{"id":"F2021L00364","name":"Statement of Principles concerning ankylosing spondylitis (Reasonable Hypothesis) (No. 39 of 2021)","slug":"statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":101581,"registerId":"commonwealth-F2021L00364-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 (Reasonable Hypothesis) (No. 39 of 2021)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning ankylosing spondylitis (Reasonable Hypothesis) (No. 39 of 2021)\n\nmade under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 39 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 (Reasonable Hypothesis) (No. 39 of 2021).\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that ankylosing spondylitis and death from ankylosing spondylitis 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting ankylosing spondylitis or death from ankylosing spondylitis with the circumstances of a person's relevant service:\n\n(1) having periodontitis for at least the three months before the clinical onset of ankylosing spondylitis;\n\n(2) having periodontitis for at least the three months before the clinical worsening of ankylosing spondylitis;\n\n(3) 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(4) being obese for at least five years within the ten years before the clinical worsening of ankylosing spondylitis;\n\n> Note: being obese is defined in the Schedule 1 \\- Dictionary.\n\n(5) 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(2) to 9(5) 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(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\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\nbeing obese means having a Body Mass Index (BMI) of 30 or greater.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\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) 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\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 (Reasonable Hypothesis) (No. 39 of 2021)                            | 29 March 2021F2021L00364  | 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(3) note.....                      | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument remains narrowly focused on setting medical criteria (factors and definitions) for establishing a reasonable hypothesis that ankylosing spondylitis is related to relevant service. The 2022 amendment clarified the technical definition of \"one pack‑year\" (Schedule 1) but did not broaden the substantive scope of the SoP beyond its original purpose of specifying medical factors and definitions for claims assessment."},"complexity_factors":["Short instrument (one SoP) focused on a single disease","About 9 defined terms in Schedule 1 (ankylosing spondylitis, ankylosing spondylitis exercises, being obese, BMI, MRCA, one pack-year, relevant service, terminal event, VEA)","Single list of 5 alternative factors in section 9 (simple conditional structure)","Timing constraints and applicability exceptions in section 10 (some nested conditions)","Cross‑reference to other Statements of Principles in section 11 (external complexity)","References to ICD‑10‑AM and other Acts (VEA/MRCA) introduce external legal/technical references","One recent technical amendment clarifying \"one pack‑year\" (endnotes) increases interpretive detail"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- This is a Statement of Principles (SoP) made under the Veterans' Entitlements Act that sets out the medical facts and the minimum factors that must exist before a \"reasonable hypothesis\" can be raised that a person's ankylosing spondylitis (AS) — or death from AS — is related to their military \"relevant service\" (see s.3, s.5, s.7).\n\n- It applies to claims under the VEA and the Military Rehabilitation and Compensation Act (MRCA) (s.5). The Repatriation Medical Authority states there is sufficient medical‑scientific evidence to link AS to relevant service in some circumstances (s.8).\n\n- The SoP defines what counts as ankylosing spondylitis for these purposes and excludes some other conditions (s.7(2)–(4)). It also treats death from a terminal event contributed to by AS as included (s.7(5)).\n\n- It lists five alternative factors — at least one of which must be present to meet the reasonable‑hypothesis threshold — and sets timing rules for how those factors relate to service (s.9–10):\n  - periodontitis for at least 3 months before clinical onset of AS (s.9(1));\n  - periodontitis for at least 3 months before clinical worsening of AS (s.9(2));\n  - for current smokers only, at least one pack‑year of smoking before clinical worsening (s.9(3));\n  - obesity (BMI ≥ 30) for at least 5 years within the 10 years before clinical worsening (s.9(4));\n  - inability to obtain appropriate clinical management for AS (s.9(5)).\n\n- The instrument sets out definitions used in the SoP (Schedule 1), including how BMI and one \"pack‑year\" are calculated, what \"ankylosing spondylitis exercises\" are, what counts as a terminal event, and what kinds of service count as relevant service.\n\n- It also says if a listed factor refers to another injury/disease that already has its own SoP, the factors in that other SoP apply as written (s.11).\n\nWho it affects\n\n- Primary: veterans and former or current members of the Forces (including peacekeepers and those covered by MRCA) who claim that their ankylosing spondylitis or death from AS is related to service (s.5, Schedule 1 definition of \"relevant service\").\n\n- Secondary: decision makers in the Department of Veterans' Affairs and adjudicators who use this SoP to decide whether a \"reasonable hypothesis\" exists linking AS to service; and health practitioners whose records will be used as evidence.\n\nWhy it matters (practical consequences)\n\n- This SoP sets the evidentiary threshold for accepting that service may be related to AS. If a claimant can show at least one of the listed factors, and that factor is related to relevant service, decision makers may be required to accept a reasonable hypothesis that service contributed to or aggravated AS (s.9–10).\n\n- The definitions matter in practice: for example, \"one pack‑year\" is precisely defined (Schedule 1) and obesity is defined by BMI ≥ 30, so claim outcomes will depend on medical records documenting these elements.\n\nAnalytical points — costs, incentives, trade‑offs and implementation risks\n\n- Who pays and who decides: the public (through the veterans' entitlements system) funds benefits if nexus is established; medical and disability decision makers apply the SoP. The Repatriation Medical Authority sets the medical criteria but DVA/tribunals apply them to individual claims (s.8, s.11).\n\n- Evidence burden and administrative cost: claimants need medical evidence of periodontitis, smoking history (pack‑years), BMI history, or evidence that appropriate clinical management was unavailable. Obtaining or reconstructing this evidence may be difficult, especially for older claims, creating compliance costs for claimants and administrative cost for decision makers.\n\n- Discretion and interpretation risk: some criteria are straightforward (BMI, pack‑year formula), but terms like \"inability to obtain appropriate clinical management\" require evaluative judgment and are open to interpretation, increasing variability in decisions (s.9(5), Schedule 1).\n\n- Timing and causation constraints: subsections 10(1)–(2) require the listed factor to be related to relevant service; subsections 9(2)–9(5) apply only where AS existed before or during service but did not arise out of service. Those timing rules narrow when particular factors can be used to argue material contribution or aggravation (s.10).\n\n- Cross‑references and aggregation: section 11 allows factors that refer to other injuries/diseases to import those other Statements of Principles, which can complicate assessments if multiple SoPs interact.\n\n- Effects on private actors: clinicians and dental practitioners will be asked for records; insurers and private providers are indirectly affected by requests for historical evidence. The measure does not alter private market prices or contract freedom directly; it standardises medical criteria for public benefit decisions.\n\n- Concentrated versus diffuse impacts: the main beneficiaries are claimants who meet the listed factors; the fiscal cost is borne by the public purse but dispersed across taxpayers. There is potential for increased claims where claimants can document the listed factors.\n\n- Implementation risk and unintended consequences: precisely defined measures (pack‑year, BMI) limit uncertainty, but reliance on historical dental records or proof of inability to access treatment may create inconsistent outcomes and delay.\n\n(See: s.5–11; Schedule 1 for definitions and calculations.)"},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses only ankylosing spondylitis and death therefrom, with the standard 'reasonable hypothesis' threshold consistent with other Statements of Principles under section 196B(2) of the VEA. The 2022 amendment merely refined the definition of 'one pack-year' without expanding the substantive scope."},"complexity_factors":["Short, focused instrument (approximately 12 operative sections)","Single disease focus with clear exclusion criteria (subsection 7(2))","Only 5 operative factors in section 9, with straightforward temporal requirements","Limited cross-referencing — primarily internal references to the Dictionary and defined terms","Simple conditional structure: 'at least one factor must exist' plus service connection requirement","One nested limitation in section 10(2) restricting factors 9(2)-9(5) to aggravation of pre-existing conditions only","Standard veterans' compensation framework definitions (VEA, MRCA, relevant service) reused from parent legislation","Mathematical formula provided for BMI calculation (W/H²) and detailed calculation method for pack-years"],"plain_english_summary":"This Statement of Principles sets medical rules under the Veterans' Entitlements Act for linking ankylosing spondylitis to Defence service. It affects veterans, peacekeepers, and DVA decision-makers by applying a low \"reasonable hypothesis\" test so certain risk factors can establish a service connection without definitive causation.\n\nIf a veteran had pre‑existing or service‑related disease, factors such as chronic gum disease, tobacco exposure, obesity, or inadequate access to care may support compensation for worsening of the condition; deaths where the disease contributed to a terminal event are also covered."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021","history":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-ankylosing-spondylitis-reasonable-hypothesis-no-39-of-2021/documents"}}