Statement of Principles

concerning

OPTOCHIASMATIC ARACHNOIDITIS
(Balance of Probabilities)

(No. 58 of 2016)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans’ Entitlements Act 1986.

Dated                                           22 April 2016

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO

Chairperson

Contents

1 Name

2 Commencement

3 Authority

4 Application

5 Definitions

6 Kind of injury, disease or death to which this Statement of Principles relates

7 Basis for determining the factors

8 Factors that must exist

9 Relationship to service

10 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning optochiasmatic arachnoiditis (Balance of Probabilities) (No. 58 of 2016).

2               Commencement

              This instrument commences on 23 May 2016.

3               Authority

This instrument is made under subsection 196B(3) of the Veterans’ Entitlements Act 1986.

4               Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

5               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

6               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about optochiasmatic arachnoiditis and death from optochiasmatic arachnoiditis.

Meaning of optochiasmatic arachnoiditis

(2)          For the purposes of this Statement of Principles, optochiasmatic arachnoiditis means chronic inflammation of the arachnoid membrane surrounding the optic chiasm and intracranial optic nerves, resulting in damage to these structures from fibrosis and the formation of adhesions, and typically presenting with progressive visual loss.

Death from optochiasmatic arachnoiditis

(3)          For the purposes of this Statement of Principles, optochiasmatic arachnoiditis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s optochiasmatic arachnoiditis.

Note: terminal event is defined in the Schedule 1 – Dictionary.

7               Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that optochiasmatic arachnoiditis and death from optochiasmatic arachnoiditis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

8               Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, optochiasmatic arachnoiditis or death from optochiasmatic arachnoiditis is connected with the circumstances of a person’s relevant service:

(1)          having a bacterial, fungal or parasitic infection involving the leptomeninges surrounding the optic chiasm or intracranial optic nerves before the clinical onset of optochiasmatic arachnoiditis;

Note: leptomeninges is defined in the Schedule 1 - Dictionary.               

(2)          having a subarachnoid haemorrhage or bleeding into the subarachnoid space before the clinical onset of optochiasmatic arachnoiditis;

(3)          having surgery to an area in close proximity to the optic chiasm before the clinical onset of optochiasmatic arachnoiditis;

(4)          having a moderate to severe traumatic brain injury before the clinical onset of optochiasmatic arachnoiditis;

(5)          undergoing a course of therapeutic radiation for cancer, where the optic chiasm was in the field of radiation, before the clinical onset of optochiasmatic arachnoiditis;

(6)          having received a cumulative equivalent dose of at least 20 sieverts of ionising radiation to the region of the optic chiasm before the clinical onset of optochiasmatic arachnoiditis;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.             

(7)          having sarcoidosis or multiple sclerosis, involving inflammation of the leptomeninges surrounding the optic chiasm, before the clinical onset of optochiasmatic arachnoiditis;

Note: leptomeninges is defined in the Schedule 1 - Dictionary.             

(8)          having an intrathecal myelogram or intrathecal treatment with a substance from the specified list of substances before the clinical onset of optochiasmatic arachnoiditis;

Note: specified list of substances is defined in the Schedule 1 - Dictionary.             

(9)          having a bacterial, fungal or parasitic infection involving the leptomeninges surrounding the optic chiasm or intracranial optic nerves before the clinical worsening of optochiasmatic arachnoiditis;

Note: leptomeninges is defined in the Schedule 1 - Dictionary.               

(10)      having a subarachnoid haemorrhage or bleeding into the subarachnoid space before the clinical worsening of optochiasmatic arachnoiditis;

(11)      having surgery to an area in close proximity to the optic chiasm before the clinical worsening of optochiasmatic arachnoiditis;

(12)      having a moderate to severe traumatic brain injury before the clinical worsening of optochiasmatic arachnoiditis;

(13)      undergoing a course of therapeutic radiation for cancer, where the optic chiasm was in the field of radiation, before the clinical worsening of optochiasmatic arachnoiditis;

(14)      having received a cumulative equivalent dose of at least 20 sieverts of ionising radiation to the region of the optic chiasm before the clinical worsening of optochiasmatic arachnoiditis;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.             

(15)      having sarcoidosis or multiple sclerosis, involving inflammation of the leptomeninges surrounding the optic chiasm, before the clinical worsening of optochiasmatic arachnoiditis;

Note: leptomeninges is defined in the Schedule 1 - Dictionary.             

(16)      having an intrathecal myelogram or intrathecal treatment with a substance from the specified list of substances before the clinical worsening of optochiasmatic arachnoiditis;

Note: specified list of substances is defined in the Schedule 1 - Dictionary.             

(17)      inability to obtain appropriate clinical management for optochiasmatic arachnoiditis.

9               Relationship to service

(1)          The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 8(9) to 8(17) apply only to material contribution to, or aggravation of, optochiasmatic arachnoiditis where the person’s optochiasmatic arachnoiditis was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

10           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 8 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 5

1               Definitions

In this instrument:

                             cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue.  The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect.  The unit of equivalent dose is the sievert.  For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents.

                             leptomeninges means the arachnoid mater and the pia mater, the two innermost layers of the cerebral meninges between which there is circulation of cerebrospinal fluid.

                               MRCA means the Military Rehabilitation and Compensation Act 2004.

                               optochiasmatic arachnoiditis—see subsection 6(2).

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

                             specified list of substances means:

(a)          iophendylate (Pantopaque or Myodil);

(b)          radioactive gold; or

(c)          thorium dioxide (Thorotrast).

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.