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Statement of Principles concerning ankylosing spondylitis No. 3 of 2013

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Statement of Principles
No. 3 of 2013
for the purposes of the
Veterans’ Entitlements Act 1986
Military Rehabilitation and Compensation Act 2004
1.         This Instrument may be cited as Statement of Principles concerning ankylosing spondylitis No. 3 of 2013.
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 25 of 2005 concerning ankylosing spondylitis; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about ankylosing spondylitis and death from ankylosing spondylitis.
(b)               For the purposes of this Statement of Principles, "ankylosing spondylitis" means a chronic, progressive, inflammatory disease of unknown aetiology which involves the sacroiliac joints and the axial skeleton, and may also involve peripheral joints and have a broad spectrum of extra-articular manifestations.
(c)                Ankylosing spondylitis attracts ICD-10-AM code M45.
(d)              In the application of this Statement of Principles, the definition of "ankylosing spondylitis" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that ankylosing spondylitis and death from ankylosing spondylitis 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 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.
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting ankylosing spondylitis or death from ankylosing spondylitis with the circumstances of a person’s relevant service is:
(a)                smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ankylosing spondylitis, and where smoking has ceased, the clinical worsening of ankylosing spondylitis has occurred within ten years of cessation; or
(b)               inability to obtain appropriate clinical management for ankylosing spondylitis.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(a) and 6(b) apply only to material contribution to, or aggravation of, ankylosing spondylitis where the person’s ankylosing spondylitis 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:
"death from ankylosing spondylitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s ankylosing spondylitis;
"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), Seventh Edition, effective date of 1 July 2010, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 154 5;
"pack-years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year, or 7300 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 means either 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;
"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.
10.       This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11.       This Instrument takes effect from 9 January 2013.
Dated this   fourteenth   day of   December   2012
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )