Statement of Principles concerning epilepsy (Balance of Probabilities) (No. 85 of 2022) (Cth)

Statement of Principles concerning EPILEPSY (Balance of Probabilities) (No. 85 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 23 August 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 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 epilepsy (Balance of Probabilities) (No. 85 of 2022). 2 Commencement This instrument commences on 19 September 2022. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning epilepsy No. 76 of 2013 (Federal Register of Legislation No. F2013L01895) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 epilepsy and death from epilepsy. Meaning of epilepsy (2) For the purposes of this Statement of Principles, epilepsy: (a) means a chronic, recurring, paroxysmal brain dysfunction due to sudden, abnormal, excessive neuronal discharge manifesting with seizures; and (b) includes status epilepticus, generalised epilepsy and focal epilepsy; and (c) excludes: (i) movement disorders such as restless legs syndrome, periodic limb movement disorder, chorea and tics; (ii) muscle dystonia or spasms associated with tetanus, drugs or chemical poisons; (iii) psychogenic seizures; (iv) seizures occurring during electroconvulsive therapy; and (v) spontaneous movements occurring with syncope, vertigo or migraine. Death from epilepsy (3) For the purposes of this Statement of Principles, epilepsy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's epilepsy. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that epilepsy and death from epilepsy can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, epilepsy or death from epilepsy is connected with the circumstances of a person's relevant service: (1) having a moderate to severe traumatic brain injury before the clinical onset of epilepsy; (2) having concussion within the 20 years before the clinical onset of epilepsy; (3) having an electrical injury of the brain before the clinical onset of epilepsy; Note: Electrical injury of the brain excludes transcranial magnetic stimulation and electroconvulsive therapy. (4) having a surgical procedure which involves a craniotomy or cranioplasty before the clinical onset of epilepsy; (5) having brain radiotherapy to treat primary or secondary brain neoplasia or to treat brain arteriovenous malformation before the clinical onset of epilepsy; (6) having an hypoxic cerebral insult within the 30 days before the clinical onset of epilepsy; Note: hypoxic cerebral insult is defined in the Schedule 1 – Dictionary. (7) having a central nervous system vascular lesion from the specified list of central nervous system vascular lesions within the 10 years before the clinical onset of epilepsy; Note: specified list of central nervous system vascular lesions is defined in the Schedule 1 – Dictionary. (8) having autoimmune encephalitis at the time of the clinical onset of epilepsy; Note 1: Examples of diseases that can cause autoimmune encephalitis include granulomatosis with polyangiitis (Wegener granulomatosis), Hashimoto encephalopathy, multiple sclerosis, neuromyelitis optica, paraneoplastic neurological syndrome and systemic lupus erythematosus. Note 2: autoimmune encephalitis is defined in the Schedule 1 – Dictionary. (9) having an infection of the brain or meninges within the 5 years before the clinical onset of epilepsy; (10) having infection with human immunodeficiency virus at the time of the clinical onset of epilepsy; (11) having septicaemia at the time of the clinical onset of epilepsy; (12) having an intracranial space-occupying lesion before the clinical onset of epilepsy; Note: intracranial space-occupying lesion is defined in the Schedule 1 – Dictionary. (13) having dementia as specified at the time of the clinical onset of epilepsy; Note: dementia as specified is defined in the Schedule 1 – Dictionary. (14) having a medical condition affecting the brain from the specified list of medical conditions at the time of the clinical onset of epilepsy; Note: specified list of medical conditions is defined in the Schedule 1 – Dictionary. (15) having obstructive sleep apnoea at the time of the clinical onset of epilepsy; (16) having tetramine poisoning before the clinical onset of epilepsy; (17) having type 1 diabetes mellitus at the time of the clinical onset of epilepsy; Note: type 1 diabetes mellitus is defined in the Schedule 1 – Dictionary. (18) consuming at least 150 kilograms of alcohol within the 10 years before the clinical onset of epilepsy; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (19) for death from epilepsy only, being exposed to a specific sensory stimulus or a specific repetitive task resulting in a reflex seizure immediately before death from epilepsy; Note: reflex seizure, specific repetitive task and specific sensory stimulus are defined in the Schedule 1 – Dictionary. (20) having a moderate to severe traumatic brain injury before the clinical worsening of epilepsy; (21) having concussion within the 20 years before the clinical worsening of epilepsy; (22) having an electrical injury of the brain before the clinical worsening of epilepsy; Note: Electrical injury of the brain excludes transcranial magnetic stimulation and electroconvulsive therapy. (23) having a surgical procedure which involves a craniotomy or cranioplasty before the clinical worsening of epilepsy; (24) having brain radiotherapy to treat primary or secondary brain neoplasia or to treat brain arteriovenous malformation before the clinical worsening of epilepsy; (25) having an hypoxic cerebral insult within the 30 days before the clinical worsening of epilepsy; Note: hypoxic cerebral insult is defined in the Schedule 1 – Dictionary. (26) having a central nervous system vascular lesion from the specified list of central nervous system vascular lesions within the 10 years before the clinical worsening of epilepsy; Note: specified list of central nervous system vascular lesions is defined in the Schedule 1 – Dictionary. (27) having autoimmune encephalitis at the time of the clinical worsening of epilepsy; Note 1: Examples of diseases that can cause autoimmune encephalitis include granulomatosis with polyangiitis (Wegener granulomatosis), Hashimoto encephalopathy, multiple sclerosis, neuromyelitis optica, paraneoplastic neurological syndrome and systemic lupus erythematosus. Note 2: autoimmune encephalitis is defined in the Schedule 1 – Dictionary. (28) having an infection of the brain or meninges within the 5 years before the clinical worsening of epilepsy; (29) having infection with human immunodeficiency virus at the time of the clinical worsening of epilepsy; (30) having septicaemia at the time of the clinical worsening of epilepsy; (31) having an intracranial space-occupying lesion before the clinical worsening of epilepsy; Note: intracranial space-occupying lesion is defined in the Schedule 1 – Dictionary. (32) having dementia as specified at the time of the clinical worsening of epilepsy; Note: dementia as specified is defined in the Schedule 1 – Dictionary. (33) having a medical condition affecting the brain from the specified list of medical conditions at the time of the clinical worsening of epilepsy; Note: specified list of medical conditions is defined in the Schedule 1 – Dictionary. (34) having obstructive sleep apnoea at the time of the clinical worsening of epilepsy; (35) having tetramine poisoning before the clinical worsening of epilepsy; (36) having type 1 diabetes mellitus at the time of the clinical worsening of epilepsy; Note: type 1 diabetes mellitus is defined in the Schedule 1– Dictionary. (37) having moderate to severe alcohol use disorder, including alcohol dependence, at the time of the clinical worsening of epilepsy; Note: moderate to severe alcohol use disorder is defined in the Schedule 1 – Dictionary. (38) consuming at least 150 kilograms of alcohol within the 10 years before the clinical worsening of epilepsy; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (39) inability to use continuous positive airway pressure (CPAP) ventilation for diagnosed sleep apnoea, at the time of the clinical worsening of epilepsy; (40) inability to obtain appropriate clinical management for epilepsy. 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(20) to 9(40) apply only to material contribution to, or aggravation of, epilepsy where the person's epilepsy 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(3) 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.