Statement of Principles concerning goitre (Reasonable Hypothesis) (No. 9 of 2022) (Cth)

Statement of Principles concerning GOITRE (Reasonable Hypothesis) (No. 9 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 December 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 goitre (Reasonable Hypothesis) (No. 9 of 2022). 2 Commencement This instrument commences on 31 January 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning goitre No. 23 of 2013 (Federal Register of Legislation No. F2013L00721) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 goitre and death from goitre. Meaning of goitre (2) For the purposes of this Statement of Principles, goitre: (a) means an enlarged thyroid gland that has persisted for at least 4 weeks; and (b) includes: (i) a diffuse enlargement; and (ii) enlargement due to a solitary thyroid nodule (thyroid adenoma) or multiple nodules of the thyroid gland; and (c) excludes: (i) congenital goitre; (ii) dyshormogenetic goitre; (iii) Graves disease; (iv) Hashimoto thyroiditis; (v) haemorrhage or infarction of the thyroid gland; and (vi) primary or secondary malignancy, including malignant neoplasm of the thyroid gland. Note 1: Goitre may be identified by a palpable or visible swelling in the front of the neck, or by imaging assessment. Note 2: The diagnosis is not dependent on thyroid hormone levels. Thyroid function may be normal (nontoxic goitre), overactive (toxic goitre), or underactive (hypothyroid goitre). Note 3: Toxic goitre may present as a thyrotoxic crisis. Note 4: thyrotoxic crisis is defined in the Schedule 1 - Dictionary. Death from goitre (3) For the purposes of this Statement of Principles, goitre, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's goitre. 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 goitre and death from goitre 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 goitre or death from goitre with the circumstances of a person's relevant service: (1) having iodine deficiency within the 6 months before the clinical onset of goitre; Note: iodine deficiency is defined in the Schedule 1 - Dictionary. (2) having iodine excess within the 6 months before the clinical onset of goitre; Note 1: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine. Note 2: iodine excess is defined in the Schedule 1 - Dictionary. (3) taking a drug from the specified list of drugs within the 6 months before the clinical onset of goitre; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (4) taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 6 months before the clinical onset of goitre; (5) taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical onset of goitre; (6) being administered an iodine-containing radiographic contrast agent within the 6 months before the clinical onset of goitre; (7) having smoked tobacco products: (a) in an amount of at least 3 pack-years before the clinical onset of goitre; and (b) if smoking has ceased before the clinical onset of goitre, then that onset occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (8) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical onset of goitre; Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary. (9) having a disease involving the thyroid gland from the specified list of diseases at the time of the clinical onset of goitre; Note: specified list of diseases is defined in the Schedule 1 - Dictionary. (10) having chronic renal failure at the time of the clinical onset of goitre; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (11) having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical onset of goitre; (12) for nodular goitre only: (a) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the thyroid gland at least 1 year before the clinical onset of nodular goitre; or (b) undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, at least 1 year before the clinical onset of nodular goitre; Note 1: Exposure to ionising radiation does not include radioiodine therapy for goitre or thyroid nodules. Note 2: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (13) for toxic goitre first presenting as thyrotoxic crisis only, having an acute precipitating event within the 48 hours before the clinical onset of toxic goitre; Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary. (14) having iodine deficiency within the 6 months before the clinical worsening of goitre; Note: iodine deficiency is defined in the Schedule 1 - Dictionary. (15) having iodine excess within the 6 months before the clinical worsening of goitre; Note 1: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine. Note 2: iodine excess is defined in the Schedule 1 - Dictionary. (16) taking a drug from the specified list of drugs within the 6 months before the clinical worsening of goitre; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (17) taking a drug containing at least 10 milligrams of iodine daily for a continuous period of at least 4 weeks, within the 6 months before the clinical worsening of goitre; (18) taking amiodarone for a continuous period of at least 2 weeks, within the 1 year before the clinical worsening of goitre; (19) being administered an iodine-containing radiographic contrast agent within the 6 months before the clinical worsening of goitre; (20) having smoked tobacco products: (a) in an amount of at least 3 pack-years before the clinical worsening of goitre; and (b) if smoking has ceased before the clinical worsening of goitre, then that worsening occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (21) having a form of thyroiditis from the specified list of forms of thyroiditis at the time of the clinical worsening of goitre; Note: specified list of forms of thyroiditis is defined in the Schedule 1 - Dictionary. (22) having a disease involving the thyroid gland from the specified list of diseases at the time of the clinical worsening of goitre; Note: specified list of diseases is defined in the Schedule 1 - Dictionary. (23) having chronic renal failure at the time of the clinical worsening of goitre; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (24) having a thyroid-stimulating, hormone-secreting pituitary adenoma at the time of the clinical worsening of goitre; (25) for nodular goitre only: (a) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the thyroid gland at least 1 year before the clinical worsening of nodular goitre; or (b) undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, at least 1 year before the clinical worsening of nodular goitre; Note 1: Exposure to ionising radiation does not include radioiodine therapy for goitre or thyroid nodules. Note 2: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (26) for thyrotoxic crisis only, having an acute precipitating event within the 48 hours before that clinical worsening of toxic goitre; Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary. (27) inability to obtain appropriate clinical management for goitre. 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(14) to 9(27) apply only to material contribution to, or aggravation of, goitre where the person's goitre 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.