Statement of Principles concerning Parkinson's disease and secondary parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) (Cth)

Statement of Principles concerning PARKINSON'S DISEASE AND SECONDARY PARKINSONISM (Reasonable Hypothesis) (No. 55 of 2016) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 22 April 2016

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 Parkinson's disease and secondary parkinsonism (Reasonable Hypothesis) (No. 55 of 2016). 2 Commencement This instrument commences on 23 May 2016. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning Parkinson's disease and parkinsonism No. 65 of 2007, as amended, made under subsections 196B(2) and (8) of the VEA is revoked. 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 Parkinson's disease and secondary parkinsonism and death from Parkinson's disease and secondary parkinsonism. Meaning of Parkinson's disease (2) For the purposes of this Statement of Principles, Parkinson's disease means a neurodegenerative disease involving the progressive failure of dopaminergic transmission in the nigrostriatal system of the basal ganglia, which: (a) is characterised clinically by: (i) the presence of bradykinesia, muscular rigidity, a resting tremor and postural instability; (ii) symptoms which may gradually progress; (iii) a sustained response to therapy with levodopa; and (iv) non-motor symptoms including sleep, mood and autonomic disturbances; and (b) is characterised pathologically by the degeneration of dopaminergic neurons in the substantia nigra pars compacta and the presence of alpha-synuclein-associated Lewy bodies or Lewy neurite intracellular inclusions at widespread locations in the central and peripheral nervous system; and (c) excludes secondary parkinsonism, parkinsonism in other primary neurodegenerative diseases and Parkinson plus diseases including dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, frontotemporal dementia and corticobasal degeneration. Meaning of secondary parkinsonism (3) For the purposes of this Statement of Principles, secondary parkinsonism means an acquired movement disorder caused by exogenous factors that interfere with dopaminergic transmission in the nigrostriatal system of the basal ganglia, which: (a) is characterised clinically by the presence of bradykinesia, muscular rigidity, a resting tremor and postural instability; and (b) excludes Parkinson's disease, dementia pugilistica, non-parkinsonian tremors such as benign essential tremor, psychogenic parkinsonism, parkinsonism in primary neurodegenerative diseases and Parkinson plus diseases including dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, frontotemporal dementia and corticobasal degeneration. Death from Parkinson's disease and secondary parkinsonism (4) For the purposes of this Statement of Principles, Parkinson's disease or secondary parkinsonism, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Parkinson's disease or secondary parkinsonism. 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 Parkinson's disease or secondary parkinsonism and death from Parkinson's disease or secondary parkinsonism 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: relevant service is 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 Parkinson's disease or secondary parkinsonism or death from Parkinson's disease or secondary parkinsonism with the circumstances of a person's relevant service: (1) for Parkinson's disease only: (a) inhaling, ingesting or having cutaneous contact with a pesticide from the specified list of pesticides, for a cumulative period of at least 1 000 hours, before the clinical onset of Parkinson's disease;