Statement of Principles concerning EOSINOPHILIC OESOPHAGITIS (No. 29 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 4 March 2022 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 eosinophilic oesophagitis (Reasonable Hypothesis) (No. 29 of 2022). 2 Commencement This instrument commences on 4 April 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about eosinophilic oesophagitis and death from eosinophilic oesophagitis. Meaning of eosinophilic oesophagitis (2) For the purposes of this Statement of Principles, eosinophilic oesophagitis means a chronic, immune-mediated oesophageal disease, characterised by symptoms related to oesophageal dysfunction, together with eosinophil-predominant inflammation of the oesophageal epithelium. Note 1: Typical symptoms of oesophageal dysfunction in adults include difficulty swallowing, chest pain, upper abdominal pain, heartburn and acute food bolus obstruction. Note 2: Eosinophil-predominant infiltration of the oesophageal epithelium is demonstrated by peak values of at least 15 eosinophils per high-power field on oesophageal biopsy. Note 3: Endoscopic findings which may increase suspicion of a diagnosis of eosinophilic oesophagitis include rings, furrows, exudates, oedema, stricture, narrowing and crepe-paper mucosa. Note 4: A clinical assessment should fully evaluate any condition that could account for oesophageal tissue eosinophilia, including gastro-oesophageal reflux disease, Crohn disease, infections and connective tissue disorders. Death from eosinophilic oesophagitis (3) For the purposes of this Statement of Principles, eosinophilic oesophagitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's eosinophilic oesophagitis. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that eosinophilic oesophagitis and death from eosinophilic oesophagitis 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. 8 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 eosinophilic oesophagitis or death from eosinophilic oesophagitis with the circumstances of a person's relevant service: (1) taking an average of at least 600 milligrams of aspirin per day for the desensitisation of aspirin-exacerbated respiratory disease for at least the 3 months before the clinical onset of eosinophilic oesophagitis; (2) taking carbamazepine daily for at least the 7 days before the clinical onset of eosinophilic oesophagitis; (3) having oral or sublingual allergen immunotherapy at the time of the clinical onset of eosinophilic oesophagitis; (4) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of eosinophilic oesophagitis; Note: organ or tissue transplantation is defined in the Schedule 1 – Dictionary. (5) taking an average of at least 600 milligrams of aspirin per day for the desensitisation of aspirin-exacerbated respiratory disease for at least the 3 months before the clinical worsening of eosinophilic oesophagitis; (6) taking carbamazepine daily for at least the 7 days before the clinical worsening of eosinophilic oesophagitis; (7) having oral or sublingual allergen immunotherapy at the time of the clinical worsening of eosinophilic oesophagitis; (8) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical worsening of eosinophilic oesophagitis; Note: organ or tissue transplantation is defined in the Schedule 1 – Dictionary. (9) inability to obtain appropriate clinical management for eosinophilic oesophagitis. 9 Relationship to service (1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 8(5) to 8(9) apply only to material contribution to, or aggravation of, eosinophilic oesophagitis where the person's eosinophilic oesophagitis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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 8 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. Schedule 1 - Dictionary Note: See Section 5 1 Definitions In this instrument: eosinophilic oesophagitis—see subsection 6(2). MRCA means the Military Rehabilitation and Compensation Act 2004. organ or tissue transplantation means the transplantation of: (a) all or part of an organ or tissue; or (b) a substance obtained from an organ or tissue. relevant service means: (a) operational service under the VEA; (b) peacekeeping service under the VEA; (c) hazardous service under the VEA; (d) British nuclear test defence service under the VEA; (e) warlike service under the MRCA; or (f) non-warlike service under the MRCA. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. terminal event means the proximate or ultimate cause of death and includes the following: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. VEA means the Veterans' Entitlements Act 1986.