Statement of Principles concerning polycythaemia vera (Reasonable Hypothesis) (No. 87 of 2021) (Cth)

Statement of Principles concerning POLYCYTHAEMIA VERA (Reasonable Hypothesis) (No. 87 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 20 August 2021

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM 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 polycythaemia vera (Reasonable Hypothesis) (No. 87 of 2021). 2 Commencement This instrument commences on 20 September 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning polycythaemia vera No. 11 of 2013 (Federal Register of Legislation No. F2013L00404) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 polycythaemia vera and death from polycythaemia vera. Meaning of polycythaemia vera (2) For the purposes of this Statement of Principles, polycythaemia vera: (a) means a chronic Philadelphia-chromosome negative myeloproliferative neoplasm characterised by proliferation of bone marrow cells of all types, resulting in elevated red cell production and increased haematocrit, haemoglobin or red blood cell mass, and usually an excess of platelets and white blood cells; and (b) includes masked, or bled down polycythaemia vera; and (c) excludes: (i) relative polycythaemia; (ii) familial and congenital polycythaemia; and (iii) secondary polycythaemia from hypoxaemia or increased erythropoietin. Note 1: Polycythaemia vera is also known as polycythaemia rubra vera. Note 2: Typical clinical manifestations of polycythaemia vera include formation of blood clots, bleeding, fatigue, night sweats, visual disturbances, headache, nausea and abdominal pain. Patients can be asymptomatic. Note 3: The clinical course is usually indolent, but transformation to bone marrow failure, myelofibrosis and acute leukaemia may occur. (3) While polycythaemia vera attracts ICD‑10‑AM code D45, in applying this Statement of Principles the meaning of polycythaemia vera 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 polycythaemia vera (5) For the purposes of this Statement of Principles, polycythaemia vera, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's polycythaemia vera. 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 polycythaemia vera and death from polycythaemia vera 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 polycythaemia vera or death from polycythaemia vera with the circumstances of a person's relevant service: (1) having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of polycythaemia vera; and (b) commencing at least 5 years before the clinical onset of polycythaemia vera; and if smoking has ceased before the clinical onset of polycythaemia vera, then that onset occurred within 15 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) inability to obtain appropriate clinical management for polycythaemia vera. 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(2) applies only to material contribution to, or aggravation of, polycythaemia vera where the person's polycythaemia vera 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.