Statement of Principles
concerning
 
SCRUB TYPHUS
No. 72 of 2009
 
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 scrub typhus No. 72 of 2009.
 
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 25 of 1995 concerning scrub typhus; and
(b)       determines in its place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about scrub typhus and death from scrub typhus.
(b)              For the purposes of this Statement of Principles, "scrub typhus" means a clinical illness caused by Orientia tsutsugamushi, formerly known as Rickettsia tsutsugamushi. The infection is transmitted by mites and is characterised by an eschar at the bite site, high fever, headache, myalgia, cough, a rash and lymphadenopathy.
(c)              Scrub typhus attracts ICD-10-AM code A75.3.
(d)              In the application of this Statement of Principles, the definition of "scrub typhus" 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 scrub typhus and death from scrub typhus 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 scrub typhus or death from scrub typhus with the circumstances of a person’s relevant service is:
 
(a)               being in an area that is endemic for scrub typhus at least five days and not more than 21 days before the clinical onset of scrub typhus; or
 
(b)              having percutaneous exposure to blood infected with Orientia tsutsugamushi at least five days and not more than 21 days before the clinical onset of scrub typhus; or
 
(c)              inability to obtain appropriate clinical management for scrub typhus.
 
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(c) applies only to material contribution to, or aggravation of, scrub typhus where the person’s scrub typhus 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 area endemic for scrub typhus" means the Asia-Pacific region extending from Pakistan, India and Nepal in the west; to southeastern Siberia, China, Japan and Korea in the north; and to Indonesia, the Philippines, Australia north of the Tropic of Capricorn and the islands of the Western Pacific and Indian Oceans in the south;
 
"death from scrub typhus" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s scrub typhus;
 
"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)       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 11 November 2009.
 
Dated this       twenty-eighth day of              October          2009
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON