{"id":"F2025L00497","name":"Statement of Principles concerning analgesic nephropathy (Reasonable Hypothesis) (No. 43 of 2025)","slug":"statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442816,"registerId":"F2025L00497-fast-fetch-1775957745816","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning analgesic nephropathy (Reasonable Hypothesis) (No. 43 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  (Reasonable Hypothesis)\n\n(No. 43 of 2025)\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 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   \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 (Reasonable Hypothesis) (No. 43 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning analgesic nephropathy No. 77 of 2016 (Federal Register of Legislation No. F2016L01667) made under subsection 196B(2) of the VEA is repealed.\n\n1.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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that analgesic nephropathy and death from analgesic nephropathy 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 analgesic nephropathy or death from analgesic nephropathy 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(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                                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)          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":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The instrument repeals the prior Statement (s4) and replaces it with specific, measurable factors: explicit phenacetin exposure thresholds (s9(1)) and a factor for inability to obtain appropriate clinical management (s9(2)). It retains the defined medical meaning of analgesic nephropathy (s7(2)) and includes death from the condition (s7(4)). The instrument is applied to claims under the VEA or MRCA (s5). These changes shift the practical criteria used to decide linkage to service by clarifying exposure and care‑access tests and by cross‑referencing other Statements where relevant (s11)."},"complexity_factors":["Technical medical definition of analgesic nephropathy with multiple pathological features (s7(2)).","Quantitative exposure thresholds for phenacetin (total ≥1 kg or average ≥1 g/day for ≥2 years) as a primary causal factor (s9(1)).","Non‑exposure causal factor: inability to obtain appropriate clinical management before clinical worsening (s9(2)).","Causation standard is legal ('reasonable hypothesis') rather than strict scientific proof (instrument to be applied under s196B(2) framework; see s8 and overall title).","Requirement that any qualifying factor be related to the person's relevant service (s10(1)) and limits on s9(2) to material contribution/aggravation where condition pre‑dated or occurred during service (s10(2)).","Cross‑references to other Statements of Principles where overlapping injuries/diseases exist (s11).","Dependence on an external disease coding standard (ICD‑10‑AM) for classification, while defining the term within the instrument (s7(3)).","Repeal and replacement of the prior Statement (No. 77 of 2016), which can change eligibility/assessment practice (s4).","Application strictly tied to claims under the VEA (s120A) or MRCA (s338) (s5), creating procedural and evidentiary linkages to those statutes.","Definitions that affect scope of death coverage (terminal event definition in Schedule 1) and what counts as relevant service (Schedule 1)."],"plain_english_summary":"This instrument replaces an earlier Repatriation Medical Authority statement and sets the medical criteria used to decide whether analgesic nephropathy (and death from it) can be connected to a veteran’s or service member’s relevant service. It requires evidence such as specified phenacetin exposure thresholds or inability to obtain appropriate clinical management. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act, and the Repatriation Medical Authority decides if a reasonable hypothesis has been raised."},"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":"The instrument maintains its original narrow purpose: establishing specific evidentiary thresholds for one discrete medical condition (analgesic nephropathy) in the veterans' compensation scheme. The 2025 revision appears to be a straightforward reissue/replacement of the 2016 version without expansion into new causal pathways or claimant categories."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 6 defined terms in the Dictionary (Schedule 1)","Clear, linear structure with minimal cross-referencing","Two alternative threshold factors in section 9 with straightforward quantitative tests (1 kg total or 1 g/day for 2 years)","Single conditional limitation in section 10(2) restricting one factor to pre-existing conditions","Incorporation by reference to ICD-10-AM Tenth Edition for coding purposes only"],"plain_english_summary":"This instrument sets the medical rules for claiming compensation for analgesic nephropathy — kidney damage linked to long-term use of phenacetin-containing painkillers — for veterans, peacekeepers and current/former Defence Force members, replacing the 2016 rules.\n\nIt requires claimants to meet strict evidence thresholds (heavy phenacetin consumption or inability to obtain treatment) and limits compensation for pre-existing cases unless service-related lack of treatment caused worsening, tightening what counts as service-related disease."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025","history":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-analgesic-nephropathy-reasonable-hypothesis-no-43-of-2025/documents"}}