Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Reasonable Hypothesis) (No. 84 of 2024)

EXPLANATORY STATEMENT

STATEMENT OF PRINCIPLES CONCERNING

TRIGEMINAL NEURALGIA OR TRIGEMINAL NEUROPATHY

(REASONABLE HYPOTHESIS) (NO. 84 OF 2024)

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

1.              This is the Explanatory Statement to the Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Reasonable Hypothesis) (No. 84 of 2024).

Background

1.              The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 77 of 2015 (Federal Register of Legislation No. F2015L00909) determined under subsections 196B(2) of the VEA concerning trigeminal neuralgia and. Instrument No. 79 of 2015 (Federal Register of Legislation No. F2015L00911) determined under subsections 196B(2) and (8) of the VEA concerning trigeminal neuropathy.
2.              The Authority is of the view that there is sound medical-scientific evidence that indicates that trigeminal neuralgia or trigeminal neuropathy and death from trigeminal neuralgia or trigeminal neuropathy 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 concerning trigeminal neuralgia or trigeminal neuropathy (Reasonable Hypothesis) (No. 84 of 2024).  This Instrument will in effect replace the repealed Statement of Principles.

Purpose and Operation

1.              The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).
2.              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;

 British nuclear test defence 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 trigeminal neuralgia or trigeminal neuropathy or death from trigeminal neuralgia or trigeminal neuropathy, with the circumstances of that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

1.              This Instrument results from investigations notified by the Authority in the Government Notices Gazette of 4 January 2023 concerning trigeminal neuralgia and, trigeminal neuropathy 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.
2.              The contents of this Instrument are in similar terms as the repealed Instrument.  Comparing this Instrument and the repealed Instrument, the differences include:

• adopting the latest revised Instrument format, which commenced in 2015;
• specifying a day of commencement for the Instrument in section 2;
• revising the definition of 'trigeminal neuralgia or trigeminal neuropathy' in subsection 7(2);
• including ICD-10-AM codes for 'trigeminal neuralgia' in subsection 7(3);
• revising the factor in subsection 9(2) concerning having one of the following traumatic injuries, for trigeminal neuropathy;
• revising the factor in subsection 9(3) concerning having an injury to the affected trigeminal nerve as a result of a dental of surgical procedure, for trigeminal neuropathy;
• revising the factor in subsection 9(4) concerning undergoing one of the following procedures, for trigeminal neuropathy;
• revising the factor in subsection 9(8) concerning having vascular compression, for trigeminal neuralgia;
• revising the factor in subsection 9(9) concerning having a mass lesion;
• factor concerning having a benign fibro-osseous lesion subsumed into factor in subsection 9(9) concerning having a mass lesion;
• factor concerning having a haematological malignancy or lymphoproliferative disease subsumed into factor in subsection 9(9) concerning having a mass lesion;
• factor concerning having amyloidosis subsumed into factor in subsection 9(9) concerning having a mass lesion;
• revising the factor in subsection 9(10) concerning having cervical disc prolapse or cervical syringomyelia, for trigeminal neuropathy;
• revising the factor in subsection 9(11) concerning having one of the following inflammatory connective tissue diseases;
• revising the factor in subsection 9(12) concerning having rheumatoid arthritis or sarcoidosis, for trigeminal neuropathy;
• revising the factor in subsection 9(13) concerning having one of the following systemic vasculitides, for trigeminal neuropathy;
• revising the factor in subsection 9(14) concerning having invasive bacterial or fungal paranasal sinusitis or viral meningoencephalitis, for trigeminal neuralgia;
• revising the factor in subsection 9(15) concerning having one of the following infections, for trigeminal neuropathy;
• revising the factor in subsection 9(16) concerning having acute herpes zoster, for trigeminal neuropathy;
• revising the factor in subsection 9(18) concerning having multiple sclerosis;
• revising the factor in subsection 9(19) concerning having Charcot-Marie-Tooth disease, for trigeminal neuralgia;
• revising the factor in subsection 9(21) concerning having diabetes, for trigeminal neuropathy;
• revising the factor in subsection 9(22) concerning being treated with one of the following medications, for trigeminal neuropathy;
• new factor in subsection 9(25) concerning having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for trigeminal neuralgia;
• deleting factor concerning having moderate to severe traumatic brain injury, for trigeminal neuropathy;
• deleting peripheral phenol injection from specified list of procedures, for trigeminal neuropathy;
• deleting factor concerning receiving a lumbar puncture or epidural anaesthesia, for trigeminal neuropathy;
• deleting factor concerning ionising radiation, for trigeminal neuropathy;
• deleting multiple conditions from specified list of inflammatory connective tissue diseases;
• deleting factors concerning having limbic encephalitis;
• deleting multiple conditions from specified list of infections, for trigeminal neuropathy;
• deleting multiple conditions from specified list of drugs, for trigeminal neuropathy;
• deleting factor concerning being envenomated by the spider Loxosceles rufescens, for trigeminal neuropathy;
• deleting factor concerning Charcot-Marie-Tooth disease from trigeminal neuropathy;
• deleting factor concerning central nervous system demyelinating disease;
• deleting factor concerning having facial contact dermatitis, for trigeminal neuropathy; and
• deleting the definitions of 'benign fibro-osseous lesion', 'cumulative equivalent dose', 'limbic encephalitis', 'mass lesion', ' specified list of drugs', 'specified list of infections', 'specified list of inflammatory connective tissue diseases', 'specified list of procedures', 'specified list of systemic vasculitides' and 'traumatic injury'.

Consultation

1.              Prior to determining this Instrument, the Authority advertised its intention to undertake investigations in relation to trigeminal neuralgia and, trigeminal neuropathy in the Government Notices Gazette of 4 January 2023, 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, the Military Rehabilitation and Compensation 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 in relation to the investigation.
2.              On 2 August 2024, 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:

Trigeminal neuralgia

• 9(8) & 9(16) factors concerning limbic encephalitis;
• 9(6) & 9(14) deleting relapsing polychondritis and rheumatoid arthritis -  from the definition of  specified list of inflammatory connective tissue diseases;
• 9(1) & 9(9) demyelinating disease - removed from the factor;

Trigeminal neuropathy

• 9(1) & 9(29) Charcot–Marie–Tooth disease and other demyelinating disease - removed from the factors;
• 9(8) & 9(36) factors concerning moderate to severe traumatic brain injury;
• 9(10) & 9(38) deleting relapsing polychondritis, dermatomyositis, and polymyositis - from the definition of specified list of inflammatory connective tissue diseases;
• 9(13) & 9(41) deleting Cerebral malaria, mastoiditis and Mycobacterium tuberculosis - from the definition of specified list of infections;
• 9(17) & 9(45) deleting interferon alpha, mefloquine, vinblastine and vindesine -  from the definition of specified list of drugs;
• 9(22) & 9(50) factors concerning  ionising radiation;
• 9(24) & 9(52) deleting phenol injection - from the definition of specified list of procedures;
• 9(25) & 9(53) factors concerning lumbar puncture or epidural anaesthesia;
• 9(26) & 9(54)  factors concerning spider envenomation;
• 9(27) & 9(55) factors concerning facial contact dermatitis;
• 9(28) & 9(56) factors concerning  limbic encephalitis;

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.  No changes were made to the proposed Instrument following this consultation process.

Human Rights

1.          This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.  A Statement of Compatibility with Human Rights follows.

Finalisation of Investigation

1.          The determining of this Instrument finalises the investigations in relation to trigeminal neuralgia and, trigeminal neuropathy as advertised in the Government Notices Gazette of 4 January 2023.

References

1.          A list of references relating to the above condition is available on the Authority's website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:

Email:    info@rma.gov.au

Post:      The Registrar

Repatriation Medical Authority

GPO Box 1014

BRISBANE    QLD    4001

Statement of Compatibility with Human Rights

(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)

Instrument No.:   Statement of Principles No. 84 of 2024

Kind of Injury, Disease or Death: Trigeminal neuralgia or trigeminal neuropathy

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

1. This Legislative Instrument is determined pursuant to subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).  Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.

2. This Legislative Instrument:-

• facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have trigeminal neuralgia or trigeminal neuropathy;
• facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
• outlines the factors which the current sound medical-scientific evidence indicates must as a minimum exist, before it can be said that a reasonable hypothesis has been raised, connecting trigeminal neuralgia or trigeminal neuropathy with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
• replaces Instrument Nos. 77 of 2015 and 79 of 2015; and
• reflects developments in the available sound medical-scientific evidence concerning trigeminal neuralgia or trigeminal neuropathy which have occurred since that earlier instrument was determined. 

3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA. 

Human Rights Implications

4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:

• the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
• the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
• the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
• the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
• ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).

Conclusion

This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.

Repatriation Medical Authority

[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.