Statement of Principles concerning fibromuscular dysplasia (Reasonable Hypothesis) (No. 79 of 2016) (Cth)

Statement of Principles concerning FIBROMUSCULAR DYSPLASIA (Reasonable Hypothesis) (No. 79 of 2016) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 28 October 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 fibromuscular dysplasia (Reasonable Hypothesis) (No. 79 of 2016). 2 Commencement This instrument commences on 28 November 2016. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning fibromuscular dysplasia No. 60 of 2008 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 fibromuscular dysplasia and death from fibromuscular dysplasia. Meaning of fibromuscular dysplasia (2) For the purposes of this Statement of Principles, fibromuscular dysplasia means a nonatherosclerotic, noninflammatory segmental stenosing disease of the muscle layer of arterial walls, with or without focal aneurysmal outpouchings of the affected artery. The disease commonly involves medium-sized arteries and is most often found in the renal artery and the internal carotid artery. (3) While fibromuscular dysplasia attracts ICD‑10‑AM code I77.3, in applying this Statement of Principles the meaning of fibromuscular dysplasia 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 fibromuscular dysplasia (5) For the purposes of this Statement of Principles, fibromuscular dysplasia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's fibromuscular dysplasia. 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 fibromuscular dysplasia and death from fibromuscular dysplasia 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 fibromuscular dysplasia or death from fibromuscular dysplasia with the circumstances of a person's relevant service: (1) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of fibromuscular dysplasia; Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. (2) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of fibromuscular dysplasia; Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. (3) inability to obtain appropriate clinical management for fibromuscular dysplasia. 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 factors set out in subsections 9(2) and 9(3) apply only to material contribution to, or aggravation of, fibromuscular dysplasia where the person's fibromuscular dysplasia 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.