Statement of Principles concerning melioidosis (Reasonable Hypothesis) (No. 55 of 2023) (Cth)

Statement of Principles concerning MELIOIDOSIS (Reasonable Hypothesis) (No. 55 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 April 2023.

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 melioidosis (Reasonable Hypothesis) (No. 55 of 2023). 2 Commencement This instrument commences on 23 May 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning melioidosis No. 60 of 2014 (Federal Register of Legislation No. F2014L00940) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 melioidosis and death from melioidosis. Meaning of melioidosis (2) For the purposes of this Statement of Principles, melioidosis means an illness caused by infection with the bacterium Burkholderia pseudomallei. Note: Melioidosis may present as an acute, chronic or latent infection. Clinical manifestations may be local or systemic, and include pulmonary infection, septicaemia, meningoencephalitis and chronic suppurative infection. (3) While melioidosis attracts ICD‑10‑AM codes A24.1, A24.2, A24.3 or A24.4, in applying this Statement of Principles the meaning of melioidosis 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 melioidosis (5) For the purposes of this Statement of Principles, melioidosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's melioidosis. 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 melioidosis and death from melioidosis 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 melioidosis or death from melioidosis with the circumstances of a person's relevant service: (1) being exposed to Burkholderia pseudomallei before the clinical onset of melioidosis; Note: being exposed to Burkholderia pseudomallei is defined in the Schedule 1 – Dictionary. (2) being in an immunocompromised state as specified at the time of the clinical onset of melioidosis; Note: immunocompromised state as specified 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 melioidosis; Note: specified list of medical conditions is defined in the Schedule 1 – Dictionary. (4) for males, having consumed at least 44 kilograms of alcohol within the 3 years before the clinical onset of melioidosis; Note: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (5) for females, having consumed at least 30 kilograms of alcohol within the 3 years before the clinical onset of melioidosis; Note: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. (6) having alcohol use disorder at the time of the clinical onset of melioidosis; (7) inability to obtain appropriate clinical management for melioidosis. 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 factor set out in subsection 9(7) applies only to material contribution to, or aggravation of, melioidosis where the person's melioidosis 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.