Specialist Medical Review Council

Reasons for Decision

| Part 1 |..| Part 2 |..| Part 3 |..| Part 4 |..| Part 5 |..| Part 6 |..| Part 7 |

Part 3

From the foregoing, it is clear that the purpose of Statements of Principles is to provide, exclusively, the medical-scientific element within a suggested chain of causation in a claim for pension for an injury, disease or death. If the claimed injury, disease or death is of a kind that is the subject of a Statement of Principles, then, where subsection 120(3) applies, a hypothesis will be reasonable for the purposes of that subsection only if the Statement of Principles upholds that hypothesis.

Similarly, where subsection 120(4) applies instead, the Commission can be reasonably satisfied that the injury, disease or death was war-caused or defence-caused only if the Statement of Principles relating to that kind of injury, disease or death upholds the contention that the injury, disease or death is, on the balance of probabilities, connected with the person's service.

It is important to note that Statements of Principles made under subsection 196B(2) do not, of themselves, define a "reasonable hypothesis". A "reasonable hypothesis" can only ever arise in the context of a claim for pension and must relate to the connection between the particular circumstances of the particular person's service and his or her injury, disease or death.

Thus, neither the Repatriation Medical Authority nor the Council is concerned with determining whether or not, as a general proposition, it is a "reasonable hypothesis" that a particular factor can cause a particular kind of injury, disease or death. However, one or more factors contained within a Statement of Principles must provide support for the medical-scientific link that forms part of a "reasonable hypothesis" when the Statement of Principles is relied upon to uphold a suggested chain of causation linking the particular circumstances of a veteran's service to his or her injury, disease or death. Therefore, the factors that are to be contained in a subsection 196B(2) Statement of Principles must be such that it can be said, in relation to every person for whom a factor is relevant and who has suffered or contracted, or who has died from, the relevant kind of injury or disease, that a "reasonable hypothesis" has been raised connecting that person's injury, disease or death with the circumstances of his or her service.

The inclusion of a particular factor in a Statement of Principles determined under subsection 196B(2) means that the Repatriation Medical Authority is satisfied that there is sound medical-scientific evidence that indicates that it can be said, in the case of every person to whom the Statement of Principles is intended to apply, that it would be a "reasonable hypothesis" that exposure of the person to that factor made a contribution to that person's injury, disease or death.

Similarly, for a Statement of Principles determined under subsection 196B(3), the inclusion of a particular factor in that Statement of Principles means that, on the sound medical-scientific evidence available, the Repatriation Medical Authority is satisfied that it can be said in the case of every person to whom that Statement of Principles is intended to apply, that it is more likely than not that exposure of the person to that factor made a contribution to that person's injury, disease or death.

Not only must the Authority and the Council make the assessments set out above, but they must determine whether a suggested factor can be related to the relevant types of service. There are some factors that could not be said to be related to service. For example, being of the male gender is certainly a relevant factor in the cause of certain diseases but it is difficult to see how it can be related to service. 

 In the current matter, the relevant Statements of Principles provide as follows:

Instrument No.95 of 1995

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE PROSTATE

ICD CODE: 185

Veterans' Entitlements Act 1986

subsection 196B(2)

1. Being of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the prostate and death from malignant neoplasm of the prostate can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the prostate or death from malignant neoplasm of the prostate with the circumstances of that service, are:

(a) being exposed to herbicides in Vietnam; or

(b) inability to obtain appropriate clinical management for the malignant neoplasm of the prostate.

2. Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(b) must be related to any service rendered by a person.

3. The factor set out in paragraph 1(b) applies only where:

(a) the person's malignant neoplasm of the prostate was contracted before a period, or part of a period, of service to which the factor is related; and

(b) the relationship suggested between the malignant neoplasm of the prostate and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act.

4. For the purposes of this Statement of Principles:

"ICD code" means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472;

"malignant neoplasm of the prostate" means a malignant neoplasm of the cells of the prostate gland, attracting ICD code 185;

"being exposed to herbicides in Vietnam" may be said to have occurred only if the person had, before the clinical onset of malignant neoplasm of the prostate:

(a) rendered more than 30 days service on land in Vietnam; or

(b) regularly eaten fish, fish products, crustaceans, shellfish or meat from Vietnam; or

(c) regularly eaten food cooked with water from Vietnam discoloured by sediment, or regularly drunk water from Vietnam discoloured by sediment; or

(d) regularly inhaled dust in a defoliated area in Vietnam or regularly inhaled herbicide fog in Vietnam; or

(e) sprayed or decanted herbicides in Vietnam as an occupational requirement.

Dated this Eighth day of March 1995

The Common Seal of the Repatriation Medical Authority was affixed to this instrument in the presence of:

KEN DONALD

CHAIRMAN

 

Instrument No.96 of 1995

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE PROSTATE

ICD CODE: 185

Veterans' Entitlements Act 1986

subsection 196B(3)

1. Being of the view that, on the sound medical-scientific evidence available to the Repatriation Medical Authority, it is more probable than not that malignant neoplasm of the prostate and death from malignant neoplasm of the prostate can be related to eligible war service (other than operational service) rendered by veterans and defence service (other than hazardous service) rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(3) of the Veterans' Entitlements Act 1986, that the factor that must exist before it can be said that, on the balance of probabilities, malignant neoplasm of the prostate or death from malignant neoplasm of the prostate is connected with the circumstances of that service, is:

(a) inability to obtain appropriate clinical management for the malignant neoplasm of the prostate.

2. Subject to clause 3 (below) the factor set out in paragraph 1(a) must be related to any service rendered by a person.

3. The factor set out in paragraph 1(a) applies only where:

(a) the person's malignant neoplasm of the prostate was contracted before a period, or part of a period, of service to which the factor is related; and

(b) the relationship suggested between the malignant neoplasm of the prostate and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), or 70(5)(d) of the Act.

4. For the purposes of this Statement of Principles:

"ICD code" means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472;

"malignant neoplasm of the prostate" means a malignant neoplasm of the cells of the prostate gland, attracting ICD code 185.

Dated this Eighth day of March 1995

The Common Seal of the Repatriation Medical Authority was affixed to this instrument in the presence of:

KEN DONALD

CHAIRMAN

 

 

Part 4 ..

Declarations


Bruce Topperwien's Legal Page

Hosted by www.Geocities.ws

1