Document ID: chunk:federal_register_of_legislation:F2022L00002:reg:9:p1
Version: federal_register_of_legislation:F2022L00002
Segment Type: reg
Provision Reference: reg 9 (pt 1/2)
Character Range: 5054–8509

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 narcolepsy or death from narcolepsy with the circumstances of a person's relevant service:
(1)          having concussion or moderate to severe traumatic brain injury within the 2 years before the clinical onset of narcolepsy, and in the case of sustained unconsciousness following injury to the head, the clinical onset of narcolepsy occurred within 2 years of regaining consciousness;
(2)          having a neurosurgical procedure involving the hypothalamus, midbrain or brainstem, within the 2 years before the clinical onset of narcolepsy;
(3)          undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, within the 3 years before the clinical onset of narcolepsy;
(4)          having a neurological disease, neurodegenerative disease or a paraneoplastic neurological syndrome, where the disease or syndrome involves the hypothalamus, midbrain or brainstem, within the 2 years before the clinical onset of narcolepsy;
            Note: Examples of neurological diseases, neurodegenerative diseases or paraneoplastic neurological syndromes that can involve the hypothalamus, midbrain or brainstem include:

               (i)              cerebrovascular accident;
               (ii)            disseminated encephalomyelitis;
               (iii)          hypoxic cerebral insult;
               (iv)           multiple sclerosis;
               (v)            neuromyelitis optica spectrum disorder; and
               (vi)           Parkinson's disease.
(5)          having:
(a)          a benign or malignant neoplasm; or
(b)          a non-malignant space occupying lesion;

involving the hypothalamus, midbrain or brainstem within the 2 years before the clinical onset of narcolepsy;
             Note 1: Examples of neoplasms that can involve the hypothalamus, midbrain or brainstem include lymphoma, glioma and craniopharyngioma.
             Note 2: Examples of non-malignant space occupying lesions that can involve the hypothalamus, midbrain or brainstem include neurosarcoidosis and vascular malformations.
(6)          receiving the adjuvanted influenza H1N1 vaccine PandemrixTM within the 2 years before the clinical onset of narcolepsy;
(7)          having infection with H1N1 influenza virus within the 2 years before the clinical onset of narcolepsy;
(8)          having infection of the pharynx with Streptococcus pyogenes within the 3 years before the clinical onset of narcolepsy;
(9)          having concussion or moderate to severe traumatic brain injury within the 2 years before the clinical worsening of narcolepsy, and in the case of sustained unconsciousness following injury to the head, the clinical worsening of narcolepsy occurred within 2 years of regaining consciousness;
(10)      having a neurosurgical procedure involving the hypothalamus, midbrain or brainstem, within the 2 years before the clinical worsening of narcolepsy;
(11)      undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, within the 3 years before the clinical worsening of narcolepsy;
(12)      having a neurological disease, neurodegenerative disease or a paraneoplastic neurological syndrome, where the disease or syndrome involves the hypothalamus, midbrain or