{"id":"F2018L01178","name":"Statement of Principles concerning bronchiolitis obliterans organising pneumonia (Reasonable Hypothesis) (No. 79 of 2018)","slug":"statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439733,"registerId":"F2018L01178-fast-fetch-1775955642005","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning bronchiolitis obliterans organising pneumonia (Reasonable Hypothesis) (No. 79 of 2018)","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\nBRONCHIOLITIS OBLITERANS ORGANISING PNEUMONIA (Reasonable Hypothesis)\n\n(No. 79 of 2018)\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 24 August 2018\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 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 bronchiolitis obliterans organising pneumonia (Reasonable Hypothesis) (No. 79 of 2018).\n\n2 Commencement\n\n This instrument commences on 24 September 2018.\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 bronchiolitis obliterans organising pneumonia No. 62 of 2009 (Federal Register of Legislation No. F2009L03225) made under subsection 196B(2) 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 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 bronchiolitis obliterans organising pneumonia and death from bronchiolitis obliterans organising pneumonia.\n\nMeaning of bronchiolitis obliterans organising pneumonia\n\n(2) For the purposes of this Statement of Principles, bronchiolitis obliterans organising pneumonia:\n\n(a) means a histological pattern of organising pneumonia consisting of the patchy filling of alveoli, alveolar ducts and bronchioles by loose plugs of granulation tissue consisting of fibroblasts embedded in connective tissue, arising in response to lung injury and resulting in excessive proliferation of healing tissue, with:\n\n(i) respiratory symptoms; or\n\n(ii) other clinical evidence of pulmonary dysfunction; and\n\n(b) excludes:\n\n(i) organising pneumonia secondary to infectious pneumonia or acute respiratory distress syndrome;\n\n(ii) organising pneumonia that occurs in the presence of another interstitial lung disease and is not the dominant histological finding;\n\n(iii) organising pneumonia that occurs as a pulmonary manifestation of a systemic disease; and\n\n(iv) pulmonary inflammation that is confined to the bronchioles (obliterative bronchiolitis, proliferative bronchiolitis).\n\nNote 1: Bronchiolitis obliterans organising pneumonia ('BOOP') is also known as cryptogenic organising pneumonia.\n\nNote 2: Although the definition refers to a histological pattern, the diagnosis of bronchiolitis obliterans organising pneumonia can be made in patients with typical clinical and radiographic features without a lung biopsy being undertaken.\n\nDeath from bronchiolitis obliterans organising pneumonia\n\n(3) For the purposes of this Statement of Principles, bronchiolitis obliterans organising pneumonia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's bronchiolitis obliterans organising pneumonia.\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 bronchiolitis obliterans organising pneumonia and death from bronchiolitis obliterans organising pneumonia 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 bronchiolitis obliterans organising pneumonia or death from bronchiolitis obliterans organising pneumonia with the circumstances of a person's relevant service:\n\n(1) taking a drug or a drug from a class of drugs from the specified list of drugs, at the time of the clinical onset of bronchiolitis obliterans organising pneumonia;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(2) being treated with a drug which is associated in the individual with the following:\n\n(a) the development of bronchiolitis obliterans organising pneumonia within six months of commencing drug therapy; and\n\n(b) the absence of bronchiolitis obliterans organising pneumonia prior to commencing drug therapy; and\n\n(c) clinical improvement within weeks of ceasing drug therapy; and\n\n(d) exclusion of other aetiologies for bronchiolitis obliterans organising pneumonia;\n\n(3) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical onset of bronchiolitis obliterans organising pneumonia;\n\n(4) undergoing a course of therapeutic radiation for the treatment of malignant neoplasm of the breast or malignant neoplasm of the lung within the two years before the clinical onset of bronchiolitis obliterans organising pneumonia;\n\n(5) having bronchial obstruction immediately adjacent to a focus of pulmonary organisation, at the time of the clinical onset of bronchiolitis obliterans organising pneumonia;\n\nNote: bronchial obstruction is defined in the Schedule 1 - Dictionary. \n\n(6) inhaling high concentrations of a substance with irritant properties, where:\n\n(a) the inhalation has resulted in signs and symptoms of acute damage to the lower respiratory tract within the 48 hours after the inhalation; and\n\n(b) the clinical onset of bronchiolitis obliterans organising pneumonia occurs within the 30 days following the inhalation of the substance;\n\n(7) inhaling sulphur mustard (mustard gas) resulting in signs and symptoms of acute damage to the lower respiratory tract within the 30 days before the clinical onset of bronchiolitis obliterans organising pneumonia;\n\n(8) having gastro-oesophageal reflux disease at the time of the clinical onset of bronchiolitis obliterans organising pneumonia;\n\n(9) taking a drug or a drug from a class of drugs from the specified list of drugs, at the time of the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(10) being treated with a drug which is associated in the individual with the following:\n\n(a) the worsening of bronchiolitis obliterans organising pneumonia within six months of commencing drug therapy; and\n\n(b) clinical improvement within weeks of ceasing drug therapy;\n\n(11) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\n(12) undergoing a course of therapeutic radiation for the treatment of malignant neoplasm of the breast or malignant neoplasm of the lung within the two years before the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\n(13) having bronchial obstruction immediately adjacent to a focus of pulmonary organisation, at the time of the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\nNote: bronchial obstruction is defined in the Schedule 1 - Dictionary. \n\n(14) inhaling high concentrations of a substance with irritant properties, where:\n\n(a) the inhalation has resulted in signs and symptoms of acute damage to the lower respiratory tract within the 48 hours after the inhalation; and\n\n(b) the clinical worsening of bronchiolitis obliterans organising pneumonia occurs within the 30 days following the inhalation of the substance;\n\n(15) inhaling sulphur mustard (mustard gas) resulting in signs and symptoms of acute damage to the lower respiratory tract within the 30 days before the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\n(16) having gastro-oesophageal reflux disease at the time of the clinical worsening of bronchiolitis obliterans organising pneumonia;\n\n(17) inability to obtain appropriate clinical management for bronchiolitis obliterans organising pneumonia.\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(9) to 9(17) apply only to material contribution to, or aggravation of, bronchiolitis obliterans organising pneumonia where the person's bronchiolitis obliterans organising pneumonia 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 determine 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 bronchial obstruction means occlusion of the lumen of a bronchus or bronchiole due to an endogenous pathological process or structure, or from exogenous material, such as a foreign body.\n\n bronchiolitis obliterans organising pneumonia—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 also defined in the Schedule 1 - Dictionary.\n\n specified list of drugs means:\n\n(a) amiodarone;\n\n(b) amphotericin B;\n\n(c) azathioprine;\n\n(d) beta-blockers;\n\n(e) bleomycin;\n\n(f) bucillamine;\n\n(g) busulphan;\n\n(h) carbamazepine;\n\n(i) cephalosporins;\n\n(j) chlorambucil;\n\n(k) cocaine;\n\n(l) cyclophosphamide;\n\n(m) cytosine arabinoside;\n\n(n) daptomycin;\n\n(o) dihydroergocryptine;\n\n(p) doxorubicin;\n\n(q) dronedarone;\n\n(r) everolimus;\n\n(s) fluvastatin;\n\n(t) gemcitabine;\n\n(u) gold salts (aurothiopropanosulfonate);\n\n(v) interferons alpha, beta and gamma;\n\n(w) ipilimumab;\n\n(x) irinotecan;\n\n(y) lamotrigine;\n\n(z) lenalidomide;\n\n(aa) L-tryptophan;\n\n(bb) mecamylamine;\n\n(cc) mesalamine;\n\n(dd) methotrexate;\n\n(ee) minocycline;\n\n(ff) mitomycin-c;\n\n(gg) nilutamide;\n\n(hh) nitrofurantoin;\n\n(ii) oxaliplatin;\n\n(jj) penicillamine;\n\n(kk) phenytoin;\n\n(ll) propylthiouracil;\n\n(mm) quinine (intravenous);\n\n(nn) risedronate;\n\n(oo) rituximab;\n\n(pp) simvastatin (simvastin);\n\n(qq) sirolimus;\n\n(rr) sulfasalazine;\n\n(ss) tacrolimus;\n\n(tt) temozolomide;\n\n(uu) temsirolimus;\n\n(vv) thalidomide;\n\n(ww) ticlopidine; or\n\n(xx) trastuzumab.\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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles that maintains the established scope of determining service connection for a specific medical condition. It updates the 2009 version with current medical evidence but does not expand beyond the original purpose of defining causal factors for BOOP in the veterans' compensation context."},"complexity_factors":["Moderate length (11 sections plus dictionary)","48 specific drugs listed in defined term 'specified list of drugs'","Multiple temporal conditions (time limits like 'within 6 months', 'within 2 years', 'within 30 days', 'within 48 hours')","Nested definitions requiring cross-reference (e.g., 'bronchiolitis obliterans organising pneumonia' defined by inclusion and 4 specific exclusions)","Dual structure covering both 'clinical onset' and 'clinical worsening' with parallel but not identical factors","Conditional logic in section 10(2) restricting application of factors 9-17 to pre-existing conditions aggravated by service","Technical medical terminology throughout (histological patterns, alveoli, granulation tissue, fibroblasts)","Cross-reference to other Statements of Principles in section 11 for compound conditions"],"plain_english_summary":"This instrument updates the medical test for deciding when bronchiolitis obliterans organising pneumonia (BOOP) is considered service-related, replacing the 2009 guidance. It affects current and former ADF members, veterans and peacekeepers covered by the VEA or MRCA and guides DVA decisions on entitlement, treatment and compensation. The law lists 17 connecting factors (e.g., certain drugs, transplants, radiation, high irritant exposure, chronic reflux) and covers aggravation and death."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument repeals the previous Statement of Principles No. 62 of 2009 (s4) and replaces it with updated definitions and an explicit, expanded list of causal and aggravating factors (see s7, s9 and Schedule 1). The replacement alters the operational criteria used to link BOOP or death from BOOP to relevant service for claims under the VEA/MRCA (see s5, s8–s11)."},"complexity_factors":["Medical definitions and diagnostic flexibility: detailed histological definition plus allowance for clinical/radiographic diagnosis without biopsy (see s7(2) and Note 2).","Extensive, enumerated list of specified drugs that can cause or worsen BOOP (Schedule 1; referenced in s9(1) and s9(9)).","Multiple temporal and conditional tests for causation or aggravation (e.g. onset within 6 months of drug therapy, inhalation windows of 48 hours/30 days, radiation within 2 years) (see s9(2)(a), s9(6)(a)-(b), s9(4)).","Distinct pathways for 'clinical onset' versus 'clinical worsening' with largely parallel factor lists, increasing evidentiary permutations (see s9 generally and s10(2)).","Service-connection requirement: every listed factor must be related to the person’s relevant service under VEA/MRCA (see s10(1) and Schedule 1 definition of relevant service).","Interplay with other Statements of Principles where factors point to other injuries/diseases—those Statements apply as in force (see s11).","Exclusions and scope limits in the disease definition (organising pneumonia secondary to infection, other interstitial disease, systemic disease, or bronchiolar-confined inflammation are excluded) which affect applicability (see s7(2)(b)(i)-(iv)).","Administrative replacement of prior instrument (repeal of No.62 of 2009) implying changes to coverage and criteria that must be reconciled in claims handling (see s4)."],"plain_english_summary":"Replaces the earlier Statement and sets the medical criteria and causal factors required to raise a reasonable hypothesis linking bronchiolitis obliterans organising pneumonia (BOOP) or death from it to a person’s relevant service. It applies to veterans and members covered by the Veterans’ Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004 and matters because those criteria determine whether service-related entitlement claims for BOOP can be accepted."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes","history":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes/history","analysis":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes/analysis","conflicts":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes/important-cases","documents":"/api/acts/statement-of-principles-concerning-bronchiolitis-obliterans-organising-pneumonia-reasonable-hypothes/documents"}}