Statement of Principles concerning systemic sclerosis (Reasonable Hypothesis) (No. 25 of 2018) (Cth)

Statement of Principles concerning SYSTEMIC SCLEROSIS (Reasonable Hypothesis) (No. 25 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 2 March 2018

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 systemic sclerosis (Reasonable Hypothesis) (No. 25 of 2018). 2 Commencement This instrument commences on 2 April 2018. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning systemic sclerosis No. 64 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 systemic sclerosis and death from systemic sclerosis. Meaning of systemic sclerosis (2) For the purposes of this Statement of Principles, systemic sclerosis (also known as scleroderma): (a) means an autoimmune, fibrosing connective tissue disorder characterised by deposition of collagen in skin and internal organs, and microvascular lesions, especially in the skin, lungs and kidneys; and (b) excludes localised sclerosis, graft versus host disease with dermal fibrosis, and scleroderma-like conditions (for example, scleromyxoedema and eosinophilic fasciitis). Note 1: The three main subsets of systemic sclerosis are limited cutaneous systemic sclerosis (previously referred to as CREST syndrome, comprising calcinosis cutis, Raynaud phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasias), diffuse cutaneous systemic sclerosis and systemic sclerosis sine scleroderma. Note 2: The diagnosis of systemic sclerosis is based on clinical findings, although histopathologic confirmation is sometimes needed to rule out other diseases. Serological markers for systemic sclerosis include elevated levels of anticentromere antibodies and anti-Scl-70 antibodies. (3) While systemic sclerosis attracts ICD‑10‑AM code M34, in applying this Statement of Principles the meaning of systemic sclerosis 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from systemic sclerosis (5) For the purposes of this Statement of Principles, systemic sclerosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's systemic sclerosis. 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 systemic sclerosis and death from systemic sclerosis 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: MRCA, relevant service and VEA are 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 systemic sclerosis or death from systemic sclerosis with the circumstances of a person's relevant service: (1) inhaling respirable crystalline silica dust, at the time material containing crystalline silica was being: (a) produced; (b) excavated; (c) drilled, cut or ground; or (d) used in construction, manufacturing, cleaning or blasting,