Statement of Principles concerning cirrhosis of the liver (Balance of Probabilities) (No. 2 of 2017) (Cth)

Statement of Principles concerning CIRRHOSIS OF THE LIVER (Balance of Probabilities) (No. 2 of 2017) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 20 December 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 cirrhosis of the liver (Balance of Probabilities) (No. 2 of 2017). 2 Commencement This instrument commences on 23 January 2017. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning cirrhosis of the liver No. 108 of 2007, as amended, made under subsections 196B(3) and (8) 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 cirrhosis of the liver and death from cirrhosis of the liver. Meaning of cirrhosis of the liver (2) For the purposes of this Statement of Principles, cirrhosis of the liver means a chronic condition of the hepatic parenchyma involving severe fibrosis in association with the formation of regenerative nodules. (3) While cirrhosis of the liver attracts ICD‑10‑AM code K70.3, K71.7 or K74.3-K74.6, in applying this Statement of Principles the meaning of cirrhosis of the liver 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 cirrhosis of the liver (5) For the purposes of this Statement of Principles, cirrhosis of the liver, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cirrhosis of the liver. 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 cirrhosis of the liver and death from cirrhosis of the liver 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, cirrhosis of the liver or death from cirrhosis of the liver is connected with the circumstances of a person's relevant service: (1) for males, consuming at least 150 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver; Note: alcohol is defined in the Schedule 1 - Dictionary. (2) for females, consuming at least 75 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver; Note: alcohol is defined in the Schedule 1 - Dictionary. (3) having received a cumulative dose of at least 0.4 sievert of ionising radiation to the liver, from internal deposition of a substance which emits alpha particles, before the clinical onset of cirrhosis of the liver; (4) having chronic infection with the hepatitis B virus before the clinical onset of cirrhosis of the liver; Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary. (5) having chronic infection with the hepatitis C virus before the clinical onset of cirrhosis of the liver; Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary. (6) having chronic infection with the hepatitis D virus before the clinical onset of cirrhosis of the liver; Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary. (7) having infection with the hepatitis E virus before the clinical onset of cirrhosis of the liver; Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary. (8) having chronic hepatitis before the clinical onset of cirrhosis of the liver; Note: chronic hepatitis is defined in the Schedule 1 - Dictionary. (9) having autoimmune chronic active hepatitis before the clinical onset of cirrhosis of the liver; Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary. (10) having steatohepatitis before the clinical onset of cirrhosis of the liver; (11) being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical onset of cirrhosis of the liver; Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary. (12) having evidence of chronic infection with schistosomiasis involving the liver before the clinical onset of cirrhosis of the liver; (13) having granulomatous liver disease before the clinical onset of cirrhosis of the liver; Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary. (14) having severe right-sided cardiac failure for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver; Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary. (15) having veno-occlusive disease for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver; Note: veno-occlusive disease is defined in the Schedule 1 - Dictionary. (16) having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical onset of cirrhosis of the liver; (17) having iron overload involving the liver at the time of the clinical onset of cirrhosis of the liver; Note: iron overload is defined in the Schedule 1 - Dictionary. (18) having alpha-1 antitrypsin deficiency before the clinical onset of cirrhosis of the liver; (19) having Gaucher's disease before the clinical onset of cirrhosis of the liver; (20) having Wilson's disease before the clinical onset of cirrhosis of the liver; (21) having Budd-Chiari syndrome for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver; Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary. (22) consuming a daily average of at least 15 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least eight grams, within the ten years before the clinical onset of cirrhosis of the liver; (23) being treated with methotrexate: