Statement of Principles concerning coeliac disease No. 1 of 2011

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Statement of Principles
concerning
 
COELIAC DISEASE
No. 1 of 2011
 
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 coeliac disease No. 1 of 2011.
 
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 17 of 1997 concerning coeliac disease; and
(b)        determines in its place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about coeliac disease and death from coeliac disease.
(b)        For the purposes of this Statement of Principles, "coeliac disease" means a malabsorption disorder causing inflammation in the small intestine, induced in susceptible people by the ingestion of gluten. It is characterised clinically by a range of gastrointestinal and extraintestinal manifestations, and by specific biopsy-demonstrated histological changes in the small intestine. Signs and symptoms of the disease generally improve when gluten is withdrawn from the diet. Coeliac disease is an insidious condition where the clinical onset may be subtle and precede the first obvious clinical signs and symptoms by many years.  Coeliac disease is also known as coeliac crisis, gluten-sensitive enteropathy or nontropical sprue.
(c)        Coeliac disease attracts ICD-10-AM code K90.0.
(d)              In the application of this Statement of Principles, the definition of "coeliac disease" 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 coeliac disease and death from coeliac disease 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 coeliac disease or death from coeliac disease with the circumstances of a person’s relevant service is:
 
(a)                being treated with interferon alpha or ribavirin within the six months before the clinical worsening of coeliac disease; or
 
(b)               having surgery to resect any part of the oesophagus, stomach, small or large intestine, within the one year before the clinical worsening of coeliac disease; or
 
(c)                being pregnant within the six months before the clinical worsening of coeliac disease; or
 
(d)               inability to maintain a gluten-free diet at the time of the clinical worsening of coeliac disease; or
 
(e)                inability to obtain appropriate clinical management for coeliac disease.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(a) to 6(e) apply only to material contribution to, or aggravation of, coeliac disease where the person’s coeliac disease 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 coeliac disease" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s coeliac disease;
 
"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)                warlike service under the MRCA; or
(e)                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 5 January 2011.
 
Dated this   fourteenth   day of   December   2010
 
 
The Common Seal of the                      )
Repatriation Medical Authority  )
was affixed to this instrument                 )
in the presence of:                                 )
 
KEN DONALD
CHAIRPERSON

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