{"id":"F2026L00145","name":"Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 21 of 2026)","slug":"statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443153,"registerId":"F2026L00145-fast-fetch-1775958066098","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 21 of 2026)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nACCOMMODATION DISORDER  (Reasonable Hypothesis)\n\n(No. 21 of 2026)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated    20 February 2026\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n \n\n\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 21 of 2026).\n\n1.                Commencement\n\n\n              This instrument commences on 23 March 2026.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning accommodation disorder (Reasonable Hypothesis) (No. 38 of 2017) (Federal Register of Legislation No. F2017L00888) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about accommodation disorder and death from accommodation disorder.\n\n\nMeaning of accommodation disorder\n\n1.           For the purposes of this Statement of Principles, accommodation disorder:\n  1.           means the inability to adjust the lens of the eye to various distances or an inability to sustain such an adjustment; and\n  2.           excludes:\n    1.             accommodative excess; and\n    2.          processes primarily affecting the lens (presbyopia and cataract) or shape of the eyeball (myopia, hypermetropia, astigmatism); and\n    3.        reversible paralysis of ciliary muscle function by means of pharmacological agents, except where such agents cannot be ceased or substituted.\n2.           While accommodation disorder attracts ICD‑10‑AM code H52.5, in applying this Statement of Principles the meaning of accommodation disorder is that given in subsection (2).\n3.           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.\n\n\nDeath from accommodation disorder\n\n1.           For the purposes of this Statement of Principles, accommodation disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's accommodation disorder.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that accommodation disorder and death from accommodation disorder 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.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.                Factors that must exist\n\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting accommodation disorder or death from accommodation disorder with the circumstances of a person's relevant service:\n\n1.           having an injury or disorder affecting the function of the oculomotor nerve or ciliary muscle of the affected eye, at the time of clinical onset or clinical worsening;\n\n\nNote: an injury or disorder affecting the function of the oculomotor nerve or ciliary muscle is defined in the Schedule 1 – Dictionary.\n\n1.           having concussion at the time of clinical onset or clinical worsening;\n2.           having moderate to severe traumatic brain injury at the time of clinical onset or clinical worsening;\n3.           taking atropine or an atropine-like medication, where the medication cannot be ceased or substituted, at the time of clinical onset or clinical worsening;\n\n\nNote: atropine-like medication is defined in the Schedule 1 - Dictionary.\n\n1.           taking a medication from the specified list, where the medication cannot be ceased or substituted, at the time of clinical onset or clinical worsening;\n\n\nNote: medication from the specified list is defined in the Schedule 1 – Dictionary.\n\n1.           taking a medication at the time of clinical onset or clinical worsening which is associated with:\n  1.           the development of accommodation disorder during medication therapy; and\n  2.           the cessation of accommodation disorder upon discontinuing medication therapy;\n2.           inability to obtain appropriate clinical management for accommodation disorder before clinical worsening.\n\n\n1.            Relationship to service\n  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.\n  2.           The clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, accommodation disorder where the person's accommodation disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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;\n\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                               accommodation disorder—see subsection 7(2).\n\n                               an injury or disorder affecting the function of the oculomotor nerve or ciliary muscle means any pathological process affecting:\n\n(a)          the brain stem or the oculomotor nerve anywhere along its course (including the oculomotor nucleus, fascicles, subarachnoid space, cavernous sinus or orbit) that leads to a disturbance in the oculomotor nerve function; or\n\n(b)          ciliary muscle function;\n\n                               and causing impairment of accommodation.\n\n                                atropine-like medication means a medication having properties similar to atropine (that is, antagonising the effects of acetylcholine at parasympathetic nerve endings).\n\nNote 1: Examples of atropine-like drugs include antispasmodic agents (for example, scopolamine), drugs used to treat overactive bladder (for example, oxybutynin), eye drops used to facilitate examination of the fundus of the eye (for example, cyclopentolate), antipsychotic agents (for example, chlorpromazine, haloperidol, clozapine), tricyclic antidepressants (for example, amitriptyline, doxepin), sedative antihistamines (for example, clemastine, diphenhydramine), the anti-depressant maprotiline, and the anti-Parkinson medications benzatropine, biperiden, procyclidine and trihexyphenidyl.\n\nNote 2: Typical symptoms and signs of atropine-like drugs are dry mouth, blurred vision, sensitivity to light, dilated pupils, lack of sweating, and rapid heartbeat.\n\n                               medication from the specified list means:\n\n(a)          amfepramone;\n\n(b)          beclomethasone dipropionate;\n\n(c)          benzylpenicillin;\n\n(d)          betamethasone dipropionate;\n\n(e)          biperiden;\n\n(f)           budesonide;\n\n(g)          carbachol;\n\n(h)          carbamazepine;\n\n(i)            chloramphenicol;\n\n(j)            chloroquine;\n\n(k)          chlorpromazine hydrochloride;\n\n(l)            cortisone acetate;\n\n(m)        cyclopentolate hydrochloride;\n\n(n)          dexamethasone;\n\n(o)          diacetylmorphine;\n\n(p)          disopyramide phosphate;\n\n(q)          dronabinol;\n\n(r)           emetine (ipecac);\n\n(s)           ethanechol;\n\n(t)            fesoterodine fumarate;\n\n(u)          fludrocortisone acetate;  \n\n(v)          fluorometholone;\n\n(w)        fluphenazine hydrochloride;\n\n(x)          fluticasone propionate;\n\n(y)          hydrocortisone;\n\n(z)          hydromorphone hydrochloride;\n\n(aa)       hydroxyamphetamine;\n\n(bb)      hydroxychloroquine;\n\n(cc)       hyoscine butylbromide;\n\n(dd)      hyoscine hydrobromide;\n\n(ee)       hyoscine methobromide;\n\n(ff)        ipratropium;\n\n(gg)      isoniazid;\n\n(hh)      lithium;\n\n(ii)         lysergic acid diethylamide;\n\n(jj)         mescaline;\n\n(kk)      methacholine (systemic administration only);\n\n(ll)         methylprednisolone;\n\n(mm) morphine sulfate;\n\n(nn)      oxcarbazepine;\n\n(oo)      oxybutynin chloride;\n\n(pp)      oxymorphone hydrochloride;\n\n(qq)      perphenazine;\n\n(rr)        pilocarpine;\n\n(ss)        pimozide;\n\n(tt)         pralidoxime chloride;\n\n(uu)      prednisolone;\n\n(vv)      prednisone;\n\n(ww)  primidone;\n\n(xx)      prochlorperazine;\n\n(yy)      procyclidine hydrochloride;\n\n(zz)       promethazine hydrochloride;\n\n(aaa)   psilocybin;\n\n(bbb)  rimexolone;\n\n(ccc)   solifenacin succinate;\n\n(ddd)  telithromycin;\n\n(eee)   thiethylperazine;\n\n(fff)      tioridazine hydrochloride;\n\n(ggg)  topiramate;\n\n(hhh)  triamcinolone acetonide;\n\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               relevant service means:\n\n(a)          operational service under the VEA;\n\n(b)          peacekeeping service under the VEA;\n\n(c)          hazardous service under the VEA;\n\n(d)          British nuclear test defence service under the VEA;\n\n(e)          warlike service under the MRCA; or\n\n(f)           non-warlike service under the MRCA.\n\nNote: MRCA and VEA are defined in the Schedule 1 - Dictionary\n\n                               terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                               VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a straightforward reissue/replacement of an existing Statement of Principles (No. 38 of 2017). It maintains the same scope — establishing medical criteria for linking accommodation disorder to veteran service. The structure, purpose, and coverage remain consistent with the original intent of the Repatriation Medical Authority's function under section 196B(2) of the VEA."},"complexity_factors":["Extensive defined term list in Schedule 1 (8 defined terms, some with nested sub-definitions)","72 specific medications listed alphabetically in the 'medication from the specified list' definition","Cross-references to two separate Acts (VEA and MRCA) and their service categories","Conditional logic in section 9 requiring 'at the time of clinical onset or clinical worsening' for most factors","Exception clauses in the definition of accommodation disorder (excluding presbyopia, cataract, myopia, etc.)","Incorporation by reference to ICD-10-AM Tenth Edition (external medical classification system)","Dual application structure — covers both original onset and 'clinical worsening' with different rules for each (section 10(2))"],"plain_english_summary":"This instrument updates the 2017 rules on accommodation disorder (difficulty focusing the eyes), replacing them with current medical evidence and setting when veterans can claim for the condition or death caused by it. It applies to veterans and current/former Defence Force members making claims under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004.\n\nIt identifies seven service-related medical pathways (e.g., head injury, certain drugs, or lack of treatment) that can reasonably link the disorder to service, lowering the proof threshold so affected veterans can more easily access compensation and care."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"The instrument expressly repeals the 2017 Statement (section 4) but the text itself defines the condition, exclusions, claimant coverage (section 5), and the factors that raise a reasonable hypothesis (section 9). The instrument does not state an explicit expansion or narrowing of scope compared with the repealed instrument; based on this text alone a demonstrable change in scope cannot be established."},"complexity_factors":["Technical medical definitions and exclusions (accommodation disorder definition; subsection 7(2))","Diagnostic cross-reference to ICD-10-AM code H52.5 (subsection 7(3))","Large specified list of medications with varied indications and pharmacology (Schedule 1 definitions)","Causal test framed as a \"reasonable hypothesis\" requiring at least one listed factor (section 9) rather than probabilistic thresholds","Temporal distinctions between clinical onset and clinical worsening, and how worsening interacts with pre-existing conditions (section 10(2))","Cross‑reference to other Statements of Principles where factors concern injuries covered elsewhere (section 11)","Application limited to statutory claim pathways under the VEA and MRCA, so administrative and legal claims procedures matter (section 5)","Repeal of an earlier Statement without textual comparison, creating potential interpretive uncertainty about substantive change (section 4)"],"plain_english_summary":"This Statement of Principles (No. 21 of 2026) sets the medical criteria the Repatriation Medical Authority uses to decide whether \"accommodation disorder\" (difficulty adjusting the eye’s lens) — and deaths it contributes to — can be reasonably linked to veterans’ relevant service. It defines the condition and exclusions, lists clinical and medication-related causal factors (including specific drugs), and applies to claims under the VEA and MRCA. It affects veterans, medical assessors and decision‑makers because it governs when a service connection can be hypothesised for entitlement purposes."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026","history":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026/history","analysis":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026/analysis","conflicts":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026/important-cases","documents":"/api/acts/statement-of-principles-concerning-accommodation-disorder-reasonable-hypothesis-no-21-of-2026/documents"}}