Statement of Principles concerning varicocoele (Reasonable Hypothesis) (No. 79 of 2019) (Cth)

Statement of Principles concerning VARICOCOELE (Reasonable Hypothesis) (No. 79 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 23 August 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 varicocoele (Reasonable Hypothesis) (No. 79 of 2019). 2 Commencement This instrument commences on 23 September 2019. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning varicocele No. 3 of 2011 (Federal Register of Legislation No. F2010L03250) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 varicocoele and death from varicocoele. Meaning of varicocoele (2) For the purposes of this Statement of Principles, varicocoele means an abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord in the scrotum. Note: Varicocoele usually presents as a scrotal swelling. Varicocoele may also be associated with male infertility. (3) While varicocoele attracts ICD‑10‑AM code I86.1, in applying this Statement of Principles the meaning of varicocoele 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 varicocoele (5) For the purposes of this Statement of Principles, varicocoele, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's varicocoele. 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 varicocoele and death from varicocoele 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 varicocoele or death from varicocoele with the circumstances of a person's relevant service: (1) having an occlusion or stenosis of the testicular venous drainage system before the clinical onset of varicocoele; Note 1: Blood vessels of the testicular venous drainage system may include, but are not limited to: (a) inferior vena cava; (b) internal iliac vein; (c) left or right renal vein; (d) lumbar vein; (e) pampiniform plexus; and (f) testicular vein. Rare anatomical variants may exist where the testicular vein and its tributaries empty into blood vessels which are not commonly part of the testicular venous drainage system. Note 2: occlusion or stenosis is defined in the Schedule 1 - Dictionary. (2) having a nephrectomy within the one year before the clinical onset of the ipsilateral varicocoele; (3) having an arterio-venous fistula between any of the arteries supplying the testis and a vein of the pampiniform plexus at the time of the clinical onset of varicocoele; Note: arteries supplying the testis is defined in the Schedule 1 - Dictionary. (4) having ankylosing spondylitis at the time of the clinical onset of varicocoele; (5) having Behcet disease at the time of the clinical onset of varicocoele; (6) having an occlusion or stenosis of the testicular venous drainage system before the clinical worsening of varicocoele; Note 1: Blood vessels of the testicular venous drainage system may include, but are not limited to: (a) inferior vena cava; (b) internal iliac vein; (c) left or right renal vein; (d) lumbar vein; (e) pampiniform plexus; and (f) testicular vein. Rare anatomical variants may exist where the testicular vein and its tributaries empty into blood vessels which are not commonly part of the testicular venous drainage system. Note 2: occlusion or stenosis is defined in the Schedule 1 - Dictionary. (7) having a nephrectomy within the one year before the clinical worsening of the ipsilateral varicocoele; (8) having an arterio-venous fistula between any of the arteries supplying the testis and a vein of the pampiniform plexus at the time of the clinical worsening of varicocoele; Note: arteries supplying the testis is defined in the Schedule 1 - Dictionary. (9) having ankylosing spondylitis at the time of the clinical worsening of varicocoele; (10) having Behcet disease at the time of the clinical worsening of varicocoele; (11) undertaking physical activity at a minimum intensity of six METs, for at least six hours per week for at least the four weeks before the clinical worsening of varicocoele; Note: MET is defined in the Schedule 1 - Dictionary. (12) for rupture of varicocoele only: (a) having sexual intercourse at the time of the clinical worsening of varicocoele; or (b) having increased intra-abdominal pressure as specified, which has resulted in a scrotal or spermatic cord haematoma, within the seven days before the clinical worsening of varicocoele; Note: increased intra-abdominal pressure as specified is defined in the Schedule 1 - Dictionary. (13) inability to obtain appropriate clinical management for varicocoele. 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(6) to 9(13) apply only to material contribution to, or aggravation of, varicocoele where the person's varicocoele 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.