Statement of Principles concerning   RETINAL VASCULAR OCCLUSIVE DISEASE No. 33 of 2006   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 retinal vascular occlusive disease No. 33 of 2006.   Determination 2.                  This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the VEA).   Kind of injury, disease or death 3.         (a)        This Statement of Principles is about retinal vascular occlusive disease and death from retinal vascular occlusive disease. (b)              For the purposes of this Statement of Principles, “retinal vascular occlusive disease” means obstruction to blood flow in the retinal artery or its branches or obstruction to blood flow in the retinal vein or its tributaries, leading to impaired vision. (c)              Retinal vascular occlusive disease attracts ICD-10-AM code H34. (d)              In the application of this Statement of Principles, the definition of “retinal vascular occlusive 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 retinal vascular occlusive disease and death from retinal vascular occlusive 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 retinal vascular occlusive disease or death from retinal vascular occlusive disease with the circumstances of a person’s relevant service is:   (a)                smoking at least 15 pack years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of retinal vascular occlusive disease, and where smoking has ceased, the clinical onset has occurred within 30 years of cessation; or   (b)               having hypertension at the time of the clinical onset of retinal vascular occlusive disease; or   (c)                having diabetes mellitus at the time of the clinical onset of retinal vascular occlusive disease; or   (d)               having dyslipidaemia before the clinical onset of retinal vascular occlusive disease; or   (e)                having hyperhomocysteinaemia at the time of the clinical onset of retinal vascular occlusive disease; or   (f)                 using a drug from the specified list within the 72 hours before the clinical onset of retinal vascular occlusive disease; or   (g)                using a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin, on at least 22 days per month for a continuous period of at least two months before the clinical onset of retinal vascular occlusive disease, where the last dose of the drug was taken within the three days before the clinical onset of retinal vascular occlusive disease; or   (h)                being obese before the clinical onset of retinal vascular occlusive disease; or   (i)                  having trauma, including surgical trauma, to the affected eye or the blood vessels supplying or draining the affected eye, within the seven days before the clinical onset of retinal vascular occlusive disease, and in the case of prolonged unconsciousness associated with such trauma, the seven day period is taken to commence upon regaining consciousness; or   (j)                 having antiphospholipid antibody syndrome at the time of the clinical onset of retinal vascular occlusive disease; or   (k)               being infected with human immunodeficiency virus (HIV) at the time of the clinical onset of retinal vascular occlusive disease; or   (l)                  for retinal vein occlusion only, having open-angle glaucoma or ocular hypertension at the time of the clinical onset of retinal vascular occlusive disease; or   (m)              for retinal vein occlusion only, being at least five percent dehydrated at the time of the clinical onset of retinal vascular occlusive disease; or   (n)                for retinal arterial occlusion only, having a potential source of cerebral embolus at the time of the clinical onset of retinal vascular occlusive disease; or   (o)               inability to obtain appropriate clinical management for retinal vascular occlusive disease.   Factors that apply only to material contribution or aggravation 7.         Paragraph 6(o) applies only to material contribution to, or aggravation of, retinal vascular occlusive disease where the person’s retinal vascular occlusive 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:   “a drug from the specified list” means: (a)               cocaine; (b)              heroin; (c)              phencyclidine (angel dust); (d)              D-lysergic acid diethylamide (LSD); (e)              amphetamines and amphetamine-like compounds, including dextroamphetamine, methamphetamine, methylphenidate (Ritalin), ephedrine, pseudoephedrine, phenylpropanolamine, phentermine, phendimetrazine, and 3,4-methylenedioxymethamphetamine (ecstasy); or (f)               marijuana;   “a potential source of cerebral embolus” means the presence of at least one of the following: (a)               thrombus formation within the pulmonary vein, left atrium, left ventricle or arteries supplying the retina; or (b)              atrial fibrillation (intermittent or sustained); or (c)              sick sinus syndrome; or (d)              any of the following mitral or aortic valve disorders: (i)                stenosis; or (ii)             regurgitation; or (iii)           calcification; or (iv)            valvulitis; or (v)               prosthetic valve; or (vi)            mitral valve prolapse; or (vii)          Lambl’s excrescences; or (e)              acute myocardial infarction; or (f)               left ventricular aneurysm; or (g)              left ventricular dyskinesia; or (h)              cardiomyopathy; or (i)                left atrial aneurysm or dilatation; or (j)                any of the following means of paradoxical embolism: (i)                atrial septal defect; or (ii)             patent foramen ovale; or (iii)           ventricular septal defect; or (iv)            pulmonary arteriovenous fistula; or (k)              any of the following causes of cerebral arterial embolism: (i)                pulmonary barotrauma; or (ii)             decompression sickness; or (iii)           severe bone trauma; or (iv)            foreign body penetration into an artery within the head, neck or chest; or (v)               primary or secondary cardiac tumours; or (vi)            primary or secondary lung tumours; or (vii)          cardiac hydatid cysts; or (l)                infective or non-infective (marantic) endocarditis; or (m)            any of the following procedures within the seven days before the clinical onset of retinal arterial occlusion: (i)                cardiac surgery or cardiac catheterisation; or (ii)             surgery involving the arteries supplying the retina; or (iii)           catheterisation of or injection into the arteries supplying the retina; or (iv)            surgery or medical procedures involving the pulmonary veins; or (v)               orthopaedic surgery;   “antiphospholipid antibody syndrome” means the presence of antiphospholipid antibodies or lupus anticoagulant antibodies, plus one or more of the following clinical manifestations: (a)               venous thrombosis; (b)              arterial thrombosis; (c)              foetal loss; or (d)              thrombocytopaenia;   “being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of thirty or greater. The BMI = W/H2 and where: W is the person’s weight in kilograms and H is the person’s height in metres;   “death from retinal vascular occlusive disease” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s retinal vascular occlusive disease;   “dehydrated” means deficient in body water, such as could occur after strenuous physical activity, vomiting, diarrhoea, or febrile illness, without adequate rehydration;  
“dyslipidaemia” generally means evidence of a persistently abnormal lipid profile after the accurate evaluation of serum lipids following a 12 hour overnight fast, and estimated on a minimum of two occasions as a: (a)            total serum cholesterol level greater than or equal to 5.5 mmol/L; or (b)            serum triglyceride level greater than or equal to 2.0 mmol/L; or (c)            having a high density lipoprotein cholesterol level less than 1.0 mmol/L;   “hyperhomocysteinaemia” means a condition characterised by an excess of homocysteine in the blood;   “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), Fourth Edition, effective date of 1 July 2004, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 594 1;   “ocular hypertension” means intra-ocular pressure greater than 21 mm Hg, without evidence of optic atrophy or visual field loss;   “pack years of cigarettes, or the equivalent thereof in other tobacco products” means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7300 cigarettes. One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack year of tailor made cigarettes equates to 7300 cigarettes, or 7.3 kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;   “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;   “trauma, including surgical trauma” means blunt trauma of sufficient force to deform the antero-posterior axis of the globe and to disrupt the intima of relevant blood vessels, or a penetrating eye injury, including such injury arising from a surgical procedure.   Date of effect 10.       This Instrument takes effect from 28 June 2006.   Dated this       nineteenth     day of              June  2006     The Common Seal of the                              ) Repatriation Medical Authority                   ) was affixed to this instrument                      ) in the presence of:                                        )   KEN DONALD CHAIRPERSON