Statement of Principles concerning CENTRAL SEROUS CHORIORETINOPATHY (Reasonable Hypothesis) (No. 45 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 27 April 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 central serous chorioretinopathy (Reasonable Hypothesis) (No. 45 of 2018). 2 Commencement This instrument commences on 28 May 2018. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about central serous chorioretinopathy and death from central serous chorioretinopathy. Meaning of central serous chorioretinopathy (2) For the purposes of this Statement of Principles, central serous chorioretinopathy: (a) means a serous detachment of the neurosensory retina affecting central vision; and (b) includes acute, recurrent and chronic serous retinal detachment; and (c) excludes retinal detachment due to a retinal tear (rhegmatogenous retinal detachment), and leakage through the retinal pigment epithelium caused by diseases of the choroid, including choroidal neovascularisation, choroidal vasculopathy, choroidal tumours, choroidal metastases and posterior uveitis. (3) While central serous chorioretinopathy attracts ICD‑10‑AM code H35.7, in applying this Statement of Principles the meaning of central serous chorioretinopathy 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 central serous chorioretinopathy (5) For the purposes of this Statement of Principles, central serous chorioretinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's central serous chorioretinopathy. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that central serous chorioretinopathy and death from central serous chorioretinopathy 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. 8 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 central serous chorioretinopathy or death from central serous chorioretinopathy with the circumstances of a person's relevant service: (1) being treated with a corticosteroid within the 30 days before the clinical onset of central serous chorioretinopathy; (2) taking a drug or a drug from a class of drugs from the specified list of drugs at the time of the clinical onset of central serous chorioretinopathy; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (3) having Cushing syndrome in the one year before the clinical onset of central serous chorioretinopathy; (4) having primary hyperaldosteronism in the one year before the clinical onset of central serous chorioretinopathy; Note: primary hyperaldosteronism is defined in the Schedule 1 - Dictionary. (5) being in the second or third trimester of pregnancy at the time of the clinical onset of central serous chorioretinopathy; (6) having chronic renal failure at the time of the clinical onset of central serous chorioretinopathy; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (7) having hypertension at the time of the clinical onset of central serous chorioretinopathy; (8) being infected with Helicobacter pylori in the one year before the clinical onset of central serous chorioretinopathy; (9) having blunt trauma to the affected eye or the unaffected eye in the two weeks before the clinical onset of central serous chorioretinopathy; (10) being treated with a corticosteroid within the 30 days before the clinical worsening of central serous chorioretinopathy; (11) taking a drug or a drug from a class of drugs from the specified list of drugs at the time of the clinical worsening of central serous chorioretinopathy; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (12) having Cushing syndrome in the one year before the clinical worsening of central serous chorioretinopathy; (13) having primary hyperaldosteronism in the one year before the clinical worsening of central serous chorioretinopathy; Note: primary hyperaldosteronism is defined in the Schedule 1 - Dictionary. (14) being in the second or third trimester of pregnancy at the time of the clinical worsening of central serous chorioretinopathy; (15) having chronic renal failure at the time of the clinical worsening of central serous chorioretinopathy; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (16) having hypertension at the time of the clinical worsening of central serous chorioretinopathy; (17) being infected with Helicobacter pylori in the one year before the clinical worsening of central serous chorioretinopathy; (18) inability to obtain appropriate clinical management for central serous chorioretinopathy. 9 Relationship to service (1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 8(10) to 8(18) apply only to material contribution to, or aggravation of, central serous chorioretinopathy where the person's central serous chorioretinopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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 8 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. Schedule 1 - Dictionary Note: See Section 5 1 Definitions In this instrument: central serous chorioretinopathy—see subsection 6(2). chronic renal failure means: (a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or (b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or (c) undergoing chronic dialysis. MRCA means the Military Rehabilitation and Compensation Act 2004. primary hyperaldosteronism means a condition in which there is excess endogenous production of the hormone aldosterone, which may be due to adrenal hyperplasia, an adrenal adenoma, adrenal carcinoma or an ectopic aldosterone-producing adenoma or carcinoma. relevant service means: (a) operational service under the VEA; (b) peacekeeping service under the VEA; (c) hazardous service under the VEA; (d) British nuclear test defence service under the VEA; (e) warlike service under the MRCA; or (f) non-warlike service under the MRCA. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. specified list of drugs means: (a) ephedrine; (b) fingolimod; (c) MEK (mitogen-activated protein kinase/extracellular signal-regulated kinase) inhibitors; (d) methylenedioxymethamphetamine (ecstasy); (e) nasal sympathomimetic decongestants; (f) ocriplasmin; (g) phosphodiesterase-5 selective inhibitors, including sildenafil, tadalafil and vardenafil; (h) pseudoephedrine; or (i) testosterone. 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. VEA means the Veterans' Entitlements Act 1986.