Statement of Principles

 concerning 

MYASTHENIA GRAVIS

(No. 75 of 2015)

The Repatriation Medical Authority determines the following Statement of Principles.

Dated                                                                                                                                                                                                                                  19 June 2015

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO

Chairperson

Contents

1 Name

2 Commencement

3 Authority

4 Revocation

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 myasthenia gravis (No. 75 of 2015).

2               Commencement

              This instrument commences on 20 July 2015.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.

4               Revocation

The Statement of Principles concerning myasthenia gravis No. 15 of 2007 made under subsection 196B(2) of the VEA is revoked.

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.

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 myasthenia gravis and death from myasthenia gravis.

Meaning of myasthenia gravis

(2)          For the purposes of this Statement of Principles, myasthenia gravis:

(a)          means an autoimmune neuromuscular disorder characterised by weakness and fatigability of skeletal muscles; and 

(b)          excludes temporary weakness and fatigability of skeletal muscles due to medication and myasthenic syndromes.

(3)          While myasthenia gravis attracts ICD‑10‑AM code G70.0, in applying this Statement of Principles the meaning of myasthenia gravis 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.

Death from myasthenia gravis

(5)          For the purposes of this Statement of Principles, myasthenia gravis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s myasthenia gravis.

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 myasthenia gravis and death from myasthenia gravis 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: relevant service is 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 myasthenia gravis or death from myasthenia gravis with the circumstances of a person’s relevant service:

(1)          having systemic treatment with a drug from Specified List of Drugs No. 1 at the time of the clinical onset of myasthenia gravis;

Note: Specified List of Drugs No. 1 is defined in the Schedule 1 - Dictionary.             

(2)          undergoing stem cell or bone marrow transplantation before the clinical onset of myasthenia gravis;

(3)          being treated with a drug from a class of drugs from Specified List of Drugs No. 2 at the time of the clinical worsening of myasthenia gravis;

Note: Specified List of Drugs No. 2 is defined in the Schedule 1 - Dictionary.             

(4)          being treated with a drug from Specified List of Drugs No. 3 at the time of the clinical worsening of myasthenia gravis;

Note: Specified List of Drugs No. 3 is defined in the Schedule 1 - Dictionary.               

(5)          having an injection of iothalamic acid, diatrizoate meglumine or diatrizoate sodium, within the 24 hours before the clinical worsening of myasthenia gravis;

(6)          undergoing stem cell or bone marrow transplantation before the clinical worsening of myasthenia gravis;

(7)          being pregnant within the six weeks before the clinical worsening of myasthenia gravis;

(8)          inability to obtain appropriate clinical management for myasthenia gravis.

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(8) apply only to material contribution to, or aggravation of, myasthenia gravis where the person’s myasthenia gravis 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:

MRCA means the Military Rehabilitation and Compensation Act 2004.

myasthenia gravis - see subsection 7(2).

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.

Specified List of Drugs No. 1 means:

(a)          atorvastatin;

(b)          chloroquine;

(c)          interferon alpha;

(d)          lithium carbonate;

(e)          penicillamine;

(f)           phenytoin; or

(g)          trimethadione.

Specified List of Drugs No. 2 means:

(a)          anaesthetic agents;

(b)          antibiotics;

(c)          beta-blockers;

(d)          calcium channel blockers;

(e)          HMG coenzyme A reductase inhibitors (statins);

(f)           systemic corticosteroids;

(g)          potassium losing diuretics;

(h)          sedative analgesics including barbiturates, muscle relaxants, narcotics and tranquillisers; or

(i)            thyroid hormone replacement therapy.

Specified List of Drugs No. 3 means any of the following drugs (including where those drugs are contained in preparations):

(a)          acetazolamide;

(b)          amantadine;

(c)          amitriptyline;

(d)          botulinum toxin;

(e)          carbamazepine;

(f)           chloroquine;

(g)          chlorpromazine;

(h)          cocaine;

(i)            colchicine;

(j)            diphenhydramine;

(k)          droperidol;

(l)            echothiophate;

(m)        ementine;

(n)          ergometrine;

(o)          etafenone;

(p)          ethosuximide;

(q)          gabapentin;

(r)           haloperidol;

(s)           imipramine;

(t)            interferon alpha;

(u)          interleukin-2;

(v)          levonorgestrel implant;

(w)        lithium carbonate;

(x)          magnesium sulphate;

(y)          mefloquine;

(z)          nicotine transdermal patch;

(aa)       paraldehyde;

(bb)      penicillamine;

(cc)       peruvoside;

(dd)      phenytoin;

(ee)       procainamide;

(ff)        proguanil;

(gg)      propafenone;

(hh)      pyrantel pamoate;

(ii)         quinidine;

(jj)         quinine;

(kk)      ribavirin;

(ll)         tiopronin;

(mm) trientine;

(nn)      trihexyphenidyl;

(oo)      trimethadione; or

(pp)      trimethaphan.

terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

VEA means the Veterans' Entitlements Act 1986.