Statement of Principles

concerning

ACQUIRED CATARACT
(Balance of Probabilities)

(No. 88 of 2016)

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

Dated 28 October 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 Revocation

5 Application

6 Definitions

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

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 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 acquired cataract (Balance of Probabilities) (No. 88 of 2016).

2               Commencement

              This instrument commences on 28 November 2016.

3               Authority

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

4               Revocation

The Statement of Principles concerning acquired cataract No. 40 of 2008, as amended, made under subsections 196B(3) and (8) of the VEA is revoked.

5               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.

6               Definitions

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

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

(1)          This Statement of Principles is about acquired cataract and death from acquired cataract.

Meaning of acquired cataract

(2)          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.

(3)          While acquired cataract attracts ICD‑10‑AM code H25, H26.1-H26.9, H28.1 or H28.2, in applying this Statement of Principles the meaning of acquired cataract is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.

Death from acquired cataract

(5)          For the purposes of this Statement of Principles, 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.

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

8               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 acquired cataract and death from acquired cataract 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.

9               Factors that must exist

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

(1)          having sunlight exposure to the eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of acquired cataract;

Note: equivalent sunlight exposure in other latitude zones and tropical area are defined in the Schedule 1 - Dictionary.               

(2)          smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of acquired cataract;

Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.             

(3)          having diabetes mellitus before the clinical onset of acquired cataract;

(4)          having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected eye before the clinical onset of acquired cataract;

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

(5)          having physical trauma to the affected eye within the ten years before the clinical onset of acquired cataract;

Note: physical trauma is defined in the Schedule 1 - Dictionary.             

(6)          having a severe thermal or chemical burn to the affected eye before the clinical onset of acquired cataract;

Note: severe thermal or chemical burn is defined in the Schedule 1 - Dictionary.             

(7)          having an electrical injury within the five years before the clinical onset of acquired cataract;

(8)          being treated with a drug as specified before the clinical onset of acquired cataract;

Note: being treated with a drug as specified is defined in the Schedule 1 - Dictionary.             

(9)          being treated with a selective serotonin reuptake inhibitor or a serotonin and noradrenaline (norepinephrine) reuptake inhibitor for the six months before the clinical onset of acquired cataract;

(10)      being treated with an oral, topical or inhalational corticosteroid as specified within the ten years before the clinical onset of acquired cataract;

Note: being treated with an oral, topical or inhalational corticosteroid as specified is defined in the Schedule 1 - Dictionary.             

(11)      having uveitis or iridocyclitis of the affected eye before the clinical onset of acquired cataract;

(12)      being overweight or obese for at least five years within the ten years before the clinical onset of acquired cataract;

Note:  being overweight or obese is defined in the Schedule 1 - Dictionary.             

(13)      for cortical and subcapsular cataract only, having hypoparathyroidism at the time of the clinical onset of acquired cataract;

(14)      having sunlight exposure to the eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical worsening of acquired cataract;

Note: equivalent sunlight exposure in other latitude zones and tropical area are defined in the Schedule 1 - Dictionary.               

(15)      smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of acquired cataract;

Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.             

(16)      having diabetes mellitus before the clinical worsening of acquired cataract;

(17)      having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected eye before the clinical worsening of acquired cataract;

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

(18)      having physical trauma to the affected eye within the ten years before the clinical worsening of acquired cataract;

Note: physical trauma is defined in the Schedule 1 - Dictionary.             

(19)      having a severe thermal or chemical burn to the affected eye before the clinical worsening of acquired cataract;

Note: severe thermal or chemical burn is defined in the Schedule 1 - Dictionary.             

(20)      having an electrical injury within the five years before the clinical worsening of acquired cataract;

(21)      being treated with a drug as specified before the clinical worsening of acquired cataract;

Note: being treated with a drug as specified is defined in the Schedule 1 - Dictionary.             

(22)      being treated with a selective serotonin reuptake inhibitor or a serotonin and noradrenaline (norepinephrine) reuptake inhibitor for the six months before the clinical worsening of acquired cataract;

(23)      being treated with an oral, topical or inhalational corticosteroid as specified within the ten years before the clinical worsening of acquired cataract;

Note: being treated with an oral, topical or inhalational corticosteroid as specified is defined in the Schedule 1 - Dictionary.             

(24)      having uveitis or iridocyclitis of the affected eye before the clinical worsening of acquired cataract;

(25)      being overweight or obese for at least five years within the ten years before the clinical worsening of acquired cataract;

Note:  being overweight or obese is defined in the Schedule 1 - Dictionary.             

(26)      for cortical and subcapsular cataract only, having hypoparathyroidism at the time of the clinical worsening of acquired cataract;

(27)      inability to obtain appropriate clinical management for acquired cataract.

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(14) to 9(27) 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 did not arise out of) the person's relevant service.

11           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 9 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 6

1               Definitions

In this instrument:

                             acquired cataract—see subsection 7(2).

                              being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.

Note: BMI is also defined in the Schedule 1 – Dictionary.

                             being treated with a drug as specified means:

(a)          for anterior subcapsular cataract only, receiving a cumulative dose of at least 1 500 grams of a phenothiazine; or

(b)          receiving a cumulative dose of at least 400 grams of amiodarone; or

(c)          receiving a cumulative dose of at least 30 grams of tamoxifen.

                             being treated with an oral, topical or inhalational corticosteroid as specified means:

(a)          applying a topical corticosteroid to the cornea of the affected eye equivalent to a cumulative dose of at least 200 drops of 0.1% dexamethasone; or

(b)          applying a topical corticosteroid to the skin for a total of at least 730 days; or

(c)          taking an oral corticosteroid equivalent to a cumulative dose of at least 900 milligrams of prednisone; or

(d)          using an inhalational corticosteroid equivalent to a cumulative dose of at least 2 000 milligrams of budesonide.

                             BMI means W/H2 and where:

W is the person's weight in kilograms; and

                             H is the person's height in metres.

                             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.

                             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' South and 23° 27' North                             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.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             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 7 300 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 7.3 kilograms of smoking tobacco by weight.  Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.

                             physical trauma means:

(a)          penetrating injury; or

(b)          intraocular surgery; or

(c)          blunt trauma resulting in symptoms and signs lasting at least three days.

                             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.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               severe thermal or chemical burn means a burn involving at least one of the following clinical features:

(a)          corneal anaesthesia;

(b)          corneal opacification;

(c)          symptoms and signs lasting at least three days and requiring medical attention; or

(d)          for chemical burns only, penetration of the chemical into the anterior chamber.

                             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.

                             tropical area means any area between the Tropic of Capricorn (23º 27' South) and the Tropic of Cancer (23º 27' North).

                             VEA means the Veterans' Entitlements Act 1986.