Statement of Principles

concerning

SEBORRHOEIC KERATOSIS
(Reasonable Hypothesis)

(No. 19 of 2024)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated                                           22 February 2024.

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 seborrhoeic keratosis (Reasonable Hypothesis) (No. 19 of 2024).

2               Commencement

              This instrument commences on 26 March 2024.

3               Authority

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

4               Repeal

The Statement of Principles concerning seborrhoeic keratosis No. 55 of 2015 (Federal Register of Legislation No. F2015L00250) made under subsection 196B(2) of the VEA is repealed.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.

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 seborrhoeic keratosis and death from seborrhoeic keratosis.

Meaning of seborrhoeic keratosis

(2)          For the purposes of this Statement of Principles, seborrhoeic keratosis:

(a)          means a benign intra-epidermal skin tumour arising from the  proliferation of basaloid keratinocytes with histopathological architecture of a papilloma with a flat base and a hyperkeratotic crown; and

(b)          includes:

(i)            basal cell papilloma;

(ii)         dermatosis papulosa nigra;

(iii)       pigmented seborrhoeic keratosis;

(iv)        seborrhoeic wart;

(v)          stucco keratosis; and

(vi)        Leser-Trélat sign/disease; and

(c)          excludes:

(i)            seborrhoeic dermatitis; 

(ii)         seborrhoeic psoriasis; and

(iii)       solar keratosis.

(3)          While seborrhoeic keratosis attracts ICD‑10‑AM code L82, in applying this Statement of Principles the meaning of seborrhoeic keratosis 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 seborrhoeic keratosis

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

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 seborrhoeic keratosis and death from seborrhoeic keratosis 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 seborrhoeic keratosis or death from seborrhoeic keratosis with the circumstances of a person's relevant service:

(1)          having sunlight exposure to unprotected skin at the affected site for at least 2,250 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones (latitude equivalent hours), before clinical onset;

Note: latitude equivalent hours are defined in the Schedule 1 - Dictionary.

(2)          for the Leser-Trélat sign only (sudden onset of >20 new seborrhoeic keratoses within 6 months), having a malignancy excluding non-melanotic malignant neoplasm of the skin, within 1 year before  clinical;

(3)          taking a course of dabrafenib or vemurafenib for the treatment of cancer within 1 year before clinical onset;

(4)          inability to obtain appropriate clinical management for seborrhoeic keratosis 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 factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, seborrhoeic keratosis where the person's seborrhoeic keratosis 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:

latitude equivalent hours means hours of exposure multiplied by the appropriate latitude weighting factor shown below.

Note: Sunlight exposure is calculated as the sum of sunlight exposure in each separate latitude, accounting for the different sunlight intensity in each latitude (weighting factor).

Sum of sunlight exposure = (hours spent in tropical latitude x tropical latitude weighting factor) + (hours spent in subtropical latitude x subtropical latitude weighting factor) + (hours spent in warm temperate latitude x warm temperate latitude weighting factor) + (hours spent in cool temperate latitude x cool temperate latitude weighting factor)

                               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.

                               seborrhoeic keratosis—see subsection 7(2).

                               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.