Statement of Principles concerning ALLERGIC RHINITIS (Reasonable Hypothesis) (No. 111 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 21 October 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 allergic rhinitis (Reasonable Hypothesis) (No. 111 of 2022). 2 Commencement This instrument commences on 21 November 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning allergic rhinitis No. 22 of 2014 (Federal Register of Legislation No. F2014L00306) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 allergic rhinitis and death from allergic rhinitis. Meaning of allergic rhinitis (2) For the purposes of this Statement of Principles, allergic rhinitis: (a) means symptomatic inflammation of the nasal mucosa associated with allergen exposure and mediated by an immunoglobulin E (IgE) allergic response; and (b) includes: (i) intermittent (seasonal) allergic rhinitis; (ii) local allergic rhinitis; (iii) occupational allergic rhinitis; and (iv) persistent (perennial) allergic rhinitis; and (c) excludes: (i) allergic fungal rhinosinusitis; (ii) eosinophilic granulomatosis with polyangiitis; (iii) non-allergic rhinitis; and (iv) vasomotor rhinitis. Note 1: Symptoms of allergic rhinitis include rhinorrhea, nasal congestion or blockage, itching of the nose and sneezing. Note 2: Some patients with chronic rhinosinusitis with nasal polyposis or central compartment atopic disease may also have allergic rhinitis. (3) While allergic rhinitis attracts ICD 10 AM code J30.1, J30.2, J30.3 or J30.4, in applying this Statement of Principles the meaning of allergic rhinitis 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 allergic rhinitis (5) For the purposes of this Statement of Principles, allergic rhinitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's allergic rhinitis. 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 allergic rhinitis and death from allergic rhinitis 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 allergic rhinitis or death from allergic rhinitis with the circumstances of a person's relevant service: (1) being exposed to an allergenic stimulus within the 24 hours before the clinical onset of allergic rhinitis; Note: allergenic stimulus is defined in the Schedule 1 – Dictionary. (2) having a sensitising exposure to an allergen before the clinical onset of allergic rhinitis; Note: sensitising exposure to an allergen is defined in the Schedule 1 – Dictionary. (3) being exposed to an allergenic stimulus within the 24 hours before the clinical worsening of allergic rhinitis; Note: allergenic stimulus is defined in the Schedule 1 – Dictionary. (4) inability to obtain appropriate clinical management for allergic rhinitis. 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(3) and 9(4) apply only to material contribution to, or aggravation of, allergic rhinitis where the person's allergic rhinitis 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: allergic rhinitis—see subsection 7(2). allergenic stimulus means an exogenous antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals through IgE responses, and which: (a) is associated with the onset of allergic rhinitis symptoms; and (b) has been confirmed by specific allergy testing, including: (i) a positive skin prick test; or (ii) a positive serum test for allergen specific IgE; or (iii) a nasal specific allergen challenge. MRCA means the Military Rehabilitation and Compensation Act 2004. 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. sensitising exposure to an allergen means an exposure to an allergen without the occurrence of symptoms where the clinical onset of allergic rhinitis occurs within 24 hours of a subsequent exposure to the same allergen. 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.