Statement of Principles concerning blepharitis (Reasonable Hypothesis) (No. 29 of 2019) (Cth)

Statement of Principles concerning BLEPHARITIS (Reasonable Hypothesis) (No. 29 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 1 March 2019

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 blepharitis (Reasonable Hypothesis) (No. 29 of 2019). 2 Commencement This instrument commences on 25 March 2019. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning blepharitis No. 63 of 2010 (Federal Register of Legislation No. F2010L02302) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 blepharitis and death from blepharitis. Meaning of blepharitis (2) For the purposes of this Statement of Principles, blepharitis: (a) means inflammation of the eyelid margins or glands of the eyelid; and (b) includes acute blepharitis, chronic blepharitis, chalazion (Meibomian cyst) and hordeolum (stye); and (c) excludes orbital or periorbital cellulitis, dacryoadenitis and dacryocystitis. Note 1: Blepharitis typically presents with itchiness, redness, flaking and crusting of the eyelids. Note 2: Chalazion typically presents as a painless, localised eyelid swelling or cyst. Note 3: Hordeolum typically presents as an abscess or cyst of the eyelid, with localised, painful, red swelling of the eyelid. Death from blepharitis (3) For the purposes of this Statement of Principles, blepharitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's blepharitis. 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 blepharitis and death from blepharitis 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 blepharitis or death from blepharitis with the circumstances of a person's relevant service: (1) being a prisoner of war at the time of the clinical onset of blepharitis; (2) having an infection of the affected eyelid at the time of the clinical onset of blepharitis; Note: infection of the affected eyelid is defined in the Schedule 1 - Dictionary. (3) having an infestation of the affected eyelid region, due to a parasite from the specified list of parasites, at the time of the clinical onset of blepharitis; Note: specified list of parasites is defined in the Schedule 1 - Dictionary. (4) having a smallpox immunisation within the two weeks before the clinical onset of blepharitis; (5) having seborrhoeic dermatitis of the periocular region at the time of the clinical onset of blepharitis; (6) having rosacea of the periocular region at the time of the clinical onset of blepharitis; (7) having psoriasis of the periocular region at the time of the clinical onset of blepharitis; (8) having discoid lupus erythematosus of the periocular region at the time of the clinical onset of blepharitis; (9) having ocular or periocular exposure to an allergen within the 48 hours before the clinical onset of blepharitis; Note: allergen is defined in the Schedule 1 - Dictionary. (10) having an irritant substance exposure to the region of the affected eye at the time of the clinical onset of blepharitis; Note: irritant substance is defined in the Schedule 1 - Dictionary. (11) having mustard gas exposure to the region of the affected eye at the time of the clinical onset of blepharitis; (12) undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical onset of blepharitis; (13) having a benign or malignant neoplasm affecting the affected eyelid at the time of the clinical onset of blepharitis; (14) having dry eye disease at the time of the clinical onset of blepharitis; Note: dry eye disease is defined in the Schedule 1 - Dictionary. (15) having diabetes mellitus at the time of the clinical onset of blepharitis; (16) being in an immunocompromised state as specified at the time of the clinical onset of blepharitis; Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. (17) taking oral isotretinoin or oral acitretin for a continuous period of at least one year before the clinical onset of blepharitis, and where treatment has ceased, the clinical onset of blepharitis has occurred within 30 days of cessation; (18) being a prisoner of war at the time of the clinical worsening of blepharitis; (19) having an infection of the affected eyelid at the time of the clinical worsening of blepharitis; Note: infection of the affected eyelid is defined in the Schedule 1 - Dictionary. (20) having an infestation of the affected eyelid region, due to a parasite from the specified list of parasites, at the time of the clinical worsening of blepharitis; Note: specified list of parasites is defined in the Schedule 1 - Dictionary. (21) having seborrhoeic dermatitis of the periocular region at the time of the clinical worsening of blepharitis; (22) having rosacea of the periocular region at the time of the clinical worsening of blepharitis; (23) having psoriasis of the periocular region at the time of the clinical worsening of blepharitis; (24) having discoid lupus erythematosus of the periocular region at the time of the clinical worsening of blepharitis; (25) having ocular or periocular exposure to an allergen within the 48 hours before the clinical worsening of blepharitis; Note: allergen is defined in the Schedule 1 - Dictionary. (26) having an irritant substance exposure to the region of the affected eye at the time of the clinical worsening of blepharitis; Note: irritant substance is defined in the Schedule 1 - Dictionary. (27) having mustard gas exposure to the region of the affected eye at the time of the clinical worsening of blepharitis; (28) undergoing a course of therapeutic radiation for cancer, where the region of the affected eye was in the field of radiation, at the time of the clinical worsening of blepharitis; (29) having a benign or malignant neoplasm affecting the affected eyelid at the time of the clinical worsening of blepharitis; (30) having dry eye disease at the time of the clinical worsening of blepharitis; Note: dry eye disease is defined in the Schedule 1 - Dictionary. (31) having diabetes mellitus at the time of the clinical worsening of blepharitis; (32) being in an immunocompromised state as specified at the time of the clinical worsening of blepharitis; Note: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. (33) inability to obtain appropriate clinical management for blepharitis. 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(18) to 9(33) apply only to material contribution to, or aggravation of, blepharitis where the person's blepharitis 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.