{"id":"F2018L00199","name":"Statement of Principles concerning chilblains (Balance of Probabilities) (No. 30 of 2018)","slug":"statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439505,"registerId":"F2018L00199-fast-fetch-1775955508057","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chilblains (Balance of Probabilities) (No. 30 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\nCHILBLAINS (Balance of Probabilities)\n\n(No. 30 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 2 March 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 \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Revocation\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 chilblains (Balance of Probabilities) (No. 30 of 2018).\n\n2 Commencement\n\n This instrument commences on 2 April 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning chilblains No. 10 of 2009 made under subsection 196B(3) of the VEA is revoked.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 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 chilblains and death from chilblains.\n\nMeaning of chilblains\n\n(2) For the purposes of this Statement of Principles, chilblains:\n\n(a) means painful, localised erythema and inflammatory swelling from the reaction of the small blood vessels in the skin to exposure to non-freezing cold; and\n\n(b) excludes non-freezing cold injury, frostnip and frostbite.\n\nNote 1: Chilblains are also known as pernios or perniosis.\n\nNote 2: Chilblains manifest as erythematous to violaceous macules, papules, plaques or nodules in sites of cold exposure. Symptoms of pruritus, pain or burning often accompany the skin lesions, and complications of blistering, ulceration or secondary infection may occur. The most common sites for involvement are the fingers and toes, but other sites such as the legs, hands, nose, face and ears may also be affected.\n\n(3) While chilblains attracts ICD‑10‑AM code T69.1, in applying this Statement of Principles the meaning of chilblains 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 chilblains\n\n(5) For the purposes of this Statement of Principles, chilblains, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chilblains.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that chilblains and death from chilblains can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, chilblains or death from chilblains is connected with the circumstances of a person's relevant service:\n\n(1) exposing the affected part of the body to non-freezing temperatures below ten degrees Celsius within the 24 hours before the clinical onset of chilblains;\n\n(2) having a disease from the specified list of diseases at the time of the clinical onset of chilblains;\n\nNote: specified list of diseases is defined in the Schedule 1 - Dictionary. \n\n(3) having a body mass index (BMI) of less than 21 at the time of the clinical onset of chilblains;\n\nNote: BMI is defined in the Schedule 1 - Dictionary. \n\n(4) inability to obtain appropriate clinical management for chilblains.\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 factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, chilblains where the person's chilblains 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(3) 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 BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n chilblains—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n specified list of diseases means:\n\n(a) anorexia nervosa;\n\n(b) antiphospholipid syndrome;\n\n(c) Behçet disease;\n\n(d) chronic myelomonocytic leukaemia;\n\n(e) cold agglutinin disorder;\n\n(f) cryofibrinogenaemia;\n\n(g) cryoglobulinaemia;\n\n(h) discoid lupus erythematosus;\n\n(i) dysproteinaemia;\n\n(j) macroglobulinaemia;\n\n(k) monoclonal gammopathy;\n\n(l) myelodysplastic syndrome;\n\n(m) Raynaud disease;\n\n(n) rheumatoid arthritis;\n\n(o) Sjögren syndrome; or\n\n(p) systemic lupus erythematosus.\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","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2009 version (No. 10 of 2009) with updated medical criteria but does not expand beyond the established purpose of determining service connection for chilblains under veterans' compensation legislation. The structure and approach remain consistent with the template used for other medical conditions under the VEA and MRCA."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 Dictionary (7 defined terms)","Nested conditional logic in section 9 with four alternative factors (only one required)","Specific exclusion clause in section 7(2)(b) distinguishing chilblains from similar conditions (non-freezing cold injury, frostnip, frostbite)","Conditional limitation in section 10(2) restricting factor 9(4) to pre-existing conditions only","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Incorporation by reference mechanism in section 11 linking to other Statements of Principles","Mathematical formula for BMI calculation (W/H²) in definitions"],"plain_english_summary":"This Statement of Principles sets the medical tests used to decide when chilblains can be accepted as caused by Australian military service, replacing the 2009 version. It applies to veterans (Veterans' Entitlements Act 1986) and current/former defence members (Military Rehabilitation and Compensation Act 2004).\n\nIt matters because it is the gatekeeper for compensation: claimants must meet the document’s medical criteria (on the balance of probabilities) to link chilblains to their service."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument is a replacement (revocation and reissue) of the earlier Statement for chilblains. It retains the core scope — determining whether chilblains or death from chilblains are connected to relevant service — and sets discrete medical factors for causal assessment. The replacement updates and clarifies criteria (for example specifying <10°C exposure within 24 hours, BMI threshold <21, and an explicit list of co‑morbid diseases) but does not materially expand the subject matter beyond the original purpose of providing medical rules for linking chilblains to service. Any change is therefore one of clarification and refinement rather than a significant scope expansion."},"complexity_factors":["Short instrument (11 substantive sections + short Schedule).","Single clear definition of the disease (s 7) that overrides ICD code reference.","Four discrete qualifying factors in s 9 (simple conditional logic: at least one must exist).","Schedule contains a specified list of 16 diseases that cross‑link to other Statements of Principles (adds cross‑reference complexity).","Cross‑reference mechanism to other Statements (s 11) introduces dependence on external instruments and their updates.","A limited but important conditional in s 10(2) restricting s 9(4) to pre‑existing or concurrent (non‑service‑arising) chilblains.","Requires factual determinations that can be evidentially difficult (timing of exposure, BMI at onset, proof of inability to obtain care).","Revocation of prior Statement (s 4) — administrative transition issue."],"plain_english_summary":"**What this instrument does (mechanics first)**\n\n- It sets a medical standard — called a Statement of Principles — that decision‑makers use to decide whether chilblains (or death from chilblains) can be linked to a person’s relevant military service on the balance of probabilities (more likely than not). (See ss 7, 8.)\n- It replaces the earlier Statement of Principles for chilblains (revokes the 2009 instrument). (See s 4.)\n- It applies to claims under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). (See s 5 and Schedule definition of “relevant service”.)\n\n**Who this affects**\n\n- Veterans and current or former members of the Defence Forces who make a claim for treatment, compensation or related entitlements where chilblains (or death from chilblains) is alleged to be connected with their service. (See s 5 and Schedule – “relevant service”.)\n\n**How the instrument defines chilblains and death from chilblains**\n\n- Chilblains are defined as painful, localised reddening and swelling of small skin blood vessels in response to exposure to non‑freezing cold; frostbite, frostnip and non‑freezing cold injury are excluded. The Statement uses that definition rather than relying solely on the ICD‑10‑AM code. (See s 7(2)–(4).)\n- “Death from chilblains” includes a terminal event or condition (for example, pneumonia or respiratory failure) that was contributed to by the person’s chilblains. (See s 7(5) and Schedule – “terminal event”.)\n\n**What must be shown to link chilblains to service (the legal tests)**\n\nAt least one of the following factors must exist, and it must be related to the person’s relevant service (see s 9 and s 10):\n\n- Exposure of the affected body part to non‑freezing temperatures below 10°C within the 24 hours before the clinical onset of chilblains (s 9(1)).\n- The person had one of a specified list of diseases at the time of clinical onset (s 9(2) and Schedule – specified list of diseases). The list includes autoimmune and blood system conditions such as systemic lupus erythematosus, Raynaud disease, antiphospholipid syndrome, various gammopathies, rheumatoid arthritis, Sjögren syndrome, and others.\n- The person had a body mass index (BMI) of less than 21 at the time of clinical onset (s 9(3); Schedule defines BMI formula W/H2).\n- The person was unable to obtain appropriate clinical management for chilblains. That inability can only be relied on to show material contribution or aggravation where the chilblains existed before or during (but not arising out of) relevant service. (See s 9(4) and s 10(2).)\n\n**Cross‑references and interaction with other Statements of Principles**\n\n- If a factor listed above refers to an injury or disease that is itself covered by another Statement of Principles, then the factors in that other Statement apply according to its terms. In practice this links claims involving, for example, Raynaud disease or autoimmune disease to whatever criteria those other Statements set out. (See s 11.)\n\n**Stated medical basis and legal effect**\n\n- The Repatriation Medical Authority states that, on the available medical evidence, it is more probable than not that chilblains and death from chilblains can be related to relevant service. The Statement sets out the factual triggers that must be present for a claims decision to accept that link on the balance of probabilities. (See s 8 and s 9.)\n\n**Why this matters (purpose claim and practical implications)**\n\n- Purpose claimed by the Authority: to provide clear medical criteria to decide when chilblains are service‑related for entitlements (s 8). The instrument translates the medical judgment into discrete, legally usable factors.\n\n- Practical implications for claimants: claimants will need evidence showing the timing and nature of cold exposure or medical records demonstrating the listed co‑morbid diseases, BMI at clinical onset, or documented inability to obtain care. Medical records, contemporaneous reports, or expert opinions will be the typical evidence.\n\n- Administrative and evidentiary effects: decision‑makers must assess whether one of the specified factors existed and whether it is related to the person’s relevant service. Cross‑referencing with other Statements creates additional linking work where a specified disease appears in another instrument (s 11).\n\n**Costs, incentives and trade‑offs (mechanisms, not opinions)**\n\n- Who pays: payment or entitlements (if accepted) flow from the veterans’ entitlements/compensation system; the instrument does not itself set budgets but affects which claims pass the medical causation test.\n- Claimant burden: the instrument shifts the practical burden to produce evidence of one of the listed factors and to show its relation to service. Some factors (e.g., documented temperature exposure within 24 hours of onset) may be hard to prove long after the event.\n- Interaction with private choices and care: the inability‑to‑obtain‑care factor (s 9(4)) can help claimants whose condition was aggravated by lack of access, but it is limited to pre‑existing chilblains that did not arise out of service (s 10(2)). This creates specific evidentiary pathways and limits.\n- Potential substitution effects: where a specified disease is the operative factor, claims may be routed to the Statement that covers that disease, producing administrative dependency between Statements (s 11).\n- Implementation risks: accurate determination of clinical onset timing, objectively establishing BMI at onset, and proving exposure to <10°C within 24 hours are potential practical difficulties that could increase the need for medical expert assessment.\n\n**Key sections to check when using this Statement**\n\n- Definition of chilblains and death from chilblains: s 7 (and Schedule definitions).\n- The four qualifying factors: s 9(1)–(4).\n- Relation to service and limits on the inability‑to‑obtain‑care factor: s 10(1)–(2).\n- Cross‑reference to other Statements: s 11.\n\n"},"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-chilblains-balance-of-probabilities-no-30-of-2018","history":"/api/acts/statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-chilblains-balance-of-probabilities-no-30-of-2018/documents"}}