Statement of Principles concerning photocontact dermatitis (Reasonable Hypothesis) (No. 82 of 2020) (Cth)

Statement of Principles concerning PHOTOCONTACT DERMATITIS (Reasonable Hypothesis) (No. 82 of 2020) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 30 October 2020

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 photocontact dermatitis (Reasonable Hypothesis) (No. 82 of 2020). 2 Commencement This instrument commences on 30 November 2020. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning photocontact dermatitis No. 108 of 2011 (Federal Register of Legislation No. F2011L01741) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 photocontact dermatitis and death from photocontact dermatitis. Meaning of photocontact dermatitis (2) For the purposes of this Statement of Principles, photocontact dermatitis: (a) means inflammation of an area of the skin from exposure to light in the presence of a phototoxic agent or photoallergen that has been applied to the same area of skin; and (b) includes phototoxic contact dermatitis and photoallergic contact dermatitis; and (c) excludes: (i) allergic contact dermatitis; (ii) irritant contact dermatitis; (iii) phototoxic contact dermatitis due to systemic administration of a phototoxicant; and (iv) systemic allergic dermatitis. Note 1: Phototoxic contact dermatitis typically presents as an exaggerated sunburn while photoallergic contact dermatitis typically presents as an eczema like rash in sun-exposed skin. Note 2: light is defined in the Schedule 1 - Dictionary. (3) While photocontact dermatitis attracts ICD‑10‑AM code L56.2, in applying this Statement of Principles the meaning of photocontact dermatitis 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 photocontact dermatitis (5) For the purposes of this Statement of Principles, photocontact dermatitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's photocontact dermatitis. 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 photocontact dermatitis and death from photocontact dermatitis 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 photocontact dermatitis or death from photocontact dermatitis with the circumstances of a person's relevant service: (1) having the affected area of skin exposed to light in the presence of a phototoxic agent within the 48 hours before the clinical onset of photocontact dermatitis; Note: phototoxic agent is defined in the Schedule 1 - Dictionary. (2) for photoallergic contact dermatitis only, having the affected area of skin exposed to light in the presence of a photoallergen within the five days before the clinical onset of photoallergic contact dermatitis; Note 1: photoallergen is defined in the Schedule 1 - Dictionary. Note 2: The initial sensitising exposure to a photoallergen may be either systemic or cutaneous and may have occurred months to years before the re-exposure that has resulted in the photocontact dermatitis. Note 3: Cross-photosensitisation may occur between photoallergens (for example ketoprofen and sunscreens containing benzophenones). (3) having the affected area of skin exposed to light in the presence of a phototoxic agent within the 48 hours before the clinical worsening of photocontact dermatitis; Note: phototoxic agent is defined in the Schedule 1 - Dictionary. (4) for photoallergic contact dermatitis only, having the affected area of skin exposed to light in the presence of a photoallergen within the five days before the clinical worsening of photoallergic contact dermatitis; Note 1: photoallergen is defined in the Schedule 1 - Dictionary. Note 2: The initial sensitising exposure to a photoallergen may be either systemic or cutaneous and may have occurred months to years before the re-exposure that has resulted in the photocontact dermatitis. Note 3: Cross-photosensitisation may occur between photoallergens (for example ketoprofen and sunscreens containing benzophenones). (5) inability to obtain appropriate clinical management for photocontact dermatitis. 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(3) to 9(5) apply only to material contribution to, or aggravation of, photocontact dermatitis where the person's photocontact dermatitis 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.