Statement of Principles concerning chilblains (Balance of Probabilities) (No. 30 of 2018) (Cth)

Statement of Principles concerning CHILBLAINS (Balance of Probabilities) (No. 30 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) 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 chilblains (Balance of Probabilities) (No. 30 of 2018). 2 Commencement This instrument commences on 2 April 2018. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning chilblains No. 10 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 chilblains and death from chilblains. Meaning of chilblains (2) For the purposes of this Statement of Principles, chilblains: (a) means painful, localised erythema and inflammatory swelling from the reaction of the small blood vessels in the skin to exposure to non-freezing cold; and (b) excludes non-freezing cold injury, frostnip and frostbite. Note 1: Chilblains are also known as pernios or perniosis. Note 2: Chilblains manifest as erythematous to violaceous macules, papules, plaques or nodules in sites of cold exposure. Symptoms of pruritus, pain or burning often accompany the skin lesions, and complications of blistering, ulceration or secondary infection may occur. The most common sites for involvement are the fingers and toes, but other sites such as the legs, hands, nose, face and ears may also be affected. (3) While chilblains attracts ICD‑10‑AM code T69.1, in applying this Statement of Principles the meaning of chilblains 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 chilblains (5) For the purposes of this Statement of Principles, chilblains, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chilblains. 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 chilblains and death from chilblains can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, chilblains or death from chilblains is connected with the circumstances of a person's relevant service: (1) exposing the affected part of the body to non-freezing temperatures below ten degrees Celsius within the 24 hours before the clinical onset of chilblains; (2) having a disease from the specified list of diseases at the time of the clinical onset of chilblains; Note: specified list of diseases is defined in the Schedule 1 - Dictionary. (3) having a body mass index (BMI) of less than 21 at the time of the clinical onset of chilblains; Note: BMI is defined in the Schedule 1 - Dictionary. (4) inability to obtain appropriate clinical management for chilblains. 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 factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, chilblains where the person's chilblains 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.