Statement of Principles concerning solar keratosis (Reasonable Hypothesis) (No. 79 of 2021) (Cth)

Statement of Principles concerning SOLAR KERATOSIS (Reasonable Hypothesis) (No. 79 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 25 June 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 solar keratosis (Reasonable Hypothesis) (No. 79 of 2021). 2 Commencement This instrument commences on 26 July 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning solar keratosis No. 73 of 2012 (Federal Register of Legislation No. F2012L02084) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 solar keratosis and death from solar keratosis. Meaning of solar keratosis (2) For the purposes of this Statement of Principles, solar keratosis: (a) means a cutaneous lesion characterised by the local proliferation of atypical (dysplastic) epidermal keratinocytes; and (b) includes sun-damaged skin adjacent to a localised skin lesion (field cancerisation); and (c) excludes Bowen disease, arsenical keratoses and other keratoses that are not related to ultraviolet light exposure. Note 1: Solar keratosis is also known as actinic keratosis. Note 2: Solar keratoses typically present as single or multiple rough erythematous plaques that occur on sun-damaged skin, but the clinical appearance is highly variable, and lesions can be difficult to visualise. Note 3: Solar keratoses may regress spontaneously, remain stable or undergo malignant transformation into invasive squamous cell carcinoma. (3) While solar keratosis attracts ICD‑10‑AM code L57.0, in applying this Statement of Principles the meaning of solar keratosis 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 solar keratosis (5) For the purposes of this Statement of Principles, solar keratosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's solar keratosis. 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 solar keratosis and death from solar keratosis 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 solar keratosis or death from solar keratosis with the circumstances of a person's relevant service: (1) having sunlight exposure to unprotected skin at the affected site for a cumulative period of at least 2,250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis; Note: equivalent sunlight exposure in other latitude zones, tropical area and unprotected skin are defined in the Schedule 1 - Dictionary. (2) having sunburn as specified: (a) on at least 5 occasions: (i) before the age of 20 years; and (ii) at least 5 years before the clinical onset of solar keratosis; and (b) where the clinical onset of solar keratosis has occurred before the age of 50 years; Note: sunburn as specified is defined in the Schedule 1 - Dictionary. (3) being a prisoner of war of Japan before the clinical onset of solar keratosis; (4) having exposure of the affected region to welding light, while arc-welding metal without skin protection, for a cumulative period of at least 12,000 hours before the clinical onset of solar keratosis; Note: Examples of skin protection include leather gloves, long sleeve jackets, and a welding helmet with a face plate. (5) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of solar keratosis; Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary. (6) having PUVA therapy involving the affected site where: (a) the first PUVA treatment commenced at least 5 years before the clinical onset of solar keratosis; and (b) at least 25 PUVA treatments were administered before the clinical onset of solar keratosis; Note: PUVA is defined in the Schedule 1 - Dictionary. (7) taking hydroxyurea or voriconazole for at least the 3 months before the clinical onset of solar keratosis; (8) inability to obtain appropriate clinical management for solar keratosis. 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 factor set out in subsection 9(8) applies only to material contribution to, or aggravation of, solar keratosis where the person's solar keratosis 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.