrument No. 73 of 1995, determined under subsection 196B(2) of the VEA concerning Buerger's disease (thromboangiitis obliterans) and death from Buerger's disease (thromboangiitis obliterans).
2. The Authority is of the view that there is sound medical-scientific evidence that indicates that thromboangiitis obliterans and death from thromboangiitis obliterans 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. 7 of 2009 concerning thromboangiitis obliterans. 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 thromboangiitis obliterans or death from thromboangiitis obliterans, with the circumstances of that service.
5. This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 2 May 2007 concerning Buerger's disease 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;
- deleting the ICD code from the Instrument header;
- change of name from "Buerger's disease (thromboangiitis obliterans)" to "thromboangiitis obliterans";
- new definition for 'thromboangiitis obliterans' in clause 3 which replaces the previous definition of 'Buerger's disease (thromboangiitis obliterans)';
- revising factor 6(a) concerning 'smoking' and clinical onset;
- revising factor 6(b) concerning 'smoking' and clinical worsening;
- new definitions of 'death from thromboangiitis obliterans', 'ICD-10-AM code', 'pack years of cigarettes, or the equivalent thereof in other tobacco products', 'pack year of cigarettes, or the equivalent thereof in other tobacco products', 'relevant service', and ' terminal event' in clause 9;
- deleting definitions of 'ICD code', and 'pack years'; 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 Buerger's disease in the Government Notices Gazette of 2 May 2007, 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. The determining of this new instrument finalises the investigation in relation to Buerger's disease as advertised in the Government Notices Gazette of 2 May 2007.
10. A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.
Overview
The Repatriation Medical Authority Instrument No. 7 of 2009, enacted in 2009, addresses the issue of establishing the connection between thromboangiitis obliterans, previously known as Buerger's disease, and specific types of military service, thereby facilitating the claims process under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. The instrument was introduced by the Repatriation Medical Authority, as mandated by the VEA, to ensure that the evidence and criteria for linking the disease to military service are up-to-date and medically sound. The primary policy objective of this instrument is to provide clarity and consistency in the assessment of claims related to thromboangiitis obliterans, ensuring that veterans and their representatives can effectively navigate the claims process with a well-defined set of principles.
Scope and Application
The Repatriation Medical Authority, pursuant to the Veterans' Entitlements Act 1986 (VEA), has issued Instrument No. 7 of 2009 to replace the previously revoked Instrument No. 73 of 1995 concerning thromboangiitis obliterans, also known as Buerger's disease. This new instrument sets out the Statement of Principles that must be met for a reasonable hypothesis to be raised that thromboangiitis obliterans or death from thromboangiitis obliterans is related to certain types of military service, including operational, peacekeeping, hazardous, warlike, and non-warlike service. The Authority's determination is made in consideration of the latest sound medical-scientific evidence, and the instrument applies to claims for compensation made under the Military Rehabilitation and Compensation Act 2004, for injuries sustained, diseases contracted, or deaths occurring on or after 1 July 2004. The instrument revises the definition of thromboangiitis obliterans and incorporates updated terminology and definitions to reflect the current legislative framework. Any person or entity affected by this instrument is encouraged to seek further information from the Repatriation Medical Authority Secretariat.
Key Provisions
The Repatriation Medical Authority has revoked Instrument No. 73 of 1995 concerning Buerger's disease (thromboangiitis obliterans) and death from Buerger's disease (thromboangiitis obliterans) under subsection 196B(8) of the Veterans' Entitlements Act 1986 (VEA). In its place, the Authority has determined a new Statement of Principles, Instrument No. 7 of 2009, concerning thromboangiitis obliterans, pursuant to subsection 196B(2) of the VEA (section 2). This new Instrument, which comes into effect on a specified date, replaces the previous one and aims to reflect the latest medical-scientific evidence.
The Statement of Principles outlines the minimum factors that must exist, and which of those factors must be related to certain kinds of service, before it can be said that a reasonable hypothesis has been raised connecting thromboangiitis obliterans or death from thromboangiitis obliterans with the circumstances of that service (section 4). The kinds of service include operational service, peacekeeping service, hazardous service under the VEA, warlike service, and non-warlike service under the Military Rehabilitation and Compensation Act 2004 (MRCA). This new Instrument adopts the latest revised Instrument format and includes several changes such as a new definition for 'thromboangiitis obliterans', revisions concerning smoking and clinical onset, new definitions for various terms, and the deletion of some previous definitions (section 6).
The Authority is obligated to consider sound medical-scientific evidence in determining the Statement of Principles and to advertise its intention to undertake an investigation in the Government Notices Gazette. It must also invite submissions from relevant parties and organisations and ensure that the new Instrument is aligned with both the VEA and the MRCA (sections 2, 5, 8, and 9). The Authority has the discretion to determine the factors necessary to establish a connection between thromboangiitis obliterans or death from thromboangiitis obliterans and the service rendered.
Breaches of the obligations and requirements under the VEA and the MRCA may result in civil or criminal penalties, depending on the nature of the breach. For instance, providing false or misleading information to the Authority may result in fines and/or imprisonment. The exact penalties are not specified in the explanatory notes, but they would be determined in accordance with the relevant Acts and regulations. The Authority ensures that the new Instrument is in compliance with the relevant legislation and that it reflects the latest medical-scientific evidence.