Statement of Principles concerning tuberculosis (Reasonable Hypothesis) (No. 47 of 2024) (Cth)

Statement of Principles concerning TUBERCULOSIS (Reasonable Hypothesis) (No. 47 of 2024) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 21 June 2024.

Professor Terence Campbell AM Chairperson by and on behalf of The Repatriation Medical Authority

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 tuberculosis (Reasonable Hypothesis) (No. 47 of 2024). 2 Commencement This instrument commences on 23 July 2024. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning tuberculosis No. 81 of 2015 (Federal Register of Legislation No. F2015L00913) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 tuberculosis and death from tuberculosis. Meaning of tuberculosis (2) For the purposes of this Statement of Principles, tuberculosis: (a) means an infection caused by bacteria belonging to the Mycobacterium tuberculosis complex, including M. tuberculosis, M. africanum, M. canettii, M. caprae, M. microti, M. orygis, M. pinnipedi and M. bovis (including Bacille Calmette-Guérin); and (b) includes: (i) latent tuberculosis; (ii) pulmonary tuberculosis; and (iii) extrapulmonary tuberculosis; and (c) excludes infection caused by atypical mycobacteria such as M. avium, M. intracellulare, M. kansasii, M. marinum and M. ulcerans. Note: The Mycobacterium tuberculosis complex is a genetically related group of Mycobacterium species that cause tuberculosis. (3) While tuberculosis attracts ICD‑10‑AM codes A15, A16, A17, A18 and A19, in applying this Statement of Principles the meaning of tuberculosis 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 tuberculosis (5) For the purposes of this Statement of Principles, tuberculosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tuberculosis. 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 tuberculosis and death from tuberculosis 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 tuberculosis or death from tuberculosis with the circumstances of a person's relevant service: (1) being exposed to bacteria belonging to the Mycobacterium tuberculosis complex at least 14 days before the clinical onset of tuberculosis; Note: being exposed to bacteria belonging to the Mycobacterium tuberculosis complex is defined in the Schedule 1 - Dictionary. (2) living or working in an area which has an incidence of tuberculosis of at least 50 cases per 100,000 of population per year, before the clinical onset of tuberculosis, provided that the individual had no negative test results for tuberculosis in any intervening period between living or working in the affected area and the onset of tuberculosis; (3) consuming unpasteurised milk, unpasteurised dairy products or uncooked meat from an animal infected with Mycobacterium bovis or Mycobacterium caprae at least 14 days before the clinical onset of tuberculosis; (4) for active tuberculosis disease due to infection with Mycobacterium bovis BCG only: (a) having intravesical BCG therapy for malignant neoplasm of the bladder; or (b) being vaccinated with BCG vaccine; before the clinical onset of tuberculosis; Note: active tuberculosis disease and BCG are defined in the Schedule 1 - Dictionary. (5) inability to access appropriate tuberculosis vaccination in accordance with contemporary medical standards before the clinical onset of tuberculosis; (6) having a substantially compromised immune system due to: (a) chronic renal failure; (b) haematological malignancy; (c) infection with human immunodeficiency virus; (d) severe malnutrition; (e) solid organ, stem cell or bone marrow transplantation; or (f) taking an immunosuppressive drug; at the time of the clinical worsening of tuberculosis; Note: chronic renal failure and immunosuppressive drug and severe malnutrition are defined in the Schedule -1 Dictionary. (7) inhaling at least 1,000 micrograms of beclomethasone, or equivalent inhaled glucocorticoid daily for the 3 months, before the clinical worsening of tuberculosis, and where the treatment has ceased, the last inhaled glucocorticoid dose was taken within the 30 days before the clinical worsening of tuberculosis; Note: equivalent inhaled glucocorticoid is defined in the Schedule 1 - Dictionary (8) having cirrhosis of the liver at the time of the clinical worsening of tuberculosis; (9) having diabetes mellitus at the time of the clinical worsening of tuberculosis; (10) inhaling respirable crystalline silica dust in an enclosed space: (a) for a cumulative period of at least 1,500 hours before the clinical worsening of tuberculosis; and (b) at the time material containing crystalline silica was being produced, excavated, drilled, cut or ground, or used in construction, manufacturing, cleaning or blasting; before the clinical worsening of tuberculosis; (11) inhaling respirable crystalline silica dust in an open environment: (a) for a cumulative period of at least 3,000 hours before the clinical worsening of tuberculosis; and (b) at the time material containing crystalline silica was being produced, excavated, drilled, cut or ground, or used in construction, manufacturing, cleaning or blasting; before the clinical worsening of tuberculosis; (12) for pulmonary tuberculosis only, smoking at least 1 cigarette per day, or the equivalent thereof in other tobacco products, for at least the 12 months before the clinical worsening of tuberculosis; Note: pulmonary tuberculosis is defined in the Schedule 1- Dictionary. (13) for pulmonary tuberculosis only, being in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5,000 hours before the clinical worsening of tuberculosis; Note: pulmonary tuberculosis is defined in the Schedule 1- Dictionary. (14) having a gastrectomy or jejunoileal bypass before the clinical worsening of tuberculosis; (15) consuming at least 40 grams of alcohol per day for at least the 12 months before the clinical worsening of tuberculosis; (16) having alcohol use disorder at the time of the clinical worsening of tuberculosis; (17) having systemic lupus erythematosus before the clinical worsening of tuberculosis; (18) having hepatitis C infection at the time of the clinical worsening of tuberculosis; (19) inability to obtain appropriate clinical management for tuberculosis before the clinical worsening of tuberculosis. 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(6) to 9(19) apply only to material contribution to, or aggravation of, tuberculosis where the person's tuberculosis 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.