{"id":"F2021L00016","name":"Statement of Principles concerning angle-closure glaucoma (Balance of Probabilities) (No. 6 of 2021)","slug":"statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440736,"registerId":"F2021L00016-fast-fetch-1775956268688","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning angle-closure glaucoma (Balance of Probabilities) (No. 6 of 2021)","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\nANGLE-CLOSURE GLAUCOMA (Balance of Probabilities)\n\n(No. 6 of 2021)\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 24 December 2020\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:
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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 angle-closure glaucoma (Balance of Probabilities) (No. 6 of 2021).\n\n2 Commencement\n\n This instrument commences on 25 January 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning angle-closure glaucoma No. 26 of 2012 (Federal Register of Legislation No. F2012L00471) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\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 angle-closure glaucoma and death from angle-closure glaucoma.\n\nMeaning of angle-closure glaucoma\n\n(2) For the purposes of this Statement of Principles, angle-closure glaucoma means acquired closure of the anterior chamber angle of the eye, leading to reduction in aqueous outflow and elevation of intraocular pressure, and with associated ocular symptoms and signs.\n\nNote 1: Angle-closure glaucoma can be acute, subacute or chronic.\n\nNote 2: Typical symptoms and signs of acute angle-closure glaucoma are rapid onset of severe eye pain, nausea or vomiting, corneal oedema and poor visual acuity.\n\nNote 3: Chronic angle-closure glaucoma causes a progressive neuropathy involving characteristic optic disc abnormalities and visual field defects.\n\n(3) While angle-closure glaucoma attracts ICD‑10‑AM code H40, in applying this Statement of Principles the meaning of angle-closure glaucoma 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 angle-closure glaucoma\n\n(5) For the purposes of this Statement of Principles, angle-closure glaucoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's angle-closure glaucoma.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that angle-closure glaucoma and death from angle-closure glaucoma 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\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, angle-closure glaucoma or death from angle-closure glaucoma is connected with the circumstances of a person's relevant service:\n\n(1) taking a drug from the specified list of drugs within the 21 days before the clinical onset of angle-closure glaucoma;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(2) taking a drug which causes:\n\n(a) mydriasis or miosis in the affected eye; or\n\n(b) an allergic or inflammatory reaction involving structures of the anterior segment of the affected eye;\n\nwithin the 21 days before the clinical onset of angle-closure glaucoma;\n\n(3) having uveitis, scleritis or episcleritis at the time of the clinical onset of angle-closure glaucoma, where the disease involves the structures of the anterior chamber of the affected eye;\n\nNote: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.\n\n(4) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-neoplastic lesion;\n\nwhich involves the anterior segment of the affected eye at the time of the clinical onset of angle-closure glaucoma;\n\nNote 1: Examples of a benign or malignant neoplasm include melanoma, retinoblastoma, leukaemia and lymphoma.\n\nNote 2: Examples of a non-neoplastic lesion include amyloidosis, cyst, ocular haemorrhage, retinal detachment and vascular malformation or thrombosis.\n\n(5) having a disorder of the lens of the affected eye at the time of the clinical onset of angle-closure glaucoma;\n\nNote: Examples of a disorder of the lens include cataract and lens displacement, subluxation or dislocation.\n\n(6) having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical onset of angle-closure glaucoma;\n\nNote: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.\n\n(7) having trauma to the affected eye before the clinical onset of angle-closure glaucoma;\n\nNote: trauma is defined in the Schedule 1 - Dictionary.\n\n(8) having sympathetic ophthalmia at the time of the clinical onset of angle-closure glaucoma;\n\nNote: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.\n\n(9) having surgery to the affected eye, or eyelid of the affected eye, before the clinical onset of angle-closure glaucoma;\n\n(10) having surgery requiring a general anaesthetic, or surgery in the prone position, within the 21 days before the clinical onset of angle-closure glaucoma;\n\n(11) undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical onset of angle-closure glaucoma;\n\n(12) taking a drug from the specified list of drugs within the 21 days before the clinical worsening of angle-closure glaucoma;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(13) taking a drug which causes:\n\n(a) mydriasis or miosis in the affected eye; or\n\n(b) an allergic or inflammatory reaction involving structures of the anterior segment of the affected eye;\n\nwithin the 21 days before the clinical worsening of angle-closure glaucoma;\n\n(14) having uveitis, scleritis or episcleritis at the time of the clinical worsening of angle-closure glaucoma, where the disease involves the structures of the anterior chamber of the affected eye;\n\nNote: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.\n\n(15) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-neoplastic lesion;\n\nwhich involves the anterior segment of the affected eye at the time of the clinical worsening of angle-closure glaucoma;\n\nNote 1: Examples of a benign or malignant neoplasm include melanoma, retinoblastoma, leukaemia and lymphoma.\n\nNote 2: Examples of a non-neoplastic lesion include amyloidosis, cyst, ocular haemorrhage, retinal detachment and vascular malformation or thrombosis.\n\n(16) having a disorder of the lens of the affected eye at the time of the clinical worsening of angle-closure glaucoma;\n\nNote: Examples of a disorder of the lens include cataract and lens displacement, subluxation or dislocation.\n\n(17) having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical worsening of angle-closure glaucoma;\n\nNote: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.\n\n(18) having trauma to the affected eye before the clinical worsening of angle-closure glaucoma;\n\nNote: trauma is defined in the Schedule 1 - Dictionary.\n\n(19) having sympathetic ophthalmia at the time of the clinical worsening of angle-closure glaucoma;\n\nNote: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.\n\n(20) having surgery to the affected eye, or eyelid of the affected eye, before the clinical worsening of angle-closure glaucoma;\n\n(21) having surgery requiring a general anaesthetic, or surgery in the prone position, within the 21 days before the clinical worsening of angle-closure glaucoma;\n\n(22) undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical worsening of angle-closure glaucoma;\n\n(23) inability to obtain appropriate clinical management for angle-closure glaucoma.\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 factors set out in subsections 9(12) to 9(23) apply only to material contribution to, or aggravation of, angle-closure glaucoma where the person's angle-closure glaucoma 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(3) 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 angle-closure glaucoma—see subsection 7(2).\n\n episcleritis means acute or chronic inflammation of the superficial, episcleral layer of the eye ball.\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 scleritis means acute or chronic inflammation that affects the white outer coating of the eye ball.\n\n specified list of conditions or procedures means:\n\n(a) carotid artery disease;\n\n(b) carotid endarterectomy;\n\n(c) diabetic retinopathy;\n\n(d) intraocular surgery;\n\n(e) intraocular tumour;\n\n(f) radiotherapy;\n\n(g) retinal detachment;\n\n(h) retinal vascular occlusion;\n\n(i) retinal vasculitis; or\n\n(j) another acquired condition causing posterior segment ischaemia.\n\n specified list of drugs means:\n\n(a) alpha-adrenoceptor agonists;\n\n(b) amphetamines; \n\n(c) anticholinergics; \n\n(d) anticoagulants; \n\n(e) antihistamines; \n\n(f) botulinum toxin; \n\n(g) cholinergic agents; \n\n(h) furosemide;\n\n(i) general anaesthetic;\n\n(j) intranasal or intraocular cocaine;\n\n(k) intravitreal injection;\n\n(l) monoamine oxidase inhibitors; \n\n(m) phenothiazine antipsychotics; \n\n(n) pilocarpine; \n\n(o) selective serotonin reuptake inhibitors; \n\n(p) serotonin noradrenaline reuptake inhibitors;\n\n(q) sulfa containing drugs;\n\n(r) tetracyclic antidepressants;\n\n(s) tetracycline; and\n\n(t) tricyclic antidepressants.\n\n sympathetic ophthalmia means the presence of uveitis in both eyes following:\n\n(a) intraocular surgery to one eye; or\n\n(b) trauma to one eye.\n\nNote: uveitis is 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 trauma means:\n\n(a) blunt or penetrating physical injury; or\n\n(b) chemical, thermal or radiation injury;\n\n that results in intraocular inflammation, intraocular bleeding or other intraocular tissue disruption.\n\n uveitis means acute or chronic inflammation of the vascular middle coat of the eye ball, comprising the iris, ciliary body and choroid. This definition includes choroidal effusion.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established scope of determining service connection for a specific medical condition. It updates the 2012 version with current medical evidence but does not expand beyond the original purpose of defining causation factors for veterans' compensation purposes."},"complexity_factors":["23 distinct factors with parallel structure (factors 1-11 for onset, 12-22 for worsening, 23 for both)","Multiple defined terms in Schedule 1 (approximately 12 formal definitions including cross-references between definitions)","Extensive use of defined lists ('specified list of drugs' with 20 entries, 'specified list of conditions or procedures' with 10 entries)","Temporal conditions requiring precise dating (21-day windows for drugs/surgery, 'before' vs 'at the time of' vs 'within')","Nested definitions (sympathetic ophthalmia refers to uveitis, which is separately defined)","Cross-referencing mechanism in section 11 linking to other Statements of Principles","Dual statutory framework application (VEA and MRCA with different service definitions)"],"plain_english_summary":"This instrument updates the medical rules for linking angle‑closure glaucoma (or death from it) to Australian military service, replacing the 2012 version with current evidence. It sets a 23‑factor framework and uses the “balance of probabilities” test to decide compensation claims under the VEA and MRCA. \n\nIt matters to veterans and DVA decision‑makers because these medical criteria (including specific drug/time windows and clinical onset/worsening rules) determine entitlement to taxpayer‑funded treatment and benefits."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning angle‑closure glaucoma No. 26 of 2012 (s.4) and replaces it with the current Statement, which specifies defined medical meanings, new/updated enumerated lists of drugs and conditions and timing rules in the Schedule (s.7, Schedule 1, s.9). It applies to claims under the VEA and MRCA (s.5). Because only the current instrument text is provided, the exact direction and extent of substantive change from the previous Statement cannot be determined from this document alone."},"complexity_factors":["Technical medical definitions and concepts (angle‑closure glaucoma, uveitis, scleritis, episcleritis, sympathetic ophthalmia, terminal event) – s.7(2), s.7(5), Schedule 1.","Multiple temporal rules and windows (21‑day windows for onset or worsening) that must be satisfied for many factors – s.9(1), s.9(12), s.9(10), s.9(21).","Extensive enumerated lists of implicated drugs and conditions/procedures in the Schedule that feed into causation findings – Schedule 1 (specified list of drugs; specified list of conditions or procedures).","Conditional application for aggravation/material contribution vs new onset (factors 9(12)–9(23) apply only where pre‑existing glaucoma was suffered or contracted before or during service) – s.10(2).","Cross‑references to other Statements of Principles which import factors from those instruments where relevant – s.11.","Normative tie to statutory claims regimes (applies to claims under s.120B of the VEA or s.339 of the MRCA) which determines administrative effect – s.5.","Repeal of prior Statement and replacement by this instrument, creating potential change in coverage or evidentiary detail (repeal stated) – s.4.","Reference to ICD‑10‑AM coding while defining the condition by its clinical description, creating a hybrid medical/legal definition – s.7(2)–(4)."],"plain_english_summary":"This instrument replaces the earlier Statement and sets the medical criteria used to decide, on the balance of probabilities, whether angle‑closure glaucoma (or death from it) is connected to a person’s military or veteran service. It affects veterans and serving members lodging claims under the VEA or MRCA by listing specific drugs, eye diseases, procedures, surgeries, traumas and timing rules that, if present, support a finding of service connection."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021","history":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-angle-closure-glaucoma-balance-of-probabilities-no-6-of-2021/documents"}}