Statement of Principles

concerning

MOTOR NEURONE DISEASE
(Reasonable Hypothesis)

(No. 111 of 2021)

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

Dated                                           26 November 2021

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 motor neurone disease (Reasonable Hypothesis) (No. 111 of 2021).

2               Commencement

              This instrument commences on 20 December 2021.

3               Authority

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

4               Repeal

The Statement of Principles concerning motor neurone disease No. 67 of 2013 (Federal Register of Legislation No. F2013L01655) made under subsections 196B(2) and (8) of the VEA is repealed.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 motor neurone disease and death from motor neurone disease.

Meaning of motor neurone disease

(2)          For the purposes of this Statement of Principles, motor neurone disease:

(a)          means               a progressive neurodegenerative disease with either:

(i)             the presence of upper and lower motor neurone dysfunction in at least one body region; or

(ii)          the presence of lower motor neurone dysfunction in at least two body regions; and

(b)           the absence of other disease processes that explain the motor neurone dysfunction.

(3)          While motor neurone disease attracts ICD‑10‑AM code G12.2, in applying this Statement of Principles the meaning of motor neurone disease 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 motor neurone disease

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

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 motor neurone disease and death from motor neurone disease 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 motor neurone disease or death from motor neurone disease with the circumstances of a person's relevant service:

(1)          having smoked tobacco products in an amount of at least 10 pack-years before the clinical onset of motor neurone disease;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(2)          being exposed to lead as specified before the clinical onset of motor neurone disease, where the first exposure occurred at least 5 years before the clinical onset of motor neurone disease;

Note: being exposed to lead as specified is defined in the Schedule 1 - Dictionary.

(3)          inhaling formaldehyde for a cumulative total of at least 5,000 hours:

(a)          at a level of at least 1 part per million; or

(b)          resulting in sensory irritation of the eyes or nose;

at least 3 years before the clinical onset of motor neurone disease;

(4)          having smoked tobacco products in an amount of at least 10 pack-years before the clinical worsening of motor neurone disease;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(5)          being exposed to lead as specified before the clinical onset of motor neurone disease, where the first exposure occurred at least 5 years before the clinical worsening of motor neurone disease;

Note: being exposed to lead as specified is defined in the Schedule 1 - Dictionary.

(6)          inhaling formaldehyde for a cumulative total of at least 5,000 hours:

(a)          at a level of at least 1 part per million; or

(b)          resulting in sensory irritation of the eyes or nose;

at least 3 years before the clinical worsening of motor neurone disease;

(7)          inability to obtain appropriate clinical management for motor neurone disease.

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(4) to 9(7) apply only to material contribution to, or aggravation of, motor neurone disease where the person's motor neurone disease 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:

                               being exposed to lead as specified means:

(a)          engaging in a lead process as specified, on more days than not, for at least 2 years; or

(b)          having a blood lead level of at least 20 micrograms per decilitre; or

(c)          having lead nephropathy.

Note: lead process as specified is also defined in the Schedule 1 - Dictionary.

                               lead process as specified means any of the following carried out at a workplace:

(a)          work that exposes a person to lead dust or lead fumes arising from the manufacture or handling of dry lead compounds;

(b)          work in connection with the manufacture, assembly, handling or repair of, or parts of, batteries containing lead that involves the manipulation of dry lead compounds, or pasting or casting lead;

(c)          breaking up or dismantling batteries containing lead, or sorting, packing and handling plates or other parts containing lead that are removed or recovered from the batteries;

(d)          spraying molten lead metal or alloys containing more than 5% by weight of lead metal;

(e)          melting or casting lead alloys containing more than 5% by weight of lead metal in which the temperature of the molten material exceeds 450°C;

(f)           recovering lead from its ores, oxides or other compounds by thermal reduction process;

(g)          dry machine grinding, discing, buffing or cutting by power tools alloys containing more than 5% by weight of lead metal;

(h)          machine sanding or buffing surfaces coated with paint containing more than 1% by dry weight of lead;

(i)            a process by which electric arc, oxyacetylene, oxy gas, plasma arc or a flame is applied for welding, cutting or cleaning, to the surface of metal coated with lead or paint containing more than 1% by dry weight of lead metal;

(j)            radiator repairs that may cause exposure to lead dust or lead fumes;

(k)          fire assays if lead, lead compounds or lead alloys are used;

(l)            hand grinding and finishing lead or alloys containing more than 50% by dry weight of lead;

(m)        painting with lead paint containing more than 1% by dry weight of lead;

(n)          melting lead metal or alloys containing more than 50% by weight of lead metal if the exposed surface area of the molten material exceeds 0.1 square metre and the temperature of the molten material does not exceed 450°C;

(o)          using a power tool, including abrasive blasting and high pressure water jets, to remove a surface coated with paint containing more than 1% by dry weight of lead and handling waste containing lead resulting from the removal;

(p)          a process that exposes a person to lead dust or lead fumes arising from manufacturing or testing detonators or other explosives that contain lead;

(q)          a process that exposes a person to lead dust or lead fumes arising from firing weapons at an indoor firing range;

(r)           foundry processes involving:

(i)            melting or casting lead alloys containing more than 1% by weight of lead metal in which the temperature of the molten material exceeds 450°C; or

(ii)         dry machine grinding, discing, buffing or cutting by power tools lead alloys containing more than 1% by weight of lead metal.

Note: This definition is adapted from the definition of lead process set out in section 392 of the Work Health and Safety Regulations 2011.

                               motor neurone disease—see subsection 7(2).

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.

Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.

Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.

                               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.

                               VEA means the Veterans' Entitlements Act 1986.