{"id":"F2019L00641","name":"Statement of Principles concerning acute rheumatic fever (Reasonable Hypothesis) (No. 53 of 2019)","slug":"statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440055,"registerId":"F2019L00641-fast-fetch-1775955837093","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning acute rheumatic fever (Reasonable Hypothesis) (No. 53 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nACUTE RHEUMATIC FEVER (Reasonable Hypothesis)\n\n(No. 53 of 2019)\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 26 April 2019\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\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\n1 Name\n\nThis is the Statement of Principles concerning acute rheumatic fever (Reasonable Hypothesis) (No. 53 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning acute rheumatic fever No. 23 of 2011 (Federal Register of Legislation No. F2011L00503) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about acute rheumatic fever and death from acute rheumatic fever.\n\nMeaning of acute rheumatic fever\n\n(2) For the purposes of this Statement of Principles, acute rheumatic fever:\n\n(a) means a systemic, inflammatory autoimmune disease that follows laboratory confirmed infection with beta-haemolytic streptococcus; and\n\n(b) excludes post-streptococcal reactive arthritis.\n\nNote 1: Acute rheumatic fever may affect the heart as clinical or subclinical carditis; the joints as polyarthritis, monoarthritis or polyarthralgia; the central nervous system; and the skin or subcutaneous tissues. It can also present as isolated Sydenham chorea or indolent subclinical carditis.\n\nNote 2: Laboratory confirmation of infection may occur at the time of the streptococcal infection using positive throat culture, positive rapid antigen test or positive molecular assay, or later using positive serology for streptococcus.\n\n(3) While acute rheumatic fever attracts ICD‑10‑AM code I00, I01 or I02, in applying this Statement of Principles the meaning of acute rheumatic fever is that given in subsection (2).\n\n(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.\n\nDeath from acute rheumatic fever\n\n(5) For the purposes of this Statement of Principles, acute rheumatic fever, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's acute rheumatic fever.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that acute rheumatic fever and death from acute rheumatic fever 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\n9 Factors that must exist\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 acute rheumatic fever or death from acute rheumatic fever with the circumstances of a person's relevant service:\n\n(1) having a group A beta-haemolytic streptococcal infection of the skin or the pharynx within the three months before the clinical onset of acute rheumatic fever;\n\n(2) for acute rheumatic fever manifesting as isolated chorea or as indolent subclinical carditis only, having a group A beta-haemolytic streptococcal infection of the skin or the pharynx within the nine months before the clinical onset of acute rheumatic fever;\n\n(3) having a group C or G streptococcal infection of the pharynx within the three months before the clinical onset of acute rheumatic fever;\n\n(4) experiencing crowded living or working conditions within the one year before the clinical onset of acute rheumatic fever;\n\n(5) having dental caries within the one year before the clinical onset of acute rheumatic fever;\n\n(6) inability to obtain appropriate clinical management for acute rheumatic fever.\n\n10 Relationship to service\n\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\n(2) The factor set out in subsection 9(6) applies only to material contribution to, or aggravation of, acute rheumatic fever where the person's acute rheumatic fever was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(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;\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 acute rheumatic fever—see subsection 7(2).\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 also 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 instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2011 version without expanding beyond the core function of establishing medical nexus criteria for veteran compensation claims. The definitional updates (ICD-10-AM edition update, exclusion clarification) are technical refinements rather than scope expansion."},"complexity_factors":["Multiple nested time limits (3 months, 9 months, 1 year) that vary by clinical presentation","Conditional logic in section 9(6) restricting the 'inability to obtain appropriate clinical management' factor to pre-existing or concurrent conditions only","Cross-referencing mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Dual statutory framework requiring definitions from both VEA and MRCA","Medical terminology requiring ICD-10-AM code cross-reference with explicit edition locking (Tenth Edition, 1 July 2017)","Specific exclusion in definition (post-streptococcal reactive arthritis excluded despite similar pathology)"],"plain_english_summary":"This rulebook sets the medical test for whether Australian Defence Force members, veterans (and their families in death claims) can get compensation for acute rheumatic fever by requiring a “reasonable hypothesis” that service contributed to the disease. It requires at least one specified infection, environmental, dental, or treatment-related factor connected to service. Replacing the 2011 guidance, it tightens evidence standards and clarifies that post‑streptococcal reactive arthritis is excluded."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2011 Statement of Principles (s4) and replaces it with updated definitions and a revised list of factors and timeframes for establishing a reasonable hypothesis of service connection (see ss7 and 9). It therefore alters the governing medical criteria applied to VEA/MRCA claims (s5)."},"complexity_factors":["Legal-technical structure: short statutory instrument with cross-references to the VEA and MRCA and internal sections (ss3,5,11).","Medical specificity: disease definition requires laboratory confirmation and distinguishes clinical presentations (s7(2), notes).","Temporal windows: different evidentiary timeframes for streptococcal infections and presentations (s9(1)–(3)).","Non-medical factors: inclusion of crowded living, dental caries and access to care as qualifying factors (s9(4)–(6)).","Interaction with other Statements: factors that overlap another Statement are governed by that Statement (s11).","Limited discretion on contribution/aggravation: factor 9(6) constrained by relationship-to-service rules (s10(2)).","Repeal and replacement of prior instrument creates need to compare criteria changes (s4)."],"plain_english_summary":"This instrument, made by the Repatriation Medical Authority, sets the medical criteria used to decide if acute rheumatic fever (or death from it) can be connected to a veteran’s or service member’s service for claims under the VEA or MRCA (ss3,5). It defines the disease, lists specific infectious, environmental and care‑access factors and timeframes that can raise a reasonable hypothesis of service connection (ss7,9), and repeals the 2011 Statement (s4)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019","history":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-acute-rheumatic-fever-reasonable-hypothesis-no-53-of-2019/documents"}}