Statement of Principles concerning macular degeneration (Reasonable Hypothesis) (No. 59 of 2018) (Cth)

Statement of Principles concerning MACULAR DEGENERATION (Reasonable Hypothesis) (No. 59 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 22 June 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 Repeal 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 macular degeneration (Reasonable Hypothesis) (No. 59 of 2018). 2 Commencement This instrument commences on 23 July 2018. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning macular degeneration No. 13 of 2009 (Federal Register of Legislation No. F2012C00634) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 macular degeneration and death from macular degeneration. Meaning of macular degeneration (2) For the purposes of this Statement of Principles, macular degeneration: (a) means a group of degenerative diseases of the macula of the eye that may cause progressive, painless loss of central vision; and (b) includes: (i) early macular degeneration; and (ii) late macular degeneration; and (c) excludes toxic retinopathy. Note: early macular degeneration and late macular degeneration are defined in the Schedule 1 – Dictionary. Death from macular degeneration (3) For the purposes of this Statement of Principles, macular degeneration, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's macular degeneration. 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 macular degeneration and death from macular degeneration 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 macular degeneration or death from macular degeneration with the circumstances of a person's relevant service: (1) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of macular degeneration, and: (a) smoking commenced at least five years before the clinical onset of macular degeneration; and (b) where smoking has ceased, the clinical onset of macular degeneration has occurred within 20 years of cessation; Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. (2) being exposed to second-hand smoke: (a) for at least 10 000 hours before the clinical onset of macular degeneration; and (b) where the first exposure to second-hand smoke commenced at least five years before the clinical onset of macular degeneration; and (c) where the last exposure to second-hand smoke occurred within the 20 years before the clinical onset of macular degeneration; Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary. (3) consuming a cumulative total of at least 15 kilograms of alcohol in a continuous period of two years, within the five years before the clinical onset of macular degeneration; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (4) being obese for at least the five years before the clinical onset of macular degeneration; Note: being obese is defined in the Schedule 1 - Dictionary. (5) having chronic kidney disease within the five years before the clinical onset of macular degeneration; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (6) having a lipid profile as specified, within the five years before the clinical onset of macular degeneration; Note: lipid profile as specified is defined in the Schedule 1 - Dictionary. (7) having diabetes mellitus at the time of the clinical onset of macular degeneration; (8) having hypertension at the time of the clinical onset of macular degeneration; (9) for wet macular degeneration only, undergoing cataract surgery involving the affected eye within the five years before the clinical onset of macular degeneration; Note: wet macular degeneration is defined in the Schedule 1 - Dictionary. (10) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of macular degeneration, and: (a) smoking commenced at least five years before the clinical worsening of macular degeneration; and (b) where smoking has ceased, the clinical worsening of macular degeneration has occurred within 20 years of cessation; Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. (11) being exposed to second-hand smoke: (a) for at least 10 000 hours before the clinical worsening of macular degeneration; and (b) where the first exposure to second-hand smoke commenced at least five years before the clinical worsening of macular degeneration; and (c) where the last exposure to second-hand smoke occurred within the 20 years before the clinical worsening of macular degeneration; Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary. (12) consuming a cumulative total of at least 15 kilograms of alcohol in a continuous period of two years, within the five years before the clinical worsening of macular degeneration; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (13) being obese for at least the five years before the clinical worsening of macular degeneration; Note: being obese is defined in the Schedule 1 - Dictionary. (14) having chronic kidney disease within the five years before the clinical worsening of macular degeneration; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (15) having a lipid profile as specified, within the five years before the clinical worsening of macular degeneration; Note: lipid profile as specified is defined in the Schedule 1 - Dictionary. (16) having diabetes mellitus at the time of the clinical worsening of macular degeneration; (17) having hypertension at the time of the clinical worsening of macular degeneration; (18) for wet macular degeneration only, undergoing cataract surgery involving the affected eye within the five years before the clinical worsening of macular degeneration; Note: wet macular degeneration is defined in the Schedule 1 - Dictionary. (19) for clinical worsening of wet macular degeneration manifesting as subretinal haemorrhage only, having anticoagulant therapy or thrombolytic therapy, within the seven days before the clinical worsening of macular degeneration; Note: anticoagulant therapy and thrombolytic therapy are defined in the Schedule 1 - Dictionary. (20) inability to obtain appropriate clinical management for macular degeneration. 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(10) to 9(20) apply only to material contribution to, or aggravation of, macular degeneration where the person's macular degeneration 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.