Statement of Principles
No. 41 of 2012
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 endometriosis No. 41 of 2012.
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 7 of 2004 concerning endometriosis; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about endometriosis and death from endometriosis.
(b) For the purposes of this Statement of Principles, "endometriosis" means a condition in which tissue containing typical endometrial glandular and stromal elements occurs ectopically, resulting in clinical symptoms and signs or requiring treatment.
(c) Endometriosis attracts ICD-10-AM code N80.
(d) In the application of this Statement of Principles, the definition of "endometriosis" 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 endometriosis and death from endometriosis 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 endometriosis or death from endometriosis with the circumstances of a person’s relevant service is:
(a) for postmenopausal women only, having hormone replacement therapy for the three months before the clinical onset of endometriosis; or
(b) having continuous tamoxifen therapy for the three months before the clinical onset of endometriosis; or
(c) for endometriosis of the abdominal wall, cervix, vagina, vulva or perineum only, having surgery or trauma involving the site of endometriosis within the six months before the clinical onset of endometriosis; or
(d) having a body mass index (BMI) of less than 20 for the five years before the clinical onset of endometriosis; or
(e) for postmenopausal women only, having hormone replacement therapy for the three months before the clinical worsening of endometriosis; or
(f) having continuous tamoxifen therapy for the three months before the clinical worsening of endometriosis; or
(g) having a BMI of less than 20 for the five years before the clinical worsening of endometriosis; or
(h) inability to obtain appropriate clinical management for endometriosis.
Factors that apply only to material contribution or aggravation
7. Paragraphs 6(e) to 6(h) apply only to material contribution to, or aggravation of, endometriosis where the person’s endometriosis 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.
9. For the purposes of this Statement of Principles:
"BMI" means body mass index and is calculated as follows:
The BMI = W/H2 where:
W is the person's weight in kilograms and
H is the person's height in metres;
"death from endometriosis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s endometriosis;
"hormone replacement therapy" means administration of oestrogen preparations often in combination with progesterone to offset a hormone deficiency following surgically induced or naturally occurring menopause;
"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:
(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 11 July 2012.
Dated this twenty-first day of June 2012
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )