{"id":"F2021L00362","name":"Statement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021)","slug":"statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":101579,"registerId":"commonwealth-F2021L00362-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021)\n\nmade under subsection 196B(3) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021) that shows the text of the law as amended and in force on 19 September 2022.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes..........................................\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1 Name\n\nThis is the Statement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021).\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\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 ankylosing spondylitis and death from ankylosing spondylitis.\n\nMeaning of ankylosing spondylitis\n\n(2) For the purposes of this Statement of Principles, ankylosing spondylitis:\n\n(a) means a chronic, progressive, systemic inflammatory disease principally involving the sacroiliac joints and the axial skeleton; and\n\n(b) excludes psoriatic arthritis, reactive arthritis and fibromyalgia.\n\n> Note: People with ankylosing spondylitis typically have HLA B27 antigen, are usually less than 45 years of age at clinical onset and may have associated manifestations of inflammatory back pain, an elevated C-reactive protein, peripheral arthritis, heel enthesitis, uveitis or a family history of spondyloarthritis.\n\n(3) While ankylosing spondylitis attracts ICD‑10‑AM code M45, in applying this Statement of Principles the meaning of ankylosing spondylitis 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 ankylosing spondylitis\n\n(5) For the purposes of this Statement of Principles, ankylosing spondylitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's ankylosing spondylitis.\n\n> Note: 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 ankylosing spondylitis and death from ankylosing spondylitis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: 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, ankylosing spondylitis or death from ankylosing spondylitis is connected with the circumstances of a person's relevant service:\n\n(1) for current smokers only, having smoked at least one pack-year of tobacco products before the clinical worsening of ankylosing spondylitis;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(2) inability to obtain appropriate clinical management for ankylosing spondylitis.\n\n> Note 1: inability to obtain appropriate clinical management includes inability to undertake prescribed ankylosing spondylitis exercises.\n\n> Note 2: ankylosing spondylitis exercises is defined in the Schedule 1 - Dictionary.\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(1) to 9(2) apply only to material contribution to, or aggravation of, ankylosing spondylitis where the person's ankylosing spondylitis 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nankylosing spondylitis—see subsection 7(2).\n\nankylosing spondylitis exercises means regular stretching and range of motion exercises, together with either aerobic exercises or group exercises.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                          | Registration              | Commencement      | Application, saving and transitional provisions |\n| ----------------------------------------------------------------------------------------------------------------------------- | ------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning ankylosing spondylitis (Balance of Probabilities) (No. 40 of 2021)                         | 29 March 2021F2021L00362  | 27 April 2021     |                                                 |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128 | 19 September 2022 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                             | How affected      |\n| ---------------------------------------------- | ----------------- |\n| Section 2……………….                               | rep LA s 48D      |\n| Section 4……………….                               | rep LA s 48C      |\n| Subsection 9(1) note.....                      | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument remains tightly focused on its original purpose: establishing the medical factors for linking ankylosing spondylitis to military service. The only amendment to date (No. 94 of 2022) clarified the definition of 'one pack-year' without expanding the scope of conditions covered or the classes of claimants affected."},"complexity_factors":["Short, focused instrument with only 11 operative sections plus a dictionary","Minimal cross-referencing — primarily refers to the Dictionary in Schedule 1 and parent Acts (VEA and MRCA)","Only 7 defined terms in the Dictionary (ankylosing spondylitis, ankylosing spondylitis exercises, MRCA, one pack-year, relevant service, terminal event, VEA)","Simple conditional structure: two alternative factors in section 9, with a single limitation in section 10(2) restricting application to aggravation cases","No nested exceptions or complex temporal calculations beyond the 'before clinical worsening' requirement for smoking","Straightforward mathematical definition for 'one pack-year' with worked examples in the notes"],"plain_english_summary":"This Statement of Principles sets the medical test the Repatriation Medical Authority and DVA use to decide compensation for ankylosing spondylitis. It requires a “balance of probabilities” that service aggravated pre‑existing disease and, for a successful claim, at least one of two specific factors: current smoker with ≥1 pack‑year before worsening, or inability to obtain appropriate clinical management (including prescribed exercises). If neither factor is proven, an aggravation claim will likely fail."},"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"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument’s substantive scope — which condition is covered and the qualifying causal pathways — remains the same. Amendments recorded in the compilation clarify measurement and definitions (notably the definition and calculation of “one pack‑year”) and add related notes, but do not expand or remove the kinds of injury or the categories of persons to whom the Statement applies (see Schedule 1 and Endnotes concerning the 2022 amendment)."},"complexity_factors":["Medical‑legal interface: the instrument translates medical-scientific judgment into legal causation criteria; the Repatriation Medical Authority expresses the medical view on probability (section 8).","Narrow, evidence‑based qualifying factors: only specified factors count (current smoking ≥ one pack‑year; inability to obtain appropriate clinical management) (section 9).","Causation linkage requirement: any qualifying factor must be related to the person’s relevant service, and applies to material contribution or aggravation where the condition pre‑existed or began before/during service (section 10).","Precision in definitions: technical definitions (ankylosing spondylitis, one pack‑year, ankylosing spondylitis exercises, terminal event, relevant service) are set in the Schedule and affect measurement and proof (section 7; Schedule 1).","Interplay with other Statements of Principles: factors that reference other injuries or diseases invoke the terms of those SOPs as in force (section 11), creating cross‑instrument dependencies.","Administrative scope: instrument applies specifically to claims under VEA s120B and MRCA s339, focusing on veterans and certain members of the Forces (section 5).","Death linkage: death is included where a terminal event or condition was contributed to by ankylosing spondylitis; terminal events are listed in the Dictionary (section 7(5); Schedule 1).","Amendment history: definitional amendments (eg. definition of one pack‑year) affect how behavioural exposure is calculated and proven (endnotes/Amendment history)."],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide whether ankylosing spondylitis (or death from it) is connected to a veteran’s relevant service for VEA and MRCA claims. It identifies the qualifying pathways (for example, current smokers meeting a defined “one pack‑year” threshold or inability to obtain appropriate clinical management) and requires those factors to be related to the person’s service. It matters because those criteria determine entitlement decisions and the evidentiary focus of claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021","history":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-balance-of-probabilities-no-40-of-2021/documents"}}