Statement of Principles concerning Barrett's oesophagus (Reasonable Hypothesis) (No. 67 of 2016) (Cth)

Statement of Principles concerning BARRETT'S OESOPHAGUS (Reasonable Hypothesis) (No. 67 of 2016) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 June 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 Barrett's oesophagus (Reasonable Hypothesis) (No. 67 of 2016). 2 Commencement This instrument commences on 25 July 2016. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about Barrett's oesophagus and death from Barrett's oesophagus. Meaning of Barrett's oesophagus (2) For the purposes of this Statement of Principles, Barrett's oesophagus means: (a) a condition in which there is metaplasia of the epithelium of the lower oesophagus from the normal stratified squamous epithelium to abnormal columnar epithelium; and (b) includes metaplasia at the gastro-oesophageal junction. (3) While Barrett's oesophagus attracts ICD‑10‑AM code K22.7, in applying this Statement of Principles the meaning of Barrett's oesophagus 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 Barrett's oesophagus (5) For the purposes of this Statement of Principles, Barrett's oesophagus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Barrett's oesophagus. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that Barrett's oesophagus and death from Barrett's oesophagus 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. 8 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 Barrett's oesophagus or death from Barrett's oesophagus with the circumstances of a person's relevant service: (1) having gastro-oesophageal reflux disease for at least the one year before the clinical onset of Barrett's oesophagus; (2) having a hiatus hernia before the clinical onset of Barrett's oesophagus; (3) being obese for at least the five years before the clinical onset of Barrett's oesophagus; Note: being obese is defined in the Schedule 1 - Dictionary. (4) an inability to consume an average of at least 200 grams per day of any combination of fruit and vegetables, for at least the five years before the clinical onset of Barrett's oesophagus; (5) having gastro-oesophageal reflux disease for at least the one year before the clinical worsening of Barrett's oesophagus; (6) having a hiatus hernia before the clinical worsening of Barrett's oesophagus; (7) being obese for at least the five years before the clinical worsening of Barrett's oesophagus; Note: being obese is defined in the Schedule 1 - Dictionary. (8) an inability to consume an average of at least 200 grams per day of any combination of fruit and vegetables, for at least the five years before the clinical worsening of Barrett's oesophagus; (9) inability to obtain appropriate clinical management for Barrett's oesophagus. 9 Relationship to service (1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 8(5) to 8(9) apply only to material contribution to, or aggravation of, Barrett's oesophagus where the person's Barrett's oesophagus was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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 8 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.