Statement of Principles concerning tinea (Balance of Probabilities) (No. 56 of 2024) (Cth)

Statement of Principles concerning TINEA (Balance of Probabilities) (No. 56 of 2024) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) 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 tinea (Balance of Probabilities) (No. 56 of 2024). 2 Commencement This instrument commences on 23 July 2024. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning tinea No. 12 of 2015 (Federal Register of Legislation No. F2014L01816) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 tinea and death from tinea. Meaning of tinea (2) For the purposes of this Statement of Principles, tinea: (a) means a fungal infection of the skin, hair or nails caused by the dermatophytes Epidermophyton, Trichophyton, Microsporum, Arthroderma, Ctenomyces, Lophophyton, Nannizzia, Guarromyces or Paraphyton; and (b) includes: (i) tinea infection of the beard (tinea barbae), scalp (tinea capitis), body (tinea corporis), groin/perineal region (tinea cruris/inguinalis), hand (tinea manus/manuum), foot (tinea pedis), and nail (tinea unguium/onchomycosis); (ii) tinea gladiatorum; and (iii) Majocchi's granuloma (granuloma trichophyticum); and (c) excludes: (i) tinea versicolour; (ii) tinea flava; (iii) tinea nigra; (iv) tinea blanca; (v) tinea amiantacea; and (vi) fungal infection involving mucous membranes or a systemic fungal infection. Note 1: Tinea includes Id reactions which is an allergic rash occurring as a result of allergy to fungal antigens from a tinea at a distant site. Note 2: The SoP should be invoked separately in relation to each instance of tinea, in each separate location of the body, and in each instance separate in time. Note 3: Some examples of clinical worsening are where tinea has disseminated, become deeply invasive in the form of Majocchi's granuloma, or has become refractory to first-line treatment. (3) While tinea attracts ICD‑10‑AM code B35, in applying this Statement of Principles the meaning of tinea 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 tinea (5) For the purposes of this Statement of Principles, tinea, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tinea. 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 tinea and death from tinea 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, tinea or death from tinea is connected with the circumstances of a person's relevant service: (1) having unprotected physical contact with: (a) a person infected with tinea; (b) an animal infected with tinea; (c) objects or surfaces contaminated with dermatophytes; (d) using communal showering or bathing facilities, swimming pool facilities or locker rooms; (e) soil contaminated with dermatophytes; or (f) a site of tinea on the same body; between 2 days and 3 weeks before the clinical onset or clinical worsening; Note 1: Examples of unprotected physical contact with a person could include contact sports and unarmed physical combat. Note 2: Examples of animals that can be infected with tinea include mammals, reptiles, birds, fish, arthropods, and worms. Note 3: Examples of objects that can be contaminated include brushes, hats, razors, footwear, towels or clothing. Examples of surfaces that can be contaminated include communal showers, baths, pools, locker rooms, and laundry facilities. (2) having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening; Note 1: Situations in which skin maceration can occur are prolonged use of occlusive footwear or clothing, heavy sweating, and prolonged exposure to water. Note 2: skin maceration is defined in the Schedule-1 dictionary. (3) having diabetes mellitus at the time of clinical worsening; (4) having a substantially lowered immune function at the time of clinical worsening due to: (a) human immunodeficiency virus (HIV) infection; (b) glucocorticoids other than inhaled glucocorticoids; (c) solid organ transplant (excluding corneal transplant), stem cell or bone marrow transplantation; (5) having topical glucocorticoid applied at the site of the tinea at the time of clinical worsening; (6) having chronic renal failure at the time of clinical worsening of tinea unguium, as indicated by any of the following; (a) a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or (b) undergoing chronic dialysis for renal failure. (7) taking risankizumab and guselkumab at the time of clinical worsening; (8) having peripheral artery disease of the lower limb at the time of clinical worsening of tinea affecting the foot; (9) having chronic venous insufficiency of the lower limb at the time of clinical worsening of tinea unguium of the toes; (10) having varicose veins of the lower limb at the time of clinical worsening of tinea unguium of the toes; (11) inability to obtain appropriate clinical management for tinea before clinical worsening. 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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, tinea where the person's tinea 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.