{"id":"F2021L01385","name":"Statement of Principles concerning chronic gastritis and chronic gastropathy (Balance of Probabilities) (No. 102 of 2021)","slug":"statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441024,"registerId":"F2021L01385-fast-fetch-1775956456862","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chronic gastritis and chronic gastropathy (Balance of Probabilities) (No. 102 of 2021)","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\nCHRONIC GASTRITIS AND CHRONIC GASTROPATHY (Balance of Probabilities)\n\n(No. 102 of 2021)\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 1 October 2021\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 Terence Campbell AM
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 chronic gastritis and chronic gastropathy (Balance of Probabilities) (No. 102 of 2021).\n\n2 Commencement\n\n This instrument commences on 1 November 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning chronic gastritis and chronic gastropathy No. 26 of 2013 (Federal Register of Legislation No. F2013L00722) made under subsections 196B(3) and (8) of the VEA is repealed.\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 chronic gastritis and chronic gastropathy and death from chronic gastritis and chronic gastropathy.\n\nMeaning of chronic gastritis and chronic gastropathy\n\n(2) For the purposes of this Statement of Principles:\n\n(a) chronic gastritis means inflammation of the gastric mucosa with histologically demonstrated chronic inflammatory cell infiltrate; and\n\n(b) chronic gastropathy means:\n\n(i) histologically demonstrated gastric epithelial cell damage and regeneration with minimal or no associated inflammation; and\n\n(ii) the presence of clinical manifestations that have persisted for at least 3 consecutive months.\n\nNote: Clinical manifestations of chronic gastritis and chronic gastropathy typically include epigastric pain, nausea, bloating and burning.\n\n(c) Chronic gastritis and chronic gastropathy exclude:\n\n(i) acute gastritis;\n\n(ii) acute gastropathy;\n\n(iii) autoimmune gastritis;\n\n(iv) chronic non-infectious granulomatous gastritis;\n\n(v) eosinophilic gastritis;\n\n(vi) gastric antral vascular ectasia;\n\n(vii) ischaemic gastritis;\n\n(viii) lymphocytic gastritis;\n\n(ix) portal hypertensive gastropathy;\n\n(x) stress gastritis/ulcer; and\n\n(xi) uraemic gastritis.\n\nDeath from chronic gastritis and chronic gastropathy\n\n(3) For the purposes of this Statement of Principles, chronic gastritis or chronic gastropathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic gastritis or chronic gastropathy.\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 chronic gastritis or chronic gastropathy and death from chronic gastritis or chronic gastropathy can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, chronic gastritis or chronic gastropathy or death from chronic gastritis or chronic gastropathy is connected with the circumstances of a person's relevant service:\n\n(1) for chronic gastritis only:\n\n(a) having a Helicobacter pylori infection of the gastric mucosa before the clinical onset of chronic gastritis;\n\n(b) having Helicobacter heilmannii sensu lato infection of the gastric mucosa before the clinical onset of chronic gastritis;\n\nNote: Helicobacter heilmannii sensu lato is defined in the Schedule 1 - Dictionary.\n\n(c) having an infection of the gastric mucosa from the specified list of infections at the time of the clinical onset of chronic gastritis;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(d) being in an immunocompromised state as specified at the time of the clinical onset of chronic gastritis; or\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.\n\n(e) taking an immune checkpoint inhibitor for at least the 4 weeks before the clinical onset of chronic gastritis;\n\nNote: Examples of immune checkpoint inhibitors include ipilimumab, tremelimumab, nivolumab and pembrolizumab.\n\n(2) for chronic gastropathy only:\n\n(a) having reflux of bile acids into the stomach at the time of the clinical onset of chronic gastropathy;\n\nNote: Examples of circumstances in which reflux of bile acids into the stomach can occur include post-gastrectomy, post-biliary surgery and decreased gastric or duodenal motility.\n\n(b) taking a non-topical, non-steroidal, anti-inflammatory drug, including aspirin, on more days than not for a continuous period of at least 2 weeks, within the 30 days before the clinical onset of chronic gastropathy;\n\n(c) taking a drug from the Specified List 1 of drugs for at least the 4 weeks before the clinical onset of chronic gastropathy;\n\nNote: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(d) consuming an average of at least 350 grams of alcohol per week for at least the 5 years before the clinical onset of chronic gastropathy;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(e) undergoing a course of therapeutic radiation for cancer, where the stomach was in the field of radiation, within the 1 year before the clinical onset of chronic gastropathy; or\n\n(f) having received yttrium-90 microspheres as therapy for primary and metastatic liver tumours, within the 1 year before the clinical onset of chronic gastropathy;\n\n(3) having reflux of bile acids into the stomach at the time of the clinical worsening of chronic gastritis or chronic gastropathy;\n\nNote: Examples of circumstances in which reflux of bile acids into the stomach can occur include post-gastrectomy, post-biliary surgery and decreased gastric or duodenal motility. \n\n(4) taking a non-topical, non-steroidal, anti-inflammatory drug, including aspirin, on more days than not for a continuous period of at least 8 days, within the 30 days before the clinical worsening of chronic gastritis or chronic gastropathy;\n\n(5) taking a drug from the Specified List 2 of drugs at the time of the clinical worsening of chronic gastritis or chronic gastropathy;\n\nNote: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.\n\n(6) consuming an average of at least 350 grams of alcohol per week for at least the 1 year before the clinical worsening of chronic gastritis or chronic gastropathy;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(7) undergoing a course of therapeutic radiation for cancer, where the stomach was in the field of radiation, within the 1 year before the clinical worsening of chronic gastritis or chronic gastropathy;\n\n(8) having received yttrium-90 microspheres as therapy for primary and metastatic liver tumours, within the 1 year before the clinical worsening of chronic gastritis or chronic gastropathy;\n\n(9) for chronic gastritis only:\n\n(a) having a Helicobacter pylori infection of the gastric mucosa before the clinical worsening of chronic gastritis;\n\n(b) having Helicobacter heilmannii sensu lato infection of the gastric mucosa before the clinical worsening of chronic gastritis;\n\nNote: Helicobacter heilmannii sensu lato is defined in the Schedule 1 - Dictionary.\n\n(c) having an infection of the gastric mucosa from the specified list of infections at the time of the clinical worsening of chronic gastritis;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(d) being in an immunocompromised state as specified at the time of the clinical worsening of chronic gastritis; or\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.\n\n(e) taking an immune checkpoint inhibitor for at least the 4 weeks before the clinical worsening of chronic gastritis;\n\nNote: Examples of immune checkpoint inhibitors include ipilimumab, tremelimumab, nivolumab and pembrolizumab.\n\n(10) inability to obtain appropriate clinical management for chronic gastritis or chronic gastropathy.\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(3) to 9(10) apply only to material contribution to, or aggravation of, chronic gastritis or chronic gastropathy where the person's chronic gastritis or chronic gastropathy 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 chronic gastritis and chronic gastropathy—see subsection 7(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 3 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 Helicobacter heilmannii sensu lato means species of Helicobacter other than Helicobacter pylori, including Helicobacter suis, Helicobacter felis, Helicobacter bizzozeronii, Helicobacter heilmannii sensu stricto and Helicobacter salomonis.\n\n immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) having a haematological or solid organ malignancy;\n\n(b) having chronic renal failure;\n\n(c) having infection with human immunodeficiency virus;\n\n(d) having severe malnutrition;\n\n(e) taking an immunosuppressive drug; or\n\n(f) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.\n\n immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\nNote: Examples of an immunosuppressive drug include:\n\n(a) chemotherapeutic agents used for the treatment of cancer;\n\n(b) corticosteroids, other than inhaled or topical corticosteroids;\n\n(c) drugs used to prevent transplant rejection; and\n\n(d) tumour necrosis factor-α inhibitors.\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 \n\n Specified List 1 of drugs means:\n\n(a) antiretroviral therapy;\n\n(b) chemotherapeutic agents delivered by hepatic arterial infusion;\n\n(c) colchicine;\n\n(d) dabigatran etexilate;\n\n(e) doxycycline; \n\n(f) non-topical corticosteroids;\n\n(g) oral bisphosphonates;\n\n(h) oral iron supplements;\n\n(i) slow-release potassium chloride; or\n\n(j) sodium polystyrene sulfonate.\n\n Specified List 2 of drugs means:\n\n(a) anticoagulants;\n\n(b) antiretroviral therapy;\n\n(c) chemotherapeutic agents delivered by hepatic arterial infusion;\n\n(d) colchicine;\n\n(e) doxycycline; \n\n(f) non-topical corticosteroids;\n\n(g) oral bisphosphonates;\n\n(h) oral iron supplements;\n\n(i) selective serotonin reuptake inhibitors;\n\n(j) slow-release potassium chloride; or\n\n(k) sodium polystyrene sulfonate.\n\n specified list of infections means:\n\n(a) actinomycosis;\n\n(b) basidiobolomycosis;\n\n(c) cytomegalovirus infection;\n\n(d) Epstein-Barr virus infection;\n\n(e) herpes simplex virus infection;\n\n(f) histoplasmosis;\n\n(g) human herpesvirus-6 infection;\n\n(h) leishmaniasis;\n\n(i) mucormycosis;\n\n(j) Sarcina ventriculi infection;\n\n(k) strongyloidiasis; or\n\n(l) Treponema pallidum infection (syphilis).\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":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It updates the 2013 version (No. 26 of 2013) but maintains the same fundamental scope: establishing medical criteria for linking chronic gastritis/gastropathy to military service. The structure and purpose remain consistent with the original legislative intent of the Repatriation Medical Authority's role under section 196B(3)."},"complexity_factors":["Multiple defined terms in Schedule 1 (15+ definitions including nested definitions like 'immunocompromised state as specified' which itself references other defined terms)","Parallel structure for gastritis vs gastropathy with different factor sets requiring careful parsing","Time-bound conditions with varying windows (4 weeks, 8 days, 30 days, 1 year, 5 years)","Cross-references between sections (e.g., section 11 incorporates other Statements of Principles by reference)","Specific numerical thresholds (350g alcohol/week, 10g per standard drink, GFR <15 mL/min)","Two separate drug lists (Specified List 1 and Specified List 2) with 10 and 11 items respectively, partially overlapping but with distinct timing requirements","Conditional logic distinguishing between 'clinical onset' and 'clinical worsening' with different applicable factors","Exclusion list of 11 specific conditions that are NOT covered"],"plain_english_summary":"This instrument sets the medical tests and legal standard for compensating Australian veterans and defence members for chronic gastritis or chronic gastropathy. It requires objective medical evidence (e.g., biopsy or visible mucosal damage with chronic symptoms), a qualifying risk factor, and causation on the balance of probabilities, and it replaces the 2013 guidance. It matters because it is the gatekeeper determining whether service‑related stomach disease leads to benefits or death-related claims."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles No. 26 of 2013 (s4) and replaces it with updated definitions, enumerated factor lists, and timeframes that determine when chronic gastritis or chronic gastropathy can be related to relevant service (see ss7–9 and Schedule 1). The text explicitly links factors to 'relevant service' and cross‑references other Statements of Principles (s10–s11), but the instrument itself does not describe the differences in policy effect beyond the repeal."},"complexity_factors":["Multiple technical medical definitions and explicit exclusions for chronic gastritis and chronic gastropathy (s7(2)(a)–(c)).","Separate and overlapping causation criteria for 'onset' versus 'clinical worsening', and different rules for gastritis and gastropathy (s9(1)–(3), (9)).","Enumerated lists of infections, drugs and therapies in Schedule 1 that must be matched to clinical history (Schedule 1: specified list of infections; Specified List 1 and 2).","Time‑window and dosage/threshold requirements (e.g. 4 weeks for checkpoint inhibitors, 2 weeks NSAID use within 30 days, 350 g alcohol/week for periods specified) creating evidentiary burdens (s9(1)(e); s9(2)(b),(d); s9(6)).","Requirement that any listed factor be related to the person's 'relevant service', with legal definitions provided in Schedule 1 and applying to different service types (s10(1); Schedule 1 'relevant service').","Interaction with other Statements of Principles and a repeal of the prior instrument, producing dependency on cross-referenced instruments (s4; s11).","Use of the 'balance of probabilities' standard tied to 'sound medical‑scientific evidence', which imports clinical judgment and evidentiary complexity into legal causation (s8).","Quantified lifestyle and clinical metrics (alcohol grams; histological demonstration; immunocompromised states) that require specific medical documentation to satisfy the criteria (s7(2)(a)–(b); s9(2)(d); Schedule 1)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether chronic gastritis or chronic gastropathy (and death from them) can be linked to a veteran’s or service member’s relevant service. It defines clinical tests, exclusions, specific infections, drugs, procedures and time windows that claimants must meet to establish service connection for entitlements under the VEA or MRCA."},"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-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie","history":"/api/acts/statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-gastritis-and-chronic-gastropathy-balance-of-probabilitie/documents"}}