Statement of Principles concerning gout (Balance of Probabilities) (No. 60 of 2019) (Cth)

Statement of Principles concerning GOUT (Balance of Probabilities) (No. 60 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 26 April 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 gout (Balance of Probabilities) (No. 60 of 2019). 2 Commencement This instrument commences on 27 May 2019. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning gout No. 31 of 2010 (Federal Register of Legislation No. F2010L01047) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 gout and death from gout. Meaning of gout (2) For the purposes of this Statement of Principles, gout means a metabolic condition characterised by deposition of urate crystals in the joints or tissues, generally following raised serum uric acid levels. Note: Clinical manifestations typically include recurrent episodes of monoarticular or polyarticular acute inflammatory arthritis, tenosynovitis, bursitis, chronic erosive arthritis and periarticular or subcutaneous urate deposits known as tophi. (3) While gout attracts ICD‑10‑AM code M10, in applying this Statement of Principles the meaning of gout 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 gout (5) For the purposes of this Statement of Principles, gout, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gout. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that gout and death from gout can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, gout or death from gout is connected with the circumstances of a person's relevant service: (1) having a haematological disorder from the specified list of haematological disorders at the time of the clinical onset of gout; Note: specified list of haematological disorders is defined in the Schedule 1 - Dictionary. (2) being treated with a drug from a class of drugs from the specified list of antihypertensive drugs for a continuous period of at least seven days, before the clinical onset of gout, where the last dose of the drug was taken within the three months before the clinical onset of gout; Note: specified list of antihypertensive drugs is defined in the Schedule 1 - Dictionary. (3) being treated with daily doses of low-dose aspirin (≤ 325 milligrams) for two consecutive days, before the clinical onset of gout, where the last dose of the drug was taken within the 48 hours before the clinical onset of gout; (4) being treated with a drug or a drug from a class of drugs from the Specified List 1 of drugs within the 48 hours before the clinical onset of gout; Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary. (5) undergoing chemotherapy for a malignant neoplasm within the seven days before the clinical onset of gout; (6) being overweight at the time of the clinical onset of gout; Note: being overweight is defined in the Schedule 1 - Dictionary. (7) consuming an average of at least 120 grams per week of alcohol, for at least the three months before the clinical onset of gout; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (8) consuming at least 70 grams of alcohol within the 48 hours before the clinical onset of gout; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (9) consuming an average of at least 750 grams per week of meat or offal, for at least the three months before the clinical onset of gout; (10) consuming at least 300 grams of meat or offal within the 48 hours before the clinical onset of gout; (11) consuming an average of at least 120 grams per week of seafood, for at least the three months before the clinical onset of gout; Note: seafood is defined in the Schedule 1 - Dictionary. (12) consuming at least 120 grams of seafood within the 48 hours before the clinical onset of gout; Note: seafood is defined in the Schedule 1 - Dictionary. (13) consuming an average of at least 400 millilitres per day of: (a) fruit juice; or (b) non-diet soft drink or other manufactured drink sweetened with fructose or sucrose; alone or in any combination, for at least the three months before the clinical onset of gout; (14) fasting for a continuous period of at least 24 hours within the 48 hours before the clinical onset of gout; (15) being dehydrated for a continuous period of at least 24 hours within the 48 hours before the clinical onset of gout; Note: being dehydrated is defined in the Schedule 1 - Dictionary. (16) being postmenopausal at the time of the clinical onset of gout; (17) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical onset of gout; (18) having surgery within the 48 hours before the clinical onset of gout; (19) having lead nephropathy before the clinical onset of gout; (20) having psoriasis or psoriatic arthritis at the time of the clinical onset of gout; (21) having chronic kidney disease at the time of the clinical onset of gout; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (22) having a haematological disorder from the specified list of haematological disorders at the time of the clinical worsening of gout; Note: specified list of haematological disorders is defined in the Schedule 1 - Dictionary. (23) being treated with a drug from a class of drugs from the specified list of antihypertensive drugs for a continuous period of at least seven days, before the clinical worsening of gout, where the last dose of the drug was taken within the three months before the clinical worsening of gout; Note: specified list of antihypertensive drugs is defined in the Schedule 1 - Dictionary. (24) being treated with daily doses of low-dose aspirin (≤ 325 milligrams) for two consecutive days, before the clinical worsening of gout, where the last dose of the drug was taken within the 48 hours before the clinical worsening of gout; (25) being treated with a drug or a drug from a class of drugs from the Specified List 2 of drugs at the time of the clinical worsening of gout; Note: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary. (26) undergoing chemotherapy for a malignant neoplasm within the seven days before the clinical worsening of gout; (27) being overweight at the time of the clinical worsening of gout; Note: being overweight is defined in the Schedule 1 - Dictionary. (28) consuming an average of at least 120 grams per week of alcohol, for at least the three months before the clinical worsening of gout; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (29) consuming at least 70 grams of alcohol within the 48 hours before the clinical worsening of gout; Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (30) consuming an average of at least 750 grams per week of meat or offal, for at least the three months before the clinical worsening of gout; (31) consuming at least 300 grams of meat or offal within the 48 hours before the clinical worsening of gout; (32) consuming an average of at least 120 grams per week of seafood, for at least the three months before the clinical worsening of gout; Note: seafood is defined in the Schedule 1 - Dictionary. (33) consuming at least 120 grams of seafood within the 48 hours before the clinical worsening of gout; Note: seafood is defined in the Schedule 1 - Dictionary. (34) consuming an average of at least 400 millilitres per day of: (a) fruit juice; or (b) non-diet soft drink or other manufactured drink sweetened with fructose or sucrose; alone or in any combination, for at least the three months before the clinical worsening of gout; (35) fasting for a continuous period of at least 24 hours within the 48 hours before the clinical worsening of gout; (36) being dehydrated for a continuous period of at least 24 hours within the 48 hours before the clinical worsening of gout; Note: being dehydrated is defined in the Schedule 1 - Dictionary. (37) being postmenopausal at the time of the clinical worsening of gout; (38) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical worsening of gout; (39) having surgery within the 48 hours before the clinical worsening of gout; (40) having lead nephropathy before the clinical worsening of gout; (41) having psoriasis or psoriatic arthritis at the time of the clinical worsening of gout; (42) having chronic kidney disease at the time of the clinical worsening of gout; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (43) inability to obtain appropriate clinical management for gout. 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(22) to 9(43) apply only to material contribution to, or aggravation of, gout where the person's gout 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(3) 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.