Statement of Principles
concerning
 
REACTIVE ARTHRITIS
No. 27 of 2010
 
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 reactive arthritis No. 27 of 2010.
 
Determination
2.         The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 18 of 1998 concerning Reiter's syndrome; and
(b)       determines in its place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about reactive arthritis and death from reactive arthritis.
(b)              For the purposes of this Statement of Principles, "reactive arthritis" means an immune-mediated arthritis of more than one month's duration, usually associated with evidence of a preceding infection. The clinical illness is typically characterised by a predominantly lower limb, asymmetric oligoarthritis and may include extra-articular manifestations, such as urethritis, cervicitis, conjunctivitis, skin lesions, sacroiliitis, spondylitis and enthesitis.
This definition excludes septic arthritis, post-streptococcal reactive arthritis, Lyme disease, leptospirosis, tuberculosis, rheumatic fever and arthritis associated with viruses which are known to cause arthritis as part of the usual spectrum of clinical manifestations (including Ross River Virus, Barmah Forest Virus, rubella virus and parvovirus B19).
(c)              Reactive arthritis attracts ICD-10-AM code M02.
(d)              In the application of this Statement of Principles, the definition of "reactive arthritis" 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 reactive arthritis and death from reactive arthritis 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, reactive arthritis or death from reactive arthritis is connected with the circumstances of a person’s relevant service is:
 
(a)               having an infection as specified within the 30 days before the clinical onset of reactive arthritis; or
 
(b)              being infected with the human immunodeficiency virus at the time of the clinical onset of reactive arthritis; or
 
(c)              being vaccinated with the hepatitis B vaccine within the 30 days before the clinical onset of reactive arthritis; or
 
(d)              having intravesical BCG therapy for malignant neoplasm of the bladder or intradermal BCG therapy for a malignant neoplasm within the 30 days before the clinical onset of reactive arthritis; or
 
(e)              having intestinal bypass surgery within the one year before the clinical onset of reactive arthritis; or
 
(f)               inability to obtain appropriate clinical management for reactive arthritis.
 
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(f) applies only to material contribution to, or aggravation of, reactive arthritis where the person’s reactive arthritis 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:
 
"an infection as specified" means:
(a)        clinical or laboratory evidence of a bowel infection;
(b)       clinical or laboratory evidence of an infection of the urethra or cervix; or
(c)       clinical or laboratory evidence of an infection with Staphylococcus aureus, Chlamydia pneumoniae, Chlamydia psittaci or Chlamydia trachomatis;
 
"BCG therapy" means treatment with the Bacille Calmette-Guerin vaccine;
 
"death from reactive arthritis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s reactive arthritis;
 
"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), Sixth Edition, effective date of 1 July 2008, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 016 6;
 
"relevant service" means:
(a)       eligible war service (other than operational service) under the VEA; or
(b)       defence service (other than hazardous 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 12 May 2010.
 
Dated this       twenty-second day of              April         2010.
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON