Statement of Principles

concerning

CONJUNCTIVITIS
(Reasonable Hypothesis)

(No. 76 of 2020)

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

Dated 30 October 2020

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 conjunctivitis (Reasonable Hypothesis) (No. 76 of 2020).

2               Commencement

              This instrument commences on 30 November 2020.

3               Authority

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

4               Repeal

The Statement of Principles concerning conjunctivitis No. 1 of 2012 (Federal Register of Legislation No. F2012L00005) made under subsection 196B(2) of the VEA is repealed.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 conjunctivitis and death from conjunctivitis.

Meaning of conjunctivitis

(2)          For the purposes of this Statement of Principles, conjunctivitis means inflammation of the conjunctiva and includes blepharoconjunctivitis and keratoconjunctivitis.

(3)          While conjunctivitis attracts ICD‑10‑AM code H10, H13.1, H13.2 or H16.2, in applying this Statement of Principles the meaning of conjunctivitis 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 conjunctivitis

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

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

(1)          having blepharitis of the affected eye at the time of the clinical onset of conjunctivitis;

(2)          having an infection of the conjunctiva of the affected eye at the time of the clinical onset of conjunctivitis;

Note: infection of the conjunctiva is defined in the Schedule 1 - Dictionary.

(3)          having a condition of the affected eye from the specified list of conditions at the time of the clinical onset of conjunctivitis;

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

(4)          having a condition that causes chronic lack of sufficient lubrication and moisture on the surface of the affected eye at the time of the clinical onset of conjunctivitis;

Note: Examples of conditions associated with a chronic lack of sufficient lubrication and moisture on the surface of the eye include dysfunctional tear syndrome, keratoconjunctivitis sicca and Sjögren syndrome.

(5)          having ocular or periocular exposure to an allergen within the 24 hours before the clinical onset of conjunctivitis;

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

(6)          having an autoimmune disease at the time of the clinical onset of conjunctivitis;

(7)          having graft versus host disease at the time of the clinical onset of conjunctivitis;

(8)          having diabetes mellitus at the time of the clinical onset of conjunctivitis;

(9)          having topical medication applied to the affected eye within the 48 hours before the clinical onset of conjunctivitis;

(10)      taking a drug from the specified list of drugs for at least the seven days before the clinical onset of conjunctivitis;

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

(11)      taking a drug which is associated in the individual with the development of conjunctivitis during drug therapy and either:

(a)           the improvement of conjunctivitis within seven days of discontinuing or tapering drug therapy; or

(b)          the redevelopment of conjunctivitis on rechallenge with the same drug;

where treatment with the drug continued for at least the seven days before the clinical onset of conjunctivitis;

(12)      having ocular or periocular exposure to an irritant substance within the 24 hours before the clinical onset of conjunctivitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(13)      having mustard gas exposure to the affected eye within the 24 hours before the clinical onset of conjunctivitis;

(14)      having a foreign body in contact with the affected conjunctiva within the 24 hours before the clinical onset of conjunctivitis;

(15)      having an injury to the conjunctiva of the affected eye within the 24 hours before the clinical onset of conjunctivitis;

Note: injury to the conjunctiva is defined in the Schedule 1 - Dictionary.

(16)      undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical onset of conjunctivitis;

(17)      having a benign or malignant neoplasm affecting the conjunctiva or eyelid margin of the affected eye at the time of the clinical onset of conjunctivitis;

(18)      being in an immunocompromised state as specified at the time of the clinical onset of conjunctivitis;

Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.

(19)      having blepharitis of the affected eye at the time of the clinical worsening of conjunctivitis;

(20)      having an infection of the conjunctiva of the affected eye at the time of the clinical worsening of conjunctivitis;

Note: infection of the conjunctiva is defined in the Schedule 1 - Dictionary.

(21)      having a condition of the affected eye from the specified list of conditions at the time of the clinical worsening of conjunctivitis;

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

(22)       having a condition that causes chronic lack of sufficient lubrication and moisture on the surface of the affected eye at the time of the clinical worsening of conjunctivitis;

Note: Examples of conditions associated with a chronic lack of sufficient lubrication and moisture on the surface of the eye include dysfunctional tear syndrome, keratoconjunctivitis sicca and Sjögren syndrome.

(23)      having ocular or periocular exposure to an allergen within the 24 hours before the clinical worsening of conjunctivitis;

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

(24)      having an autoimmune disease at the time of the clinical worsening of conjunctivitis;

(25)      having graft versus host disease at the time of the clinical worsening of conjunctivitis;

(26)      having diabetes mellitus at the time of the clinical worsening of conjunctivitis;

(27)      having topical medication applied to the affected eye within the 48 hours before the clinical worsening of conjunctivitis;

(28)      taking a drug from the specified list of drugs for at least the seven days before the clinical worsening of conjunctivitis;

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

(29)      taking a drug which is associated in the individual with:

(a)          the worsening of conjunctivitis during drug therapy; and

(b)          the improvement of conjunctivitis within seven days of discontinuing or tapering drug therapy;

where treatment with the drug continued for at least the seven days before the clinical worsening of conjunctivitis;

(30)      having ocular or periocular exposure to an irritant substance within the 24 hours before the clinical worsening of conjunctivitis;

Note: irritant substance is defined in the Schedule 1 - Dictionary.

(31)      having mustard gas exposure to the affected eye within the 24 hours before the clinical worsening of conjunctivitis;

(32)      having a foreign body in contact with the affected conjunctiva within the 24 hours before the clinical worsening of conjunctivitis;

(33)      having an injury to the conjunctiva of the affected eye within the 24 hours before the clinical worsening of conjunctivitis;

Note: injury to the conjunctiva is defined in the Schedule 1 - Dictionary.

(34)      undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical worsening of conjunctivitis;

(35)      having a benign or malignant neoplasm affecting the conjunctiva or eyelid margin of the affected eye at the time of the clinical worsening of conjunctivitis;

(36)      being in an immunocompromised state as specified at the time of the clinical worsening of conjunctivitis;

Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.

(37)      inability to obtain appropriate clinical management for conjunctivitis.

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(19) to 9(37) apply only to material contribution to, or aggravation of, conjunctivitis where the person's conjunctivitis 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:

                               allergen means an antigenic substance capable of producing an immune response.

                               chronic renal failure means:

(a)          having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or

(b)          a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or

(c)          undergoing chronic dialysis.

                               conjunctivitis—see subsection 7(2).

                               immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:

(a)          taking an immunosuppressive drug;

(b)          having a haematological or solid organ malignancy;

(c)          having chronic renal failure;

(d)          having infection with human immunodeficiency virus;

(e)          having severe malnutrition; or

(f)           undergoing solid organ, stem cell or bone marrow transplantation.

Note: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.

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

Note: Examples of an immunosuppressive drug include:

(                                          a)                             chemotherapeutic agents used for the treatment of cancer;

(b)               corticosteroids, other than inhaled or topical corticosteroids;

(c)               drugs used to prevent transplant rejection; or

(d)               a tumour necrosis factor-alpha inhibitor.

                               infection of the conjunctiva means a bacterial, viral, rickettsial, parasitic or fungal infection involving the conjunctiva.

                               injury to the conjunctiva means trauma to the ocular surface involving the conjunctiva by mechanisms including thermal, electrical and chemical burns and blunt or penetrating trauma.

                               irritant substance means a chemical which causes an inflammatory effect on living tissue by chemical action at the site of contact.

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               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 list of conditions means:

(a)          disorder of nasolacrimal duct or gland;

(b)          ectropion;

(c)          exophthalmos; or

(d)          lid retraction.

                               specified list of drugs means:

(a)          benzodiazepines;

(b)          bisphosphonates;

(c)          celecoxib;

(d)          chemotherapy for cancer;

(e)          cyclosporine;

(f)           dupilumab;

(g)          fluoxetine;

(h)          imatinib;

(i)            isotretinoin;

(j)            paroxetine;

(k)          risperidone;

(l)            tadalafil;

(m)        topiramate;

(n)          vardenafil; or

(o)          vemurafenib.

                               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.