Statement of Principles concerning hepatitis E infection (Reasonable Hypothesis) (No. 39 of 2024)
1Statement of Principles concerning hepatitis E infection (Reasonable Hypothesis) (No. 39 of 2024)
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The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.
Dated 21 June 2024
Professor Terence Campbell AM<br>Chairperson<br>by and on behalf of <br>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 hepatitis E infection (Reasonable Hypothesis) (No. 39 of 2024).
2 Commencement
This instrument commences on 23 July 2024.
3 Authority
This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.
4 Repeal
The Statement of Principles concerning hepatitis E (Reasonable Hypothesis) No. 112 of 2015 (Federal Register of Legislation No. F2015L01332) made under subsection 196B(2) of the VEA is repealed.
5 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.
Section 1 - Statement of Principles concerning hepatitis E infection (Reasonable Hypothesis) (No. 39 of 2024) - Statement of Principles concerning hepatitis E infection (Reasonable Hypothesis) (No. 39 of 2024) | Zoe
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 hepatitis E infection and death from hepatitis E infection.
Meaning of hepatitis E infection
(2) For the purposes of this Statement of Principles, hepatitis E infection means infection with the hepatitis E virus resulting in an illness characterised by inflammation of the liver, and which is confirmed by laboratory testing for hepatitis E serological or nucleic acid markers.
Note 1: Signs and symptoms of hepatitis E infection include malaise, vomiting, loss of appetite, abdominal pain, fever, hepatomegaly and jaundice.
Note 2: Clinical worsening may be indicated by the development of chronic hepatitis E from acute hepatitis E. Chronic hepatitis E is an infection lasting for at least 6 months.
Note 3: It will usually be the case that the date of the confirmation of laboratory evidence of hepatitis E serological or nucleic acid markers is after the date of clinical onset.
Note 4: Clinical onset is defined in the schedule 1 – Dictionary.
(3) While hepatitis E infection attracts ICD‑10‑AM code B17.2, in applying this Statement of Principles the meaning of hepatitis E infection 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 hepatitis E infection
(5) For the purposes of this Statement of Principles, hepatitis E infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hepatitis E infection.
Note: terminal event is defined in the Schedule 1 – Dictionary.
8 Basis for determining the factors
The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that hepatitis E infection and death from hepatitis E infection 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.
9 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 hepatitis E infection or death from hepatitis E infection with the circumstances of a person's relevant service:
(1) being exposed to the hepatitis E virus by:
(a) being in the same living quarters or immediate work environment as a person infected with the hepatitis E virus;
(b) consuming water or food contaminated with the hepatitis E virus;
(c) having direct contact with human or primate faecal material contaminated with the hepatitis E virus;
(d) having direct physical contact with a human or a primate infected with the hepatitis E virus;
(e) having percutaneous (intravenous, intramuscular, subcutaneous or intradermal) exposure to blood or body fluids contaminated with the hepatitis E virus; or
(f) receiving a transfusion of blood or blood products contaminated with the hepatitis E virus;
where hepatitis E virus exposure occurs between 14 and 70 days before clinical onset;
(2) having a solid organ transplant (excluding corneal transplant), where the tissue or organ is derived from a person infected with the hepatitis E virus, within the 4 months before clinical onset;
(3) having a liver, kidney, heart, lung, stem cell or bone marrow transplant before clinical worsening;
(4) being pregnant at the time of death due to hepatitis E infection or being pregnant at the time of liver transplantation necessitated by hepatitis E infection;
Note: Death due to hepatitis E infection is considered to be a clinical worsening. Liver transplantation necessitated by hepatitis E infection is considered to be a clinical worsening.
(5) having human immunodeficiency virus infection at the time of clinical worsening;
(6) having chemotherapy for cancer at the time of clinical worsening;
(7) inability to obtain appropriate clinical management for hepatitis E infection 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 factors set out in subsections 9(3) to 9(7) apply only to material contribution to, or aggravation of, hepatitis E infection where the person's hepatitis E infection 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(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.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
clinical onset means the point backwards in time from the first date of confirmation of laboratory evidence of hepatitis E serological or nucleic acid markers, to the date at which the symptoms of hepatitis E were persistently present, as assessed by a registered medical practitioner.
MRCA means the Military Rehabilitation and Compensation Act 2004.
relevant service means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA.
Note: MRCA and VEA are defined in the Schedule 1 - Dictionary.
hepatitis e infection—see subsection 7(2).
terminal event means the proximate or ultimate cause of death and includes the following: