Statement of Principles

concerning

MACULAR DEGENERATION
(Reasonable Hypothesis)

(No. 59 of 2018)

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

Dated                                                                                        22 June 2018

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

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 macular degeneration (Reasonable Hypothesis) (No. 59 of 2018).

2               Commencement

              This instrument commences on 23 July 2018.

3               Authority

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

4               Repeal

The Statement of Principles concerning macular degeneration No. 13 of 2009 (Federal Register of Legislation No. F2012C00634) made under subsections 196B(2) and (8) of the VEA is repealed.

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 macular degeneration and death from macular degeneration.

Meaning of macular degeneration

(2)          For the purposes of this Statement of Principles, macular degeneration:

(a)          means a group of degenerative diseases of the macula of the eye that may cause progressive, painless loss of central vision; and

(b)          includes:

(i)             early macular degeneration; and

(ii)          late macular degeneration; and

(c)          excludes toxic retinopathy.

Note:   early macular degeneration and late macular degeneration are defined in the Schedule 1 – Dictionary.

Death from macular degeneration

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

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 macular degeneration and death from macular degeneration 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 macular degeneration or death from macular degeneration with the circumstances of a person's relevant service:

(1)          smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of macular degeneration, and:

(a)          smoking commenced at least five years before the clinical onset of macular degeneration; and

(b)          where smoking has ceased, the clinical onset of macular degeneration has occurred within 20 years of cessation;

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

(2)          being exposed to second-hand smoke:

(a)          for at least 10 000 hours before the clinical onset of macular degeneration; and

(b)          where the first exposure to second-hand smoke commenced at least five years before the clinical onset of macular degeneration; and

(c)          where the last exposure to second-hand smoke occurred within the 20 years before the clinical onset of macular degeneration;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.             

(3)          consuming a cumulative total of at least 15 kilograms of alcohol in a continuous period of two years, within the five years before the clinical onset of macular degeneration;

Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

(4)          being obese for at least the five years before the clinical onset of macular degeneration;

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

(5)          having chronic kidney disease within the five years before the clinical onset of macular degeneration;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.             

(6)          having a lipid profile as specified, within the five years before the clinical onset of macular degeneration;

Note: lipid profile as specified is defined in the Schedule 1 - Dictionary.             

(7)          having diabetes mellitus at the time of the clinical onset of macular degeneration;

(8)          having hypertension at the time of the clinical onset of macular degeneration;

(9)          for wet macular degeneration only, undergoing cataract surgery involving the affected eye within the five years before the clinical onset of macular degeneration;

Note: wet macular degeneration is defined in the Schedule 1 - Dictionary.             

(10)      smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of macular degeneration, and:

(a)          smoking commenced at least five years before the clinical worsening of macular degeneration; and

(b)          where smoking has ceased, the clinical worsening of macular degeneration has occurred within 20 years of cessation;

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

(11)      being exposed to second-hand smoke:

(a)          for at least 10 000 hours before the clinical worsening of macular degeneration; and

(b)          where the first exposure to second-hand smoke commenced at least five years before the clinical worsening of macular degeneration; and

(c)          where the last exposure to second-hand smoke occurred within the 20 years before the clinical worsening of macular degeneration;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.             

(12)      consuming a cumulative total of at least 15 kilograms of alcohol in a continuous period of two years, within the five years before the clinical worsening of macular degeneration;

Note:  Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

(13)      being obese for at least the five years before the clinical worsening of macular degeneration;

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

(14)      having chronic kidney disease within the five years before the clinical worsening of macular degeneration;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.             

(15)      having a lipid profile as specified, within the five years before the clinical worsening of macular degeneration;

Note: lipid profile as specified is defined in the Schedule 1 - Dictionary.             

(16)      having diabetes mellitus at the time of the clinical worsening of macular degeneration;

(17)      having hypertension at the time of the clinical worsening of macular degeneration;

(18)      for wet macular degeneration only, undergoing cataract surgery involving the affected eye within the five years before the clinical worsening of macular degeneration;

Note: wet macular degeneration is defined in the Schedule 1 - Dictionary.             

(19)      for clinical worsening of wet macular degeneration manifesting as subretinal haemorrhage only, having anticoagulant therapy or thrombolytic therapy, within the seven days before the clinical worsening of macular degeneration;

Note: anticoagulant therapy and thrombolytic therapy are defined in the Schedule 1 - Dictionary.

(20)      inability to obtain appropriate clinical management for macular degeneration.

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(10) to 9(20) apply only to material contribution to, or aggravation of, macular degeneration where the person's macular degeneration 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:

                             an abnormality of kidney structure or function means:

(a)          having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or

(b)          having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or

(c)          having had a kidney transplant.

                             anticoagulant therapy means therapeutic administration of a pharmacological agent which suppresses, delays or nullifies blood coagulation (such as heparin, warfarin or dicumarol), but excludes antiplatelet therapy (such as aspirin, clopidogrel, ticlopidine or monoclonal antibodies and recombinant and chemically synthesised peptides that block platelet adhesion or aggregation).

                             being exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by a person who is smoking.

                               being obese means having a Body Mass Index (BMI) of 30 or greater.

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

                               BMI means W/H2 where:

W is the person's weight in kilograms; and

H is the person's height in metres.

                               chronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.

Note: an abnormality of kidney structure or function is also defined in the Schedule 1 – Dictionary.

                               early macular degeneration means:

(a)          drusen of at least medium size (≥63 μm); or

(b)          retinal pigmentary abnormalities; or

(c)          soft indistinct or reticular drusen.

                               late macular degeneration means dry macular degeneration (geographic atrophy) or wet macular degeneration.

Note: wet macular degeneration is also defined in the Schedule 1 – Dictionary.

                             lipid profile as specified means a high density lipoprotein cholesterol level greater than or equal to 1.7 mmol/L after the accurate evaluation of serum lipids following a 12 hour overnight fast, and estimated on a minimum of two occasions.

                             macular degeneration—see subsection 7(2).

                             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 20 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.

                             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.

                             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.

                               thrombolytic therapy means therapeutic administration of a pharmacological agent which breaks up or dissolves blood clots (such as streptokinase or tissue plasminogen activator).

                             VEA means the Veterans' Entitlements Act 1986.

                               wet macular degeneration means choroidal neovascularisation and retinal angiomatous proliferation.  It is also known as neovascular or exudative macular degeneration.  Complications include subretinal haemorrhage.