REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 43 of 2007

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. 81 of 1997 determined under subsection 196B(2) of the VEA concerning tuberculosis and death from tuberculosis.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that tuberculosis and death from tuberculosis 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. 43 of 2007 concerning tuberculosis.  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 tuberculosis or death from tuberculosis, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 1 September 2004 concerning tuberculosis 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 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;
• revising the definition of 'tuberculosis' in clause 3;
• revising factor 6(b) concerning 'overcrowded and poorly ventilated living or working conditions';
• revising factor 6(h) & 6(p) concerning 'immunosuppressed state';
• new factor 6(a) concerning 'infectious tuberculosis';
• new factor 6(c) concerning 'incidence of tuberculosis';
• new factor 6(d) concerning 'biological material';
• new factor 6(e) concerning 'working with animals';
• new factor 6(f) concerning 'infected animal';
• new factors 6(i) & 6(q) concerning 'chronic disease';
• new factors 6(j) & 6(r) concerning 'crystalline silica dust';
• new factors 6(k) & 6(s) concerning'smoking';
• new factors 6(l) & 6(t) concerning 'gastrectomy or jejunoileal bypass';
• new factors 6(m) & 6(u) concerning 'BCG therapy';
• new factors 6(n) & 6(v) concerning 'BCG vaccine';
• deleting factor concerning 'evidence of previous primary tuberculosis';
• revising the definition of 'relevant service' in clause 9;
• new definitions of 'a specified chronic disease'; 'active tuberculosis disease'; 'an immunosuppressed state affecting cell-mediated immunity'; 'BCG'; 'biological material'; 'infectious tuberculosis'; 'minimum ideal weight'; 'moderate to severe renal failure'; 'pack year of cigarettes, or the equivalent thereof in other tobacco products'; 'pulmonary tuberculosis'; 'terminal event' and 'undergoing treatment with corticosteroids' in clause 9;
• deleting the definitions of 'being in an immunosuppressed state affecting cell-mediated immunity'; 'being infected with Human Immunodeficiency Virus (HIV)'; 'ICD code'; 'ideal weight'; 'primary tuberculosis' and 'reactivated tuberculosis' in clause 9; 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 tuberculosis in the Government Notices Gazette of 1 September 2004, 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.  One submission was received for consideration by the Authority during the investigation process.

9.             On 20 December 2006, 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 factor relating to evidence of previous primary tuberculosis. 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 in response to this letter.

10.         The determining of this new instrument finalises the investigation in relation to tuberculosis as advertised in the Government Notices Gazette of 1 September 2004.

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