Statement of Principles concerning motor neurone disease (Reasonable Hypothesis) (No. 111 of 2021) (Cth)

Statement of Principles concerning MOTOR NEURONE DISEASE (Reasonable Hypothesis) (No. 111 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 26 November 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 motor neurone disease (Reasonable Hypothesis) (No. 111 of 2021). 2 Commencement This instrument commences on 20 December 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning motor neurone disease No. 67 of 2013 (Federal Register of Legislation No. F2013L01655) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 motor neurone disease and death from motor neurone disease. Meaning of motor neurone disease (2) For the purposes of this Statement of Principles, motor neurone disease: (a) means a progressive neurodegenerative disease with either: (i) the presence of upper and lower motor neurone dysfunction in at least one body region; or (ii) the presence of lower motor neurone dysfunction in at least two body regions; and (b) the absence of other disease processes that explain the motor neurone dysfunction. (3) While motor neurone disease attracts ICD‑10‑AM code G12.2, in applying this Statement of Principles the meaning of motor neurone disease 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 motor neurone disease (5) For the purposes of this Statement of Principles, motor neurone disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's motor neurone disease. 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 motor neurone disease and death from motor neurone disease 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 motor neurone disease or death from motor neurone disease with the circumstances of a person's relevant service: (1) having smoked tobacco products in an amount of at least 10 pack-years before the clinical onset of motor neurone disease; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) being exposed to lead as specified before the clinical onset of motor neurone disease, where the first exposure occurred at least 5 years before the clinical onset of motor neurone disease; Note: being exposed to lead as specified is defined in the Schedule 1 - Dictionary. (3) inhaling formaldehyde for a cumulative total of at least 5,000 hours: (a) at a level of at least 1 part per million; or (b) resulting in sensory irritation of the eyes or nose; at least 3 years before the clinical onset of motor neurone disease; (4) having smoked tobacco products in an amount of at least 10 pack-years before the clinical worsening of motor neurone disease; Note: one pack-year is defined in the Schedule 1 - Dictionary. (5) being exposed to lead as specified before the clinical onset of motor neurone disease, where the first exposure occurred at least 5 years before the clinical worsening of motor neurone disease; Note: being exposed to lead as specified is defined in the Schedule 1 - Dictionary. (6) inhaling formaldehyde for a cumulative total of at least 5,000 hours: (a) at a level of at least 1 part per million; or (b) resulting in sensory irritation of the eyes or nose; at least 3 years before the clinical worsening of motor neurone disease; (7) inability to obtain appropriate clinical management for motor neurone disease. 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(4) to 9(7) apply only to material contribution to, or aggravation of, motor neurone disease where the person's motor neurone disease 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.