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(3) of the Veterans’ Entitlements Act
1986 (the Act):
(a) revokes Instrument No.89 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. On the sound
medical-scientific evidence available, the Repatriation Medical Authority is of
the view that it is more probable than not that gout and death from
gout can be related to relevant service rendered by veterans 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 exist
before it can be said that, on the balance of probabilities, gout or death
from gout is connected 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 220kg 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 220kg 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) or 70(5)(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) eligible war service (other than operational service); or
(b) defence service (other than 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 120B of the Act applies.