Statement of Principles concerning REACTIVE ARTHRITIS (Reasonable Hypothesis) (No. 75 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 reactive arthritis (Reasonable Hypothesis) (No. 75 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 reactive arthritis No. 26 of 2010 (Federal Register of Legislation No. F2010L01042) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 reactive arthritis and death from reactive arthritis. Meaning of reactive arthritis (2) For the purposes of this Statement of Principles, reactive arthritis: (a) means an immune-mediated arthritis of more than four weeks' duration; and (b) is usually associated with evidence of a preceding extra-articular infection; and (c) excludes: (i) acute rheumatic fever; (ii) arthritis associated with viruses which are known to cause arthritis as part of the usual spectrum of clinical manifestations (for example, Ross River virus infection, Barmah Forest virus, rubella virus, parvovirus B19); (iii) leptospirosis; (iv) Lyme disease; (v) post-streptococcal reactive arthritis; and (vi) septic arthritis. Note: Typical clinical manifestations include a predominantly lower limb, asymmetric oligoarthritis and may include extra-articular manifestations, such as urethritis, cervicitis, conjunctivitis, skin lesions, sacroiliitis, spondylitis and enthesitis. (3) While reactive arthritis attracts ICD‑10‑AM code M02, in applying this Statement of Principles the meaning of reactive arthritis 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 reactive arthritis (5) For the purposes of this Statement of Principles, reactive arthritis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's reactive arthritis. 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 reactive arthritis and death from reactive arthritis 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 reactive arthritis or death from reactive arthritis with the circumstances of a person's relevant service: (1) having an infection as specified within the three months before the clinical onset of reactive arthritis; Note: infection as specified is defined in the Schedule 1 - Dictionary. (2) having infection with human immunodeficiency virus at the time of the clinical onset of reactive arthritis; (3) being vaccinated with hepatitis B vaccine within the 30 days before the clinical onset of reactive arthritis; (4) having intravesical BCG therapy for malignant neoplasm of the bladder or intradermal BCG therapy for a malignant neoplasm within the 30 days before the clinical onset of reactive arthritis; Note: BCG therapy is defined in the Schedule 1 - Dictionary. (5) having active mycobacterial disease within the 30 days before the clinical onset of reactive arthritis; Note: active mycobacterial disease is defined in the Schedule 1 - Dictionary. (6) having intestinal bypass surgery within the one year before the clinical onset of reactive arthritis; (7) inability to obtain appropriate clinical management for reactive arthritis. 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(7) applies only to material contribution to, or aggravation of, reactive arthritis where the person's reactive arthritis 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: active mycobacterial disease means an illness in which tuberculosis bacteria or atypical mycobacteria are multiplying and inducing an inflammatory response. BCG therapy means treatment with the Bacille Calmette-Guerin vaccine. infection as specified means: (a) clinical or laboratory evidence of a bowel infection; or (b) clinical or laboratory evidence of a sexually acquired urogenital infection (including proctitis and excluding genital warts and herpes simplex); or (c) clinical or laboratory evidence of an infection with Staphylococcus aureus, Chlamydia pneumoniae, Chlamydia psittaci or Chlamydia trachomatis. MRCA means the Military Rehabilitation and Compensation Act 2004. reactive arthritis—see subsection 7(2). 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. 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.