Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE EYE
(Reasonable Hypothesis)

(No. 27 of 2018)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 2 March 2018

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 malignant neoplasm of the eye (Reasonable Hypothesis) (No. 27 of 2018).

2               Commencement

              This instrument commences on 2 April 2018.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4               Revocation

The Statement of Principles concerning malignant neoplasm of the eye No. 15 of 2010 made under subsection 196B(2) of the VEA is revoked.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 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 malignant neoplasm of the eye and death from malignant neoplasm of the eye.

Meaning of malignant neoplasm of the eye

(2)          For the purposes of this Statement of Principles, malignant neoplasm of the eye:

(a)         means a primary malignant neoplasm arising from the tissue of the eyeball and conjunctiva; and

(b)        includes:

(i)             malignant melanoma of the uveal tract (iris, ciliary body and choroid); and

(ii)          malignant melanoma of the conjunctiva, including melanoma in situ; and

(iii)        squamous cell carcinoma of the cornea or the conjunctiva, including carcinoma in situ; and

(c)        excludes eye retinoblastoma, connective tissue and bone tumours (sarcomas), vascular tumours (sarcoma), non-Hodgkin's lymphoma, Hodgkin's lymphoma and carcinoid tumour.

Note: The eye means the eyeball with conjunctival covering but excluding extraocular muscles, connecting nerves (optic nerve, autonomic sympathetic and parasympathetic nerves), arteries, veins and lymphatics, other orbital contents such as orbital fat and orbital bone, eyelid skin, Meibomian glands, the caruncle and the lacrimal apparatus.

(3)          While malignant neoplasm of the eye attracts ICD‑10‑AM code C69.0, C69.1, C69.2, C69.3, C69.4, C69.8, C69.9 or D09.2, in applying this Statement of Principles the meaning of malignant neoplasm of the eye 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from malignant neoplasm of the eye

(5)          For the purposes of this Statement of Principles, malignant neoplasm of the eye, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant neoplasm of the eye.

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

8               Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that malignant neoplasm of the eye and death from malignant neoplasm of the eye 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 MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the eye or death from malignant neoplasm of the eye with the circumstances of a person's relevant service:

(1)          having sunlight or ultraviolet light exposure to the eye for a cumulative period of at least 2 250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of malignant neoplasm of the eye;

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

(2)          having ultraviolet radiation exposure from an ultraviolet-emitting tanning device to the unprotected eye on at least ten occasions, at least five years before the clinical onset of malignant neoplasm of the eye;

Note:   unprotected eye is defined in the Schedule 1 - Dictionary.             

(3)          being infected with human immunodeficiency virus before the clinical onset of malignant neoplasm of the eye;

(4)          being treated with an immunosuppressive drug at least five years before the clinical onset of malignant neoplasm of the eye;

Note:   immunosuppressive drug is defined in the Schedule 1 - Dictionary.

(5)          having a solid organ or stem cell transplantation before the clinical onset of malignant neoplasm of the eye;

(6)          for uveal melanoma of the eye only:

(a)        using manual welding equipment for welding metal, for a cumulative period of at least ten years before the clinical onset of malignant neoplasm of the eye; or

(b)        having exposure to transformer or capacitor oils containing polychlorinated biphenyls, on an average of at least two times per month, for a cumulative period of at least ten years before the clinical onset of malignant neoplasm of the eye;

(7)          for melanoma of the eye only:

(a)        having ultraviolet radiation exposure from whole body PUVA therapy to the unprotected eye, where:

(i)            the first PUVA treatment commenced at least ten years before the clinical onset of malignant neoplasm of the eye; and

(ii)         at least 200 PUVA treatments were administered before the clinical onset of malignant neoplasm of the eye; or

Note:    unprotected eye and whole body PUVA are defined in the Schedule 1 - Dictionary.

(b)        having at least two episodes of photokeratitis of the affected eye, where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the eye;

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

(8)          for conjunctival melanoma of the eye only, receiving a conjunctival transplant to the affected eye before the clinical onset of malignant neoplasm of the eye;

(9)          for squamous cell carcinoma of the cornea or the conjunctiva only:

(a)        acquiring persistent infection of the epithelium of the conjunctiva of the affected eye with a specified human papilloma virus (HPV) before the clinical onset of malignant neoplasm of the eye;

Note:   specified human papilloma virus (HPV) is defined in the Schedule 1 - Dictionary.

(b)        having ultraviolet radiation exposure from whole body PUVA therapy to the unprotected eye, where:

(i)             the first PUVA treatment commenced at least five years before the clinical onset of malignant neoplasm of the eye; and

(ii)         at least 25 PUVA treatments were administered before the clinical onset of malignant neoplasm of the eye; or

Note:                                                                       unprotected eye and whole body PUVA are defined in the Schedule 1 - Dictionary.

(c)        being treated with voriconazole for a continuous period of at least the four weeks before the clinical onset of malignant neoplasm of the eye;

(10)      for squamous cell carcinoma of the conjunctiva only, having an ocular prosthesis in an anophthalmic socket of the affected eye for more than ten years before the clinical onset of malignant neoplasm of the eye;

(11)      inability to obtain appropriate clinical management for malignant neoplasm of the eye.

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 factor set out in subsection 9(11) applies only to material contribution to, or aggravation of, malignant neoplasm of the eye where the person's malignant neoplasm of the eye 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(2) 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:

                             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.

Note: tropical area is also defined in the Schedule 1 - Dictionary.

                             immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses. 

Note: This definition includes corticosteroids other than inhaled or topical corticosteroids, drugs used to prevent transplant rejection, tumour necrosis factor-α inhibitors and chemotherapeutic agents used for the treatment of cancer.

                              malignant neoplasm of the eye—see subsection 7(2).

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             photokeratitis means a clinical illness manifesting from radiation damage to the cornea and conjunctiva by exposure of the eye to ultraviolet light rays from natural sources including snowblindness or artificial sources including electrical arc welding.

                             relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

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

                             specified human papilloma virus (HPV) means HPV type 5, 8, 14, 16 or 18.

                             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).

                             unprotected eye means an eye not protected by ultraviolet radiation screening devices such as goggles.

                             VEA means the Veterans' Entitlements Act 1986.

                             whole body PUVA means photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation.  It does not include localised PUVA therapy.