Statement of Principles concerning alpha-1 antitrypsin deficiency (Reasonable Hypothesis) (No. 33 of 2023) (Cth)

Statement of Principles concerning ALPHA-1 ANTITRYPSIN DEFICIENCY (Reasonable Hypothesis) (No. 33 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 alpha-1 antitrypsin deficiency (Reasonable Hypothesis) (No. 33 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 alpha-1 antitrypsin deficiency No. 29 of 2015 (Federal Register of Legislation No. F2014L01837) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 alpha-1 antitrypsin deficiency and death from alpha-1 antitrypsin deficiency. Meaning of alpha-1 antitrypsin deficiency (2) For the purposes of this Statement of Principles, alpha-1 antitrypsin deficiency means a genetic disorder of plasma protein metabolism which involves reduced serum levels of alpha-1 antitrypsin. Note: Common clinical manifestations include emphysema and cirrhosis of the liver. Death from alpha-1 antitrypsin deficiency (3) For the purposes of this Statement of Principles, alpha-1 antitrypsin deficiency, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's alpha-1 antitrypsin deficiency. 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 alpha-1 antitrypsin deficiency and death from alpha-1 antitrypsin deficiency 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 alpha-1 antitrypsin deficiency or death from alpha-1 antitrypsin deficiency with the circumstances of a person's relevant service: (1) having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of alpha-1 antitrypsin deficiency; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) inability to obtain appropriate clinical management for alpha-1 antitrypsin deficiency. 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(1) and 9(2) apply only to material contribution to, or aggravation of, alpha-1 antitrypsin deficiency where the person's alpha-1 antitrypsin deficiency 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.