Statement of Principles concerning erectile dysfunction (Reasonable Hypothesis) (No. 72 of 2022) (Cth)

Statement of Principles concerning ERECTILE DYSFUNCTION (Reasonable Hypothesis) (No. 72 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 June 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 Repeal 5 Application 6 Schedules 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 Schedule 2 - Drugs 1 Specified Drugs

1 Name This is the Statement of Principles concerning erectile dysfunction (Reasonable Hypothesis) (No. 72 of 2022). 2 Commencement This instrument commences on 25 July 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning erectile dysfunction No. 43 of 2013 (Federal Register of Legislation No. F2013L01136) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 Schedules Any item in a Schedule to this Instrument has effect according to its terms. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about erectile dysfunction and death from erectile dysfunction. Meaning of erectile dysfunction (2) For the purposes of this Statement of Principles, erectile dysfunction: (a) means persistent or recurrent inability to develop or maintain an erection adequate for sexual intercourse; and (b) includes psychogenic and organic impotence; and (c) excludes transient failure of erection due to fatigue, situational anxiety, alcohol or drugs. (3) While erectile dysfunction attracts ICD‑10‑AM code F52.2 or N48.4, in applying this Statement of Principles the meaning of erectile dysfunction 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 erectile dysfunction (5) For the purposes of this Statement of Principles, erectile dysfunction, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's erectile dysfunction. 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 erectile dysfunction and death from erectile dysfunction 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 erectile dysfunction or death from erectile dysfunction with the circumstances of a person's relevant service: (1) having a clinically significant disorder of mental health as specified at the time of the clinical onset of erectile dysfunction; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (2) having a cardiovascular disease from the specified list of cardiovascular diseases at the time of the clinical onset of erectile dysfunction; Note: specified list of cardiovascular diseases is defined in the Schedule 1 - Dictionary. (3) having a medical condition from the specified list of medical conditions at the time of the clinical onset of erectile dysfunction; Note: specified list of medical conditions is defined in the Schedule 1 - Dictionary. (4) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of erectile dysfunction; Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. (5) having an endocrine disorder from the specified list of endocrine disorders at the time of the clinical onset of erectile dysfunction; Note: specified list of endocrine disorders is defined in the Schedule 1 - Dictionary. (6) having a neurological disorder from the specified list of neurological disorders at the time of the clinical onset of erectile dysfunction; Note: specified list of neurological disorders is defined in the Schedule 1 – Dictionary. (7) having a urological condition from the specified list of urological conditions, where that condition causes lower urinary tract symptoms, for at least the 3 months before the clinical onset of erectile dysfunction; Note: specified list of urological conditions is defined in the Schedule 1 – Dictionary. (8) having an infection from the specified list of infections at the time of the clinical onset of erectile dysfunction; Note: specified list of infections is defined in the Schedule 1 – Dictionary. (9) having herpes zoster affecting a sacral dermatome at the time of the clinical onset of erectile dysfunction; (10) having hypertension at the time of the clinical onset of erectile dysfunction; (11) having chronic renal failure at the time of the clinical onset of erectile dysfunction; Note: chronic renal failure is defined in the Schedule 1 – Dictionary. (12) having Peyronie disease before the clinical onset of erectile dysfunction; Note: Peyronie disease is defined in the Schedule 1 – Dictionary. (13) having hidradenitis suppurativa at the time of the clinical onset of erectile dysfunction; (14) having ischaemic priapism for a continuous period of at least the 4 hours before the clinical onset of erectile dysfunction; Note: ischaemic priapism is defined in the Schedule 1 – Dictionary. (15) having a surgical operation from the specified list of surgical operations within the 3 months before the clinical onset of erectile dysfunction; Note: specified list of surgical operations is defined in the Schedule 1 – Dictionary. (16) having a trauma or surgery involving the brain, spinal cord, thoracolumbosacral nerve roots, cauda equina or the nerve supply to the penis, where the trauma or surgery results in permanent neurological impairment, within the 3 months before the clinical onset of erectile dysfunction; (17) having blunt trauma, penetrating trauma including surgical trauma, explosive blast injury or gunshot injury to the external genitals, perineum or pelvis, within the 3 months before the clinical onset of erectile dysfunction; Note: blunt trauma is defined in the Schedule 1 – Dictionary. (18) having internal burns, substantial external burns, or electrical injury to the external genitals, perineum or pelvic region within the 3 months before the clinical onset of erectile dysfunction; Note: substantial external burns is defined in the Schedule 1 – Dictionary. (19) having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of erectile dysfunction; and (b) if smoking has ceased before the clinical onset of erectile dysfunction, then that onset occurred within 20 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (20) undergoing a course of therapeutic radiation for cancer, where the penis, pelvis or perineal region was in the field of radiation, within the 10 years before the clinical onset of erectile dysfunction; (21) being obese at the time of the clinical onset of erectile dysfunction; Note: being obese is defined in the Schedule 1 - Dictionary. (22) taking a drug specified in the Schedule 2 - Drugs of this Instrument at the time of the clinical onset of erectile dysfunction; (23) inhaling, ingesting or having cutaneous contact with carbon disulphide, where inhalation occurred in an unventilated and confined space, on more days than not for a consecutive period of at least 5 years before the clinical onset of erectile dysfunction, and if exposure has ceased before the clinical onset of erectile dysfunction, then that onset occurred within 1 year of cessation; (24) inability to undertake any physical activity greater than 3 METs for at least the 5 years before the clinical onset of erectile dysfunction; Note: MET is defined in the Schedule 1 – Dictionary. (25) experiencing childhood sexual abuse before the clinical onset of erectile dysfunction; (26) having a clinically significant disorder of mental health as specified at the time of the clinical worsening of erectile dysfunction; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (27) having a cardiovascular disease from the specified list of cardiovascular diseases at the time of the clinical worsening of erectile dysfunction; Note: specified list of cardiovascular diseases is defined in the Schedule 1 - Dictionary. (28) having a medical condition from the specified list of medical conditions at the time of the clinical worsening of erectile dysfunction; Note: specified list of medical conditions is defined in the Schedule 1 - Dictionary. (29) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of erectile dysfunction; Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. (30) having an endocrine disorder from the specified list of endocrine disorders at the time of the clinical worsening of erectile dysfunction; Note: specified list of endocrine disorders is defined in the Schedule 1 - Dictionary. (31) having a neurological disorder from the specified list of neurological disorders at the time of the clinical worsening of erectile dysfunction; Note: specified list of neurological disorders is defined in the Schedule 1 – Dictionary. (32) having a urological condition from the specified list of urological conditions, where that condition causes lower urinary tract symptoms, for at least the 3 months before the clinical worsening of erectile dysfunction; Note: specified list of urological conditions is defined in the Schedule 1 – Dictionary. (33) having an infection from the specified list of infections at the time of the clinical worsening of erectile dysfunction; Note: specified list of infections is defined in the Schedule 1 – Dictionary. (34) having herpes zoster affecting a sacral dermatome at the time of the clinical worsening of erectile dysfunction; (35) having hypertension at the time of the clinical worsening of erectile dysfunction; (36) having chronic renal failure at the time of the clinical worsening of erectile dysfunction; Note: chronic renal failure is defined in the Schedule 1 – Dictionary. (37) having Peyronie disease before the clinical worsening of erectile dysfunction; Note: Peyronie disease is defined in the Schedule 1 – Dictionary. (38) having hidradenitis suppurativa at the time of the clinical worsening of erectile dysfunction; (39) having ischaemic priapism for a continuous period of at least the 4 hours before the clinical worsening of erectile dysfunction; Note: ischaemic priapism is defined in the Schedule 1 – Dictionary. (40) having a surgical operation from the specified list of surgical operations within the 3 months before the clinical worsening of erectile dysfunction; Note: specified list of surgical operations is defined in the Schedule 1 – Dictionary. (41) having a trauma or surgery involving the brain, spinal cord, thoracolumbosacral nerve roots, cauda equina or the nerve supply to the penis, where the trauma or surgery results in permanent neurological impairment, within the 3 months before the clinical worsening of erectile dysfunction; (42) having blunt trauma, penetrating trauma including surgical trauma, explosive blast injury or gunshot injury to the external genitals, perineum or pelvis, within the 3 months before the clinical worsening of erectile dysfunction; Note: blunt trauma is defined in the Schedule 1 – Dictionary. (43) having internal burns, substantial external burns, or electrical injury to the external genitals, perineum or pelvic region within the 3 months before the clinical worsening of erectile dysfunction; Note: substantial external burns is defined in the Schedule 1 – Dictionary. (44) having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical worsening of erectile dysfunction; and (b) if smoking has ceased before the clinical worsening of erectile dysfunction, then that worsening occurred within 20 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (45) undergoing a course of therapeutic radiation for cancer, where the penis, pelvis or perineal region was in the field of radiation, within the 10 years before the clinical worsening of erectile dysfunction; (46) being obese at the time of the clinical worsening of erectile dysfunction; Note: being obese is defined in the Schedule 1 - Dictionary. (47) taking a drug specified in the Schedule 2 - Drugs of this Instrument at the time of the clinical worsening of erectile dysfunction; (48) inhaling, ingesting or having cutaneous contact with carbon disulphide, where inhalation occurred in an unventilated and confined space, on more days than not for a consecutive period of at least 5 years before the clinical worsening of erectile dysfunction, and if exposure has ceased before the clinical worsening of erectile dysfunction, then that worsening occurred within 1 year of cessation; (49) inability to undertake any physical activity greater than 3 METs for at least the 5 years before the clinical worsening of erectile dysfunction; Note: MET is defined in the Schedule 1 – Dictionary. (50) inability to obtain appropriate clinical management for erectile dysfunction. 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(26) to 9(50) apply only to material contribution to, or aggravation of, erectile dysfunction where the person's erectile dysfunction 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.