Revocation and Determination
of
Statement of Principles
concerning
GOUT
ICD-10-AM CODE: M10
Veterans’ Entitlements Act 1986
1. The
Repatriation Medical Authority under subsection 196B(2) of the Veterans’
Entitlements Act 1986 (the Act):
(a) revokes Instrument No.88 of 1997; and
(b) determines in its place the following
Statement of Principles.
Kind
of injury, disease or death
2. (a) This
Statement of Principles is about gout and death from gout.
(b) For the purposes of this
Statement of Principles, “gout” means a
metabolic condition characterised by hyperuricaemia, tissue deposition of urate
crystals and clinical manifestations, which manifestations include acute
inflammatory arthritis, tenosynovitis, bursitis, cellulitis, chronic erosive
arthritis, or periarticular or subcutaneous urate deposits, attracting
ICD-10-AM code M10.
Basis
for determining the factors
3. The Repatriation Medical Authority is of the view that there
is sound medical-scientific evidence that indicates that gout and death
from gout can be related to relevant service rendered by veterans, members
of Peacekeeping Forces, or members of the Forces.
Factors
that must be related to service
4. Subject to clause 6, at least one of the factors set out in
clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said
that a reasonable hypothesis has been raised connecting gout or death from gout with the circumstances of a person’s relevant service
are:
(a) suffering from one of the
diseases in the specified list of diseases within the 180 days immediately
before the clinical onset of gout; or
(b) being treated with a
specified drug before the clinical onset of gout; or
(c) being obese at the time of
the clinical onset of gout; or
(d) suffering from lead
nephropathy before the clinical onset of gout; or
(e)
undergoing chemotherapy for a
malignant tumour within the seven days immediately before the clinical onset of
gout; or
(f) drinking at least 150kg of alcohol
(contained within alcoholic drinks) within the ten years immediately before the
clinical onset of gout; or
(g) suffering from one of the
diseases in the specified list of diseases within the 180 days immediately
before the clinical worsening of gout; or
(h) being treated with a
specified drug before the clinical worsening of gout; or
(j) being obese at the time of
the clinical worsening of gout; or
(k) suffering from lead
nephropathy before the clinical worsening of gout; or
(m) undergoing chemotherapy for a
malignant tumour within the seven days immediately before the clinical
worsening of gout; or
(n) drinking at least 150kg of alcohol
(contained within alcoholic drinks) within the ten years immediately before the
clinical worsening of gout; or
(o) inability to obtain
appropriate clinical management for gout.
Factors
that apply only to material contribution or aggravation
6. Paragraphs 5(g) to 5(o) apply only to material
contribution to, or aggravation of gout where the person’s gout was suffered or
contracted before or during (but not arising out of) the person’s relevant
service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion
of Statements of Principles
7. In this Statement of Principles if a relevant
factor applies and that factor includes an injury or disease in respect of
which there is a Statement of Principles then the factors in that last
mentioned Statement of Principles apply in accordance with the terms of that
Statement of Principles.
Other
definitions
8. For the purposes of this Statement of
Principles:
“alcohol (contained within alcoholic drinks)” is measured by the alcohol consumption
calculations utilising the Australian Standard of 10 grams of alcohol per
standard alcoholic drink;
“being obese” means
an increase in body weight by way of fat accumulation which results in a Body
Mass Index (BMI) of 30 or greater.
The BMI = W/H2
and where:
W is the person’s weight in kilograms and
H is the person’s height in metres.
“being treated with a specified drug” means being treated with any of the drugs (including
where those drugs are contained in preparations) listed in the following Table
of Drugs, under the circumstances as specified in the Table, with regard to the
mode of administration, dose level, minimum duration of treatment, and
temporality (time relationship between the last administration of the drug and
the onset or worsening of the disease, as
the case may be, where the drug has ceased);
Table of
Drugs
|
Drug or Group of Drugs
|
Mode *
|
Dose
|
Minimum Duration of Treatment
|
Temporality
|
|
thiazide diuretic
|
IV, IM, O
|
any weekly dose
|
2 months
|
within the 28 days immediately
before
|
|
frusemide
|
IV, IM, O
|
any weekly dose
|
2 months
|
within the 28 days immediately
before
|
|
pyrazinamide
|
O
|
any dose on at least two days
within any seven day period
|
2 days
|
within the 28 days immediately
before
|
|
ethambutol
|
O
|
any dose on at least two days
within any seven day period
|
2 days
|
within the 28 days immediately
before
|
|
cyclosporine A
|
O, IV
|
any daily dose
|
one week
|
within the 28 days immediately
before
|
*
Abbreviations: IV = intravenous; IM = intramuscular; O = oral
“chemotherapy”
means systemic treatment of a malignant disease with a chemical agent which can
lead to the breakdown of cells, examples of which include vincristine,
busulphan, thiotepa, cytarabine, 6‑mercaptopurine and chlorambucil;
“death from gout” in relation to a person
includes death from a terminal event or condition that was contributed to by
the person’s gout;
“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in
The International Statistical Classification of Diseases and Related Health
Problems, 10th revision, Australian Modification (ICD-10-AM), effective date of
1 July 1998, copyrighted by the National Centre for Classification in Health,
Sydney, NSW, and having ISBN 1 86451 340 3;
“lead nephropathy” means chronic tubulointerstitial renal disease caused by exposure to
lead;
“relevant
service” means:
(a) operational
service; or
(b) peacekeeping service; or
(c) hazardous service;
“specified list of diseases” means the following:
(i) active systemic leukaemia;
or
(ii) myeloid metaplasia; or
(iii)
polycythaemia vera; or
(iv)
secondary polycythaemia; or
(v)
multiple myeloma;
“terminal event” means the proximate or ultimate cause of death and includes:
a) pneumonia;
b) respiratory failure;
c) cardiac arrest;
d) circulatory failure; or
e) cessation of brain function.
Application
9. This Instrument applies to all matters to which section 120A
of the Act applies.