Statement of Principles
concerning
ACQUIRED CATARACT
No. 39 of 2008
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 acquired cataract No. 39 of 2008.
Determination
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 37 of 2001, as amended by Instrument No. 32 of 2002, concerning acquired cataract; and
(b) determines in their place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about acquired cataract and death from acquired cataract.
(b) For the purposes of this Statement of Principles, "acquired cataract" means an opacification of the lens or lens capsule of the eye which causes visual impairment and which is not due to congenital or infantile cataract or lens malformation.
(c) Acquired cataract attracts ICD-10-AM code H25, H26, H28.1 or H28.2.
(d) In the application of this Statement of Principles, the definition of "acquired cataract" 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 acquired cataract and death from acquired cataract 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 acquired cataract or death from acquired cataract with the circumstances of a person’s relevant service is:
(a) having sunlight exposure to the unprotected eye for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of acquired cataract; or
(b) smoking at least 10 pack years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of acquired cataract; or
(c) having diabetes mellitus before the clinical onset of acquired cataract; or
(d) having glaucoma of the affected eye before the clinical onset of acquired cataract; or
(e) undergoing a course of therapeutic radiation to the region of the affected eye before the clinical onset of acquired cataract; or
(f) having received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the affected eye before the clinical onset of acquired cataract; or
(g) having physical trauma to the affected eye within the 20 years before the clinical onset of acquired cataract; or
(h) being treated with oral, topical or inhalational corticosteroids as specified within the 10 years before the clinical onset of acquired cataract; or
(i) having a severe thermal or chemical burn to the affected eye before the clinical onset of acquired cataract; or
(j) having an electrical injury within the five years before the clinical onset of acquired cataract; or
(k) being treated with a drug as specified before the clinical onset of acquired cataract; or
(l) having uveitis or iridocyclitis of the affected eye before the clinical onset of acquired cataract; or
(m) for cortical and subcapsular cataract only, having chronic hypocalcaemia at the time of the clinical onset of acquired cataract; or
(n) having sunlight exposure to the unprotected eye for at least 2250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical worsening of acquired cataract; or
(o) smoking at least 10 pack years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of acquired cataract; or
(p) having diabetes mellitus before the clinical worsening of acquired cataract; or
(q) having glaucoma of the affected eye before the clinical worsening of acquired cataract; or
(r) undergoing a course of therapeutic radiation to the region of the affected eye before the clinical worsening of acquired cataract; or
(s) having received a cumulative equivalent dose of at least 0.5 Sievert of atomic radiation to the affected eye before the clinical worsening of acquired cataract; or
(t) having physical trauma to the affected eye within the 20 years before the clinical worsening of acquired cataract; or
(u) being treated with oral, topical or inhalational corticosteroids as specified within the 10 years before the clinical worsening of acquired cataract; or
(v) having a severe thermal or chemical burn to the affected eye before the clinical worsening of acquired cataract; or
(w) having an electrical injury within the five years before the clinical worsening of acquired cataract; or
(x) being treated with a drug as specified before the clinical worsening of acquired cataract; or
(y) having uveitis or iridocyclitis of the affected eye before the clinical worsening of acquired cataract; or
(z) for cortical and subcapsular cataract only, having chronic hypocalcaemia at the time of the clinical worsening of acquired cataract; or
(aa) inability to obtain appropriate clinical management for acquired cataract.
Factors that apply only to material contribution or aggravation
7. Paragraphs 6(n) to 6(aa) apply only to material contribution to, or aggravation of, acquired cataract where the person’s acquired cataract 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 course of therapeutic radiation" means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;
"a severe thermal or chemical burn" means a burn involving at least one of the following clinical features:
(a) greater than 50% involvement of the limbus or conjunctiva; or
(b) corneal anaesthesia; or
(c) a significant degree of corneal opacification; or
(d) for chemical burns only, penetration of the chemical into the anterior chamber;
"a tropical area" means any area between the Tropic of Capricorn (23º 27' South) and the Tropic of Cancer (23º 27' North);
"atomic radiation" means ionising radiation excluding:
(a) natural background radiation;
(b) therapeutic radiation; and
(c) radiation from diagnostic procedures;
"being treated with a drug as specified" means:
(a) for anterior subcapsular cataract only, receiving a cumulative dose of at least 750 grams of phenothiazines; or
(b) for anterior subcapsular cataract only, receiving amiodarone therapy for a cumulative period of at least 180 days; or
(c) receiving a cumulative dose of at least 200 grams of allopurinol;
"being treated with oral, topical or inhalational corticosteroids as specified" means:
(a) applying topical corticosteroids to the cornea of the affected eye equivalent to a cumulative dose of at least 100 drops of 0.1% dexamethasone; or
(b) applying topical corticosteroids to the skin for a total of at least 365 days; or
(c) taking oral corticosteroids equivalent to a cumulative dose of at least 900 mg of prednisone; or
(d) using inhalational corticosteroids equivalent to a cumulative dose of at least 500 mg of beclomethasone;
"cumulative equivalent dose" means the total equivalent dose of radiation from all types of ionising radiation. It accounts for the differences in biological effectiveness of various types of radiation and allows doses from different radiations to be combined. Each component is calculated by multiplying the absorbed dose in a particular tissue or organ for a given type of radiation by the radiation weighting factor for that radiation. The unit of equivalent dose is the Sievert;
"death from acquired cataract" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s acquired cataract;
"electrical injury" means:
(a) lightning strike resulting in loss of consciousness or burns; or
(b) electric shock from at least 220 voltage current resulting in loss of consciousness or burns;
"equivalent sunlight exposure in other latitude zones" means the cumulative hours of sunlight exposure equivalent to that specified for a tropical area, calculated by multiplying the hours of exposure in each latitude zone by the latitude weighting factor for the zone as per the latitude weighting factor schedule and adding together the result for each zone:
Latitude weighting factor schedule
Latitude zone Latitude weighting factor
a latitude between 23° 27' S and 23° 27' N 1.0
a latitude from > 23° 27' to 35° 0.75
a latitude from > 35° to 45° 0.5
a latitude from > 45° to 65° 0.25;
"glaucoma" means open-angle glaucoma or angle-closure glaucoma;
"hypocalcaemia" means confirmed findings of serum calcium
