Statement of Principles concerning malaria (Reasonable Hypothesis) (No. 46 of 2017) (Cth)

Statement of Principles concerning MALARIA (Reasonable Hypothesis) (No. 46 of 2017) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 18 August 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 malaria (Reasonable Hypothesis) (No. 46 of 2017). 2 Commencement This instrument commences on 18 September 2017. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning malaria No. 60 of 2009 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 malaria and death from malaria. Meaning of malaria (2) For the purposes of this Statement of Principles, malaria means an infection that is due to one of the human malaria species Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale or Plasmodium malariae, or infection with Plasmodium knowlesi or other simian malaria species. Note 1: Malaria typically presents with prostration, fever, chills, sweats, headaches, nausea, body aches and general malaise. Physical findings may include elevated temperature, perspiration, weakness, enlarged spleen, jaundice, enlargement of the liver and anaemia. Note 2: Malaria due to Plasmodium vivax or Plasmodium ovale may relapse due to reactivation of a dormant liver phase. (3) While malaria attracts ICD‑10‑AM code B50, B51, B52, B53 or B54, in applying this Statement of Principles the meaning of malaria 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 malaria (5) For the purposes of this Statement of Principles, malaria, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malaria. 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 malaria and death from malaria 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 malaria or death from malaria with the circumstances of a person's relevant service: (1) being bitten by a mosquito infected with Plasmodium vivax or Plasmodium ovale at least four days, but less than five years, before the clinical onset of malaria; (2) being exposed to Plasmodium vivax or Plasmodium ovale as specified at least four days, but less than one year, before the clinical onset of malaria; Note: being exposed to Plasmodium vivax or Plasmodium ovale as specified is defined in the Schedule 1 - Dictionary. (3) being exposed to Plasmodium malariae, Plasmodium falciparum or simian malaria species as specified at least four days, but less than one year, before the clinical onset of malaria; Note: being exposed to Plasmodium malariae, Plasmodium falciparum or simian malaria species as specified is defined in the Schedule 1 - Dictionary. (4) being in an immunocompromised state as specified at the time of the clinical onset of malaria; Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. (5) being pregnant within the six months before the clinical onset of malaria; (6) being in an immunocompromised state as specified at the time of the clinical worsening of malaria; Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. (7) being pregnant within the six months before the clinical worsening of malaria; (8) for malaria due to Plasmodium vivax or Plasmodium ovale only, having a systemic infectious disease as specified within the 30 days before the clinical worsening of malaria; Note: systemic infectious disease as specified is defined in the Schedule 1 - Dictionary. (9) inability to obtain appropriate clinical management for malaria. 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(6) to 9(9) apply only to material contribution to, or aggravation of, malaria where the person's malaria 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.