Statement of Principles concerning MODERATE TO SEVERE TRAUMATIC BRAIN INJURY (Reasonable Hypothesis) (No. 94 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 26 October 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 moderate to severe traumatic brain injury (Reasonable Hypothesis) (No. 94 of 2018). 2 Commencement This instrument commences on 26 November 2018. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning moderate to severe traumatic brain injury No. 62 of 2012 (Federal Register of Legislation No. F2012L01804) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 moderate to severe traumatic brain injury and death from moderate to severe traumatic brain injury. Meaning of moderate to severe traumatic brain injury (2) For the purposes of this Statement of Principles, moderate to severe traumatic brain injury: (a) means damage to the brain resulting from the transfer of kinetic energy to the brain from external physical forces, as manifested by at least one of the following: (i) loss of consciousness for more than 30 minutes; (ii) anterograde amnesia for more than 24 hours; (iii) an intracranial lesion, including an abnormality attributable to the injury seen on structural imaging (conventional magnetic resonance imaging or computed tomography scanning); (iv) penetration of the dura mater; or (v) a Glasgow Coma Scale score of less than 13; and (b) excludes injury from radiation, electricity, heat and surgery. Note: This Statement of Principles applies to moderate to severe traumatic brain injury only. Trauma to the brain can cause other diseases or injuries, and these are covered by a range of other Statements of Principles in which trauma to the brain (variously worded) is listed as a risk factor. The relevant Statements of Principles include but are not limited to: accommodation disorder, Alzheimer disease, anosmia, arachnoid cyst, bruxism, cerebrovascular accident, deep vein thrombosis, dementia pugilistica, epilepsy, epileptic seizure, female sexual dysfunction, hypopituitarism, Meniere's disease, narcolepsy, optochiasmatic arachnoiditis, Parkinson's disease and parkinsonism, periodic limb movement disorder, pulmonary thromboembolism, schizophrenia, subarachnoid haemorrhage, subdural haematoma, suicide and attempted suicide, and trigeminal neuropathy. Death from moderate to severe traumatic brain injury (3) For the purposes of this Statement of Principles, moderate to severe traumatic brain injury, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's moderate to severe traumatic brain injury. 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 moderate to severe traumatic brain injury and death from moderate to severe traumatic brain injury 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 moderate to severe traumatic brain injury or death from moderate to severe traumatic brain injury with the circumstances of a person's relevant service: (1) experiencing a specified event at the time of the clinical onset of moderate to severe traumatic brain injury; Note: specified event is defined in the Schedule 1 - Dictionary. (2) inability to obtain appropriate clinical management for moderate to severe traumatic brain injury. 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, moderate to severe traumatic brain injury where the person's moderate to severe traumatic brain injury 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: moderate to severe traumatic brain injury—see subsection 7(2). 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. specified event means: (a) the head being struck by an object; (b) the head striking an object; (c) the brain undergoing an acceleration or deceleration movement without direct external trauma to the head; (d) a foreign body penetrating the brain; or (e) an explosion or explosive blast. 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.