{"id":"F2018L00552","name":"Statement of Principles concerning central serous chorioretinopathy (Reasonable Hypothesis) (No. 45 of 2018)","slug":"statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439604,"registerId":"F2018L00552-fast-fetch-1775955565973","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning central serous chorioretinopathy (Reasonable Hypothesis) (No. 45 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\nCENTRAL SEROUS CHORIORETINOPATHY (Reasonable Hypothesis)\n\n(No. 45 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 27 April 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:
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Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 central serous chorioretinopathy (Reasonable Hypothesis) (No. 45 of 2018).\n\n2 Commencement\n\n This instrument commences on 28 May 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about central serous chorioretinopathy and death from central serous chorioretinopathy.\n\nMeaning of central serous chorioretinopathy\n\n(2) For the purposes of this Statement of Principles, central serous chorioretinopathy:\n\n(a) means a serous detachment of the neurosensory retina affecting central vision; and\n\n(b) includes acute, recurrent and chronic serous retinal detachment; and\n\n(c) excludes retinal detachment due to a retinal tear (rhegmatogenous retinal detachment), and leakage through the retinal pigment epithelium caused by diseases of the choroid, including choroidal neovascularisation, choroidal vasculopathy, choroidal tumours, choroidal metastases and posterior uveitis.\n\n(3) While central serous chorioretinopathy attracts ICD‑10‑AM code H35.7, in applying this Statement of Principles the meaning of central serous chorioretinopathy 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 central serous chorioretinopathy\n\n(5) For the purposes of this Statement of Principles, central serous chorioretinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's central serous chorioretinopathy.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that central serous chorioretinopathy and death from central serous chorioretinopathy 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\n8 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 central serous chorioretinopathy or death from central serous chorioretinopathy with the circumstances of a person's relevant service:\n\n(1) being treated with a corticosteroid within the 30 days before the clinical onset of central serous chorioretinopathy;\n\n(2) 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 central serous chorioretinopathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(3) having Cushing syndrome in the one year before the clinical onset of central serous chorioretinopathy;\n\n(4) having primary hyperaldosteronism in the one year before the clinical onset of central serous chorioretinopathy;\n\nNote: primary hyperaldosteronism is defined in the Schedule 1 - Dictionary. \n\n(5) being in the second or third trimester of pregnancy at the time of the clinical onset of central serous chorioretinopathy;\n\n(6) having chronic renal failure at the time of the clinical onset of central serous chorioretinopathy;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary. \n\n(7) having hypertension at the time of the clinical onset of central serous chorioretinopathy;\n\n(8) being infected with Helicobacter pylori in the one year before the clinical onset of central serous chorioretinopathy;\n\n(9) having blunt trauma to the affected eye or the unaffected eye in the two weeks before the clinical onset of central serous chorioretinopathy;\n\n(10) being treated with a corticosteroid within the 30 days before the clinical worsening of central serous chorioretinopathy;\n\n(11) 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 central serous chorioretinopathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(12) having Cushing syndrome in the one year before the clinical worsening of central serous chorioretinopathy;\n\n(13) having primary hyperaldosteronism in the one year before the clinical worsening of central serous chorioretinopathy;\n\nNote: primary hyperaldosteronism is defined in the Schedule 1 - Dictionary. \n\n(14) being in the second or third trimester of pregnancy at the time of the clinical worsening of central serous chorioretinopathy;\n\n(15) having chronic renal failure at the time of the clinical worsening of central serous chorioretinopathy;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary. \n\n(16) having hypertension at the time of the clinical worsening of central serous chorioretinopathy;\n\n(17) being infected with Helicobacter pylori in the one year before the clinical worsening of central serous chorioretinopathy;\n\n(18) inability to obtain appropriate clinical management for central serous chorioretinopathy.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(10) to 8(18) apply only to material contribution to, or aggravation of, central serous chorioretinopathy where the person's central serous chorioretinopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n central serous chorioretinopathy—see subsection 6(2).\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n primary hyperaldosteronism means a condition in which there is excess endogenous production of the hormone aldosterone, which may be due to adrenal hyperplasia, an adrenal adenoma, adrenal carcinoma or an ectopic aldosterone-producing adenoma or carcinoma.\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) ephedrine;\n\n(b) fingolimod;\n\n(c) MEK (mitogen-activated protein kinase/extracellular signal-regulated kinase) inhibitors;\n\n(d) methylenedioxymethamphetamine (ecstasy);\n\n(e) nasal sympathomimetic decongestants;\n\n(f) ocriplasmin;\n\n(g) phosphodiesterase-5 selective inhibitors, including sildenafil, tadalafil and vardenafil;\n\n(h) pseudoephedrine; or\n\n(i) testosterone.\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":{"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":4,"scope_assessment":{"changed":false,"description":"The instrument confines its scope to central serous chorioretinopathy and death from it and applies to claims under section 120A of the VEA or section 338 of the MRCA (s1, s4, s6). It does not indicate any expansion or narrowing beyond those terms, and requires cross-reference to other Statements where overlap exists (s10). No textual change from an earlier scope is asserted within this instrument."},"complexity_factors":["Specialised medical definitions and explicit exclusions for the condition (s6(2)–(3))","Temporal distinctions between clinical onset and clinical worsening with different factor windows (s8(1)–(18))","Defined lists of implicated drugs and medical conditions in the Schedule that must be cross-checked (Schedule: specified list of drugs; definitions)","Numeric clinical thresholds for chronic renal failure (Schedule: GFR <15 mL/min/1.73 m2 or dialysis/transplant) creating objective but technical evidentiary requirements (Schedule)","Reference to ICD‑10‑AM coding for classification while relying on the instrument’s own definition (s6(3)–(4))","Interpretive threshold of a 'reasonable hypothesis' and RMA’s 'sound medical‑scientific evidence' statement, which allow medical and administrative discretion (s7; ss8–9)","Interaction with other Statements of Principles requiring cross-reference where factors concern other injuries/diseases (s10)","Application tied to statutory claims pathways under the VEA and MRCA, creating procedural linkage to entitlement law (s4)"],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority (RMA) uses to treat central serous chorioretinopathy — a specific retinal condition — as potentially connected to a veteran’s service. It defines the condition, lists clinical risk factors and time windows that, if met, raise a “reasonable hypothesis” connecting the condition or death from it to relevant service (ss6–9).\n\nThe RMA makes the decision and claimants must supply medical evidence showing an eligible factor and a link to relevant service (ss3–4,8–9). The instrument relies on ICD‑10‑AM coding and a specified drug list, creating a medical documentation and timing burden on claimants and clinicians (s6, Schedule)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses a single specific medical condition (central serous chorioretinopathy) for a defined population (veterans and defence members) under established statutory frameworks. The structure follows the standard template for Repatriation Medical Authority Statements of Principles without expansion into adjacent policy areas."},"complexity_factors":["18 distinct factors with varying timeframes (30 days, 1 year, 2 weeks, 'at the time of') requiring careful matching to clinical timelines","9 defined terms in Schedule 1, including nested definitions (e.g., 'relevant service' has 6 sub-categories spanning two different Acts)","Cross-referencing between two compensation schemes (VEA and MRCA) with different service categories","Medical specificity requiring interpretation of ICD-10-AM coding and exclusion of related but distinct conditions (rhegmatogenous retinal detachment, choroidal diseases)","Dual application structure — factors 1-9 for initial onset, factors 10-18 for worsening, with factor 18 (clinical management) applying only to worsening","Section 10 creates dynamic incorporation of other Statements of Principles by reference, meaning the instrument's full effect depends on external instruments not reproduced here"],"plain_english_summary":"This Statement of Principles sets out the medical factors that, if present and connected to military service, create a \"reasonable hypothesis\" that central serous chorioretinopathy (fluid under the retina causing blurred central vision) was caused or aggravated by service. It applies to veterans and current/former defence members claiming under the VEA or MRCA.\n\nFactors include recent corticosteroid use, certain drugs (e.g. stimulants, erectile dysfunction meds), pregnancy, blunt eye trauma, medical comorbidities, or lack of treatment. Being reasonable-hypothesis lowers the proof threshold."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2","history":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2/history","analysis":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2/analysis","conflicts":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2/important-cases","documents":"/api/acts/statement-of-principles-concerning-central-serous-chorioretinopathy-reasonable-hypothesis-no-45-of-2/documents"}}