Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
Repatriation Medical Authority—Report for 2013-14


Download PDF Download PDF

Twentieth Annual Report

2013/2014

2 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

© Commonwealth of Australia 2014

ISSN 1327-7278

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General’s Department, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.

For further information, contact:

The Registrar Repatriation Medical Authority GPO Box 1014 BRISBANE Qld 4001

T +61 7 3815 9404 F +61 7 3815 9412 W http://www.rma.gov.au

3 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Senator the Hon Michael Ronaldson Minister for Veterans’ Affairs Parliament House CANBERRA ACT 2600

Dear Minister

On behalf of the Repatriation Medical Authority, I am pleased to submit this report for the year ending 30 June 2014.

Yours sincerely

Professor Nicholas Saunders AO Chairperson

15 September 2014

ABN 23 964 290 824 GPO Box 1014 Brisbane Qld 4001 Phone (07) 3815 9404 Fax (07) 3815 9412 www.rma.gov.au

Level 8, 259 Queen Street, Brisbane 4000

4 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Contents

EXECUTIVE STATEMENT BY THE CHAIRPERSON 5

BACKGROUND AND FUNCTION 7

THE AUTHORITY 10

Members 10

Member remuneration 11

Meetings 12

ecretar RMA S iat 12

Website 12

Freedom of Information 13

STATEMENTS OF PRINCIPLES 4 1

Determinations 14

Investigations and reviews 14

Distribution 19

REVIEWS BY THE SPECIALIST MEDICAL REVIEW COUNCIL 20 Reviews 20

DEPARTMENT OF VETERANS’ AFFAIRS 25

EX-SERVICE ORGANISATIONS 6 2

FINANCIAL 27

APPENDICES 28

Appendix 1: RMA Secretariat staffi ng structure 28

Appendix 2: Statements of Principles determined 2013/14 29

Appendix 3: Outstanding investigations and reviews as at 30/06/2014 33

TABLES Table 1: Requests under the FOI Act 13

Table 2: Statements of Principles 14

Table 3: Overview of investigations and reviews 15

Table 4: Outcome of investigations and reviews 15

Table 5: Ex-Service Organisation meetings attended 26

Table 6: Financial expenditure 27

Table 7: Outstanding investigations pursuant to s 196B(4) 3 3

Table 8: Outstanding reviews pursuant to s 196B(7) 3 3

Table 9: Outstanding reviews pursuant to s 196B(7A) 37

FIGURES Figure 1: Determination of Statements of Principles 9

Figure 2: Visitor numbers to the RMA website 12

5 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Executive Statement by the Chairperson

The Repatriation Medical Authority (the Authority) marked the 20th anniversary of its establishment in June 2014, a milestone perhaps not expected by many to be reached when the organisation initially commenced its role of developing legally binding Statements of Principles (SOPs) in 1994.

The Authority is extremely fortunate to have enjoyed a remarkable level of stability in membership, which continued over this reporting period. This stability, and the acquired expertise and corporate knowledge which it produces, enables a careful skilled application of medical science to the complex legislative environment applying to veterans’ compensation. It is particularly important in the context of the provisions of a compensation system which whilst very generous is reliant upon a sound medical scientifi c base. Consistent, high quality, useable SOPs produced following assessment of an ever expanding body of medical science is an impressive result. I would like to acknowledge and thank my colleagues for the continued quality of their work and assistance.

Work loads and work practices

The Authority has confronted steady increases in its backlog of investigations and reviews each year since 2004. I reported last year that the Authority had reviewed its operations to ensure that its assessment and investigation of the medical science was undertaken in the most effi cient manner possible. The Authority prepared a three year workplan to ensure that all reviews would be completed prior to their sunset date in an orderly and timely manner. I anticipated that the work plan, revisiting of operations and work practices, and a more timely scheduling of review notifi cations would see a signifi cant reduction in the backlog of investigations and reviews over the next two years, without compromising the quality of assessment applied to the medical scientifi c evidence.

I am pleased to report that these initiatives have been successful, with the backlog of advertised investigations and reviews reduced to 97 as at 30 June 2014.

The reporting period has been an extremely busy year for the Authority, which is refl ected in the number of investigations and reviews completed and SOPs produced. A number of signifi cant, complex and time-consuming reviews have been completed during the year, including consideration of a number of factors which are contained in multiple SOPs. These have involved factors contained in mental health, haematological and cancer conditions in particular. Reviews of previous decisions concerning malignant neoplasm of the prostate and Gulf War syndrome were concluded after considerable investigation and deliberation.

Gulf War syndrome/chronic multisymptom illness

In 2012 a review of previous decisions not to recognise Gulf War syndrome as a disease under the Veterans’ Entitlements Act 1986 (VEA) was notifi ed. This is the third review of the issue undertaken in 15 years, and was fi nalised in May 2014. The Authority concluded that there is insuffi cient evidence to recognise a disease specifi c to the Gulf War, but there is a grouping of medically unexplained symptoms experienced by veterans of various deployments which may cause signifi cant distress and disability and as such meets the defi nition of disease. The condition, which is sometimes referred to by clinicians as ‘medically unexplained physical symptoms’, has been extensively researched using the term ‘chronic multisymptom illness’ and the Authority issued SOPs using that title. In determining the SOPs the Authority included a tight defi nition of

6 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

the disease, including the severity and persistence of symptoms, and required that “any or all of the symptoms are not better explained by another medical or psychiatric condition”. The SOPs have been generally welcomed, although an application for review has since been received by the Specialist Medical Review Council.

Mental health conditions

2013 saw the release and commencement of use of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5TM) of the American Psychiatric Association (DSM-5). The new edition of this manual contained some signifi cant changes to diagnostic criteria and/ or possible causes/exposures for conditions covered by the publication. Most of the defi nitions of the kind of disease included in the SOPs covering mental health conditions are derived from the manual. As a result, the Authority notifi ed (and prioritised) a range of reviews, including posttraumatic stress disorder (PTSD), acute stress disorder, alcohol dependence and alcohol abuse, drug dependence and drug abuse, and depressive disorder. These reviews were all completed or signifi cantly progressed during the reporting period.

Evidence in support of a ‘hostile environment’ factor (generally expressed by the Authority as “living or working in a hostile or life-threatening environment”) has led to such factors being included in a number of SOPs, including PTSD, chronic multisymptom illness and chronic fatigue syndrome. Receipt of a request to include such a factor in the SOPs concerning alcohol use disorder resulted in the Authority notifying a focussed review to consider the matter for that condition, and similar consideration is being given to a wide range of other mental health conditions.

Technology

The Authority moved to exclusive use of digital records in 2013. The RMA Secretariat continued its work over the reporting period to convert outstanding paper records (created in years immediately following the organisation’s 1994 establishment) to digital form for retention in its Electronic Document and Records Management System (HP TRIM). It was very pleasing to receive the recent National Archives of Australia assessment of our digital records management performance, which confi rmed signifi cant gains over the previous year and results in the top quartile of all Commonwealth agencies.

The Authority regards the internet as its principal method to distribute SOPs and other information to stakeholders. The Authority website was again enhanced during the reporting period, with a redesign of its home page, general website structure and further information about Authority processes and deliberations. The Authority receives and answers several hundred specifi c questions - many quite detailed - each year, and drew upon these communications to create a Frequently Asked Questions (FAQ) page during the year. Further improvements to the website to enhance accessibility are planned in the coming year.

RMA Secretariat

On behalf of my fellow Members, I would like to express our appreciation for the efforts of all of the staff of the RMA Secretariat in providing support and assistance to the Authority. Their commitment and expertise is essential to the operations of the Authority.

Professor Nicholas Saunders AO Chairperson

7 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Background and Function

A move towards a formal review of the compensation program was prompted by the 1992 Auditor-General’s report on the compensation provided to veterans and their dependants by the Department of Veterans’ Affairs (DVA); the High Court case of Bushell; and the inquiry by the Senate Committee on Legal and Constitutional Affairs. The Veterans’ Compensation Review Committee, chaired by Professor Peter Baume, took evidence from the veteran community and issued its report, ‘A Fair Go’ in March 1994.

The Authority arose from the recommendation of the Baume Committee that an expert medical committee be formed. It was considered that such a committee would assist in providing a more equitable and consistent system of determining claims for disability pensions for veterans and their dependants.

The Government announced the establishment of the Authority in the 1994/95 Federal Budget. The VEA was amended to refl ect this announcement on 30 June 1994.

The functions of the Authority are specifi ed in s 196B of the VEA. The major function of the Authority is to determine SOPs in respect of particular kinds of injury, disease or death, based on “sound medical scientifi c evidence” for the purpose of applying the applicable standards of proof relating to veterans’ matters; the “reasonable hypothesis” standard and the “reasonable satisfaction” (or “balance of probabilities”) standard.

The passage of the Military Rehabilitation and Compensation Act 2004 (MRCA) extended the application of SOPs to the consideration of claims to have injury, disease or death accepted as service-related under that Act for all service on or after 1 July 2004.

A SOP in respect of a particular kind of injury, disease or death which applies for the purposes of the “reasonable hypothesis” standard of proof details the factors that must as a minimum exist and which of those factors must be related to relevant service rendered by a person, before it can be said that a reasonable hypothesis has been raised connecting an injury, disease or death of that kind with the circumstances of that service.

A SOP which applies for the purposes of the “reasonable satisfaction” standard of proof sets out the factors that must exist, and which of those factors must be related to relevant service rendered by a person before it can be said that, on the balance of probabilities, an injury, disease or death of that kind is connected with the circumstances of that service.

It can be seen that the Authority is not concerned with individual claims or cases, but with the task of developing SOPs in order for the Repatriation Commission and Military Rehabilitation and Compensation Commission to assess claims for disability pension.

The function of the Authority is to conduct investigations either on its own initiative or when it receives a request under s 196E of the VEA in respect of a particular kind of injury, disease or death. Investigations may lead to the determination of a new SOP, an amendment of an existing SOP, or a decision not to determine or amend a SOP, depending upon whether the Authority is of the view that there is suffi cient sound medical scientifi c evidence on which it can rely to determine a new, or amend an existing, SOP.

8 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Sound medical scientifi c evidence is defi ned in s 5AB(2) of the VEA as follows:

“Information about a particular kind of injury, disease or death is taken to be sound medical scientifi c evidence if:

1. the information:

(i) i s consistent with material relatin g to medical science that has been published in a medical or scientifi c publication and has been, in the opinion of the Repatriation Medical Authority, subjected to a peer review process; or

(ii) i n accordance with generally accepted medical practice, would serve as the basis for the diagnosis and management of a medical condition; and

2. in the case of information about how that kind of injury, disease or death may be caused - meets the applicable criteria for assessing causation currently applied in the fi eld of epidemiology.”

The Veterans’ Affairs Legislation Amendment (Statements of Principles and Other Measures) Act 2007, which commenced on 16 March 2007, provided the Authority with the discretionary power to determine whether a review of the contents of an existing SOP would be undertaken in relation to some or all of the contents of the SOP.

A SOP is a legislative instrument for the purposes of the Legislative Instruments Act 2003 (LIA). The LIA requires legislative instruments to be reissued within approximately ten years of determination, or automatically lapse (sunset) and cease to have legal effect except if extended by a resolution of Parliament or a certifi cate issued by the Attorney-General.

The fl ow chart (Figure 1) sets out the process of consideration adopted by the Authority in its determination of SOPs.

9 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Figure 1: Determination of Statements of Principles

Yes

Yes

Yes Yes No No

No

No

No SOP

No SOP factor

SOP No SOP SOP

BOP BOP

s

s

s

s s

s

10 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

The Authority

Members

The membership of the Repatriation Medical Authority comprises a Chairperson and four other members who are all eminent medical or scientifi c experts. Members work on a part-time basis and are appointed by the Minister for Veterans’ Affairs. There is a legislative requirement for at least one member to have at least fi ve years experience in the fi eld of epidemiology. Members hold offi ce for such period, not exceeding fi ve years, as is specifi ed in the instrument of appointment. They are eligible for reappointment.

The members during the 2013/14 reporting period were Professors Nick Saunders AO (Chairperson), Andrew Wilson (Deputy Chair), Gerard Byrne, Flavia Cicuttini and John Kaldor.

Professor Nicholas Saunders AO, MD, Hon LLD, retired as Vice-Chancellor and President of the University of Newcastle, Australia in late 2011. He was previously Dean of the Faculty of Medicine, Nursing and Health Sciences at Monash University, Head of the Faculty of Health Sciences and Dean of the School of Medicine at Flinders University of South Australia, and Professor of Medicine at the University of Newcastle.

Professor Saunders has served on many national committees and councils relevant to higher education, research and health care. He is currently acting Chief Commissioner and CEO of the Tertiary Education Quality and Standards Agency.

Professor Saunders’ term of appointment is to 30 June 2017.

Professor Andrew Wilson, BMed Sci, MBBS (Hons), PhD, FRACP, FFAPHM. Professor Wilson is Director of the Menzies Centre for Health Policy in the Faculty of Medicine, University of Sydney. In addition to his academic career, Professor Wilson has worked in senior public sector roles in the NSW Health Department as Chief Health Offi cer and the Queensland Health Department as Deputy Director-General, Policy, Strategy and Resourcing.

Professor Wilson is Deputy Chairperson of the Repatriation Medical Authority. His term of appointment is to 30 September 2015.

Professor Gerard Byrne, BSc(Med), MBBS (Hons), PhD, FRANZCP. Professor Byrne is Head of the Discipline of Psychiatry within the School of Medicine at the University of Queensland and Director of Geriatric Psychiatry at the Royal Brisbane and Women’s Hospital. He is Immediate Past Chair of the Faculty of Psychiatry of Old Age of the Royal Australian and New Zealand College of Psychiatrists. Professor Byrne has active research interests in depression, anxiety and dementia in older people.

Professor Byrne’s term of appointment is to 30 June 2017.

11 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Professor Flavia Cicuttini, MBBS, PhD, FRACP, M Sc (Lond), DLSHTM, FAFPHM. Professor Cicuttini is Head of Rheumatology, Alfred Hospital and Head of Musculoskeletal Unit, School of Epidemiology and Preventive Medicine, Monash University. Professor Cicuttini leads an active research group aimed at understanding factors that affect the development and progression of osteoarthritis.

Professor Cicuttini’s term of appointment is to 30 June 2017.

Professor John Kaldor, PhD. Professor Kaldor is a Professor of Epidemiology and NHMRC Senior Principal Research Fellow at the Kirby Institute, University of New South Wales, where he has worked for over 23 years. Previously Professor Kaldor was with the International Agency for Research on Cancer, in Lyon, France. He is a past President of the Australasian Epidemiological Association (1996-2000). Professor Kaldor has active research interests in infectious disease, cancer and epidemiological methods.

Professor Kaldor’s term of appointment is to 1 February 2016.

Member remuneration

Since June 1998, the Remuneration Tribunal has determined the remuneration for the Chairperson and Members of the Authority.

The Chairperson and Members receive an annual retainer, and a daily allowance payable for attendance at meetings and other business of the Authority. The details of the rates payable during the reporting period are contained in Remuneration Tribunal Determination 2013/11 and Determination 2014/03 (from 1 March 2014). The Remuneration Tribunal reviews the rates annually. The provisions applying to travel on offi cial business are contained in Remuneration Tribunal Determination 2004/03, as amended by 2012/18 (prior to 1 September 2013) and 2013/16 (from 1 September 2013).

12 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Meetings

The Authority held six meetings in Brisbane during 2013/14 on the following dates:

August 6 & 7 February 18 & 19

October 8 & 9 April 8 & 9

December 10 & 11 June 3 & 4

In accordance with the legislation, minutes are kept of the proceedings of each meeting.

RMA Secretariat

The staff (see Appendix 1 - RMA Secretariat staffi ng structure) necessary to assist the Authority consists of persons appointed or employed under the Public Service Act 1999 and made available to the Authority by the Secretary of the Department of Veterans’ Affairs. For the year 2013/14, staffi ng of the Secretariat equated to 9.15 FTE (Full-Time Equivalent) positions. There are no Senior Executive Service positions in the RMA Secretariat.

Website

Established in April 2000, the Authority website has continued to be refi ned and improved to increase the range, accessibility and timeliness of services to clients and stakeholders. A review of the content and design of the website was undertaken, with the aim of enabling information about the practices, processes and reasoning utilised by the Authority to be easily accessed by stakeholders. The website home page and side bars were redesigned, and a Frequently Asked Questions (FAQ) page developed. As shown in Figure 2, visitor numbers have signifi cantly increased over the reporting period, particularly since the changes were implemented in early 2014.

The LIA requires the Authority to prepare compilations of SOPs where a SOP is amended, and links to those compilation SOPs are provided on the Authority website, as well as to the Principal and each Amendment SOP.

The Authority website address is http://www.rma.gov.au. The website offers direct access to SOPs, Authority publications, and information on current investigations and reviews. Subscribers to the website receive notifi cation of any updates. As at the end of the 2013/14 fi nancial year, 2,544 subscribers were receiving updates. This fi gure represents a 3.7% increase over the preceding year.

The Authority views the internet medium as its principal method of distributing SOPs and related information.

Figure 2: Visitor numbers to the RMA website

0

2000

4000

6000

8000

10000

12000

14000

16000

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Visits for www.rma.gova.au

2011-12 2012-13 2013-14

13 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Freedom of Information

Agencies subject to the Freedom of Information Act 1982 (FOI Act) are required to publish information to the public as part of the Information Publication Scheme (IPS). This requirement is in Part II of the FOI Act and has replaced the former requirement to publish a s 8 statement in an annual report. Each agency must display on its website a plan showing what information it publishes in accordance with the IPS requirements. The plan and other published information can be accessed on the Authority website at http://www.rma.gov.au/foi/main.htm.

The substantial increase in requests made under the FOI Act to the Authority during the previous reporting period reduced to levels more consistent with historical levels, which reduced the staff resources required to process the requests. All requests were able to be addressed to the satisfaction of the applicants.

One request refused in 2012/13 was the subject of a review by the Australian Offi ce of the Information Commissioner. The request related to documents exempted from release on the grounds of legal professional privilege under the FOI Act. The decision to refuse access was upheld by the Information Commissioner. A request for a further review of the decision has been made to the Administrative Appeals Tribunal.

Table 1: Requests under the FOI Act

2013/14 2012/13 2011/12

Requests received 2 13 1

Information provided under s196I1 1 4 1

Invalid requests 0 1 0

Requests granted 2 2 1

Requests refused (in full or part)2 0 8 0

Requests completed3 2 13 1

1 Section 196I which provides for eligible persons and organisations to access documents containing information considered by the Authority as part of an investigation, is the Authority’s preferred mechanism for providing information and incurs no charge. In some cases not all aspects of a request can be addressed under s196I.

2 Reasons for the refusal of requests include legal professional privilege (5), documents do not exist (2) and that the request represents an unreasonable diversion of resources (1).

3 Some requests completed may have been dealt with in a number of ways (eg. some information requested being provided under s196I, some information requested being refused in part as exempt and access granted to other information requested). Accordingly, in many years the number of requests completed will be exceeded by the total number of the various means of completing the requests.

14 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Statements of Principles

Determinations

At its formal meetings during 2013/14, the Authority determined a total of 103 SOPs. The various categories of SOPs determined are set out in Table 2, and the specifi c SOPs revoked and determined are detailed in Appendix 2.

Table 2: Statements of Principles

Revoked SOPs1

2013/14

78

2012/13

56

2011/12

64

Re-issued SOPs2 76 56 66

SOPs issued for new conditions 12 18 8

Amendment SOPs 15 7 6

Total number of SOPs determined 103 81 80

1 The figures cited refer only to SOPs which are the principal instrument, and do not include any amending instruments which may have also been revoked as a consequence of the principal instrument being revoked.

2 The definition of the kind of injury, disease or death with which the SOP is concerned may vary slightly from that of the previous (revoked) SOP.

Since its inception, the Authority has determined 2,097 SOPs, with 322 particular kinds of injury or disease currently covered by SOPs.

Investigations and reviews

Under s 196E of the VEA the Repatriation Commission, the Military Rehabilitation and Compensation Commission, an ex-service person or eligible dependant, an organisation representing veterans or their dependants, or persons eligible to make a claim under the MRCA may request the Authority to carry out an investigation in respect of a particular kind of injury, disease or death, or to review the contents of a SOP. The commencement of the Veterans’ Affairs Legislation Amendment (Statements of Principles and Other Measures) Act 2007, which came into effect on 16 March 2007, allows the Authority, at its discretion, to review some, rather than all of the contents of a SOP, if it is so minded. Those reviews which the Authority determined should be restricted to some of the contents of the relevant SOP are referred to as “focussed reviews”.

15 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Table 3: Overview of investigations and reviews

Category 2013/14 2012/13 2011/12

1

Investigations notifi ed 1 5 10

Reviews notifi ed 2 3 35 37

Focussed reviews notifi ed 3 16 3 2

Total investigations and reviews notifi ed 20 43 49

4

Total investigations and reviews completed 53 38 42

Average time taken to complete (days) 5 962 (850) 799 (759) 787 (744)

Focussed reviews completed 7 3 4

Average time taken to complete focussed 5 reviews (days) 238 292 338

Investigations and reviews notifi ed in previous reporting periods and yet to be completed 6 82 90 78

Investigations and reviews notifi ed in reporting 6

period and yet to be completed

15 40 47

Total investigations and reviews outstanding 97 130 125

Requests for investigation or review refused 7 13 6

1 An investigation is undertaken pursuant to s 196B(4) to determine whether a SOP may be determined.

2 A review is undertaken pursuant to s 196B(7), generally to consider the contents of a previously determined SOP. These figures refer only to reviews of all of the contents of the particular SOPs.

3 A focussed review is undertaken pursuant to s 196B(7A), at the discretion of the Authority, and is restricted to some of the contents of a previously determined SOP.

4 These figures include all investigations and reviews completed, including focussed reviews.

5 Time taken is measured from date of Gazette notice of investigation to date of effect of SOP determined, or date of Gazette notice of declaration that no SOP is to be determined, and expressed in days. This figure initially excludes focussed reviews. The average time taken for all investigations and reviews follows in brackets.

6 The investigations and reviews advertised but not finalised as at 30 June 2013 are detailed in Appendix 3.

Table 4: Outcome of investigations and reviews

Subject of investigation Outcome or review

1. malignant neoplasm of the Pr evious Statements of Principles concerning malignant anal canal neoplasm of the anal canal revoked and new Statements of Principles determined for malignant neoplasm of the anus and anal canal

2.

fi brosing interstitial lung Previous Statements of Principles concerning fi brosing interstitial disease lung disease revoked and new Statements of Principles

determined

3. asbestosis Pr

evious Statements of Principles concerning asbestosis revoked and new Statements of Principles determined

4.

sudden unexpected death Previous Statements of Principles concerning sudden unexpected death revoked and new Statements of Principles determined for sudden unexplained death

5.

Guillain-Barre syndrome Previous Statements of Principles concerning Guillain-Barre syndrome revoked and new Statements of Principles determined

16 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

6. malignant neoplasm of the larynx Previous Statements of Principles concerning malignant neoplasm of the larynx revoked and new Statements of Principles

determined

7. hypertension Previous Statements of Principles concerning hypertension revoked and new Statements of Principles determined

8. gastro-oesophageal refl ux disease Previous Statements of Principles concerning gastro-oesophageal refl ux disease revoked and new Statements of Principles

determined

9. motor neurone disease Previous Statements of Principles concerning motor neurone disease revoked and new Statements of Principles determined

10. solvent related chronic encephalopathy Previous Statements of Principles concerning solvent related chronic encephalopathy revoked and new Statements of

Principles determined for chronic solvent encephalopathy

11. malignant neoplasm of the pancreas Previous Statements of Principles concerning malignant neoplasm of the pancreas revoked and new Statements of

Principles determined

12. epilepsy Previous Statements of Principles concerning epilepsy revoked and new Statements of Principles determined

13. epileptic seizure Previous Statements of Principles concerning epileptic seizure revoked and new Statements of Principles determined

14 steatohepatitis Previous Statements of Principles concerning steatohepatitis revoked and new Statements of Principles determined

15. diabetes mellitus Declaration that the sound medical scientifi c evidence available (measles infection and mumps infection*) is not suffi cient to justify an amendment to the Statements of

Principles concerning diabetes mellitus

16. malignant neoplasm of the brain (carbon monoxide, benzene and other

Declaration that the sound medical scientifi c evidence available is not suffi cient to justify an amendment to the Statements of Principles concerning malignant neoplasm of the brain

chemicals associated with exhaust fumes; smoking; nerve agents and oil well fi re smoke*)

17. heart block Previous Statements of Principles concerning heart block revoked and new Statements of Principles determined

18. dental pulp disease Previous Statements of Principles concerning dental pulp disease revoked and new Statements of Principles determined for dental pulp and apical disease

19. morbid obesity Previous Statements of Principles concerning morbid obesity revoked and new Statements of Principles determined

20. narcolepsy Previous Statements of Principles concerning narcolepsy revoked and new Statements of Principles determined

21. dermatomyositis Previous Statements of Principles concerning dermatomyositis revoked and new Statements of Principles determined

17 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

22. chronic fatigue syndrome Previous Statements of Principles concerning chronic fatigue syndrome revoked and new Statements of Principles determined

23. fi bromyalgia New Statements of Principles determined concerning fi bromyalgia

24. sick sinus syndrome New Statements of Principles determined concerning sick sinus syndrome

25. Alzheimer-type dementia (posttraumatic stress disorder and diabetes

Amendment Statements of Principles concerning Alzheimer-type dementia determined

mellitus*)

26. Alzheimer-type dementia (ionising radiation*) Amendment Statements of Principles concerning Alzheimer-type dementia determined

27. restless legs syndrome Previous Statements of Principles concerning restless legs syndrome revoked and new Statements of Principles determined

28. allergic rhinitis Previous Statements of Principles concerning allergic rhinitis revoked and new Statements of Principles determined

29. undifferentiated somatoform disorder New Statements of Principles determined concerning somatic symptom disorder

30. periodic limb movement disorder New Statements of Principles determined concerning periodic limb movement disorder

31. alcohol dependence and alcohol abuse (the defi nition of alcohol

Amendment Statements of Principles concerning alcohol use disorder determined

dependence and alcohol abuse and any consequential effects on any factors*)

32. drug dependence and drug abuse (the defi nition of drug dependence and drug abuse and any consequential effects on any factors*)

Amendment Statements of Principles concerning substance use disorder determined

33. ischaemic heart disease (extreme physical activity and extreme cold*)

Amendment Statements of Principles concerning ischaemic heart disease determined

34. Hodgkin’s lymphoma Previous Statements of Principles concerning Hodgkin’s lymphoma revoked and new Statements of Principles determined

35. chronic bronchitis and emphysema Previous Statements of Principles concerning chronic bronchitis and emphysema revoked and new Statements of Principles

determined for chronic obstructive pulmonary disease

36. malignant neoplasm of the thyroid gland Previous Statements of Principles concerning malignant neoplasm of the thyroid gland revoked and new Statements of

Principles determined

18 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

37. acute stress disorder Previous Statements of Principles concerning acute stress disorder revoked and new Statements of Principles determined

38. mitral valve prolapse Previous Statements of Principles concerning mitral valve prolapse revoked and new Statements of Principles determined

39. pleural plaque Previous Statements of Principles concerning pleural plaque revoked and new Statements of Principles determined

40. chronic myeloid Previous Statements of Principles concerning chronic myeloid leukaemia leukaemia revoked and new Statements of Principles determined

41. atrial fi brillation Previous Statements of Principles concerning atrial fi brillation revoked and new Statements of Principles determined for atrial fi brillation and atrial fl utter

42. atrial fl utter Previous Statements of Principles concerning atrial fl utter revoked and new Statements of Principles determined for atrial fi brillation and atrial fl utter

43. otitis media Previous Statements of Principles concerning otitis media revoked and new Statements of Principles determined

44. malignant neoplasm of Previous Statements of Principles concerning malignant the prostate neoplasm of the prostate revoked and new Statements of Principles determined

45. Gulf War syndrome New Statements of Principles determined concerning chronic multisymptom illness

46. non-Hodgkin’s Amendment Statement of Principles concerning non-Hodgkin’s lymphoma (ionising lymphoma determined under s 196B(2) radiation and benzene exposure*)

Declaration that the sound medical scientifi c evidence available is not suffi cient to justify an amendment to the Statement of Principles concerning non-Hodgkin’s lymphoma determined under s 196B(3)

47. malignant neoplasm of Previous Statements of Principles concerning malignant the stomach neoplasm of the stomach revoked and new Statements of Principles determined

48. melioidosis Previous Statements of Principles concerning melioidosis revoked and new Statements of Principles determined

49. lumbar spondylosis Previous Statements of Principles concerning lumbar spondylosis revoked and new Statements of Principles determined

50. thoracic spondylosis Previous Statements of Principles concerning thoracic spondylosis revoked and new Statements of Principles determined

51. cervical spondylosis Previous Statements of Principles concerning cervical spondylosis revoked and new Statements of Principles determined

52. hiatus hernia Previous Statements of Principles concerning hiatus hernia revoked and new Statements of Principles determined

53. plantar warts New Statements of Principles determined concerning warts

[*] This investigation was restricted to the notified focus of the review of the relevant SOPs as indicated.

19 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

In addition to the above SOPs determined following investigations notifi ed under s 196G, the Authority determined Amendment SOPs concerning lumbar spondylosis; an Amendment SOP concerning posttraumatic stress disorder; an Amendment SOP concerning chronic lymphoid leukaemia; and Amendment SOPs concerning myeloma at the direction of the Specialist Medical Review Council.

As at 30 June 2014, the Authority had received fi ve requests for review under s 196E(1)(f) of the VEA in response to which it decided not to carry out an investigation. These decisions not to carry out a review were made under s 196CA. In each of these requests, written reasons were provided to the person or organisation making the request.

In summary, the Authority commenced the 2013/14 year with 130 investigations outstanding. During the course of the year, the Authority notifi ed 19 further investigations, completed 52 investigations and as at 30 June 2014 has ongoing investigations in respect of 97 conditions. Eleven of those on-going investigations are in relation to some (rather than all) of the contents of the relevant SOPs.

The Authority declined to undertake fi ve investigations over the 12-month period.

Distribution

The gradual shift in the method of distributing SOPs has continued during the reporting period. Since the establishment of the Authority website, a growing number of individuals and/or organisations access the SOPs through the website. There are now some 2,544 persons or organisations who have registered to receive advice of new or additional information via the website subscription service.

In addition, SOPs are distributed to 101 organisations and individuals, including ex-service and serving member organisations, ex-service personnel and their representatives, the Department of Veterans’ Affairs, the Veterans’ Review Board and the Administrative Appeals Tribunal. Of the 101 recipients, 26 receive paper copies, 11 receive CD copies, while 64 receive them via email.

Since 1 January 2005, all new SOPs determined by the Authority have been lodged with the Attorney-General’s Department for registration on the Federal Register of Legislative Instruments (FRLI), and subsequent tabling in both Houses of Parliament. The FRLI website (http://comlaw.gov. au) is the repository of the authoritative version of the Authority’s determinations.

20 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Reviews by the Specialist Medical Review Council

The VEA provides that the Repatriation Commission, the Military Rehabilitation and Compensation Commission, an ex-service person or an eligible dependant, an organisation representing veterans or a person eligible to make a claim under the MRCA may ask the Specialist Medical Review Council (SMRC) to review:

 some or all of the contents of a SOP; or

 a decision of the Authority not to make or amend a SOP in respect of a particular kind of injury, disease or death; or

 a decision by the Authority under s 196C(4) of the VEA not to carry out an investigation in respect of a particular kind of injury, disease or death.

Reviews

In the period 1 July 2013 to 30 June 2014, the Authority received the following advice in relation to the status of reviews being conducted by the SMRC pursuant to s196Y of the VEA:

1. Chronic lymphoid leukaemia

As previously reported, in May 2005 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 9 and 10 of 2005, concerning chronic lymphoid leukaemia. Notifi cation of this review appeared in the Government Notices Gazette of 29 June 2005. In the Government Notices Gazette of 16 November 2013, the SMRC notifi ed its Declaration No. 22 in relation to this review.

The SMRC directed the Authority to amend Instrument No. 9 of 2005 by including factors for:

 non-ionising radiation

 benzene

 herbicides, pesticides and dioxin (seperately or in combination)

 asbestos

at an exposure level, duration of exposure and period of time from exposure to onset of disease to be ascertained by the Authority.

The SMRC also directed the Authority to conduct a review of the contents of Instrument Nos. 9 and 10 of 2005 in order to determine new SOPs concerning chronic lymphocytic leukaemia and small lymphocytic lymphoma as the same (that is, a single) disease and to excise small lymphocytic lymphoma from the current SOPs concerning non-Hodgkin’s lymphoma. The full Declaration is available on the SMRC website at http://www.smrc.gov.au/decisions.htm.

In response to the declaration, the Authority notifi ed a review in the Government Notices Gazette of 18 December 2013 of the contents of SOPs, Instrument Nos. 9 and 10 of 2005, concerning chronic lymphoid leukaemia. The Authority also notifi ed a review of the contents of SOPs, Instrument Nos. 28 and 29 of 2010, concerning non-Hodgkin’s lymphoma. The notices specifi ed that the review would be restricted to classifi cation and naming of haematopoietic cancers,

21 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

in particular chronic lymphoid leukaemia, chronic lymphocytic leukaemia, small lymphocytic lymphoma and non-Hodgkin’s lymphoma, taking account of the recommendation of the SMRC to excise small lymphocytic lymphoma from the SOPs concerning non-Hodgkin’s lymphoma.

The Authority unsuccessfully requested guidance from the SMRC about how the term(s) “herbicides, pesticides and dioxin (separately or in combination)” should be defi ned to allow it to determine a factor (or factors) with an exposure level, duration of exposure and period of time from exposure to onset of disease. Subsequently, the Authority determined Amendment SOP, Instrument No. 28 of 2014, concerning chronic lymphoid leukaemia. Instrument No. 28 of 2014 amends Instrument No. 9 of 2005. The Instrument was registered with the Federal Register of Legislative Instruments on 19 March 2014, with an effective date of 26 November 2013.

2. Posttraumatic stress disorder

As previously reported, in March 2008 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 5 and 6 of 2008, concerning posttraumatic stress disorder. Notifi cation of this review appeared in the Government Notices Gazette of 13 August 2008. In the Government Notices Gazette of 19 December 2013, the SMRC notifi ed its Declaration No. 23 in relation to this review.

The SMRC directed the Authority to amend Instrument No. 5 of 2008 by including the following factors:

(a) Having a perception of threat and/or harm to the integrity of the self as a consequence of being in what:

(i) the individual concerned; and

(ii) a reasonable person in the circumstances of that individual would have;

considered to be any or all of a threatening, hostile, hazardous and/or menacing situation and/or environment.

(b) Having a perception of threat and/or harm to the integrity of:

(i) a signifi cant other; and/or

(ii) other persons known to the individual or with whom the individual concerned has had contact in the discharge of that individual’s duties and/or responsibilities;

as a consequence of the individual concerned and the persons in (i) and/or (ii) being in the same or similar circumstances as the individual concerned which:

(iii) the individual concerned; and

(iv) a reasonable person in the circumstances of that individual would have;

considered to be any or all of a threatening, hostile, hazardous and/or menacing situation and/or environment but excluding a perception engendered from viewing or listening to mass media (unless such viewing or listening is part of that individual’s duties and/or responsibilities).

The SMRC also directed the Authority to conduct a review of the contents of Instrument Nos. 5 and 6 of 2008 as soon as reasonably practicable, including but not limited to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5TM) American Psychiatric Association 2013 (DSM-5). The full Declaration is available on the SMRC website at http://www.smrc.gov.au/ decisions.htm.

22 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

In response to the declaration, the Authority determined Amendment SOP, Instrument No. 19 of 2014, concerning posttraumatic stress disorder. Instrument No. 19 of 2014 amends Instrument No. 5 of 2008. The Instrument was registered with the Federal Register of Legislative Instruments on 22 January 2014, with an effective date of 19 December 2013.

The Authority noted that it had previously determined to notify a review of the contents of the SOPs concerning posttraumatic stress disorder, and that a Notice of Investigation had appeared in the Government Notices Gazette of 21 August 2013. The decision to notify the review was driven by the commencement of DSM-5. The Authority advised the SMRC that the completion of this review at the earliest opportunity met the terms of the SMRC direction.

3. Malignant neoplasm of the brain

As previously reported, in December 2008 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 58 and 59 of 2008, concerning malignant neoplasm of the brain. Notifi cation of this review appeared in the Government Notices Gazette of 18 February 2009. In the Government Notices Gazette of 16 September 2013, the SMRC notifi ed its Declaration No. 20 in relation to this review.

Declaration No. 18 stated that:

1. In relation to the Repatriation Medical Authority (the RMA) Statement of Principles concerning malignant neoplasm of the brain No. 58 of 2008 as amended by Amendment Statement of Principles No. 37 of 2011 made under subsection 196B (2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA), the Specialist Medical Review Council (the Council) under subsection 196W of the VEA:

DECLARES THAT:

the sound medical-scientifi c evidence available to the RMA is insuffi cient to justify an amendment to include a factor or factors for exposure to heat beyond fever temperature, melatonin depletion due to sleep deprivation, alcohol consumption, exposure to non-ionising electromagnetic radiation emitted from radio equipment (as used in aircraft) or exposure to non-ionising electromagnetic radiation emitted from radar equipment.

2. In relation to the Repatriation Medical Authority (the RMA) Statement of Principles concerning malignant neoplasm of the brain No. 59 of 2008 as amended by Amendment Statement of Principles No. 38 of 2011, made under subsection 196B (3) and (8) of the VEA, the Council under subsection 196W of the VEA:

DECLARES THAT:

the sound medical-scientifi c evidence available to the RMA is insuffi cient to justify an amendment to include a factor or factors for exposure to heat beyond fever temperature, melatonin depletion due to sleep deprivation, alcohol consumption, exposure to non-ionising electromagnetic radiation emitted from radio equipment (as used in aircraft) or exposure to non-ionising electromagnetic radiation emitted from radar equipment.

4. Alzheimer-type dementia

As previously reported, in June 2010 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 22 and 23 of 2010, concerning Alzheimer-type dementia. Notifi cation of this review appeared in the Government Notices Gazette of 3 November 2010. In the Government Notices Gazette of 16 September 2013, the SMRC notifi ed its Declaration No. 21 in relation to this review.

23 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Declaration No. 21 stated that:

1. In relation to the Repatriation Medical Authority (the RMA) Statement of Principles No. 22 of 2010 concerning Alzheimer-type dementia and death from Alzheimer-type dementia, made under subsection 196B (2) of the Veterans’ Entitlements Act 1986 (the VEA), the Specialist Medical Review Council (the Council) under subsection 196W of the VEA:

DECLARES THAT it is of the view that there was insuffi cient sound medical-scientifi c evidence on which the RMA could have relied to amend the Statement of Principles to include a factor or factors for exposure to ionising radiation.

2. In relation to the RMA Statement of Principles No. 23 of 2010 concerning Alzheimer-type dementia and death from Alzheimer-type dementia, made under subsection 196B (3) of the VEA, the Council under subsection 196W of the VEA:

DECLARES THAT it is of the view that there was insuffi cient sound medical-scientifi c evidence on which the RMA could have relied to amend the Statement of Principles to include a factor or factors for exposure to ionising radiation.

The SMRC also recommended that the Authority conduct a new investigation to fi nd out whether there is new information about Alzheimer-type dementia, in particular in relation to exposure to ionising radiation. The full Declaration is available on the SMRC website at http://www.smrc.gov. au/decisions.htm.

In response to the declaration, the Authority notifi ed a review in the Government Notices Gazette of 16 October 2013 of the contents of SOPs, Instrument Nos. 22 and 23 of 2010, concerning Alzheimer-type dementia. The notices specifi ed that the review would be restricted to exposure to ionising radiation as a factor in Alzheimer-type dementia.

5. Diabetes Mellitus

In October 2011, the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 89 and 90 of 2011, concerning diabetes mellitus. Notifi cation of this review appeared in the Government Notices Gazette of 19 October 2011. In the Government Notices Gazette of 13 May 2014, the SMRC notifi ed its Declaration No. 24 in relation to this review.

Declaration No. 24 stated that:

In relation to the Repatriation Medical Authority (the RMA) Statements of Principles Nos. 89 and 90 of 2011 concerning diabetes mellitus, made under subsections 196B (2) and (3) of the Veterans’ Entitlements Act 1986 (the VEA), the Specialist Medical Review Council (the Council) under subsection 196W of the VEA:

DECLARES that it is of the view that the sound medical-scientifi c evidence on which the RMA could have relied to amend either of the Statements of Principles is insuffi cient to include a factor or factors for having been on board a vessel and having been exposed to dioxin diluted in water supplied on that vessel, including but not limited to consuming potable water, when the supply had been produced by evaporative distillation of estuarine Vietnamese waters.

6. Myeloma

In February 2013 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 69 and 70 of 2012, concerning myeloma. Notifi cation of this review appeared in the Government Notices Gazette of 27 February 2013. In the Government Notices Gazette of 13 May 2014, the SMRC notifi ed its Declaration No. 23 in relation to this review.

24 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Declaration No. 23 stated that:

1. In relation to the Repatriation Medical Authority (the RMA) Statement of Principles No. 70 of 2012 concerning myeloma and death from myeloma, made under subsection 196B (3) of the Veterans’ Entitlements Act 1986 (the VEA), the Specialist Medical Review Council (the Council) under subsection 196W of the VEA:

DECLARES that the sound medical-scientifi c evidence available to the RMA is insuffi cient to justify an amendment to Statement of Principles No. 70 of 2012 to include a factor or factors in the same or similar terms to existing factors 6(c) and 6(d) in Statement of Principles No. 69 of 2012.

2. In relation to the RMA Statements of Principles Nos. 69 and 70 of 2012 concerning myeloma and death from myeloma, made under subsections 196B (2) and 196B (3) of the VEA, the Council under subsection 196W of the VEA:

DECLARES that there is sound medical-scientifi c evidence on which the RMA could have relied to amend both the Statements of Principles to include the factor set out below; and

DIRECTS the RMA to amend both Statements of Principles Nos. 69 and 70 of 2012 by including the following factor:

Having exposure to 2,3,7,8 tetrachlorodibenzo-para-dioxin (TCDD) suffi cient to produce an expected initial serum TCDD level of at least 1500 parts per trillion before the clinical onset of myeloma.

In response to the declaration, the Authority determined Amendment SOPs, Instrument Nos. 72 and 73 of 2014, concerning myeloma. Instrument No. 72 of 2014 amends Instrument No. 69 of 2012, and Instrument No. 73 of 2014 amends Instrument No. 70 of 2012. The Instruments were registered with the Federal Register of Legislative Instruments on 2 July 2014, with an effective date of 13 May 2014.

7. Asbestosis

In November 2013 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 55 and 56 of 2013, concerning asbestosis. Notifi cation of this review appeared in the Government Notices Gazette of 12 March 2014. As at 30 June 2014, the Authority had not been advised of the outcome of the review.

8. Fibrosing interstitial lung disease

In November 2013 the SMRC advised the Authority that a request for review had been received in relation to SOPs, Instrument Nos. 53 and 54 of 2013, concerning fi brosing interstitial lung disease. Notifi cation of this review appeared in the Government Notices Gazette of 12 March 2014. As at 30 June 2014, the Authority had not been advised of the outcome of the review.

25 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Department of Veterans’ Affairs

Although the Authority is separate and independent of the Department of Veterans’ Affairs, the Department provided the Authority with assistance and support during the year.

As in previous years, for the purposes of ss 120A(2) and 120B(2) of the VEA, the Authority consulted with DVA in order to ascertain what kinds of injury, disease or death were the most frequently claimed and the number of claims outstanding. The Department’s Brisbane Offi ce also assisted the Authority by providing Corporate Services support in the areas of Human Resource and Payroll Services, Financial Services, Offi ce Services and Information Technology Services.

26 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Ex-Service Organisations

The Authority continued its policy of regular meetings with leading offi ce bearers and accepting invitations to attend congresses of the major Ex-Service Organisations (ESOs) throughout the year. These meetings enable an exchange of information about current issues being dealt with by the Authority and address matters of interest that may be raised by ESOs. Meetings where the Authority was represented are listed in Table 5 below.

Table 5: Ex-Service Organisation meetings attended

Ex-Service Organisation Location Date Authority

Representative/s

RSL - Victorian State Congress Melbourne, Vic 2 July 2013 Chairperson and Deputy Registrar

RSL - South Australian State Congress Adelaide, SA 6 July 2013 Chairperson and

Registrar

Legacy National Pensions Committee Annual General Meeting

Canberra, ACT 12 August 2013 Chairperson and Registrar

RSL - National Congress Canberra, ACT 24-25 September 2013 Registrar

RSL - WA State Congress Perth, WA 26 October 2013 Registrar

RSL - Tasmanian State Congress Launceston, Tasmania 16 May 2014 Chairperson and Registrar

Vietnam Veterans’ Association National Congress Ingleburn, NSW 23 May 2014 Chairperson and Registrar

RSL - NSW State Congress Coffs Harbour, NSW 26-27 May 2014 Chairperson and Registrar

RSL - National Pensions Offi cers’ Forum Melbourne, Vic 11 June 2014 Registrar

RSL - ACT Branch Congress Canberra, ACT 13 June 2014 Chairperson and Registrar

RSL - Queensland State Congress Townsville, Qld 20-21 June 2014 Chairperson and Registrar

27 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Financial

A summary of cash expenditure incurred by the Authority in 2013/14 with comparison to 2012/13 is detailed in Table 6.

Financial information prepared on an accrual basis is included in the DVA Financial Statements.

Table 6: Financial expenditure

Item 2013/14 2012/13 2011/12

Salary and related $1,580.955 $1,603,289 $1,458,438

expenses

Administrative $ 265,599 $ 230,974 $ 241,155

expenses

Legal expenses $ 70,684 $ 146,667 $ 95,039

Total expenditure $1,917,238.00 $1,980,930.00 $1,794,632.00

28 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Appendices

Appendix 1: RMA Secretariat staffi ng structure

Medical Research Staff

Administrative Staff

Chairperson and Members Repatriation Medical Authority

RMA Registrar

Deputy Registrar Principal Medical Offi cer

Medical Research Offi cer

Medical Research Offi cer

Medical Research Offi cer

Medical Research Offi cer

Finance and Information Manager

Minister for Veterans’ Affairs

Administrative Assistant

Administrative Assistant

Medical Research Offi cer

Note: A number of the positions are staffed on ‘a part-time basis’.

29 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Appendix 2: Statements of Principles determined 2013/14

2013

Instrument No. Title Effective Date Other Comments

51 & 52/2013 malignant neoplasm of the anus and anal canal 4/09/2013 51 revokes 34/2002 52 revokes 35/2002

53 & 54/2013 fi brosing interstitial lung disease 4/09/2013 53 revokes 35/2009, as amended by 59/2010, 79/2011

and 66/2012

54 revokes 36/2009, as amended by 60/2010, 80/2011 and 67/2012

55 & 56/2013 asbestosis 4/09/2013 55 revokes 23/2005

56 revokes 24/2005

57 & 58/2013 sudden unexplained death 4/09/2013 57 revokes 43/2005 58 revokes 44/2005

59 & 60/2013 Guillain-Barre syndrome 4/09/2013 59 revokes 53/2005

60 revokes 54/2005

61 & 62/2013 malignant neoplasm of the larynx 4/09/2013 61 revokes 1/2006 62 revokes 2/2006

63 & 64/2013 hypertension 4/09/2013 63 revokes 35/2003, as

amended by 3/2004 and 11/2008

61 revokes 36/2003, as amended by 4/2004 and 12/2008

65 & 66/2013 gastro-oesophageal refl ux disease 4/09/2013 65 revokes 11/2005 66 revokes 12/2005

67 & 68/2013 motor neurone disease 4/09/2013 67 revokes 7/2006, as amended by 53/2009

68 revokes 8/2006

69 & 70/2013 lumbar spondylosis 21/06/2012 69 amends 37/2005

70 amends 38/2005

71 & 72/2013 chronic solvent encephalopathy 13/11/2013 71 revokes 39/2005 72 revokes 40/2005

73 & 74/2013 malignant neoplasm of the pancreas 13/11/2013 73 revokes 45/2005 74 revokes 46/2005

75 & 76/2013 epilepsy 13/11/2013 75 revokes 49/2005

76 revokes 50/2005

30 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

77 & 78/2013

Title

epileptic seizure

Effective Date

13/11/2013

Other Comments

77 revokes 47/2005, as amended by 37/2009

78 revokes 48/2005, as amended by 38/2009

79 & 80/2013 steatohepatitis 13/11/2013 79 revokes 55/2005

80 revokes 56/2005

2014

Instrument No. Title Effective Date Other Comments

1 & 2/2014 heart block 15/01/2014 1 revokes 3/2006

2 revokes 4/2006

3 & 4/2014 dental pulp and apical disease 15/01/2014 3 revokes 73/2002 4 revokes 74/2002

5 & 6/2014 morbid obesity 15/01/2014 5 revokes 31/2003

6 revokes 32/2003

7 & 8/2014 narcolepsy 15/01/2014 7 revokes 57/2005

8 revokes 58/2005

9 & 10/2014 dermatomyositis 15/01/2014 9 revokes 51/2005

10 revokes 52/2005

11 & 12/2014 chronic fatigue syndrome 15/01/2014 11 revokes 23/2003 12 revokes 24/2003

13 & 14/2014 fi bromyalgia 15/01/2014 New condition

15 & 16/2014 sick sinus syndrome 15/01/2014 New condition

17 & 18/2014 Alzheimer-type dementia 15/01/2014 17 amends 22/2010 18 amends 23/2010

19/2014 posttraumatic stress disorder 19/12/2013 19 amends 5/2008

20 & 21/2014 restless legs syndrome 26/03/2014 20 revokes 33/2003

21 revokes 34/2003

22 & 23/2014 allergic rhinitis 26/03/2014 22 revokes 3/2003

23 revokes 4/2003

24 & 25/2014 somatic symptom disorder 26/03/2014 New condition

26 & 27/2014 periodic limb movement disorder 26/03/2014 New condition

28/2014 chronic lymphoid

leukaemia

26/11/2013 28 amends 9/2005

31 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Instrument No. Title Effective Date Other Comments

29 & 30/2014 alcohol use disorder 26/03/2014 29 amends 1/2009

30 amends 2/2009

31 & 32/2014 substance use disorder 26/03/2014 31 amends 3/2009

32 amends 4/2009

33 & 34/2014 ischaemic heart disease 26/03/2014 33 amends 89/2007 34 amends 90/2007

35 & 36/2014 Hodgkin’s lymphoma 7/05/2014 35 revokes 28/2004

36 revokes 29/2004

37 & 38/2014 chronic obstructive pulmonary disease 7/05/2014 37 revokes 30/2004 38 revokes 31/2004

39 & 40/2014 malignant neoplasm of the thyroid gland 7/05/2014 39 revokes 9/2006 40 revokes 10/2006

41 & 42/2014 acute stress disorder 7/05/2014 41 revokes 33/2007

42 revokes 34/2007

43 & 44/2014 mitral valve prolapse 7/05/2014 43 revokes 11/2003

44 revokes 12/2003

45 & 46/2014 pleural plaque 7/05/2014 45 revokes 51/2003

46 revokes 52/2003

47 & 48/2014 chronic myeloid leukaemia 7/05/2014 47 revokes 15/2003, as amended by 47/2011

48 revokes 16/2003, as amended by 48/2011

49 & 50/2014 atrial fi brillation & atrial fl utter 7/05/2014 49 revokes 19/2003 (atrial fi brillation) & 71/2002 (atrial

fl utter)

50 revokes 20/2003 (atrial fi brillation) & 72/2002 (atrial fl utter)

51 & 52/2014 otitis media 7/05/2014 51 revokes 1/2003

52 revokes 2/2003

53 & 54/2014 malignant neoplasm of the prostate 14/05/2014 53 revokes 28/2005, as amended by 77/2012

54 revokes 29/2005, as amended by 78/2012

55 & 56/2014 chronic multisymptom illness 14/05/2014 New condition

57/2014 non-Hodgkin’s

lymphoma

7/05/2014 57 amends 28/2010

32 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Instrument No. Title Effective Date Other Comments

58 & 59/2014 malignant neoplasm of the stomach 2/07/2014 58 revokes 7/2003, as amended by 65/2011

59 revokes 8/2003, as amended by 66/2011

60 & 61/2014 melioidosis 2/07/2014 60 revokes 27/2003

61 revokes 28/2003

62 & 63/2014 lumbar spondylosis 2/07/2014 62 revokes 37/2005, as amended by 78/2008, 36/2010 and 69/2013

63 revokes 38/2005, as amended by 79/2008, 37/2010 and 70/2013

64 & 65/2014 thoracic spondylosis 2/07/2014 64 revokes 35/2005

65 revokes 36/2005

66 & 67/2014 cervical spondylosis 2/07/2014 66 revokes 33/2005, as amended by 76/2008

67 revokes 34/2005, as amended by 77/2008

68 & 69/2014 hiatus hernia 2/07/2014 68 revokes 17/2004

69 revokes 18/2004

70 & 71/2014 warts 2/07/2014 New condition

72 & 73/2014 myeloma 2/07/2014 72 amends 69/2012

73 amends 70/2012

33 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Appendix 3: Outstanding investigations and reviews as at 30/06/2014

The following investigations and reviews were notifi ed in the Government Notices Gazette on the date indicated, but had not been fi nalised as at 30 June 2014. The amendments to the VEA introduced in 2007 gives the Authority the discretion to limit the scope of a review. The Authority refers to such reviews as “focussed reviews” and they are listed in Table 9. The scope of each focussed review is also shown.

The Investigations listed in Table 7 refer to action undertaken by the Authority pursuant to s 196B(4) of the VEA to determine whether a SOP may be determined, that is, there is no existing SOP for the injury or disease.

Reviews and focussed reviews listed in Tables 8 and 9 refer to action undertaken by the Authority pursuant to ss 196B(7) and 196B(7A) of the VEA, respectively.

Table 7: Outstanding investigations pursuant to s 196B(4)

Date of Gazettal

1. arachnoid cyst of the brain 02/11/2011

2. trochanteric bursitis of the hip 02/07/2014

Table 8: Outstanding reviews pursuant to s 196B(7)

Reviews Instrument Nos. Date of Gazettal

1. chronic lymphoid leukaemia 9 & 10 of 2005 3/11/2010

2. osteomyelitis 5 & 6 of 2004 18/05/2011

3. tinea of the skin 13 & 14 of 2004 18/05/2011

4. malignant neoplasm of the testis and paratesticular tissues 15 & 16 of 2004 18/05/2011

5. Creutzfeldt-Jakob disease 34 & 35 of 2004 18/05/2011

6. malignant neoplasm of the small intestine 40 of 2004, as amended by 19 of 2010 & 41 of 2004

18/05/2011

7. malignant neoplasm of unknown primary site 44 & 45 of 2004 18/05/2011

8. malignant neoplasm of the salivary gland 46 & 47 of 2004 18/05/2011

9. leptospirosis 52 & 53 of 2004 18/05/2011

10. epicondylitis 52 & 53 of 2004 18/05/2011

11. peripheral neuropathy 41 & 42 of 2005 18/05/2011

12. spondylolisthesis and spondylolysis 5 & 6 of 2006, as amended by 44 & 45 of 2010

18/05/2011

13. soft tissue sarcoma 13 & 14 of 2006, as

amended by 35 & 36 of 2008 and 73 & 74

02/11/2011

of 2011

34 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Reviews Instrument Nos. Date of Gazettal

14. malignant neoplasm of the lung 17 & 18 of 2006, as

amended by 87 & 88 of 2007 and 41 & 42

02/11/2011

of 2011

15. Paget’s disease of bone 19 & 20 of 2006 02/11/2011

16. vascular dementia 21 & 22 of 2006, as

amended by 63 & 64 of 2006 and 61 & 62

02/11/2011

of 2010

17. malignant neoplasm of the breast 27 & 28 of 2006, as amended by 53 & 54 of 2011

02/11/2011

18. osteoporosis 29 & 30 of 2006 02/11/2011

19. seborrhoeic keratosis 31 & 32 of 2006 02/11/2011

20. acute myeloid leukaemia 35 & 36 of 2006, as

amended by 43 & 44 of 2011

02/11/2011

21. myelodysplastic disorder 37 & 38 of 2006, as

amended by 45 & 46 of 2011

02/11/2011

22. rotator cuff syndrome 39 & 40 of 2006 02/11/2011

23. external burn 41 & 42 of 2006 02/11/2011

24. decompression sickness 43 & 44 of 2006 02/11/2011

25. pulmonary barotrauma 45 & 46 of 2006 02/11/2011

26. dysbaric osteonecrosis 47 & 48 of 2006 02/11/2011

27. shin splints 49 & 50 of 2006, as

amended by 105 & 106 of 2007

02/11/2011

28. cerebrovascular accident 51 & 52 of 2006, as

amended by 123 & 124 of 2011

02/05/2012

29. fracture 53 & 54 of 2006 02/05/2012

30. gastric ulcer and duodenal ulcer 57 & 58 of 2006 02/05/2012

31. Meniere’s disease 59 & 60 of 2006 02/05/2012

32. alpha-1antitrypsin defi ciency 1 & 2 of 2007 02/05/2012

33. Gaucher’s disease 3 & 4 of 2007 02/05/2012

34. Huntington’s chorea 5 & 6 of 2007 02/05/2012

35. Wilson’s disease 7 & 8 of 2007 02/05/2012

36. Charcot-Marie-Tooth disease 9 & 10 of 2007 02/05/2012

37. multiple osteochondromatosis 11 & 12 of 2007 02/05/2012

38. hereditary spherocytosis 13 & 14 of 2007 02/05/2012

35 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Reviews Instrument Nos. Date of Gazettal

39. myasthenia gravis 15 & 16 of 2007 02/05/2012

40. plantar fasciitis 19 & 20 of 2007 02/05/2012

41. malignant neoplasm of the bile duct 21 & 22 of 2007, as amended by 49 & 50 of 2011

02/05/2012

42. cardiomyopathy 23 & 24 of 2007 02/05/2012

43. chicken pox 25 & 26 of 2007 02/05/2012

44. herpes zoster 27 & 28 of 2007 02/05/2012

45. hepatitis A 29 & 30 of 2007 02/05/2012

46. hepatitis E 31 & 32 of 2007 02/05/2012

47. familial hypertrophic cardiomyopathy 35 & 36 of 2007 02/05/2012

48. trigeminal neuralgia 54 & 55 of 2009 31/10/2012

49. trigeminal neuropathy 29 & 30 of 2009 31/10/2012

50. Achilles tendinopathy & bursitis 37 & 38 of 2007 31/10/2012

51. intervertebral disc prolapse 39 & 40 of 2007, as

amended by 80 & 81 of 2008 and 38 & 39

31/10/2012

of 2010

52. malignant neoplasm of the oesophagus 41 & 42 of 2007, as amended by 55 & 56 of 2011

31/10/2012

53. tuberculosis 43 & 44 of 2007 31/10/2012

54. albinism 45 & 46 of 2007 31/10/2012

55. alkaptonuria 47 & 48 of 2007 31/10/2012

56. congenital cataract 49 & 50 of 2007 31/10/2012

57. horseshoe kidney 51 & 52 of 2007 31/10/2012

58. Marfan syndrome 53 & 54 of 2007 31/10/2012

59. autosomal dominant polycystic kidney disease 55 & 56 of 2007 31/10/2012

60. von Willebrand’s disease 57 & 58 of 2007 31/10/2012

61. osteogenesis imperfecta 59 & 60 of 2007 31/10/2012

62. spina bifi da 61 & 62 of 2007 31/10/2012

63. haemophilia 63 & 64 of 2007 31/10/2012

64. Parkinson’s disease and parkinsonism 65 & 66 of 2007, as amended by 83 of 2010

31/10/2012

65. malignant neoplasm of the gallbladder 67 & 68 of 2007, as amended by 51 & 52 of 2011

31/10/2012

36 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Reviews Instrument Nos. Date of Gazettal

66. myopia, hypermetropia and astigmatism 69 & 70 of 2007 31/10/2012

67. dental caries 71 & 72 of 2007 31/10/2012

68. loss of teeth 73 & 74 of 2007, as

amended by 121 & 122 of 2007

31/10/2012

69. pterygium 75 & 76 of 2007 31/10/2012

70. pinguecula 77 & 78 of 2007 31/10/2012

71. malignant melanoma of the skin 79 & 80 of 2007 31/10/2012

72. non-melanotic malignant neoplasm of the skin 81 & 82 of 2007, as amended by 71 & 72

of 2011

31/10/2012

73. mesothelioma 83 & 84 of 2007 31/10/2012

74. systemic lupus erythematosus 85 & 86 of 2007, as

amended by 41 & 42 of 2009

31/10/2012

75. ischaemic heart disease 89 & 90 of 2007, as

amended by 43 & 44 of 2009, 96 & 97 of 2010 and 125 & 126

31/10/2012

of 2011

76. hallux valgus 91 & 92 of 2007 31/10/2012

77. ingrowing nail 93 & 94 of 2007 31/10/2012

78. lipoma 95 & 96 of 2007 31/10/2012

79. malignant neoplasm of the endometrium 99 & 100 of 2007, as amended 91 of 2011 31/10/2012

80. anxiety disorder 101 & 102 of 2007, as

amended by 42 & 43 of 2010 and 15 & 16

31/10/2012

11 of 20

81. peritoneal adhesions 103 & 104 of 2007 31/10/2012

82. posttraumatic stress disorder 5 & 6 of 2008, as

amended by 19 of 2014

21/08/2013

83. chronic lymphoid leukaemia 9 & 10 of 2005, as

amended by 28 of 2014

18/12/2013

84. depressive disorder 27 & 28 of 2008, as

amended by 41 & 42 of 2010

26/03/2014

37 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Table 9: Outstanding reviews pursuant to s 196B(7A)

Focussed Reviews Focus of Review Instrument Nos. Date of Gazettal

1. diabetes mellitus posttraumatic stress disorder, antipsychotic medication & antidepressant medication

89 & 90 of 2011 18/12/2013

2. non-Hodgkin’s lymphoma defi nition /small lymphocytic lymphoma

28 & 29 of 2010 18/12/2013

3. alcohol use disorder threatening, hostile, hazardous and/or menacing situation and/or environment

1 & 2 of 2009, as amended by 29 & 30 of 2014

26/03/2014

4. substance use disorder threatening, hostile, hazardous and/or menacing

situation and/or environment

3 & 4 of 2009, as amended by 31 & 32 of 2014

26/03/2014

5. bipolar disorder threatening, hostile, hazardous and/or menacing situation and/or environment

27 & 28 of 2009 26/03/2014

6. panic disorder threatening, hostile, hazardous and/or menacing situation and/or environment

68 & 69 of 2009 26/03/2014

7. schizophrenia threatening, hostile, hazardous and/or menacing situation and/or environment

15 & 16 of 2009, as amended by 93 of 2011

26/03/2014

8. adjustment disorder threatening, hostile, hazardous and/or menacing situation and/or environment

37 & 38 of 2008 26/03/2014

9. eating disorder threatening, hostile, hazardous and/or menacing situation and/or environment

47 & 48 of 2008, as amended by 47 & 48 of 2009

26/03/2014

10. suicide and attempted suicide threatening, hostile, hazardous and/or menacing

situation and/or environment

11 & 12 of 2010 26/03/2014

11. migraine anxiety, depressive &

posttraumatic disorders 56 & 57 of 2009 2/07/2014

38 Repatriation Medical Authority - Twentieth Annual Report 2013/2014

Glossary of terms

BOP balance of probabilities

DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association 2013

DVA Department of Veterans’ Affairs

ESO Ex-Service Organisation

FOI Freedom of Information

LIA Legislative Instruments Act 2003

MRCA Military Rehabilitation and Compensation Act 2004

PTSD posttraumatic stress disorder

RH reasonable hypothesis

RMA Repatriation Medical Authority

SMRC Specialist Medical Review Council

SOP Statement of Principles

VEA Veterans’ Entitlements Act 1986

39 Repatriation Medical Authority - Twentieth Annual Report 2013/2014