{"id":"F2023L00176","name":"Statement of Principles concerning chronic obstructive pulmonary disease (Balance of Probabilities) (No. 18 of 2023)","slug":"statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441738,"registerId":"F2023L00176-fast-fetch-1775956966273","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chronic obstructive pulmonary disease (Balance of Probabilities) (No. 18 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCHRONIC OBSTRUCTIVE PULMONARY DISEASE (Balance of Probabilities)\n\n(No. 18 of 2023)\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 27 February 2023\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 obstructive pulmonary disease (Balance of Probabilities) (No. 18 of 2023).\n\n2 Commencement\n\n This instrument commences on 27 March 2023.\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 obstructive pulmonary disease No. 38 of 2014 (Federal Register of Legislation No. F2014L00475) 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 obstructive pulmonary disease and death from chronic obstructive pulmonary disease.\n\nMeaning of chronic obstructive pulmonary disease\n\n(2) For the purposes of this Statement of Principles, chronic obstructive pulmonary disease:\n\n(a) means a chronic progressive inflammatory pathology occurring with different proportions of involvement of the airways, lung parenchyma and vasculature; and\n\n(b) includes:\n\n(i) chronic bronchitis;\n\n(ii) emphysema; and\n\n(iii) persistent airflow limitation; and\n\n(c) excludes:\n\n(i) asbestosis;\n\n(ii) asthma;\n\n(iii) bronchiectasis;\n\n(iv) bronchiolitis obliterans;\n\n(v) fibrosing interstitial lung disease and other fibrosing lung disease;\n\n(vi) hypersensitivity pneumonitis (extrinsic allergic alveolitis); and\n\n(vii) surgical, traumatic or localised emphysema.\n\n \n\nNote 1: Symptoms of chronic obstructive pulmonary disease include dyspnoea, cough and the production of phlegm. Chronic bronchitis typically occurs with the presence of a productive cough for at least three months of the year for at least two consecutive years. Emphysema is characterized by the destruction of alveolar septa with the enlargement of alveolar airspaces.\n\nNote 2: persistent airflow limitation is defined in the Schedule 1 – Dictionary.\n\n(3) While chronic obstructive pulmonary disease attracts ICD‑10‑AM code J41, J42, J43 and J44, in applying this Statement of Principles the meaning of chronic obstructive pulmonary disease 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 chronic obstructive pulmonary disease\n\n(5) For the purposes of this Statement of Principles, chronic obstructive pulmonary disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic obstructive pulmonary disease.\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 obstructive pulmonary disease and death from chronic obstructive pulmonary disease 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 obstructive pulmonary disease or death from chronic obstructive pulmonary disease is connected with the circumstances of a person's relevant service:\n\n(1) having smoked tobacco products:\n\n(a) in an amount of at least 5 pack-years before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 – Dictionary.\n\n(2) having been exposed to second-hand smoke:\n\n(a) for at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if exposure to second-hand smoke has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;\n\nNote: being exposed to second-hand smoke is defined in the Schedule 1 – Dictionary.\n\n(3) having smoked cannabis:\n\n(a) in an amount of at least 20 joint-years before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;\n\nNote: joint-years of cannabis is defined in the Schedule 1 – Dictionary. \n\n(4) inhaling smoke from the combustion of polluting fuels in an enclosed space:\n\n(a) for a cumulative period of at least 10,000 hours before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;\n\nNote: polluting fuels is defined in the Schedule 1 – Dictionary.\n\n(5) inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in:\n\n(a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and\n\n(b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 5 years before the clinical onset of chronic obstructive pulmonary disease;\n\nNote: specified list of respiratory tract irritants is defined in the Schedule 1 – Dictionary.\n\n(6) inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space:\n\n(a) for a cumulative period of at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: specified list of substances is defined in the Schedule 1 – Dictionary.\n\n(7) inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment:\n\n(a) for a cumulative period of at least 40 000 hours before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: specified list of substances is defined in the Schedule 1 – Dictionary.\n\n(8) inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre:\n\n(a) for a cumulative period of at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: dust is defined in the Schedule 1 – Dictionary.\n\n(9) having infection with human immunodeficiency virus before the clinical onset of chronic obstructive pulmonary disease;\n\n(10) having pulmonary tuberculosis at least 1 year before the clinical onset of chronic obstructive pulmonary disease;\n\nNote: pulmonary tuberculosis is defined in the Schedule 1 – Dictionary.\n\n(11) having alpha-1 antitrypsin deficiency at the time of the clinical onset of chronic obstructive pulmonary disease;\n\n(12) having asthma before the clinical onset of chronic obstructive pulmonary disease;\n\n(13) having bronchiectasis before the clinical onset of chronic obstructive pulmonary disease;\n\n(14) having smoked tobacco products:\n\n(a) in an amount of at least 1 pack-year before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 10 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 – Dictionary.\n\n(15) being exposed to second-hand smoke:\n\n(a) for at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if exposure to second-hand smoke has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;\n\nNote: being exposed to second-hand smoke is defined in the Schedule 1 – Dictionary.\n\n(16) having smoked cannabis:\n\n(a) in an amount of at least 20 joint-years before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;\n\nNote: joint-years of cannabis is defined in the Schedule 1 – Dictionary.\n\n(17) inhaling smoke from the combustion of polluting fuels in an enclosed space:\n\n(a) for a cumulative period of at least 10,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;\n\nNote: polluting fuels is defined in the Schedule 1 – Dictionary.\n\n(18) inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in:\n\n(a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and\n\n(b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 5 years before the clinical worsening of chronic obstructive pulmonary disease;\n\nNote: specified list of respiratory tract irritants is defined in the Schedule 1 – Dictionary.\n\n(19) inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space:\n\n(a) for a cumulative period of at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: specified list of substances is defined in the Schedule 1 – Dictionary.\n\n(20) inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment:\n\n(a) for a cumulative period of at least 40,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: specified list of substances is defined in the Schedule 1 – Dictionary.\n\n(21) inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre:\n\n(a) for a cumulative period of at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and\n\n(b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;\n\nNote: dust is defined in the Schedule 1 – Dictionary.\n\n(22) having infection with human immunodeficiency virus before the clinical worsening of chronic obstructive pulmonary disease;\n\n(23) having at least 4 episodes of acute viral or bacterial lower respiratory tract infection requiring medical treatment within the 1 year before the clinical worsening of chronic obstructive pulmonary disease;\n\nNote: lower respiratory tract is defined in the Schedule 1 – Dictionary.\n\n(24) having pulmonary tuberculosis at least 1 year before the clinical worsening of chronic obstructive pulmonary disease;\n\nNote: pulmonary tuberculosis is defined in the Schedule 1 – Dictionary.\n\n(25) having alpha-1 antitrypsin deficiency at the time of the clinical worsening of chronic obstructive pulmonary disease;\n\n(26) having asthma before the clinical worsening of chronic obstructive pulmonary disease;\n\n(27) having bronchiectasis before the clinical worsening of chronic obstructive pulmonary disease;\n\n(28) having gastro-oesophageal reflux disease, with erosive oesophagitis or oesophageal stricture at the time of the clinical worsening of chronic obstructive pulmonary disease;\n\n(29) inability to obtain appropriate clinical management for chronic obstructive pulmonary disease.\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(14) to 9(29) apply only to material contribution to, or aggravation of, chronic obstructive pulmonary disease where the person's chronic obstructive pulmonary disease 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 being exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\n chronic obstructive pulmonary disease—see subsection 7(2).\n\n dust means airborne particulate matter consisting of solid particles of organic or inorganic matter, of aerodynamic diameter between 0.5 and 30 micrometres, excluding wood dust.\n\n joint-years of cannabis means a calculation of consumption where 1 joint-year of cannabis equals 1 joint per day for a period of 1 year.\n\n lower respiratory tract means the trachea, bronchi, and lungs.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\nNote 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\nNote 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\n persistent airflow limitation is a post-bronchodilator spirometric ratio of forced expiratory volume in one second divided by forced vital capacity (FEV1/FVC) less than 0.7, which is not attributable to other pathology.\n\n polluting fuels means animal dung, wood, charcoal, coal, coke, crop residues, and kerosene.\n\n pulmonary tuberculosis means an active tuberculosis infection that occurs in the lung or respiratory tract in which the tuberculosis bacteria are multiplying and inducing an inflammatory response.\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 respiratory tract irritants means:\n\n(a) ammonia;\n\n(b) chlorine;\n\n(c) dust at a concentration of greater than five milligrams per cubic metre;\n\n(d) Lewisite;\n\n(e) oxides of nitrogen;\n\n(f) oxides of sulphur;\n\n(g) phosgene;\n\n(h) phthalic anhydride;\n\n(i) smoke from fires;\n\n(j) sulphur mustard (mustard gas); or\n\n(k) another respirable agent which causes comparable tissue damage. \n\nNote: Dust is also defined in the Schedule 1 – Dictionary.\n\n specified list of substances means:\n\n(a) cadmium fumes at a concentration >0.00001 mg/m3;\n\n(b) sulphur dioxide gas at a concentration >0.1 ppm; or\n\n(c) sulphur mustard (mustard gas).\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":{"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":7,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning COPD No. 38 of 2014 (section 4) and replaces it. It applies to claims governed by VEA s120B or MRCA s339 (section 5). The instrument sets out the definitions, exclusions (section 7(2)(c)), required exposure and timing criteria (section 9) and relationship‑to‑service rules (section 10). The source text itself does not state whether coverage is broader or narrower than the repealed instrument; it is a replacement with its own specified thresholds and terms."},"complexity_factors":["Technical medical definitions and diagnostic thresholds (definition of COPD, persistent airflow limitation: Schedule 1; subsection 7(2)).","Multiple numeric exposure thresholds and cessation windows (pack‑years, joint‑years, cumulative hours, concentration limits) create measurement and evidentiary demands on claimants (section 9; Schedule 1).","Distinct treatment of clinical onset versus clinical worsening with different threshold values and time limits (section 9, subsections 9(1)–9(29); relationship limitation in section 10(2)).","Discrete inclusions and exclusions that require medical differentiation from other lung diseases (exclusions in section 7(2)(c)).","Specified lists of irritants and substances with concentration limits (Schedule 1: specified list of respiratory tract irritants; specified list of substances).","Cross‑references to other Statements of Principles where factors refer to other injuries or diseases (section 11), increasing interdependence across instruments.","Decision‑maker and legal test: instrument is determined by the Repatriation Medical Authority under VEA s196B(3) and applies to claims under VEA s120B or MRCA s339 (sections 3 and 5); the causal standard is balance of probabilities (section 8).","Compliance and evidentiary burden on claimants to prove cumulative exposures, timing and medical history (many provisions in section 9 and definitions in Schedule 1).","Implementation reliance on ‘sound medical‑scientific evidence’ (section 8) introduces scope for expert interpretation and administrative/medical discretion."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority uses to decide whether chronic obstructive pulmonary disease (COPD) or death from COPD is connected to a veteran’s or service member’s relevant service. It lists precise diagnostic definitions, excluded conditions, and measurable exposure and timing thresholds (for smoking, second‑hand smoke, dust, fumes, infections, etc.) that must be met for a claim under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act."},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It updates the 2014 version with revised medical evidence and modified thresholds (notably the addition of cannabis smoking as factor 3/16 and refined dust concentration specifications), but remains within the original legislative framework of determining service connection for veterans' compensation claims. The structure — defining the disease, listing specific etiological factors with quantitative thresholds, and distinguishing onset from worsening — is consistent with the original intent under subsection 196B(3) of the VEA."},"complexity_factors":["29 distinct factors with dual pathways (clinical onset vs clinical worsening), each with specific quantitative thresholds (pack-years, joint-years, hours of exposure, concentration levels in mg/m³ or ppm)","Multiple temporal limitation clauses ('if exposure has ceased...within X years') creating conditional logic that varies by factor (10 years for some, 20 years for others)","Extensive cross-referencing to Schedule 1 definitions — 15+ defined terms including technical medical measurements (FEV1/FVC ratio, aerodynamic diameter specifications)","Nested exclusion structure in section 7(2)(c) excluding 7 specific conditions from the COPD definition, plus a complex inclusion/exclusion framework for death from terminal events","Bifurcated application framework distinguishing between causation of new disease (factors 1-13) and aggravation of pre-existing disease (factors 14-29), with section 10(2) creating a conditional limitation on the latter set","Incorporation by reference of external medical classification systems (ICD-10-AM Tenth Edition) with specific edition and ISBN citation","Section 11 creates dynamic incorporation of other Statements of Principles, meaning this instrument's meaning changes as other instruments are updated"],"plain_english_summary":"This instrument sets the medical tests for when Australian veterans and defence members can get compensation for COPD under the Veterans' Entitlements Act and MRCA. It replaces the 2014 rules, applies to peacetime/non‑operational service, uses the balance‑of‑probabilities standard, and lists 29 service‑related risk factors.\n\nIt recognises smoking thresholds, heavy second‑hand smoke, cannabis, infections, and specific fumes/chemicals as potential causes or worseners, includes time limits and exclusions, and clarifies how service exposures can establish liability."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no","history":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-obstructive-pulmonary-disease-balance-of-probabilities-no/documents"}}