Statement of Principles concerning Paget disease of bone (Reasonable Hypothesis) (No. 62 of 2023) (Cth)

Statement of Principles concerning PAGET DISEASE OF BONE (Reasonable Hypothesis) (No. 62 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 23 June 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 Paget disease of bone (Reasonable Hypothesis) (No. 62 of 2023). 2 Commencement This instrument commences on 25 July 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning Paget's disease of bone No. 49 of 2015 (Federal Register of Legislation No. F2015L00255) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 Paget disease of bone and death from Paget disease of bone. Meaning of Paget disease of bone (2) For the purposes of this Statement of Principles, Paget disease of bone means a focal disease of bone at single or multiple sites, with repeated episodes of accelerated bone resorption followed by disorganised new bone formation, resulting in bone of impaired integrity and structure. Note: Clinical manifestations typically include bone pain, bone enlargement, deformity or bowing of bones but may be asymptomatic. Bones commonly involved include the skull, spine, pelvis, and long bones of the lower extremity. Paget disease of bone is also known as osteitis deformans. (3) While Paget disease of bone attracts ICD‑10‑AM code M88, in applying this Statement of Principles the meaning of Paget disease of bone 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 Paget disease of bone (5) For the purposes of this Statement of Principles, Paget disease of bone, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Paget disease of bone. 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 Paget disease of bone and death from Paget disease of bone 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 Paget disease of bone or death from Paget disease of bone with the circumstances of a person's relevant service: (1) inability to obtain appropriate clinical management for Paget disease of bone before the clinical worsening of Paget disease of bone. 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(1) applies only to material contribution to, or aggravation of, Paget disease of bone where the person's Paget disease of bone 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.