Statement of Principles concerning discoid lupus erythematosus (Reasonable Hypothesis) (No. 126 of 2015)

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Statement of Principles
concerning
DISCOID LUPUS ERYTHEMATOSUS
(Reasonable Hypothesis)
(No. 126 of 2015)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
                                                                                                       
Dated    16 October         2015
 
 
 
 
 
The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:
 
 
 
 
Professor Nicholas Saunders AO
Chairperson
 
 
 
  
Contents
1          Name........................................................................................................................................... 3
2          Commencement........................................................................................................................ 3
3          Authority..................................................................................................................................... 3
4          Application................................................................................................................................. 3
5          Definitions.................................................................................................................................. 3
6          Kind of injury, disease or death to which this Statement of Principles relates............... 3
7          Basis for determining the factors........................................................................................... 4
8          Factors that must exist............................................................................................................. 4
9          Relationship to service............................................................................................................. 5
10        Factors referring to an injury or disease covered by another Statement of Principles. 5
Schedule 1 - Dictionary............................................................................................. 6
1          Definitions.................................................................................................................................. 6
 
 
 
1               Name
This is the Statement of Principles concerning discoid lupus erythematosus (Reasonable Hypothesis) (No. 126 of 2015).
2               Commencement
This instrument commences on 16 November 2015.
3               Authority
This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
4               Application
This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.
5               Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
6               Kind of injury, disease or death to which this Statement of Principles relates
(1)          This Statement of Principles is about discoid lupus erythematosus and death from discoid lupus erythematosus.
Meaning of discoid lupus erythematosus
(2)          For the purposes of this Statement of Principles, discoid lupus erythematosus means:
(a)           a form of chronic cutaneous lupus erythematosus that commonly presents with erythematous, scaly plaques which often heal with scarring and atrophy; and
(b)          excludes systemic lupus erythematosus.
(3)          While discoid lupus erythematosus attracts ICD‑10‑AM code L93.0, in applying this Statement of Principles the meaning of discoid lupus erythematosus is that given in subsection (2).
(4)          For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.
Death from discoid lupus erythematosus
(5)          For the purposes of this Statement of Principles, discoid lupus erythematosus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s discoid lupus erythematosus.
Note: terminal event is defined in the Schedule 1 – Dictionary.
7               Basis for determining the factors
The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that discoid lupus erythematosus and death from discoid lupus erythematosus can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.
Note: relevant service is defined in the Schedule 1 – Dictionary.
8               Factors that must exist
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting discoid lupus erythematosus or death from discoid lupus erythematosus with the circumstances of a person’s relevant service:
(1)          being exposed to sunlight or ultraviolet light at a level sufficient to induce erythema at least 24 hours, but not more than 30 days, before the clinical onset of discoid lupus erythematosus;
(2)          being treated with a class of drug from the specified list of classes of drugs at the time of the clinical onset of discoid lupus erythematosus;
Note: specified list of classes of drugs is defined in the Schedule 1 - Dictionary.
(3)          having an injury to the skin at the affected site within the 30 days before the clinical onset of discoid lupus erythematosus;
Note: injury to the skin is defined in the Schedule 1 - Dictionary.
(4)          having hormone replacement therapy with an oestrogen for at least the two years before the clinical onset of discoid lupus erythematosus;
(5)          being exposed to sunlight or ultraviolet light at a level sufficient to induce erythema at least 24 hours, but not more than 30 days, before the clinical worsening of discoid lupus erythematosus;
(6)          being treated with a class of drug from the specified list of classes of drugs at the time of the clinical worsening of discoid lupus erythematosus;
Note: specified list of classes of drugs is defined in the Schedule 1 - Dictionary.
(7)          having an injury to the skin at the affected site within the 30 days before the clinical worsening of discoid lupus erythematosus;
Note: injury to the skin is defined in the Schedule 1 - Dictionary.
(8)          where smoking has not ceased before the clinical worsening of discoid lupus erythematosus, smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of discoid lupus erythematosus;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(9)          inability to obtain appropriate clinical management for discoid lupus erythematosus.
9               Relationship to service
(1)          The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.
(2)          The factors set out in subsections 8(5) to 8(9) apply only to material contribution to, or aggravation of, discoid lupus erythematosus where the person’s discoid lupus erythematosus was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
10           Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1)          if a factor referred to in section 8 applies in relation to a person; and
(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;
then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
 
Schedule 1 - Dictionary  
Note: See Section 5
1               Definitions
 In this instrument:
                             discoid lupus erythematosus—see subsection 6(2).
                              injury to the skin means any injury which is capable of causing inflammation of the skin, and includes cuts, abrasions, radiation, burns, pressure, tattooing and contact dermatitis.
                               MRCA means the Military Rehabilitation and Compensation Act 2004.
                              pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes.  One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight.  Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.
                               relevant service means:
(a)           operational service under the VEA;
(b)          peacekeeping service under the VEA;
(c)           hazardous service under the VEA;
(d)          British nuclear test defence service under the VEA;
(e)           warlike service under the MRCA; or
(f)           non-warlike service under the MRCA.
                              specified list of classes of drugs means:
(a)           fluorouracils, excluding topical agents; or
(b)          tumour necrosis factor-alpha inhibitors.
                             terminal event means the proximate or ultimate cause of death and includes the following:
(a)           pneumonia;
(b)          respiratory failure;
(c)           cardiac arrest;
(d)          circulatory failure; or
(e)           cessation of brain function.
                                   VEA means the Veterans' Entitlements Act 1986.
 
 

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