Statement of Principles concerning HEAT-INDUCED BURN (Balance of Probabilities) (No. 2 of 2024) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 22 December 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 heat-induced burn (Balance of Probabilities) (No. 2 of 2024). 2 Commencement This instrument commences on 22 January 2024. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning external burn No. 111 of 2015 (Federal Register of Legislation No. F2015L01331) made under subsections 196B(3) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 heat-induced burn and death from heat-induced burn. Meaning of heat-induced burn (2) For the purposes of this Statement of Principles, heat-induced burn: (a) means an injury to the skin and external body covering tissues due to transfer of energy into the tissue with external contact with flame, or heat; and (b) includes burns of deep tissues and organs that are part of a multiple burn injury that includes injury to the skin and external body covering tissues; and (c) excludes: (i) freezing cold injury (frostbite); (ii) electrical contact or electrical flash burns (electrical injury); (iii) chemical burns; (iv) radiation burns due to ionising radiation; (v) isolated retinal burn of the eye; (vi) photocontact dermatitis; (vii) friction burns (abrasion); and (viii) isolated burn of the internal body organs such as the respiratory tract, gastrointestinal tract and internal genitourinary tract. Note 1: flame and heat burns may include the effects of incendiary devices such as white phosphorous grenades and rockets. Note 2: heat-induced burn may include a systemic response of the body with systemic inflammation and vascular shock. Death from heat-induced burn (3) For the purposes of this Statement of Principles, heat-induced burn, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's heat-induced burn. 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 heat-induced burn and death from heat-induced burn 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, heat-induced burn or death from heat-induced burn is connected with the circumstances of a person's relevant service: (1) having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; (2) having exposure to high intensity, focussed ultrasound sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; (3) having exposure to ultraviolet radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; Note: Some examples of potential ultraviolet radiation exposure include sun exposure, electric welding arc exposure, and PUVA therapy for skin conditions. (4) having exposure to solar radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; (5) having laser applied, sufficient to cause at least erythema, at the affected area of the body at the time of the clinical onset of heat-induced burn; (6) having exposure to infrared radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; (7) having exposure to radiofrequency or microwave radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn; (8) inability to obtain appropriate clinical management for heat-induced burn before the clinical worsening of heat-induced burn. 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(8) applies only to material contribution to, or aggravation of, heat-induced burn where the person's heat-induced burn 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: heat-induced burn—see subsection 7(2). MRCA means the Military Rehabilitation and Compensation Act 2004. relevant service means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime service under the MRCA. Note: MRCA and VEA are defined in the Schedule 1 - Dictionary. 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.