{"id":"F2019L00256","name":"Statement of Principles concerning chronic pruritus ani (Balance of Probabilities) (No. 32 of 2019)","slug":"statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439967,"registerId":"F2019L00256-fast-fetch-1775955783020","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chronic pruritus ani (Balance of Probabilities) (No. 32 of 2019)","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 PRURITUS ANI (Balance of Probabilities)\n\n(No. 32 of 2019)\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 March 2019\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\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 pruritus ani (Balance of Probabilities) (No. 32 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 2019.\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 pruritus ani No. 76 of 2010 (Federal Register of Legislation No. F2010L02315) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 pruritus ani and death from chronic pruritus ani.\n\nMeaning of chronic pruritus ani\n\n(2) For the purposes of this Statement of Principles, chronic pruritus ani means intense itching of more than six weeks duration affecting the perianal skin.\n\nDeath from chronic pruritus ani\n\n(3) For the purposes of this Statement of Principles, chronic pruritus ani, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic pruritus ani.\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 pruritus ani and death from chronic pruritus ani 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 pruritus ani or death from chronic pruritus ani is connected with the circumstances of a person's relevant service:\n\n(1) an inability to maintain adequate anal hygiene for at least the four weeks before the clinical onset of chronic pruritus ani;\n\nNote: adequate anal hygiene is defined in the Schedule 1 - Dictionary. \n\n(2) undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical onset of chronic pruritus ani;\n\nNote: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary. \n\n(3) having daily episodes of diarrhoea for at least the seven days before the clinical onset of chronic pruritus ani;\n\nNote: diarrhoea is defined in the Schedule 1 - Dictionary. \n\n(4) having faecal incontinence for at least the four weeks before the clinical onset of chronic pruritus ani;\n\nNote: faecal incontinence is defined in the Schedule 1 - Dictionary. \n\n(5) having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical onset of chronic pruritus ani;\n\nNote: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary. \n\n(6) having a perianal or anal infection from the specified list of infections, at the time of the clinical onset of chronic pruritus ani;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary. \n\n(7) having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical onset of chronic pruritus ani;\n\nNote: specified list of infestations is defined in the Schedule 1 - Dictionary.\n\n(8) having a pathological vaginal discharge at the time of the clinical onset of chronic pruritus ani;\n\nNote: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.\n\n(9) having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical onset of chronic pruritus ani;\n\nNote: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.\n\n(10) having a systemic disease from the specified list of systemic diseases at the time of the clinical onset of chronic pruritus ani;\n\nNote: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.\n\n(11) undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical onset of chronic pruritus ani;\n\n(12) having corticosteroid-related atrophy of the perianal skin at the time of the clinical onset of chronic pruritus ani;\n\n(13) an inability to maintain adequate anal hygiene for at least the four weeks before the clinical worsening of chronic pruritus ani;\n\nNote: adequate anal hygiene is defined in the Schedule 1 - Dictionary. \n\n(14) undertaking excessive cleansing of the perianal area for at least the four weeks before the clinical worsening of chronic pruritus ani;\n\nNote: excessive cleansing of the perianal area is defined in the Schedule 1 - Dictionary. \n\n(15) having daily episodes of diarrhoea for at least the seven days before the clinical worsening of chronic pruritus ani;\n\nNote: diarrhoea is defined in the Schedule 1 - Dictionary. \n\n(16) having faecal incontinence for at least the four weeks before the clinical worsening of chronic pruritus ani;\n\nNote: faecal incontinence is defined in the Schedule 1 - Dictionary. \n\n(17) having a condition from the specified list of rectal, anal and perianal conditions at the time of the clinical worsening of chronic pruritus ani;\n\nNote: specified list of rectal, anal and perianal conditions is defined in the Schedule 1 - Dictionary. \n\n(18) having a perianal or anal infection from the specified list of infections, at the time of the clinical worsening of chronic pruritus ani;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary. \n\n(19) having a perianal or anal infestation with an agent from the specified list of infestations, at the time of the clinical worsening of chronic pruritus ani;\n\nNote: specified list of infestations is defined in the Schedule 1 - Dictionary.\n\n(20) having a pathological vaginal discharge at the time of the clinical worsening of chronic pruritus ani;\n\nNote: pathological vaginal discharge is defined in the Schedule 1 - Dictionary.\n\n(21) having a dermatological disease from the specified list of dermatological diseases affecting the perianal or anal region at the time of the clinical worsening of chronic pruritus ani;\n\nNote: specified list of dermatological diseases is defined in the Schedule 1 - Dictionary.\n\n(22) having a systemic disease from the specified list of systemic diseases at the time of the clinical worsening of chronic pruritus ani;\n\nNote: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.\n\n(23) undergoing a course of therapeutic radiation for cancer, where the perianal region was in the field of radiation, within the 30 days before the clinical worsening of chronic pruritus ani;\n\n(24) having corticosteroid-related atrophy of the perianal skin at the time of the clinical worsening of chronic pruritus ani;\n\n(25) inability to obtain appropriate clinical management for chronic pruritus ani.\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(13) to 9(25) apply only to material contribution to, or aggravation of, chronic pruritus ani where the person's chronic pruritus ani 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 adequate anal hygiene means the personal maintenance of cleanliness of the perianal area by wiping with paper or washing with water.\n\n chronic pruritus ani—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 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 diarrhoea means predominantly liquid faecal discharge.\n\n excessive cleansing of the perianal area means vigorous scrubbing of the perianal skin resulting in mechanical trauma to the skin, or the excessive use of soap or wipes containing alcohol or other astringents, irritants or allergens.\n\n faecal incontinence means the involuntary discharge of liquid or solid faeces. \n\nNote: Causes of faecal incontinence include, but are not limited to, constipation with overflow, laxative effects of drugs, and abnormalities of the anal sphincter muscles, rectum, puborectalis muscle, pudendal nerve, central nervous system, spinal cord and autonomic nervous system.\n\n iron deficiency means having a serum ferritin level of less than 20 micrograms per litre.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pathological vaginal discharge means a discharge of fluid from the vagina due to one of the following diseases: vulvovaginal candidiasis, trichomonal vaginitis, bacterial vaginosis, Chlamydia trachomatis cervicitis or gonorrhoea of the lower genitourinary tract.\n\n radiation recall dermatitis means an acute inflammatory skin reaction in an area that has undergone a course of therapeutic radiation at least seven days earlier, and develops following the administration of a systemic antineoplastic agent or other drug.\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 dermatological diseases means:\n\n(a) acanthosis nigricans;\n\n(b) allergic contact dermatitis;\n\n(c) atopic dermatitis;\n\n(d) hidradenitis suppurativa;\n\n(e) irritant contact dermatitis;\n\n(f) lichen planus;\n\n(g) lichen sclerosus;\n\n(h) neurodermatitis;\n\n(i) psoriasis;\n\n(j) radiation dermatitis;\n\n(k) radiation recall dermatitis;\n\n(l) seborrhoeic dermatitis; or\n\n(m) systemic contact dermatitis.\n\nNote 1: Various forms of contact dermatitis may be precipitated by irritants or allergens, including, but not limited to, foods, chemicals, drugs and faeces.\n\nNote 2: Neurodermatitis is also known as lichen simplex chronicus. \n\nNote 3: systemic contact dermatitis and radiation recall dermatitis are also defined in the Schedule 1 - Dictionary.\n\n specified list of infections means:\n\n(a) Candida albicans;\n\n(b) Corynebacterium spp.;\n\n(c) Epidermophyton spp., Microsporum spp. or Trichophyton spp. (tinea);\n\n(d) herpes simplex virus;\n\n(e) human papilloma virus;\n\n(f) molluscum contagiosum virus;\n\n(g) Neisseria gonorrhoeae (gonorrhoea);\n\n(h) Staphylococcus spp.;\n\n(i) Streptococcus spp.; or\n\n(j) Treponeum pallidum (syphilis).\n\n specified list of infestations means:\n\n(a) Enterobius vermicularis (pin worm);\n\n(b) Phthirus pubis or Pediculus humanus (lice);\n\n(c) Sarcoptes scabiei (scabies);\n\n(d) Strongyloides stercoralis (strongyloides); or\n\n(e) Taenia saginata or Taenia solium (tapeworm).\n\n specified list of rectal, anal and perianal conditions means:\n\n(a) anal fissure;\n\n(b) anal fistula;\n\n(c) anal skin tag;\n\n(d) anal sphincter incompetence;\n\n(e) familial adenomatous polyposis;\n\n(f) haemorrhoid;\n\n(g) inflammatory bowel disease;\n\n(h) perianal wart;\n\n(i) perianal abscess;\n\n(j) proctitis;\n\n(k) rectal prolapse; or\n\n(l) any benign or malignant neoplasm of the rectum, anus, anal canal or perianal skin.\n\n specified list of systemic diseases means:\n\n(a) aplastic anaemia;\n\n(b) cholestatic liver disease;\n\n(c) chronic renal failure;\n\n(d) diabetes mellitus;\n\n(e) hyperbilirubinaemia;\n\n(f) hyperthyroidism;\n\n(g) hypothyroidism;\n\n(h) human immunodeficiency virus;\n\n(i) iron deficiency;\n\n(j) leukaemia;\n\n(k) lymphoma; or\n\n(l) polycythaemia vera.\n\nNote: chronic renal failure and iron deficiency are also defined in the Schedule 1 - Dictionary.\n\n systemic contact dermatitis means an inflammatory skin condition in a person who has experienced allergic contact dermatitis from cutaneous contact with an allergen at the affected site, and subsequently experiences a reactivation at that site following systemic exposure to that same allergen or a cross-reacting allergen.\n\nNote: Systemic contact dermatitis may occur following systemic exposure to a range of contact allergens, including, but not limited to, chemicals and drugs found in topical medications.\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":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard format and scope of Repatriation Medical Authority Statements of Principles. It replaces the 2010 version (No. 76 of 2010) with updated medical criteria but does not expand beyond the original purpose of establishing service connection criteria for chronic pruritus ani. The structure follows the standard template used for all such instruments under section 196B(3) of the VEA."},"complexity_factors":["25 distinct factors in section 9, with 12 factors for initial onset and 12 parallel factors for clinical worsening, plus one standalone factor (inability to obtain appropriate clinical management)","Multiple defined terms (approximately 15) in Schedule 1, including nested definitions where some defined terms refer to other defined terms (e.g., 'systemic contact dermatitis' and 'radiation recall dermatitis' are defined separately but appear in lists)","Five separate 'specified lists' containing multiple medical conditions, infections, infestations, and diseases that must be cross-referenced","Temporal requirements vary across factors (4 weeks, 7 days, 30 days, 'at the time of') creating conditional logic","Section 10(2) contains a limitation clause restricting factors 13-25 to aggravation cases only, creating a conditional subset","Section 11 incorporates external Statements of Principles by reference, creating interdependence with other instruments","Dual statutory framework application (VEA and MRCA) requiring understanding of two separate Acts"],"plain_english_summary":"This instrument sets the medical test for linking chronic pruritus ani (persistent anal itching >6 weeks) to military service — using the \"balance of probabilities\" rule and a prescribed list of 25 medical factors — and replaces the 2010 version. It affects veterans and current/former defence personnel claiming under veterans’ compensation laws and the Department of Veterans’ Affairs decision-makers. It matters because it determines eligibility for financial and medical support based on specified medical evidence rather than ad hoc judgement."},"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":4,"scope_assessment":{"changed":false,"description":"The instrument replaces the earlier Statement of Principles but continues to apply to claims under the VEA and MRCA. It defines the same disease concept (chronic pruritus ani), covers both onset and clinical worsening and includes death from the condition. The text does not itself assert a broader or narrower statutory scope beyond updating the factors and definitions."},"complexity_factors":["Numerous medical definitions and specified lists (dermatological diseases, infections, infestations, rectal/anal conditions, systemic diseases) located in Schedule 1, increasing reference complexity.","Separate, repeated factor sets for clinical onset and for clinical worsening (sections 9 and 10(2)), requiring different causal analyses depending on timing.","Multiple temporal thresholds for required exposures or symptoms (e.g. 4 weeks, 7 days, 30 days) that must be proved.","Interplay with other Statements of Principles where factors refer to injuries/diseases covered elsewhere (section 11), creating cross-instrument dependency.","Causation standard is balance of probabilities and requires the factor to be related to relevant service (sections 8 and 10(1)), so evidentiary and attribution judgments are central.","Instrument repeals a prior Statement (section 4), so practitioners must ensure they apply the current text rather than earlier versions."],"plain_english_summary":"This instrument tells decision-makers what medical facts must be present for chronic pruritus ani (intense anal itching lasting more than six weeks) or death from it to be regarded as connected with a veteran’s service for VEA or MRCA claims. It lists specific, time‑bounded medical, infectious, dermatological, behavioural and treatment‑related factors which, if tied to relevant service, establish a causal link on the balance of probabilities and so affect entitlement to benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019","history":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-pruritus-ani-balance-of-probabilities-no-32-of-2019/documents"}}