{"id":"F2024L00759","name":"Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024)","slug":"statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105275,"registerId":"commonwealth-F2024L00759-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 May 2025\n\nIncludes amendments: Amendment Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 53 of 2025) (F2025L00509)\n\nThe day of commencement of this Amendment Statement of Principles concerning cardiomyopathy is 19 May 2025.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024) that shows the text of the law as amended and in force on 19 May 2025.\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 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 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 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 cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024).\n\n1.  Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.  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\n1.  Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.  Kind of injury, disease or death to which this Statement of Principles relates\n    1.  This Statement of Principles is about cardiomyopathy and death from cardiomyopathy.\n\nMeaning of cardiomyopathy\n\n1.  For the purposes of this Statement of Principles, cardiomyopathy:\n    1.  means a heterogeneous group of acquired diseases of the heart muscle (myocardium) involving mechanical or electrical dysfunction; and\n    2.  includes:\n        1.  dilated cardiomyopathy;\n        2.  restrictive cardiomyopathy;\n        3.  myocarditis with persistent mechanical or electrical dysfunction;\n        4.  hypertrophic cardiomyopathy;\n        5.  arrhythmogenic cardiomyopathy;\n        6.  hypertensive cardiomyopathy; and\n        7.  takotsubo (stress) cardiomyopathy; and\n    3.  excludes:\n        1.  exercise-induced cardiac remodelling (athlete’s heart);\n        2.  myocardial abnormality caused by ischaemic heart disease or valvular disease; and\n        3.  pericardial disease including pericarditis.\n\n> Note: acquired diseases of the heart muscle, arrhythmogenic cardiomyopathy and takotsubo cardiomyopathy are defined in the Schedule 1 - Dictionary.\n\n1.  While cardiomyopathy attracts ICD‑10‑AM codes I42, I43 or O90.3, in applying this Statement of Principles the meaning of cardiomyopathy is that given in subsection (2).\n2.  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 cardiomyopathy\n\n1.  For the purposes of this Statement of Principles, cardiomyopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cardiomyopathy.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.  Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that cardiomyopathy and death from cardiomyopathy 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\n1.  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 cardiomyopathy or death from cardiomyopathy with the circumstances of a person's relevant service:\n\n1.  undergoing a course of radiotherapy for cancer, where the heart was in the field of radiation, before the clinical onset or clinical worsening;\n2.  having myocarditis before clinical onset or at the time of clinical worsening;\n\n(2a) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before clinical onset or clinical worsening;\n\nNote: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).\n\n1.  having infection with Trypanosoma cruzi (Chagas disease) before clinical onset or clinical worsening;\n2.  having infection with human immunodeficiency virus before clinical onset or clinical worsening;\n3.  having phaeochromocytoma or paraganglioma at the time of clinical onset or clinical worsening;\n\n> Note: paraganglioma and phaeochromocytoma are defined in the Schedule 1 – Dictionary.\n\n1.  having infiltration of the myocardium due to:\n    1.  amyloidosis;\n    2.  iron overload (haemosiderosis); or\n    3.  sarcoidosis;\n\nat the time of the clinical onset or clinical worsening;\n\n> Note: iron overload is defined in the Schedule 1 - Dictionary.\n\n1.  having a primary or metastatic neoplasm infiltrating the myocardium at the time of the clinical onset or clinical worsening;\n2.  having one of the following endocrine disorders:\n    1.  acromegaly;\n    2.  adrenal insufficiency;\n    3.  Cushing syndrome;\n    4.  diabetes mellitus;\n    5.  hyperthyroidism, including goitre or Graves disease that has resulted in hyperthyroidism;\n    6.  hypoparathyroidism;\n    7.  hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism;\n    8.  primary hyperaldosteronism; or\n    9.  thyrotoxicosis;\n\nat the time of clinical onset or clinical worsening;\n\n> Note: acromegaly and primary hyperaldosteronism are defined in the Schedule 1 – Dictionary.\n\n1.  being obese at the time of clinical onset or clinical worsening;\n\n> Note: being obese is defined in the Schedule 1 - Dictionary.\n\n1.  having a clinically apparent nutritional deficiency involving:\n    1.  carnitine;\n    2.  niacin (pellagra);\n    3.  selenium (Keshan disease); or\n    4.  thiamine (wet beriberi);\n\nat the time of clinical onset or clinical worsening;\n\n1.  having coeliac disease at the time of clinical onset or clinical worsening;\n2.  having acquired generalised lipodystrophy at the time of the clinical onset or clinical worsening;\n\n> Note: lipodystrophy is defined in the Schedule 1 – Dictionary.\n\n1.  having chronic renal failure at the time of clinical onset or clinical worsening as indicated by any of the following:\n    1.  a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n    2.  undergoing chronic dialysis for renal failure;\n2.  having cirrhosis of the liver before clinical onset or clinical worsening;\n3.  taking one of the following medications within the 3 months before clinical onset or clinical worsening:\n    1.  5-fluorouracil (non-topical);\n    2.  alemtuzumab;\n    3.  amphotericin B;\n    4.  anagrelide;\n    5.  bevacizumab;\n    6.  cisplatin;\n    7.  clozapine;\n    8.  cobimetinib;\n    9.  cyclophosphamide;\n    10.  dasatinib;\n    11.  exogenous catecholamine;\n    12.  ifosfamide;\n    13.  imatinib;\n    14.  interferon alpha;\n    15.  isotretinoin or tretinoin;\n    16.  lithium;\n    17.  methylphenidate;\n    18.  mitomycin C;\n    19.  olanzapine;\n    20.  osimertinib;\n    21.  paclitaxel (when used in combination with doxorubicin);\n    22.  sunitinib;\n    23.  tacrolimus;\n    24.  trabectedin;\n    25.  trametinib;\n    26.  trastuzumab; or\n    27.  zidovudine;\n4.  taking a medication that cannot be ceased or substituted in the long term and which is associated in the individual with the development/worsening of cardiomyopathy during medication therapy; and either:\n    1.  the improvement of cardiomyopathy within days or weeks of discontinuing or tapering medication therapy; or\n    2.  the redevelopment/worsening of cardiomyopathy on rechallenge with the same medication; and\n\nwhere the medication was being taken within the 3 months before clinical onset or clinical worsening;\n\n1.  being treated with an anthracycline within the 25 years before clinical onset or clinical worsening;\n\n> Note: anthracycline is defined in the Schedule 1 - Dictionary.\n\n1.  taking chloroquine or hydroxychloroquine daily for at least the one year before clinical onset or clinical worsening;\n2.  for males only, consuming an average of at least 80 grams of alcohol per day for a continuous period of at least 5 years, before clinical onset or clinical worsening;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.  for females only, consuming an average of at least 40 grams of alcohol per day for a continuous period of at least 5 years, before clinical onset or clinical worsening;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.  using one of the following illicit drugs at the time of clinical onset or clinical worsening:\n    1.  amphetamines or amphetamine derivatives, including 3, 4-methylenedioxymethamphetamine (Ecstasy);\n    2.  anabolic-androgenic steroids; or\n    3.  cocaine;\n2.  being poisoned with cobalt, as demonstrated by haematological or biochemical evidence, at the time of clinical onset or clinical worsening;\n3.  being in the last trimester of pregnancy or being within the six months immediately postpartum at the time of clinical onset or clinical worsening;\n4.  undertaking intense physical activity of at least 6 METs at the time of clinical worsening;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n1.  being a prisoner of war of Japan before clinical onset;\n2.  experiencing a severe stressful event that causes an intense emotional or psychological response within the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;\n\n> Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.\n\n1.  having:\n    1.  an injury or illness requiring admission to an intensive care unit or artificial ventilation;\n    2.  major trauma; or\n    3.  septicaemia;\n\nwithin the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;\n\n> Note 1: artificial ventilation is defined in the Schedule 1 - Dictionary.\n\n> Note 2: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.\n\n1.  having a cerebrovascular accident (stroke) or subarachnoid haemorrhage within the 30 days before the clinical onset or clinical worsening of takotsubo cardiomyopathy;\n\n> Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.\n\n1.  being envenomated by a:\n    1.  bee or wasp;\n    2.  jellyfish such as the box jellyfish or Pelagia noctiluca (mauve stinger);\n    3.  scorpion;\n    4.  snake; or\n    5.  spider such as a funnel web spider, red back or katipō (black widow) spider;\n\nwithin the 24 hours before the clinical onset or clinical worsening of takotsubo cardiomyopathy;\n\n> Note: takotsubo cardiomyopathy is defined in the Schedule 1 - Dictionary.\n\n1.  having hypertension for at least the 5 years before the clinical onset of hypertensive cardiomyopathy, or at the time of the clinical worsening of hypertensive cardiomyopathy;\n2.  inability to obtain appropriate clinical management for cardiomyopathy before clinical worsening.\n\n1.  Relationship to service\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    2.  The clinical worsening aspects of the factors set out in section 9 apply only to material contribution to, or aggravation of, cardiomyopathy where the person's cardiomyopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.  Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n1.  if a factor referred to in section 9 applies in relation to a person; and\n2.  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\nacquired diseases of the heart muscle means a disease of the heart muscle acquired during or after adolescence, and not caused by genetic mutations.\n\nacromegaly means a chronic disease of adults resulting from excessive production of growth hormone after closure of the epiphyses.\n\nanthracycline means a class of cell-cycle non-specific drugs used in cancer chemotherapy derived from Streptomyces peucetius var. caesius, and includes daunorubicin (daunomycin), doxorubicin (adriamycin), epirubicin, idarubicin, valrubicin and mitoxantrone.\n\narrhythmogenic cardiomyopathy means an arrhythmogenic heart muscle disorder with structural abnormalities of the myocardium and clinical presentation with arrhythmia.\n\nartificial ventilation means a method to assist or replace spontaneous breathing, which may involve a mechanically-controlled ventilator, manually-assisted bag ventilation of an intubated patient, or expired air resuscitation.\n\nbeing obese means having a Body Mass Index (BMI) of 30 or greater.\n\n> Note: BMI is 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\ncardiomyopathy—see subsection 7(2).\n\niron overload means an accumulation of excess iron in tissues and organs, which has been confirmed by elevated ferritin or transferrin saturation levels. Causes include haemochromatosis and blood transfusions.\n\nlipodystrophy means a condition due to defective metabolism of fat, resulting in the absence of subcutaneous fat.\n\nMET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nparaganglioma means a neoplasm of chromaffin tissue which is associated with excess secretion of catecholamines, and is located in an extra-adrenal sympathetic ganglion.\n\nphaeochromocytoma means a neoplasm of chromaffin tissue which is associated with excess secretion of catecholamines, and is located in the adrenal medulla.\n\nprimary hyperaldosteronism means a syndrome associated with excess production of the major adrenal mineralocorticoid, aldosterone, and commonly caused by adrenal adenoma or unilateral or bilateral adrenal hyperplasia.\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 defined in the Schedule 1 - Dictionary.\n\ntakotsubo cardiomyopathy, also known as stress cardiomyopathy, means a type of acute non-ischaemic cardiomyopathy in which there is a sudden temporary weakening of the myocardium, with ballooning of the left ventricular apex and a hypercontractile left ventricular base.\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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.\n\nIf a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n| ad = added or inserted                         | orig = original                     |\n| ---------------------------------------------- | ----------------------------------- |\n| am = amended                                   | par = paragraph(s)/subparagraph(s)  |\n| amdt = amendment                               | /sub‑subparagraph(s)                |\n| c = clause(s)                                  | pres = present                      |\n| C[x] = Compilation No. x                       | prev = previous                     |\n| Ch = Chapter(s)                                | (prev…) = previously                |\n| def = definition(s)                            | Pt = Part(s)                        |\n| Dict = Dictionary                              | r = regulation(s)/rule(s)           |\n| disallowed = disallowed by Parliament          | reloc = relocated                   |\n| Div = Division(s)                              | renum = renumbered                  |\n| exp = expires/expired or ceases/ceased to have | rep = repealed                      |\n| effect                                         | rs = repealed and substituted       |\n| F = Federal Register of Legislation            | s = section(s)/subsection(s)        |\n| gaz = gazette                                  | Sch = Schedule(s)                   |\n| LA = Legislation Act 2003                      | Sdiv = Subdivision(s)               |\n| LIA = Legislative Instruments Act 2003         | 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| o = order(s)                                   | commenced or to be commenced        |\n| Ord = Ordinance                                |                                     |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                 | Registration             | Commencement | Application, saving and transitional provisions |\n| ---------------------------------------------------------------------------------------------------- | ------------------------ | ------------ | ----------------------------------------------- |\n| Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 57 of 2024)           | 24 June 2024F2024L00759  | 23 July 2024 |                                                 |\n| Amendment Statement of Principles concerning cardiomyopathy (Reasonable Hypothesis) (No. 53 of 2025) | 16 April 2025F2025L00509 | 19 May 2025  |                                                 |\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(2a)……… | ad No. 53 of 2025 |","sortOrder":0}],"analysis":{"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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"Yes. The instrument was amended to add infection with SARS‑CoV‑2 (COVID‑19) as a listed factor that, if present before clinical onset or clinical worsening, raises a reasonable hypothesis connecting cardiomyopathy to relevant service (new subsection 9(2a) added by Amendment No. 53 of 2025). This broadens the scope of antecedent events recognised by the Statement of Principles to explicitly include COVID‑19 infection, and therefore increases the range of medical histories that may meet the instrument’s threshold for service connection. Apart from this insertion, the Statement retains its earlier framework (definitions, detailed factor list, timing windows and interaction with other SOPs)."},"complexity_factors":["Approximately 19 defined terms in Schedule 1 (acquired diseases of the heart muscle, BMI, MET, MRCA, VEA, takotsubo cardiomyopathy, terminal event, etc.).","Section 9 contains 35+ distinct factor items with multiple nested subparagraphs and conditions (e.g. infections, endocrine disorders, drug lists, etc.).","Multiple explicit timing windows and thresholds across factors (3 months for many drugs; 25 years for anthracycline exposure; 1 year for chloroquine; 5 years for alcohol use; 30 days or 24 hours for takotsubo triggers).","Compound conditional logic for some items (for example, medication that cannot be ceased requires either clinical improvement on cessation or recurrence on rechallenge).","Gender‑specific quantitative thresholds (different alcohol thresholds for males and females).","Cross‑references to other Statements of Principles where a factor overlaps with another SOP (section 11).","Inclusions and exclusions to the medical definition of cardiomyopathy, plus mapping to ICD‑10‑AM codes (section 7).","Mix of clinical concepts (myocarditis, infiltrative disease, metabolic deficiencies) and lay quantifiers (BMI formula, alcohol grams per day) requiring both clinical and documentary evidence.","Recent amendment inserting SARS‑CoV‑2 (9(2a)) creates temporal complexity for claims tied to a pandemic era (see amendment history)."],"plain_english_summary":"**What this instrument is and who it affects**\n\n- This is a Statement of Principles (a medical‑evidence instrument used under the Veterans' Entitlements Act 1986) that sets out the medical definitions and the specific medical factors that, if present and connected to a person’s relevant military service, are sufficient to raise a “reasonable hypothesis” that cardiomyopathy (or death from cardiomyopathy) is related to that service. (See sections 1, 3, 7 and 8.)\n\n- It applies to claims made under the VEA and the Military Rehabilitation and Compensation Act (MRCA) where those Acts require a Statement of Principles to determine whether a disease or death can be related to service (section 3). The practical effect is on claimants (veterans and eligible members) and the Department that assesses and pays entitlements: if a listed factor is present and linked to service, the claim can meet the statutory threshold of a reasonable hypothesis (section 9 and section 10 on relationship to service).\n\n**What “cardiomyopathy” covers here**\n\n- The instrument defines cardiomyopathy as a heterogeneous group of acquired heart‑muscle diseases causing mechanical or electrical dysfunction. It explicitly lists common types included (dilated, restrictive, hypertrophic, arrhythmogenic, hypertensive, takotsubo, and myocarditis with persistent dysfunction) and excludes athlete’s heart, ischaemic or valvular heart disease, and pericardial disease (section 7(2)). It also maps to ICD‑10‑AM codes for administrative purposes (section 7(4)).\n\n- Death from cardiomyopathy is included when the terminal event or condition was contributed to by the person’s cardiomyopathy (section 7(6)).\n\n**What must exist to raise a reasonable hypothesis**\n\n- The instrument lists the minimum medical factors that, if they existed before clinical onset or at the time of clinical worsening and are related to relevant service, will raise a reasonable hypothesis linking the cardiomyopathy to service (section 9). Key categories include:\n  - Radiotherapy where the heart was in the radiation field (section 9(1)).\n  - Prior myocarditis (9(2)).\n  - Infection with SARS‑CoV‑2 (COVID‑19) before onset or worsening (newly inserted: 9(2a)).\n  - Specific infections (Trypanosoma cruzi/Chagas, HIV) (9(3)–(4)).\n  - Tumours or infiltration of the myocardium (9(6)–(7)).\n  - A set of endocrine disorders (diabetes, thyroid disorders, Cushing syndrome, etc.) (9(8)).\n  - Obesity (BMI ≥30) at onset/worsening (9(9)).\n  - Nutritional deficiencies (carnitine, niacin, selenium, thiamine) (9(10)).\n  - Chronic renal failure, cirrhosis, certain listed medications (with specified timing windows), prior anthracycline chemotherapy (within 25 years), and long‑term chloroquine/hydroxychloroquine use (9(12)–(17)).\n  - High sustained alcohol consumption (sex‑specific thresholds and duration) (9(18)–(19)).\n  - Use of specified illicit drugs (amphetamines, anabolic steroids, cocaine) (9(20)).\n  - Poisoning with cobalt, late pregnancy/early postpartum, intense physical activity at time of worsening, prior status as a prisoner of war of Japan, and a detailed list of triggers and timing conditions relevant to takotsubo cardiomyopathy (9(21)–(33)).\n  - Longstanding hypertension for hypertensive cardiomyopathy, and inability to obtain appropriate clinical management before worsening (9(34)–(35)).\n\n- Many factors include explicit timing windows (for example, some medications within 3 months before onset; anthracycline within 25 years), and some have conditional tests (for example, medication that cannot be stopped must have caused improvement on cessation or recurrence on rechallenge) (section 9(12) and 9(13)).\n\n**How the linkage to service works**\n\n- A listed factor must be related to the person’s relevant service (section 10(1)). The rules about clinical worsening apply only where the cardiomyopathy was suffered or contracted before or during (but did not arise out of) the person’s relevant service — i.e., the instrument treats aggravation of pre‑existing conditions differently from conditions that arose out of service (section 10(2)).\n\n**Interaction with other Statements of Principles**\n\n- If a listed factor in this instrument refers to a disease that has its own Statement of Principles, that other instrument’s factors apply according to its terms (section 11). This creates cross‑application of prior disease‑specific SOPs.\n\n**Why it matters in practical terms**\n\n- Mechanically, the instrument sets the medical gates for acceptance of service connection on a reasonable hypothesis basis. Veterans who can demonstrate one or more listed factors, occurring within the specified timing and linked to their relevant service, meet the statutory evidentiary threshold that can move a claim forward to the decision stage under the VEA/MRCA (sections 8–10).\n\n- Costs and incentives: expanding or clarifying the list of recognised factors (for example, adding SARS‑CoV‑2 infection) increases the chance some claims will satisfy the reasonable‑hypothesis threshold and proceed to entitlement decisions; that can increase administrative and compensation costs for the Department. The burden falls on claimants to provide relevant medical and service records to show the factor existed and was related to service; the Department and medical assessors decide whether the relationship to service is established (sections 9–11).\n\n**Practical implementation points and risks**\n\n- Evidence quality and timing matter: the instrument frequently ties factors to specific time windows (3 months, 25 years, 1 year, 5 years, 30 days, 24 hours), so record availability (medication histories, infection dates, radiotherapy fields, BMI records) is crucial (section 9).\n\n- Definitions and thresholds are explicit (BMI ≥30 for obesity; alcohol thresholds expressed in grams per day using Australia’s 10 g per standard drink convention), which reduces some interpretive uncertainty but requires objective measurement (Schedule 1).\n\n- Cross‑references to other Statements of Principles add complexity: where a listed factor invokes another SOP, that other SOP governs the detailed medical tests (section 11).\n\n- The recent insertion of SARS‑CoV‑2 infection (9(2a)) specifically recognises COVID‑19 infection as a listed antecedent event that can raise the reasonable hypothesis, which will affect claims where post‑COVID myocarditis or cardiomyopathy is alleged (section 9).\n\n**Key sections to consult**: definitions and scope (section 7 and Schedule 1); list of qualifying factors and timing/conditions (section 9); relationship to service rules (section 10); interaction with other SOPs (section 11)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles instrument. It follows the established template and scope for determining medical connections to service. The 2025 amendment added COVID-19 (SARS-CoV-2) infection as a new factor (9(2a)), reflecting evolving medical knowledge rather than scope creep. The instrument remains focused on its original purpose: establishing medical-scientific bases for linking cardiomyopathy to veteran service."},"complexity_factors":["28 distinct medical factors with varying temporal requirements (ranging from 24 hours to 25 years before onset)","Multiple defined terms in Schedule 1 (approximately 15-20 definitions including medical conditions, measurements like BMI/MET, and legal references)","Specific exclusions in the definition of cardiomyopathy (3 categories excluded)","Gender-specific provisions for alcohol consumption (separate thresholds for males and females)","Condition-specific factors that only apply to subtypes (e.g., factors 9(25)-(29) only apply to takotsubo cardiomyopathy; factor 9(30) only applies to hypertensive cardiomyopathy)","Cross-references to other Statements of Principles for conditions mentioned as factors","Dual legislative framework application (VEA and MRCA with different service definitions)","Nested definitions (e.g., 'being obese' defined by BMI, which has its own formula definition)","Specific medication list with 27 named drugs plus a general category for non-substitutable medications"],"plain_english_summary":"This Statement of Principles sets when cardiomyopathy and related heart-muscle disorders can be taken as service-related under the \"reasonable hypothesis\" test. It affects veterans and current/former defence members under the VEA and MRCA, allowing compensation if a listed medical factor present in service could plausibly explain the disease. Covered conditions include dilated, hypertrophic, restrictive and stress cardiomyopathy and myocarditis with dysfunction; listed links include certain cancer therapies, infections (e.g. COVID‑19), drugs/substances, pregnancy/stress and metabolic or organ diseases."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024","history":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-cardiomyopathy-reasonable-hypothesis-no-57-of-2024/documents"}}