Statement of Principles concerning endometriosis (Balance of Probabilities) (No. 52 of 2021) (Cth)

Statement of Principles concerning ENDOMETRIOSIS (Balance of Probabilities) (No. 52 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 23 April 2021

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 endometriosis (Balance of Probabilities) (No. 52 of 2021). 2 Commencement This instrument commences on 24 May 2021. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning endometriosis No. 42 of 2012 (Federal Register of Legislation No. F2012L01356) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 endometriosis and death from endometriosis. Meaning of endometriosis (2) For the purposes of this Statement of Principles, endometriosis: (a) means a condition in females in which functional endometrial tissue occurs outside the uterus, resulting in clinical symptoms and signs or warranting treatment; and (b) excludes adenomyosis. Note: Endometriosis commonly manifests with abdominal pain, a pelvic mass or infertility. (3) While endometriosis attracts ICD‑10‑AM code N80, in applying this Statement of Principles the meaning of endometriosis 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 endometriosis (5) For the purposes of this Statement of Principles, endometriosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's endometriosis. 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 endometriosis and death from endometriosis 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, endometriosis or death from endometriosis is connected with the circumstances of a person's relevant service: (1) having penetrating trauma or surgery involving the site of subsequent endometriosis before the clinical onset of endometriosis; (2) taking tamoxifen for the six months before the clinical onset of endometriosis; (3) taking tamoxifen for the six months before the clinical worsening of endometriosis; (4) inability to obtain appropriate clinical management for endometriosis. 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(4) apply only to material contribution to, or aggravation of, endometriosis where the person's endometriosis 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.