Statement of Principles
concerning
ACQUIRED CATARACT
No. 40 of 2008
for the purposes of the
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and
Compensation Act 2004
Title
1.
This Instrument may be cited
as Statement of Principles concerning acquired cataract No. 40 of 2008.
Determination
2.
The Repatriation Medical
Authority under subsection 196B(3) and (8) of the Veterans’
Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 38 of 2001, as
amended by Instrument No. 33 of 2002, concerning acquired cataract; and
(b) determines in their place this Statement
of Principles.
Kind of injury, disease
or death
3. (a) This
Statement of Principles is about acquired cataract and death from
acquired cataract.
(b)
For the purposes of this Statement
of Principles, "acquired cataract" means an opacification of
the lens or lens capsule of the eye which causes visual impairment and which is
not due to congenital or infantile cataract or lens malformation.
(c)
Acquired cataract attracts
ICD-10-AM code H25, H26, H28.1 or H28.2.
(d)
In the application of this
Statement of Principles, the definition of "acquired cataract" is
that given at paragraph 3(b) above.
Basis for determining the
factors
4. On the sound medical-scientific evidence available, the
Repatriation Medical Authority is of the view that it is more probable than not
that acquired cataract and death from acquired cataract can be
related to relevant service rendered by veterans or members of the Forces under
the VEA, or members under the Military Rehabilitation and Compensation Act
2004 (the MRCA).
Factors that must be
related to service
5. Subject to clause 7, at least one of the factors set out in
clause 6 must be related to the relevant service rendered by the person.
Factors
6. The factor that must exist before it can be said that, on the
balance of probabilities, acquired cataract or death from acquired
cataract is connected with the circumstances of a person’s relevant service
is:
(a)
having sunlight exposure to the
unprotected eye for at least 4500 hours while in a tropical area, or having
equivalent sunlight exposure in other latitude zones, before the clinical onset
of acquired cataract; or
(b)
smoking at least 20 pack years of
cigarettes, or the equivalent thereof in other tobacco products, before the
clinical onset of acquired cataract; or
(c)
having diabetes mellitus before
the clinical onset of acquired cataract; or
(d)
having glaucoma of the affected
eye before the clinical onset of acquired cataract; or
(e)
undergoing a course of therapeutic
radiation to the region of the affected eye before the clinical onset of
acquired cataract; or
(f)
having received a cumulative
equivalent dose of at least 1.0 Sievert of atomic radiation to the affected eye
before the clinical onset of acquired cataract; or
(g)
having physical trauma to the
affected eye within the 10 years before the clinical onset of acquired
cataract; or
(h)
being treated with oral, topical
or inhalational corticosteroids as specified within the 10 years before the
clinical onset of acquired cataract; or
(i)
having a severe thermal or
chemical burn to the affected eye before the clinical onset of acquired
cataract; or
(j)
having an electrical injury within
the five years before the clinical onset of acquired cataract; or
(k)
being treated with a drug as
specified before the clinical onset of acquired cataract; or
(l)
having uveitis or iridocyclitis of
the affected eye before the clinical onset of acquired cataract; or
(m)
for cortical and subcapsular
cataract only, having chronic hypocalcaemia at the time of the clinical onset
of acquired cataract; or
(n)
having sunlight exposure to the
unprotected eye for at least 4500 hours while in a tropical area, or having
equivalent sunlight exposure in other latitude zones, before the clinical
worsening of acquired cataract; or
(o)
smoking at least 20 pack years of
cigarettes, or the equivalent thereof in other tobacco products before the
clinical worsening of acquired cataract; or
(p)
having diabetes mellitus before
the clinical worsening of acquired cataract; or
(q)
having glaucoma of the affected
eye before the clinical worsening of acquired cataract; or
(r)
undergoing a course of therapeutic
radiation to the region of the affected eye before the clinical worsening of
acquired cataract; or
(s)
having received a cumulative
equivalent dose of at least 1.0 Sievert of atomic radiation to the affected eye
before the clinical worsening of acquired cataract; or
(t)
having physical trauma to the
affected eye within the 10 years before the clinical worsening of acquired
cataract; or
(u)
being treated with oral, topical
or inhalational corticosteroids as specified within the 10 years before the
clinical worsening of acquired cataract; or
(v)
having a severe thermal or
chemical burn to the affected eye before the clinical worsening of acquired
cataract; or
(w)
having an electrical injury within
the five years before the clinical worsening of acquired cataract; or
(x)
being treated with a drug as
specified before the clinical worsening of acquired cataract; or
(y)
having uveitis or iridocyclitis of
the affected eye before the clinical worsening of acquired cataract; or
(z)
for cortical and subcapsular
cataract only, having chronic hypocalcaemia at the time of the clinical
worsening of acquired cataract; or
(aa)
inability to obtain appropriate
clinical management for acquired cataract.
Factors that apply only
to material contribution or aggravation
7. Paragraphs 6(n) to 6(aa) apply only to material
contribution to, or aggravation of, acquired cataract where the person’s
acquired cataract was suffered or contracted before or during (but not arising
out of) the person’s relevant service.
Inclusion of Statements of Principles
8.
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 as in force from time to time.
Other definitions
9.
For the purposes of this
Statement of Principles:
"a course of therapeutic radiation" means one or more fractions (treatment portions) of
ionising radiation administered with the aim of achieving palliation or cure
with gamma rays, x-rays, alpha particles or beta particles;
"a
severe thermal or chemical burn"
means a burn involving at least one of the following clinical features:
(a)
greater than 50% involvement of
the limbus or conjunctiva; or
(b)
corneal anaesthesia; or
(c)
a significant degree of corneal
opacification; or
(d)
for chemical burns only,
penetration of the chemical into the anterior chamber;
"a tropical area" means any area between the Tropic of Capricorn (23º
27' South) and the Tropic of Cancer (23º 27' North);
"atomic radiation" means ionising radiation excluding:
(a) natural background radiation;
(b) therapeutic radiation; and
(c) radiation from diagnostic procedures;
"being treated with a drug as specified" means:
(a) for
anterior subcapsular cataract only, receiving a cumulative dose of at least
1500 grams of phenothiazines; or
(b) for
anterior subcapsular cataract only, receiving amiodarone therapy for a
cumulative period of at least 365 days; or
(c) receiving a cumulative dose of at least
400 grams of allopurinol;
"being treated with oral, topical or inhalational
corticosteroids as specified" means:
(a) applying
topical corticosteroids to the cornea of the affected eye equivalent to a
cumulative dose of at least 200 drops of 0.1% dexamethasone; or
(b) applying
topical corticosteroids to the skin for a total of at least 730 days; or
(c) taking
oral corticosteroids equivalent to a cumulative dose of at least 1800 mg of
prednisone; or
(d) using
inhalational corticosteroids equivalent to a cumulative dose of at least 1000
mg of beclomethasone;
"cumulative equivalent dose" means the total equivalent dose of radiation from all
types of ionising radiation. It accounts for the differences in biological
effectiveness of various types of radiation and allows doses from different
radiations to be combined. Each component is calculated by multiplying the
absorbed dose in a particular tissue or organ for a given type of radiation by
the radiation weighting factor for that radiation. The unit of equivalent dose
is the Sievert;
"death from acquired cataract" in relation to a person includes death from a terminal
event or condition that was contributed to by the person’s acquired cataract;
"equivalent sunlight exposure in
other latitude zones" means the
cumulative hours of sunlight exposure equivalent to that specified for a
tropical area, calculated by multiplying the hours of exposure in each latitude
zone by the latitude weighting factor for the zone as per the latitude
weighting factor schedule and adding together the result for each zone:
Latitude weighting factor schedule
Latitude zone Latitude
weighting factor
a latitude between 23° 27' S and 23°
27' N 1.0
a latitude from > 23° 27' to 35° 0.75
a latitude from > 35° to 45° 0.5
a latitude from > 45° to 65° 0.25;
"glaucoma" means open-angle glaucoma or angle-closure glaucoma;
"hypocalcaemia" means confirmed findings of serum calcium <8.2
mg/dL (2.05 mmol/L) or ionized calcium <4.4 mg/dL (1.1 mmol/L);
"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), Sixth Edition, effective date of 1 July 2008,
copyrighted by the National Centre for Classification in Health, Sydney, NSW,
and having ISBN 978 1 74210 016 6;
"pack years of cigarettes, or the equivalent
thereof in other tobacco products"
means a calculation of consumption where one pack year of cigarettes equals
twenty tailor made cigarettes per day for a period of one calendar year, or
7300 cigarettes. One tailor made cigarette approximates one gram of tobacco or
one gram of cigar or pipe tobacco by weight. One pack year of tailor made
cigarettes equates to 7300 cigarettes, or 7.3 kg of smoking tobacco by weight.
Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone
or in any combination;
"physical trauma" means:
(a) penetrating
injury;
(b) intraocular
surgery; or
(c) blunt trauma
resulting in symptoms and signs lasting at least three days;
"relevant
service" means:
(a) eligible war
service (other than operational service) under the VEA; or
(b) defence
service (other than hazardous service) under the VEA; or
(c) peacetime
service under the MRCA;
"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;
"the unprotected eye" means an eye exposed to sunlight and not
protected by UV screening devices.
Application
10. This Instrument applies to all matters to which
section 120B of the VEA or section 339 of the MRCA applies.
Date of effect
11. This Instrument takes effect from 2 July 2008.
Notes to Statement of Principles concerning acquired
cataract (Instrument No. 40 of 2008)
The Statement of Principles concerning acquired cataract
(Instrument No. 40 of 2008) in force under section 196B(3) of the Veterans’
Entitlements Act 1986, as shown in this compilation is amended as indicated
in the Tables below.
Table
of Instruments
|
Title
|
Date of notification
in Gazette or FRLI registration
|
Date of
commencement
|
Application, saving or
transitional provisions
|
|
Statement
of Principles concerning acquired cataract (Instrument No. 40 of 2008)
|
25 June 2008
|
2 July 2008
|
|
|
Amendment
of Statement of Principles concerning acquired cataract (Instrument No. 52 of
2009)
|
23 June 2009
|
1 July 2009
|
|
Table
of Amendments
|
ad. = added or inserted am. = amended
rep. = repealed rs. = repealed and substituted
|
|
Provision affected
|
How affected
|
|
Clause 9 "electrical injury"
|
rep. Instrument No.52 of 2009
|