{"id":"F2025L00499","name":"Statement of Principles concerning analgesic nephropathy (Balance of Probabilities) (No. 44 of 2025)","slug":"statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442817,"registerId":"F2025L00499-fast-fetch-1775957745832","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning analgesic nephropathy (Balance of Probabilities) (No. 44 of 2025)","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\nANALGESIC NEPHROPATHY  (Balance of Probabilities)\n\n(No. 44 of 2025)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 15 April 2025\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\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 analgesic nephropathy (Balance of Probabilities) (No. 44 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 19 May 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning analgesic nephropathy No. 78 of 2016 (Federal Register of Legislation No. F2016L01680) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 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 analgesic nephropathy and death from analgesic nephropathy.\n\n\nMeaning of analgesic nephropathy\n\n1.           For the purposes of this Statement of Principles, analgesic nephropathy:\n\n\nmeans a bilateral chronic renal disease characterised by papillary necrosis, chronic interstitial nephritis, renal cortical atrophy and capillary sclerosis, and a clinical state of loss of renal function in an individual with a history of consumption of large amounts of analgesic agents, occurring in the absence of another biochemical, anatomical or metabolic cause for renal impairment.\n\n1.           While analgesic nephropathy attracts ICD‑10‑AM code N14.0, in applying this Statement of Principles the meaning of analgesic nephropathy is that given in subsection (2).\n2.           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 analgesic nephropathy\n\n1.           For the purposes of this Statement of Principles, analgesic nephropathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's analgesic nephropathy.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that analgesic nephropathy and death from analgesic nephropathy can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, analgesic nephropathy or death from analgesic nephropathy is connected with the circumstances of a person's relevant service:\n\n1.           Consuming:\n  1.           a total of at least 1 kg of phenacetin in a phenacetin-containing analgesic before clinical onset; or\n  2.           an average of at least 1 g/day of phenacetin in a phenacetin-containing analgesic for a continuous period of at least 2 years immediately preceding clinical onset;\n\n\nNote 1: Phenacetin is an aniline derivative drug with analgesic and antipyretic properties. It was a constituent of over-the-counter compound analgesic medications including Bex powder, Vincent’s powder, Empirin Compound, and Bromo seltzer. \n\nNote 2: Phenacetin is also known as acetophenetidin, aceto-p-phenetidide, acetylphenetidin, phenacetinum, N-(4-ethoxyphenyl) acetamide, p-ethoxyacetanilide, or CAS 62-44-2.\n\n1.           inability to obtain appropriate clinical management for analgesic nephropathy 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 factor set out in subsection 9(2) applies only to material contribution to, or aggravation of, analgesic nephropathy where the person's analgesic nephropathy 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(3) 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                               analgesic nephropathy—see subsection 7(2).\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime 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":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2016 Statement (section 4) and replaces it with a Statement that includes explicit phenacetin‑consumption thresholds (section 9), a textual medical definition with exclusion of other causes (section 7), clarified inclusion of death (section 7(4)) and specific relationship-to-service rules (section 10). Those concrete changes to qualifying criteria alter the practical scope of cases that will satisfy a service connection, though the instrument itself does not include a side‑by‑side comparison to the repealed text."},"complexity_factors":["Quantitative phenacetin exposure thresholds required as qualifying factors (section 9(1)(a)-(b)), creating reliance on historical dosage evidence.","Medical-definition requires exclusion of other biochemical, anatomical or metabolic causes (section 7(2)), imposing differential-diagnosis burdens on clinicians and decision-makers.","Application limited to statutory claim frameworks (section 5) — Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004 — so legal entitlement hinges on medical finding.","Relationship-to-service rules require a causal link to 'relevant service' (section 10(1)) and restrict material contribution/aggravation where the disease pre-existed or was contracted before/during but 'did not arise out of' service (section 10(2)), creating nuanced causation inquiries.","Interaction with other Statements of Principles (section 11) means overlapping or prior determinations can change which factors apply to a claim.","Replaces an earlier Statement (section 4), so claim outcomes may shift depending on differences between the instruments.","Inclusion of death via 'terminal event' brings additional medical-causation issues and requires application of Schedule 1 definitions (section 7(4); Schedule 1).","Evidentiary standard specified as 'balance of probabilities' (title and section 8) — legal standard applied to medical evidence.","Reference to ICD-10-AM coding (section 7(3)) while defining the condition by text may create alignment issues between clinical coding and statutory definition.","Commencement date (section 2) and repeal timing require administrative transition for ongoing claims and evidence that spans instruments."],"plain_english_summary":"This Statement fixes the medical criteria the Repatriation Medical Authority will use to decide, on the balance of probabilities, whether analgesic nephropathy (and death from it) is connected to a veteran’s relevant service. It defines the condition, includes death from terminal events, prescribes specific phenacetin‑consumption thresholds as qualifying factors, applies to VEA and MRCA claims, and repeals the 2016 Statement. The instrument commences on 19 May 2025."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2016 predecessor and the standard Repatriation Medical Authority format. It addresses a single, specific medical condition (analgesic nephropathy) with defined clinical parameters and established causal factors. There is no evidence of scope creep; the instrument remains tightly focused on determining service connection for this particular kidney disease through well-established phenacetin consumption thresholds or clinical management factors."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (analgesic nephropathy, MRCA, relevant service, terminal event, VEA)","Single medical condition with precise clinical definition","Only 2 substantive factors for establishing connection to service (phenacetin consumption threshold OR inability to obtain clinical management)","Minimal cross-referencing — primarily internal references to the Dictionary and parent Acts","Clear structure following standard Repatriation Medical Authority template","No nested exceptions or complex conditional logic beyond basic temporal requirements (\"before clinical onset\", \"continuous period of at least 2 years\")"],"plain_english_summary":"This instrument replaces the 2016 rules and sets the medical test for when analgesic nephropathy — kidney damage from heavy use of phenacetin-containing painkillers — qualifies for compensation. It applies to veterans under the VEA and current/former defence members under the MRCA and requires showing, on the balance of probabilities, a service-linked history of heavy phenacetin use or inadequate medical care that worsened the condition; it also covers related deaths."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025","history":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-balance-of-probabilities-no-44-of-2025/documents"}}