Statement of Principles concerning CLONORCHIASIS (Reasonable Hypothesis) (No. 47 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 clonorchiasis (Reasonable Hypothesis) (No. 47 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 clonorchiasis No. 113 of 2007 made under subsection 196B(2) 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 clonorchiasis and death from clonorchiasis. Meaning of clonorchiasis (2) For the purposes of this Statement of Principles, clonorchiasis means a symptomatic clinical infection of the biliary system by the trematode Clonorchis sinensis. This infection is characterised by loss of appetite, diarrhoea, or a sense of abdominal pressure. (3) While clonorchiasis attracts ICD‑10‑AM code B66.1, in applying this Statement of Principles the meaning of clonorchiasis 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 clonorchiasis (5) For the purposes of this Statement of Principles, clonorchiasis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's clonorchiasis. 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 clonorchiasis and death from clonorchiasis 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 clonorchiasis or death from clonorchiasis with the circumstances of a person's relevant service: (1) ingesting the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish containing encysted larvae of Clonorchis sinensis, at least three weeks before the clinical onset of clonorchiasis; (2) ingesting the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish from a country from the specified list of countries, at least three weeks before the clinical onset of clonorchiasis; Note: specified list of countries is defined in the Schedule 1 - Dictionary. (3) inability to obtain appropriate clinical management for clonorchiasis. 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, clonorchiasis where the person's clonorchiasis 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: clonorchiasis—see subsection 7(2). MRCA means the Military Rehabilitation and Compensation Act 2004. relevant service means: (a) operational service under the VEA; (b) peacekeeping service under the VEA; (c) hazardous service under the VEA; (d) British nuclear test defence service under the VEA; (e) warlike service under the MRCA; or (f) non-warlike service under the MRCA. specified list of countries means: (a) Cambodia; (b) China; (c) Hong Kong; (d) Japan; (e) Korea; (f) Laos; (g) Myanmar (Burma); (h) Russia (far eastern region only); (i) Taiwan; (j) Thailand; or (k) Vietnam. 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.