{"id":"F2020L01085","name":"Statement of Principles concerning aplastic anaemia (Reasonable Hypothesis) (No. 58 of 2020)","slug":"statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440586,"registerId":"F2020L01085-fast-fetch-1775956160132","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning aplastic anaemia (Reasonable Hypothesis) (No. 58 of 2020)","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\nAPLASTIC ANAEMIA (Reasonable Hypothesis)\n\n(No. 58 of 2020)\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 28 August 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:
|\n| --- |\n| 
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 Schedules\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\nSchedule 2 - Drugs\n\n1 Specified Drugs\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning aplastic anaemia (Reasonable Hypothesis) (No. 58 of 2020).\n\n2 Commencement\n\n This instrument commences on 28 September 2020.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning aplastic anaemia No. 50 of 2012 (Federal Register of Legislation No. F2012L01791) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 Schedules\n\nAny item in a Schedule to this Instrument has effect according to its terms.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about aplastic anaemia and death from aplastic anaemia.\n\nMeaning of aplastic anaemia\n\n(2) For the purposes of this Statement of Principles, aplastic anaemia:\n\n(a) means bone marrow failure, characterised by:\n\n(i) destruction of haematopoietic stem cells with peripheral blood cytopaenia; and\n\n(ii) hypocellular bone marrow in which normal haematopoietic tissue is replaced by fatty marrow; and\n\n(b) excludes:\n\n(i) inherited bone marrow failure syndromes, including Fanconi anaemia, dyskeratosis congenita, Shwachman-Diamond syndrome and inherited amegakaryocytic thrombocytopaenia;\n\n(ii) isolated leukopaenia and isolated thrombocytopaenia;\n\n(iii) myelodysplastic syndrome;\n\n(iv) paroxysmal nocturnal haemoglobinuria; and\n\n(v) replacement of bone marrow due to fibrosis or an infiltrative neoplastic process.\n\n(3) While aplastic anaemia attracts ICD‑10‑AM code D61.1, D61.2, D61.3 or D61.8, in applying this Statement of Principles the meaning of aplastic anaemia 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 aplastic anaemia\n\n(5) For the purposes of this Statement of Principles, aplastic anaemia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's aplastic anaemia.\n\nNote: 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 aplastic anaemia and death from aplastic anaemia 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\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 aplastic anaemia or death from aplastic anaemia with the circumstances of a person's relevant service:\n\n(1) being pregnant at the time of the clinical onset of aplastic anaemia;\n\n(2) being treated with a drug specified in the Schedule 2 - Drugs of this Instrument within the one year before the clinical onset of aplastic anaemia;\n\n(3) being treated with a drug which is associated in the individual with:\n\n(a) the development of aplastic anaemia within six months of drug therapy; and\n\n(b) the improvement of aplastic anaemia within six months of discontinuing or tapering drug therapy;\n\n(4) taking a non-aspirin, nonsteroidal, anti-inflammatory drug on at least four days per week for a continuous period of at least four weeks, within the one year before the clinical onset of aplastic anaemia;\n\n(5) using 3,4-methylenedioxymethamphetamine (ecstasy) within the three months before the clinical onset of aplastic anaemia;\n\n(6) being exposed to benzene as specified on at least 30 days within the one year before the clinical onset of aplastic anaemia;\n\nNote: being exposed to benzene as specified is defined in the Schedule 1 - Dictionary. \n\n(7) inhaling, ingesting or having cutaneous contact with a herbicide or insecticide from the specified list of herbicides and insecticides, on at least 30 days within the six months before the clinical onset of aplastic anaemia;\n\nNote: specified list of herbicides and insecticides is defined in the Schedule 1 - Dictionary. \n\n(8) having acute hepatitis within the one year before the clinical onset of aplastic anaemia;\n\n(9) having a liver transplant within the six months before the clinical onset of aplastic anaemia;\n\n(10) having an autoimmune disease from the specified list of autoimmune diseases within the two years before the clinical onset of aplastic anaemia;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. \n\n(11) having a haematological malignancy from the specified list of haematological malignancies within the six months before the clinical onset of aplastic anaemia;\n\nNote: specified list of haematological malignancies is defined in the Schedule 1 - Dictionary. \n\n(12) having a thymoma or thymic carcinoma before the clinical onset of aplastic anaemia;\n\n(13) having an infection with parvovirus B19 or acute infectious mononucleosis within the six months before the clinical onset of aplastic anaemia;\n\n(14) being pregnant at the time of the clinical worsening of aplastic anaemia;\n\n(15) inability to obtain appropriate clinical management for aplastic anaemia.\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(14) and 9(15) apply only to material contribution to, or aggravation of, aplastic anaemia where the person's aplastic anaemia 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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n 8-hour time-weighted average (TWA) means the averaging of different exposure levels to benzene during an average exposure period equivalent to eight hours.\n\n aplastic anaemia—see subsection 7(2).\n\n being exposed to benzene as specified means:\n\n(a) having cutaneous contact with liquids containing benzene greater than 1% by volume; or\n\n(b) ingesting liquids containing benzene greater than 1% by volume; or\n\n(c) inhaling benzene vapour where such exposure occurs at an ambient 8‑hour time-weighted average (TWA) benzene concentration exceeding five parts per million.\n\nNote: 8-hour time-weighted average (TWA) is also defined in the Schedule 1 - Dictionary.\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 also defined in the Schedule 1 - Dictionary.\n\n specified list of autoimmune diseases means:\n\n(a) ABO mismatched haematopoietic stem cell transplant;\n\n(b) coeliac disease;\n\n(c) eosinophilic fasciitis;\n\n(d) graft versus host disease;\n\n(e) hyperimmunoglobulinaemia;\n\n(f) hypoimmunoglobulinaemia; or\n\n(g) systemic lupus erythematosus.\n\n specified list of haematological malignancies means:\n\n(a) chronic lymphocytic leukaemia/small lymphocytic lymphoma;\n\n(b) Hodgkin's lymphoma;\n\n(c) non-Hodgkin lymphoma; or\n\n(d) T-cell large granular lymphocytic leukaemia.\n\n specified list of herbicides and insecticides means:\n\n(a) a carbamate insecticide;\n\n(b) an organochlorine insecticide;\n\n(c) an organophosphate insecticide; or\n\n(d) paraquat.\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\n\nSchedule 2 - Drugs\n\nNote: See Section 6, Subsection 9(2)\n\n1 Specified Drugs\n\n \n\n| albendazole | 2. alkylating agents (including temozolomide, busulfan, dacarbazine, cyclophosphamide, melphalan hydrochloride, nitrogen mustard) | 3. allopurinol |\n| --- | --- | --- |\n| 4. aminoglutethimide | 5. antimetabolite agents (including 6-mercaptopurine, fludarabine, fluouracil, methotrexate, pemetrexed) | 6. arsenic |\n| 7. azathioprine | 8. azithromycin | 9. bismuth |\n| 10. captopril | 11. carbamazepine | 12. carbimazole |\n| 13. carbonic anhydrase inhibitors (including acetazolamide, methazolamide) | 14. cephalosporins | 15. chloramphenicol |\n| 16. chlordiazepoxide | 17. chloroquine | 18. chlorpheniramine |\n| 19. chlorthalidone | 20. cimetidine | 21. clopidogrel |\n| 22. clozapine | 23. colchicine | 24. dapsone |\n| 25. daunorubicin | 26. doxycycline | 27. d-penicillamine |\n| 28. erythromycin | 29. etanercept | 30. ethosuximide |\n| 31. felbamate | 32. flucloxacillin | 33. flucytosine |\n| 34. fluoxetine | 35. furosemide | 36. ganoderma |\n| 37. gold | 38. golimumab | 39. guanidine |\n| 40. hydantoins | 41. imatinib | 42. immune checkpoint inhibitors (including nivolumab, pembrolizumab) |\n| 43. indapamide | 44. infliximab | 45. interferon alfa-2 and peg-interferon alfa-2 |\n| 46. lamivudine | 47. lamotrigine | 48. leflunomide |\n| 49. lenalidomide | 50. linezolid | 51. lisinopril |\n| 52. lithium | 53. mebendazole | 54. mepacrine |\n| 55. meprobamate | 56. mercury | 57. mesalamine |\n| 58. methicillin | 59. methimazole | 60. methyldopa |\n| 61. methyprylon | 62. mycophenolate | 63. nifedipine |\n| 64. nizatidine | 65. non-topical corticosteroids | 66. osimertinib |\n| 67. pentoxifylline | 68. phenothiazines | 69. phenytoin |\n| 70. procainamide | 71. proguanil | 72. propylthiouracil |\n| 73. protease inhibitors for chronic hepatitis C | 74. quinacrine | 75. quinidine |\n| 76. quinine | 77. quinolones | 78. ribavirin |\n| 79. rituximab | 80. streptomycin | 81. sulphonamide antibiotics (including trimethoprim, sulfamethoxazole) and drugs containing sulphonamide antibiotics (including sulfasalazine) |\n| 82. sulphonylureas (including chlorpropamide, tolbutamide) | 83. tetracycline | 84. thiazide diuretics |\n| 85. thiocyanate | 86. ticlopidine | 87. tocainide |\n| 88. valganciclovir | 89. valproic acid | 90. zidovudine |\n| 91. zonisamide | | |\n\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2012 version with updated medical knowledge and expanded drug lists, but does not extend beyond the original purpose of establishing service connection criteria for veterans' compensation claims. The structure and function remain consistent with the legislative framework established under section 196B of the Veterans' Entitlements Act 1986."},"complexity_factors":["Multiple defined terms (12 explicit definitions in Schedule 1, plus cross-references to other legislation)","Extensive drug schedule with 91 specific medications requiring precise identification","Multiple time-based thresholds varying by factor (3 months, 6 months, 1 year, 2 years)","Technical medical terminology requiring specialist knowledge (haematopoietic stem cells, cytopaenia, hypocellular bone marrow, thymoma)","Nested definitions (definitions referring to other definitions within the same instrument)","Conditional logic in section 10 distinguishing between disease onset versus aggravation of pre-existing disease","Cross-reference mechanism in section 11 linking to other Statements of Principles","Specific quantitative exposure thresholds (benzene: >1% by volume, >5 parts per million; 30 days exposure; 4 days/week for 4 weeks)"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding whether a veteran’s aplastic anaemia is connected to military service. It affects veterans and Defence/DFR decision-makers by applying a lower “reasonable hypothesis” test: if a listed factor (one of 15, e.g. certain drugs, chemical exposures, infections, autoimmune conditions, pregnancy, or inability to access treatment) and a service link are present, compensation may be payable. The instrument excludes inherited disorders and other specified conditions and updates a 2012 version."},"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":6,"scope_assessment":{"changed":true,"description":"Section 4 expressly repeals the 2012 Statement of Principles and replaces it with this instrument, so the operative criteria for linking aplastic anaemia to service have been updated (see sections 4, 7–11 and Schedules 1–2). The instrument continues to apply to claims under section 120A of the VEA and section 338 of the MRCA (section 5) but alters the substantive scope by revising definitions, exclusions (section 7(2)) and the list of qualifying factors and specified drugs (Schedule 2)."},"complexity_factors":["Extensive, detailed lists of specified drugs that must be checked against treatment history (Schedule 2).","Technical medical definitions and explicit exclusions for aplastic anaemia that require clinical interpretation (section 7(2)–(4)).","Multiple, different exposure and time‑limit thresholds (e.g. benzene: ≥30 days in 1 year with 8‑hour TWA >5 ppm; NSAID use: ≥4 days/week for ≥4 weeks within 1 year) creating varied evidentiary tests (section 9, Schedule 1).","Cross-references to other Statements of Principles where overlapping conditions are involved, requiring claim-by-claim coordination (section 11).","Requirement that any listed factor be related to the person’s defined ‘relevant service’, so factual proof of timing and service exposure is necessary (section 10; Schedule 1 definitions of relevant service).","Use of the legal causation threshold ‘reasonable hypothesis’ (section 9), which is lower than scientific proof but still demands documentary/medical evidence.","Potential administrative discretion and claimant evidentiary burden to establish exposures, clinical onset and treatment timelines (sections 9–10)."],"plain_english_summary":"This instrument replaces the prior Repatriation Medical Authority statement and sets the medical criteria used to decide whether aplastic anaemia (or death from it) can be linked to a person’s relevant service for veterans’ or defence compensation claims. It lists defined medical features, specific drugs, infections, chemicals and exposure thresholds and time limits that, if present, raise a “reasonable hypothesis” connecting the condition to service—affecting claimants, medical assessors and decision-makers."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020","history":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-aplastic-anaemia-reasonable-hypothesis-no-58-of-2020/documents"}}