Statement of Principles concerning PTERYGIUM (Balance of Probabilities) (No. 117 of 2015) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 16 October 2015 The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of: Professor Nicholas Saunders AO Chairperson Contents 1 Name 2 Commencement 3 Authority 4 Revocation 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions 1 Name This is the Statement of Principles concerning pterygium (Balance of Probabilities) (No. 117 of 2015). 2 Commencement This instrument commences on 16 November 2015. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning pterygium No. 76 of 2007 made under subsection 196B(3) of the VEA is revoked. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 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 pterygium and death from pterygium. Meaning of pterygium (2) For the purposes of this Statement of Principles, pterygium means: (a) a wing-like, abnormal triangular fold of membrane, in the interpalpebral fissure, extending from the conjunctiva to the cornea, being immovably united to the cornea at its apex, firmly attached to the sclera throughout its middle portion, and merged with the conjunctiva at its base; and (b) excludes pinguecula. (3) While pterygium attracts ICD‑10‑AM code H11.0, in applying this Statement of Principles the meaning of pterygium 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5. Death from pterygium (5) For the purposes of this Statement of Principles, pterygium, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pterygium. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that pterygium and death from pterygium can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA. Note: relevant service is defined in the Schedule 1 – Dictionary. 9 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, pterygium or death from pterygium is connected with the circumstances of a person's relevant service: (1) having sunlight exposure to the unprotected eye for at least 4 500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of pterygium; Note: equivalent sunlight exposure in other latitude zones, tropical area and unprotected eye are defined in the Schedule 1 – Dictionary. (2) having heavy exposure of the affected eye to dust, for an average of at least 20 hours per week, for at least the four years before the clinical onset of pterygium; Note: heavy exposure of the affected eye to dust is defined in the Schedule 1 – Dictionary. (3) inability to obtain appropriate clinical management for pterygium. 10 Relationship to service (1) The existence in a person of any factor referred to in section 9 must be related to the relevant service rendered by the person. (2) The factor set out in subsection 9(3) applies only to material contribution to, or aggravation of, pterygium where the person's pterygium 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(3) of the VEA; then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: equivalent sunlight exposure in other latitude zones means the cumulative hours of sunlight exposure equivalent to that specified for a tropical area, calculated by multiplying the hours of exposure in each latitude zone by the latitude weighting factor for the zone as per the latitude weighting factor schedule and adding together the result for each zone: Latitude weighting factor schedule Latitude zone Latitude weighting factor a latitude between 23° 27' South and 23° 27' North 1.0 a latitude from > 23° 27' to 35° 0.75 a latitude from > 35° to 45° 0.5 a latitude from > 45° to 65° 0.25. heavy exposure of the affected eye to dust means exposure of the affected eye to dust in an environment where the person is covered in dust and is without eye protection. MRCA means the Military Rehabilitation and Compensation Act 2004. pterygium—see subsection 7(2). relevant service means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime service under the MRCA. terminal event means the proximate or ultimate cause of death and includes the following: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. tropical area means any area between the Tropic of Capricorn (23º 27' South) and the Tropic of Cancer (23º 27' North). unprotected eye means an eye exposed to sunlight and not protected by ultraviolet radiation screening devices. VEA means the Veterans' Entitlements Act 1986.