Statement of Principles concerning SCRUB TYPHUS (Reasonable Hypothesis) (No. 77 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 24 August 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 scrub typhus (Reasonable Hypothesis) (No. 77 of 2018). 2 Commencement This instrument commences on 24 September 2018. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning scrub typhus No. 72 of 2009 (Federal Register of Legislation No. F2009L04043) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 scrub typhus and death from scrub typhus. Meaning of scrub typhus (2) For the purposes of this Statement of Principles, scrub typhus means a clinical illness caused by Orientia tsutsugamushi, formerly known as Rickettsia tsutsugamushi. Note 1: Humans usually acquire the infection from the bite of an infected trombiculid mite (chigger). Note 2: Typical symptoms of scrub typhus include eschar at the bite site, high fever, headache, myalgia, cough, a rash and lymphadenopathy. (3) While scrub typhus attracts ICD‑10‑AM code A75.3, in applying this Statement of Principles the meaning of scrub typhus 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 scrub typhus (5) For the purposes of this Statement of Principles, scrub typhus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's scrub typhus. 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 scrub typhus and death from scrub typhus 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 scrub typhus or death from scrub typhus with the circumstances of a person's relevant service: (1) being exposed to Orientia tsutsugamushi within the 28 days before the clinical onset of scrub typhus; Note: being exposed to Orientia tsutsugamushi is defined in the Schedule 1 - Dictionary. (2) inability to obtain appropriate clinical management for scrub typhus. 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(2) applies only to material contribution to, or aggravation of, scrub typhus where the person's scrub typhus 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: area endemic for scrub typhus means Africa, the Middle East, South America and Islands of the Pacific, and the part of the world known as the "tsutsugamushi triangle" which extends from northern Japan and far-eastern Russia in the north, to northern Australia in the south, and to Pakistan in the west. being exposed to Orientia tsutsugamushi means: (a) being bitten by a trombiculid mite (chigger) infected with Orientia tsutsugamushi; or (b) being in an area that is endemic for scrub typhus; or (c) having percutaneous exposure to blood contaminated with Orientia tsutsugamushi; or (d) receiving a blood transfusion, blood products or a stem cell transplant contaminated with Orientia tsutsugamushi. Note: area endemic for scrub typhus is also defined in the Schedule 1 - Dictionary. MRCA means the Military Rehabilitation and Compensation Act 2004. 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. scrub typhus—see subsection 7(2). 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.