Statement of Principles concerning opisthorchiasis (Reasonable Hypothesis) (No. 21 of 2025) (Cth)

Statement of Principles concerning OPISTHORCHIASIS (Reasonable Hypothesis) (No. 21 of 2025) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 18 February 2025.

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 opisthorchiasis (Reasonable Hypothesis) (No. 21 of 2025). 1. Commencement This instrument commences on 25 March 2025. 1. Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 1. Repeal The Statement of Principles concerning opisthorchiasis (Reasonable Hypothesis) (No. 45 of 2016) (Federal Register of Legislation No. F2016L00579) made under subsection 196B(2) of the VEA is repealed. 1. 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. 1. Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 1. Kind of injury, disease or death to which this Statement of Principles relates 1. This Statement of Principles is about opisthorchiasis and death from opisthorchiasis. Meaning of opisthorchiasis 1. For the purposes of this Statement of Principles, opisthorchiasis means an infestation of the biliary system by the trematodes (parasitic flatworms) Opisthorchis felineus or Opisthorchis viverrini. Note 1: Opisthorchis felineus is also known as the cat liver fluke and Opisthorchis viverrini is also known as the Southeast Asian liver fluke. Note 2: Symptoms of opisthorchiasis include loss of appetite, diarrhoea or a sense of abdominal pressure. 1. While opisthorchiasis attracts ICD‑10‑AM code B66.0, in applying this Statement of Principles the meaning of opisthorchiasis is that given in subsection (2). 2. 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 opisthorchiasis 1. For the purposes of this Statement of Principles, opisthorchiasis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's opisthorchiasis. Note: terminal event is defined in the Schedule 1 – Dictionary. 1. Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that opisthorchiasis and death from opisthorchiasis 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. 1. 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 opisthorchiasis or death from opisthorchiasis with the circumstances of a person's relevant service: 1. ingesting the skin or flesh of raw, undercooked, iced, pickled or smoked freshwater fish at least 3 weeks before clinical onset; Note: Freshwater fish contaminated by Opisthorchis viverrini are mainly found in Southeast Asia and freshwater fish contaminated by Opisthorchis felineus are mainly found in Eastern and Central Europe and Southeast Asia. 1. having a liver transplant, where the liver is derived from a person infected with Opisthorchis viverrini or Opisthorchis felineus, within the 7 days before clinical onset; 2. inability to obtain appropriate clinical management for opisthorchiasis before clinical worsening. 1. 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(3) applies only to material contribution to, or aggravation of, opisthorchiasis where the person's opisthorchiasis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 2. 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.