Statement of Principles concerning THROMBOANGIITIS OBLITERANS (Balance of Probabilities) (No. 29 of 2017) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 21 April 2017 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 thromboangiitis obliterans (Balance of Probabilities) (No. 29 of 2017). 2 Commencement This instrument commences on 22 May 2017. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning thromboangiitis obliterans No. 8 of 2009 made under subsection 196B(3) 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 thromboangiitis obliterans and death from thromboangiitis obliterans. Meaning of thromboangiitis obliterans (2) For the purposes of this Statement of Principles, thromboangiitis obliterans means a nonatherosclerotic, segmental, inflammatory, occlusive vascular disease affecting the small and medium-sized arteries and veins. Note: Thromboangiitis obliterans is also known as Buerger's disease. (3) While thromboangiitis obliterans attracts ICD‑10‑AM code I73.1, in applying this Statement of Principles the meaning of thromboangiitis obliterans 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 thromboangiitis obliterans (5) For the purposes of this Statement of Principles, thromboangiitis obliterans, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's thromboangiitis obliterans. 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 thromboangiitis obliterans and death from thromboangiitis obliterans 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, thromboangiitis obliterans or death from thromboangiitis obliterans is connected with the circumstances of a person's relevant service: (1) smoking at least three pack-years of cigarettes, or the equivalent thereof in other tobacco products, within the three years before the clinical onset of thromboangiitis obliterans; Note: pack-year of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. (2) smoking at least half a pack-year of cigarettes, or the equivalent thereof in other tobacco products, within the one year before the clinical worsening of thromboangiitis obliterans; Note: pack-year 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 thromboangiitis obliterans. 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, thromboangiitis obliterans where the person's thromboangiitis obliterans 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(3) 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: MRCA means the Military Rehabilitation and Compensation Act 2004. pack-year of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination. relevant service means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime service under the MRCA. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. 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. thromboangiitis obliterans—see subsection 7(2). VEA means the Veterans' Entitlements Act 1986.