Statement of Principles
concerning
 
CONJUNCTIVITIS
No. 1 of 2012
 
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 conjunctivitis No. 1 of 2012.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 111 of 1996 concerning conjunctivitis; and
(b)        determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about conjunctivitis and death from conjunctivitis.
(b)               For the purposes of this Statement of Principles, "conjunctivitis" means an inflammation of the conjunctiva (the membrane lining the eyelids and exposed surface of the sclera) and includes blepharoconjunctivitis and keratoconjunctivitis.
(c)                Conjunctivitis attracts ICD-10-AM code H10, H13.1, H13.2 or H16.2.
(d)              In the application of this Statement of Principles, the definition of "conjunctivitis" 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 conjunctivitis and death from conjunctivitis 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.
Factors
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting conjunctivitis or death from conjunctivitis with the circumstances of a person’s relevant service is:
(a)                having blepharitis of the affected eye at the time of the clinical onset of conjunctivitis; or
(b)               having an infection of the conjunctiva of the affected eye at the time of the clinical onset of conjunctivitis; or
(c)                having a condition of the affected eye from the specified list at the time of the clinical onset of conjunctivitis; or
(d)               having ocular or periocular exposure to an allergen within the 12 hours before the clinical onset of conjunctivitis; or
(e)                having a condition from the specified list at the time of the clinical onset of conjunctivitis; or
(f)                for iatrogenic conjunctivitis only, having received therapy to the affected eye with topically applied medication within the 48 hours before the clinical onset of conjunctivitis; or
(g)               having ocular or periocular exposure to an irritant substance within the 24 hours before the clinical onset of conjunctivitis; or
(h)               having mustard gas exposure to the affected eye within the 24 hours before the clinical onset of  conjunctivitis; or
(i)                 having a foreign body in contact with the affected conjunctiva within the 24 hours before the clinical onset of conjunctivitis; or
(j)                 having an injury to the conjunctiva of the affected eye within the 24 hours before the clinical onset of conjunctivitis; or
(k)               having a benign or malignant neoplasm affecting the conjunctiva or eyelid margin at the time of the clinical onset of conjunctivitis; or
(l)                 being in an immunosuppressed state at the time of the clinical onset of conjunctivitis; or
(m)             having blepharitis of the affected eye at the time of the clinical worsening of conjunctivitis; or
(n)               having an infection of the conjunctiva of the affected eye at the time of the clinical worsening of conjunctivitis; or
(o)               having a condition of the affected eye from the specified list at the time of the clinical worsening of conjunctivitis; or
(p)               having ocular or periocular exposure to an allergen within the 12 hours before the clinical worsening of conjunctivitis; or
(q)               having a condition from the specified list at the time of the clinical worsening of conjunctivitis; or
(r)                 for iatrogenic conjunctivitis only, having received therapy to the affected eye with topically applied medication within the 48 hours before the clinical worsening of conjunctivitis; or
(s)                having ocular or periocular exposure to an irritant substance within the 24 hours before the clinical worsening of conjunctivitis; or
(t)                 having mustard gas exposure to the affected eye within the 24 hours before the clinical worsening of  conjunctivitis; or
(u)               having a foreign body in contact with the affected conjunctiva within the 24 hours before the clinical worsening of conjunctivitis; or
(v)               having an injury to the conjunctiva of the affected eye within the 24 hours before the clinical worsening of conjunctivitis; or
(w)             having a benign or malignant neoplasm affecting the conjunctiva or eyelid margin at the time of the clinical worsening of conjunctivitis; or
(x)               being in an immunosuppressed state at the time of the clinical worsening of conjunctivitis; or
(y)               inability to obtain appropriate clinical management for conjunctivitis.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(m) to 6(y) apply only to material contribution to, or aggravation of, conjunctivitis where the person’s conjunctivitis 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 condition from the specified list" means:
(a)                cicatricial pemphigoid;
(b)               dermatitis herpetiformis;
(c)                dermatomyositis;
(d)               diabetes mellitus;
(e)                graft-versus-host disease;
(f)                primary biliary cirrhosis;
(g)               psoriasis;
(h)               rheumatoid arthritis;
(i)                 sarcoidosis;
(j)                 Sjogren's syndrome;
(k)               symptomatic Vitamin A deficiency;
(l)                 symptomatic Vitamin B deficiency;
(m)             systemic lupus erythematosus;
(n)               systemic sclerosis (scleroderma); or
(o)               Wegener's granulomatosis;
"a condition of the affected eye from the specified list" means:
(a)                disorder of nasolacrimal duct or gland;
(b)               ectropion;
(c)                exophthalmos; or
(d)               lid retraction;
"an allergen" means an antigenic substance capable of producing an immune response;
"an infection of the conjunctiva" means a bacterial, viral, rickettsial, parasitic or fungal infection involving the conjunctiva;
"an injury to the conjunctiva" means trauma to the ocular surface involving the conjunctiva by mechanisms including thermal, electrical and chemical burns and blunt or penetrating trauma;
"an irritant substance" means a chemical agent (including those contained in smokes, smog, aerosolised sprays and fumes) which causes an inflammatory effect on living tissue at the site of contact;
"being in an immunosuppressed state" means being in a condition of lowered immune function due to one of the following circumstances or conditions:
(a)          being infected with the human immunodeficiency virus;
(b)          having a haematological or solid organ malignancy;
(c)          undergoing chemotherapy for the treatment of a malignant or proliferative disease;
(d)         undergoing solid organ, stem cell or bone marrow transplantation; or
(e)          undergoing treatment with a tumour necrosis factor-alpha antagonist;
"death from conjunctivitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s conjunctivitis;
"iatrogenic conjunctivitis" means a toxic follicular or infiltrative, nonspecific conjunctivitis produced by application of topical ocular medication;
"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;
"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.
Application
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 11 January 2012.
Dated this   twenty-second   day of   December   2011
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
KEN DONALD
CHAIRPERSON