Statement of Principles
concerning
 
ALKAPTONURIA
No. 48 of 2007
 
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 alkaptonuria No. 48 of 2007.
 
Determination
2.                  The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 14 of 1995, as amended by Instrument No. 189 of 1995, concerning alkaptonuria; and
(b)       determines in their place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about alkaptonuria and death from alkaptonuria.
(b)              For the purposes of this Statement of Principles, "alkaptonuria" means a genetic metabolic disorder heritable as an autosomal recessive trait, characterised by deficiency of the hepatic enzyme homogentisic acid oxidase.  This leads to the accumulation of homogentisic acid, a metabolite of tyrosine in connective tissues of various organs.
(c)              Alkaptonuria attracts ICD-10-AM code E70.2.
(d)              In the application of this Statement of Principles, the definition of "alkaptonuria" 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 alkaptonuria and death from alkaptonuria 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, alkaptonuria or death from alkaptonuria is connected with the circumstances of a person’s relevant service is:
 
(a)               having cirrhosis of the liver at the time of the clinical worsening of alkaptonuria; or
 
(b)              having moderate to severe renal failure at the time of the clinical worsening of alkaptonuria; or
 
(c)              inability to obtain appropriate clinical management for alkaptonuria.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(a) to 6(c) apply only to material contribution to, or aggravation of, alkaptonuria where the person’s alkaptonuria 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 alkaptonuria" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s alkaptonuria;
 
"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), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;
 
"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;
 
"moderate to severe renal failure" means a glomerular filtration rate of less than 60 ml/minute;
 
"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 9 May 2007.
 
Dated this       twenty-fourth day of              April         2007
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON