Statement of Principles
concerning
PSORIASIS
No. 31 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 psoriasis No. 31 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. 56 of 2002 concerning psoriasis; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about psoriasis and death from psoriasis.
(b) For the purposes of this Statement of Principles, "psoriasis" means a chronic inflammatory skin disorder characterised by keratinocyte hyperproliferation resulting in erythematous plaques, patches and papules which may be pruritic and are classically covered by a silver scale. Morphological variants include the common plaque type, as well as flexural, erythrodermic, pustular and guttate forms.
(c) Psoriasis attracts ICD-10-AM code L40.0, L40.1, L40.2, L40.4 or L40.8.
(d) In the application of this Statement of Principles, the definition of "psoriasis" 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 psoriasis and death from psoriasis 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 psoriasis or death from psoriasis with the circumstances of a person’s relevant service is:
(a) for a first episode of psoriasis only,
(i) having an acute injury to the skin of the affected site or developing a lesion of the affected site within the one month before the clinical onset of psoriasis; or
(ii) being treated with a drug or a drug from a class of drugs in the specified list for at least the seven days before the clinical onset of psoriasis; or
(iii) withdrawing from systemic glucocorticoids or high potency topical glucocorticoids in the one month before the clinical onset of psoriasis; or
(iv) being treated with a drug which is associated in the individual with:
A. the development of psoriasis during drug therapy; and either
B. the improvement of psoriasis within two months of discontinuing or tapering drug therapy; or
C. the redevelopment of psoriasis on rechallenge with the same drug;
where treatment with the drug continued for at least the seven days before the clinical onset of psoriasis; or
(v) consuming an average of at least 420 grams of alcohol per week for a continuous period of at least the one year before the clinical onset of psoriasis; or
(vi) experiencing a category 1A stressor within the three months before the clinical onset of psoriasis; or
(vii) experiencing a category 1B stressor within the three months before the clinical onset psoriasis; or
(viii) experiencing a category 2 stressor within the one month before the clinical onset of psoriasis; or
(ix) having a laboratory confirmed Streptococcus pyogenes infection of the pharynx, tonsils or skin within the one month before the clinical onset of psoriasis; or
(x) being infected with human immunodeficiency virus before the clinical onset of psoriasis; or
(xi) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of psoriasis, and where smoking has ceased, the clinical onset of psoriasis has occurred within twenty years of cessation; or
(xii) immersion in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 10 000 hours before the clinical onset of psoriasis; or
(xiii) being overweight for at least five years before the clinical onset of psoriasis; or
(b) for impetigo herpetiformis only, being pregnant within the six weeks before the clinical onset of psoriasis; or
(c) having an acute injury to the skin of the affected site or developing a lesion of the affected site within the one month before the clinical worsening of psoriasis; or
(d) being treated with a drug or a drug from a class of drugs in the specified list for at least the seven days before the clinical worsening of psoriasis; or
(e) withdrawing from systemic glucocorticoids or high potency topical glucocorticoids in the one month before the clinical worsening of psoriasis; or
(f) being treated with a drug which is associated in the individual with:
(i) the worsening of psoriasis during drug therapy; and either
(ii) the improvement of psoriasis within two months of discontinuing or tapering drug therapy; or
(iii) the worsening of psoriasis on rechallenge with the same drug;
where treatment with the drug continued for at least the seven days before the clinical worsening of psoriasis; or
(g) consuming an average of at least 420 grams of alcohol per week for a continuous period of at least the one year before the clinical worsening of psoriasis; or
(h) experiencing a category 1A stressor within the three months before the clinical worsening of psoriasis; or
(i) experiencing a category 1B stressor within the three months before the clinical worsening psoriasis; or
(j) experiencing a category 2 stressor within the one month before the clinical worsening of psoriasis; or
(k) having a laboratory confirmed Streptococcus pyogenes infection of the pharynx, tonsils or skin within the one month before the clinical worsening of psoriasis; or
(l) being infected with human immunodeficiency virus before the clinical worsening of psoriasis; or
(m) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of psoriasis, and where smoking has ceased, the clinical worsening of psoriasis has occurred within twenty years of cessation; or
(n) immersion in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 10 000 hours before the clinical worsening of psoriasis; or
(o) being overweight for at least five years before the clinical worsening of psoriasis; or
(p) inability to obtain appropriate clinical management for psoriasis.
Factors that apply only to material contribution or aggravation
7. Paragraphs 6(c) to 6(p) apply only to material contribution to, or aggravation of, psoriasis where the person’s psoriasis 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 category 1A stressor" means one or more of the following severe traumatic events:
(a) experiencing a life-threatening event;
(b) being subject to a serious physical attack or assault including rape and sexual molestation; or
(c) being threatened with a weapon, being held captive, being kidnapped, or being tortured;
"a category 1B stressor" means one of the following severe traumatic events:
(a) being an eyewitness to a person being killed or critically injured;
(b) viewing corpses or critically injured casualties as an eyewitness;
(c) being an eyewitness to atrocities inflicted on another person or persons;
(d) killing or maiming a person; or
(e) being an eyewitness to or participating in, the clearance of critically injured casualties;
"a category 2 stressor" means one or more of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:
(a) being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;
(b) experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation or divorce;
(c) having concerns in the work or school environment including on-going disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful work loads, or experiencing bullying in the workplace or school environment;
(d) experiencing serious legal issues including being detained or held in custody, on-going involvement with the police concerning violations of the law or court appearances associated with personal legal problems;
(e) having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property or bankruptcy;
(f) having a family member or significant other experience a major deterioration in their health; or
(g) being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability;
"a drug or a drug from a class of drugs in the specified list" means:
(a) angiotensin-converting enzyme inhibitors;
(b) beta-blockers;
(c) interferons;
(d) lithium;
(e) non-steroidal anti-inflammatory drugs;
(f) synthetic antimalarial drugs (e.g., quinacrine, hydroxychloroquine, chloroquine, primaquine, mefloquine);
(g) tetracyclines; or
(h) tumour necrosis factor alpha antagonists;
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;
"being overweight" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 25 or greater.
The BMI = W/H2 and where:
W is the person’s weight in kilograms and
H is the person’s height in metres;
"death from psoriasis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s psoriasis;
"high potency topical glucocorticoids" means:
(a) betamethasone dipropionate 0.05%;
(b) betamethasone valerate 0.1%;
(c) clobetasol proprionate 0.05%;
(d) diflucortolone valerate 0.1%;
(e) fluocinolone acetonide 0.025%; or
(f) another topical glucocorticoid of equivalent potency;
"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;
"impetigo herpetiformis" means a pustular skin condition of pregnancy, characterised by the presence of widespread tiny superficial pustules in a herpetiform pattern on erythematosquamous plaques, and often associated with constitutional symptoms;
"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 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.
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 2 May 2012.
Dated this twentieth day of April 2012
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRPERSON
