Statement of Principles
concerning
 
MELIOIDOSIS
No. 61 of 2014
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1.         This Instrument may be cited as Statement of Principles concerning melioidosis No. 61 of 2014.
Determination
2.         The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 28 of 2003 concerning melioidosis; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about melioidosis and death from melioidosis.
(b)        For the purposes of this Statement of Principles, "melioidosis" means a clinical illness due to infection with the bacterium Burkholderia pseudomallei.  Clinical manifestations may be local or systemic and include pulmonary infection, septicaemia, meningoencephalitis and chronic suppurative infections.
(c)        Melioidosis attracts ICD-10-AM code A24.1, A24.2, A24.3 or A24.4.
(d)       In the application of this Statement of Principles, the definition of "melioidosis" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that melioidosis and death from melioidosis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
Factors
6.         The factor that must exist before it can be said that, on the balance of probabilities, melioidosis or death from melioidosis is connected with the circumstances of a person’s relevant service is:
(a)               being exposed to Burkholderia pseudomallei before the clinical onset of melioidosis; or
(b)               being in an immunosuppressed state as specified at the time of the clinical onset of melioidosis; or
(c)               having a specified condition at the time of the clinical onset of melioidosis; or
(d)              for males, consuming at least 65 kilograms of alcohol within the three years before the clinical onset of melioidosis; or
(e)               for females, consuming at least 44 kilograms of alcohol within the three years before the clinical onset of melioidosis; or
(f)                being in an immunosuppressed state as specified at the time of the clinical worsening of melioidosis; or
(g)               having a specified condition at the time of the clinical worsening of melioidosis; or
(h)               for males, consuming at least 65 kilograms of alcohol within the three years before the clinical worsening of melioidosis; or
(i)                 for females, consuming at least 44 kilograms of alcohol within the three years before the clinical worsening of melioidosis; or
(j)                 inability to obtain appropriate clinical management for melioidosis.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(f) to 6(j) apply only to material contribution to, or aggravation of, melioidosis where the person’s melioidosis was suffered or contracted before or during (but not arising out of) the person’s relevant service.
Inclusion of Statements of Principles
8.                  In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Other definitions
9.                  For the purposes of this Statement of Principles:
"a specified condition" means one of the following:
(a)                chronic obstructive pulmonary disease;
(b)               chronic renal failure;
(c)                congestive cardiac failure;
(d)               diabetes mellitus; or
(e)                rheumatic heart disease;
"an immunosuppressed state as specified" means a condition of lowered immune function due to one of the following circumstances or conditions:
(a)                being treated with an immunosuppressive drug;
(b)               having a haematological or solid organ malignancy; or
(c)                malnutrition;
"an immunosuppressive drug" means a drug or an agent administered orally, intravenously or intramuscularly for the purpose of suppressing the immune responses, but does not include an inhaled or topical steroid;
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink;
"being exposed to Burkholderia pseudomallei" means:
(a)                being in close contact with animals or humans infected with Burkholderia pseudomallei;
(b)               being in contact with soil contaminated with Burkholderia pseudomallei;
(c)                consuming water or food contaminated with Burkholderia pseudomallei;
(d)               having percutaneous exposure to blood or body fluids infected with Burkholderia pseudomallei; or
(e)                inhaling dust, water droplets or aerosols contaminated with Burkholderia pseudomallei;
"being in close contact with animals or humans" means having direct physical contact with animals or humans, or having direct contact with body fluids or tissues from animals or humans;
"chronic renal failure" means having a glomerular filtration rate of less than 60 mL/min/1.73 m2 for a period of at least three months, or the presence of irreversible kidney damage;
"congestive cardiac failure" means a clinical syndrome due to heart disease, resulting in congestion in the peripheral circulation with or without congestion of the lungs;
"death from melioidosis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s melioidosis;
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"relevant service" means:
(a)        eligible war service (other than operational service) under the VEA;
(b)        defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c)        peacetime service under the MRCA;
"terminal event" means the proximate or ultimate cause of death and includes:
(a)                pneumonia;
(b)               respiratory failure;
(c)                cardiac arrest;
(d)               circulatory failure; or
(e)                cessation of brain function.
Application
10.       This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
Date of effect
11.       This Instrument takes effect from 2 July 2014.
Dated this  twentieth   day of   June   2014
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed at the direction of:          )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON