{"id":"F2017L00002","name":"Statement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017)","slug":"statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":95691,"registerId":"commonwealth-F2017L00002-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 18 September 2017\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017) (F2017L01067)\n\nThe day of commencement of this Amendment Determination is 18 September 2017.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017) that shows the text of the law as amended and in force on 18 September 2017.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\n![RMA-Red](image.002.jpeg)\n\nStatement of Principles\n\nconcerning\n\nCIRRHOSIS OF THE LIVER  \n(Reasonable Hypothesis)\n\n(No. 1 of 2017)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\nDated 20 December 2016\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\n1 Name\n\nThis is the Statement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017).\n\n2 Commencement\n\nThis instrument commences on 23 January 2017.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning cirrhosis of the liver No. 107 of 2007, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.\n\n5 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\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 cirrhosis of the liver and death from cirrhosis of the liver.\n\nMeaning of cirrhosis of the liver\n\n(2) For the purposes of this Statement of Principles, cirrhosis of the liver means a chronic condition of the hepatic parenchyma involving severe fibrosis in association with the formation of regenerative nodules.\n\n(3) While cirrhosis of the liver attracts ICD‑10‑AM code K70.3, K71.7 or K74.3-K74.6, in applying this Statement of Principles the meaning of cirrhosis of the liver 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.\n\nDeath from cirrhosis of the liver\n\n(5) For the purposes of this Statement of Principles, cirrhosis of the liver, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cirrhosis of the liver.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that cirrhosis of the liver and death from cirrhosis of the liver 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\n> Note: relevant service is defined in the Schedule 1 – Dictionary.\n\n9 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 cirrhosis of the liver or death from cirrhosis of the liver with the circumstances of a person's relevant service:\n\n(1) for males, consuming at least 110 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;\n\n> Note: alcohol is defined in the Schedule 1 - Dictionary.\n\n(2) for females, consuming at least 55 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;\n\n> Note: alcohol is defined in the Schedule 1 - Dictionary.\n\n(3) having received a cumulative equivalent dose of at least 0.4 sievert of ionising radiation to the liver before the clinical onset of cirrhosis of the liver;\n\n> Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n  \n\n(4) having chronic infection with the hepatitis B virus before the clinical onset of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.\n\n(5) having chronic infection with the hepatitis C virus before the clinical onset of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.\n\n(6) having chronic infection with the hepatitis D virus before the clinical onset of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.\n\n(7) having infection with the hepatitis E virus before the clinical onset of cirrhosis of the liver;\n\n> Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.\n\n(8) having chronic hepatitis before the clinical onset of cirrhosis of the liver;\n\n> Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.\n\n(9) having autoimmune chronic active hepatitis before the clinical onset of cirrhosis of the liver;\n\n> Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.\n\n(10) having steatohepatitis before the clinical onset of cirrhosis of the liver;\n\n(11) being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical onset of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.\n\n(12) having evidence of chronic infection with schistosomiasis involving the liver before the clinical onset of cirrhosis of the liver;\n\n(13) having granulomatous liver disease before the clinical onset of cirrhosis of the liver;\n\n> Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.\n\n(14) having severe right-sided cardiac failure for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;\n\n> Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.\n\n(15) having veno\\-occlusive disease for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;\n\n> Note: veno\\-occlusive disease is defined in the Schedule 1 - Dictionary.\n\n(16) having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical onset of cirrhosis of the liver;\n\n(17) having iron overload involving the liver at the time of the clinical onset of cirrhosis of the liver;\n\n> Note: iron overload is defined in the Schedule 1 - Dictionary.\n\n(18) having alpha-1 antitrypsin deficiency before the clinical onset of cirrhosis of the liver;\n\n(19) having Gaucher's disease before the clinical onset of cirrhosis of the liver;\n\n(20) having Wilson's disease before the clinical onset of cirrhosis of the liver;\n\n(21) having Budd-Chiari syndrome for a continuous period of at least six months, within the five years before the clinical onset of cirrhosis of the liver;\n\n> Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.\n\n(22) consuming a daily average of at least 7.5 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least four grams, within the ten years before the clinical onset of cirrhosis of the liver;\n\n(23) being treated with methotrexate:\n\n(a) for at least the six months; or\n\n(b) to a cumulative dose of methotrexate of at least 500 milligrams taken over at least a three month period,\n\nbefore the clinical onset of cirrhosis of the liver;\n\n(24) being treated with dideoxynucleoside-analogue drugs as specified for at least six months before the clinical onset of cirrhosis of the liver;\n\n> Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.\n\n(25) inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 500 hours within the five years before the clinical onset of cirrhosis of the liver;\n\n(26) inhaling a cumulative dose of at least 500 ppm-years of gaseous vinyl chloride before the clinical onset of cirrhosis of the liver;\n\n> Note: ppm-years is defined in the Schedule 1 - Dictionary.\n\n(27) inhaling gaseous vinyl chloride for a cumulative period of at least 1 000 hours while working in the production or processing of vinyl chloride monomer or polyvinyl chloride before the clinical onset of cirrhosis of the liver;\n\n(28) for males, consuming at least 110 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;\n\n> Note: alcohol is defined in the Schedule 1 - Dictionary.\n\n(29) for females, consuming at least 55 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;\n\n> Note: alcohol is defined in the Schedule 1 - Dictionary.\n\n(30) having received a cumulative equivalent dose of at least 0.4 sievert of ionising radiation to the liver before the clinical worsening of cirrhosis of the liver;\n\n> Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n(31) having chronic infection with the hepatitis B virus before the clinical worsening of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.\n\n(32) having chronic infection with the hepatitis C virus before the clinical worsening of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.\n\n(33) having chronic infection with the hepatitis D virus before the clinical worsening of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.\n\n(34) having infection with the hepatitis E virus before the clinical worsening of cirrhosis of the liver;\n\n> Note: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.\n\n(35) having chronic hepatitis before the clinical worsening of cirrhosis of the liver;\n\n> Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.\n\n  \n\n(36) having autoimmune chronic active hepatitis before the clinical worsening of cirrhosis of the liver;\n\n> Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.\n\n(37) having steatohepatitis before the clinical worsening of cirrhosis of the liver;\n\n(38) being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical worsening of cirrhosis of the liver;\n\n> Note: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.\n\n(39) having evidence of chronic infection with schistosomiasis involving the liver before the clinical worsening of cirrhosis of the liver;\n\n(40) having granulomatous liver disease before the clinical worsening of cirrhosis of the liver;\n\n> Note: granulomatous liver disease is defined in the Schedule 1 - Dictionary.\n\n(41) having severe right-sided cardiac failure for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;\n\n> Note: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.\n\n(42) having veno\\-occlusive disease for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;\n\n> Note: veno\\-occlusive disease is defined in the Schedule 1 - Dictionary.\n\n(43) having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical worsening of cirrhosis of the liver;\n\n(44) having iron overload involving the liver at the time of the clinical worsening of cirrhosis of the liver;\n\n> Note: iron overload is defined in the Schedule 1 - Dictionary.\n\n(45) having alpha-1 antitrypsin deficiency before the clinical worsening of cirrhosis of the liver;\n\n(46) having Gaucher's disease before the clinical worsening of cirrhosis of the liver;\n\n(47) having Wilson's disease before the clinical worsening of cirrhosis of the liver;\n\n(48) having Budd-Chiari syndrome for a continuous period of at least six months, within the five years before the clinical worsening of cirrhosis of the liver;\n\n> Note: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.\n\n(49) consuming a daily average of at least 7.5 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least four grams, within the ten years before the clinical worsening of cirrhosis of the liver;\n\n(50) being treated with methotrexate:\n\n(a) for at least the six months; or\n\n(b) to a cumulative dose of methotrexate of at least 500 milligrams taken over at least a three month period,\n\nbefore the clinical worsening of cirrhosis of the liver;\n\n(51) being treated with dideoxynucleoside-analogue drugs as specified for at least six months before the clinical worsening of cirrhosis of the liver;\n\n> Note: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.\n\n(52) inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 500 hours within the five years before the clinical worsening of cirrhosis of the liver;\n\n(53) inhaling a cumulative dose of at least 500 ppm-years of gaseous vinyl chloride before the clinical worsening of cirrhosis of the liver;\n\n> Note: ppm-years is defined in the Schedule 1 - Dictionary.\n\n(54) inhaling gaseous vinyl chloride for a cumulative period of at least 1 000 hours while working in the production or processing of vinyl chloride monomer or polyvinyl chloride before the clinical worsening of cirrhosis of the liver;\n\n(55) inability to obtain appropriate clinical management for cirrhosis of the liver.\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(28) to 9(55) apply only to material contribution to, or aggravation of, cirrhosis of the liver where the person's cirrhosis of the liver 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(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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nalcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\nautoimmune chronic active hepatitis means a chronic disorder of autoimmunity characterised by continuing hepatocellular necrosis and inflammation and seroimmunologic abnormalities.\n\nBudd-Chiari syndrome means symptomatic obstruction or occlusion of the hepatic veins or hepatic portion of the inferior vena cava, characterised by hepatomegaly, abdominal pain and tenderness, ascites, mild jaundice, and eventually, portal hypertension and liver failure.\n\nchronic hepatitis means symptomatic, biochemical or infectious agent biomarker evidence of continuing or relapsing hepatocellular necrosis and hepatic inflammation for at least six months.\n\nchronic infection with the hepatitis B virus means infection with the hepatitis B virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis B serological or nucleic acid markers, or both.\n\nchronic infection with the hepatitis C virus means infection with the hepatitis C virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis C serological or nucleic acid markers, or both.\n\nchronic infection with the hepatitis D virus means infection with the hepatitis D virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis D serological or nucleic acid markers, or both.\n\ncirrhosis of the liver—see subsection 7(2).\n\n> cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.\n\n> Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.\n\n> Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.\n\ndideoxynucleoside-analogue drugs as specified means didanosine, stavudine or zalcitabine.\n\ngranulomatous liver disease means an inflammatory liver disease characterised by granuloma formation in the liver and associated with many disorders such as sarcoidosis, infections (tuberculosis, brucellosis, syphilis), and adverse drug reactions.\n\ninfection with the hepatitis E virus means infection with the hepatitis E virus resulting in an infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis E serological or nucleic acid markers, or both.\n\niron overload means an accumulation of excess iron in tissues and organs which has been confirmed by elevated ferritin or transferrin saturation levels. Causes include haemochromatosis and blood transfusions.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nppm-years means parts per million multiplied by years of exposure.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nsevere right-sided cardiac failure means a reduced ability of the right ventricle to process venous return, evidenced by marked venous and liver congestion and extensive peripheral oedema.\n\nterminal 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  \n\nVEA means the Veterans' Entitlements Act 1986.\n\nveno\\-occlusive disease means symptomatic occlusion of the sublobular branches of the hepatic veins or the small hepatic venules.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                       | Registration              | Commencement      | Application, saving and transitional provisions |\n| -------------------------------------------------------------------------------------------------------------------------- | ------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning cirrhosis of the liver (Reasonable Hypothesis) (No. 1 of 2017)                          | 4 Jan 2017F2017L00002     | 23 January 2017   |                                                 |\n| Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017) | 22 August 2017F2017L01067 | 18 September 2017 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                                          | How affected       |\n| ----------------------------------------------------------- | ------------------ |\n| Schedule 1 – Dictionary – ' \"cumulative equivalent dose\"……' | rs. No. 58 of 2017 |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument replaces the 2007 Statement of Principles (s.4) and expands and clarifies the evidentiary framework in several ways: (1) it explicitly lists parallel factors for both clinical onset and clinical worsening of cirrhosis (s.9), extending the circumstances in which a \"reasonable hypothesis\" can be raised; (2) it introduces or clarifies quantitative exposure thresholds (alcohol, radiation, toxic exposures, drug cumulative doses) that were either absent or less specific previously (s.9, Schedule 1); (3) it adds 'inability to obtain appropriate clinical management for cirrhosis' as a factor for clinical worsening (s.9(55)), which broadens the kinds of service-related contribution considered; and (4) it tightens technical definitions and links radiation dose calculations to an external ARPANSA methodology (Schedule 1). Together these changes broaden and make more technical the scope of the SoP compared with the earlier instrument."},"complexity_factors":["Large enumerated list: 55 discrete factors across onset and clinical worsening (s.9)","Repeated parallel structure for 'onset' and 'clinical worsening' doubles the list of conditions (s.9(1)-(27) and s.9(28)-(55))","Multiple technical numeric thresholds (e.g. 110 kg alcohol/10 years, 0.4 sievert, 500 ppm‑years, 1,000 hours) requiring measurement and historical reconstruction (s.9, Schedule 1)","Numerous defined medical and technical terms in Schedule 1 (alcohol, chronic infections, cumulative equivalent dose, ppm‑years, terminal event, etc.)","Cross-reference to external technical guidance for radiation dose reconstruction (Schedule 1 definition of 'cumulative equivalent dose')","Cross-reference to other Statements of Principles that may replace or modify application of particular factors (s.11)","Conditional relationship requirement to 'relevant service' and restriction on some factors to material contribution/aggravation where disease pre-existed service (s.10)","Requirement for laboratory confirmation for several infectious causes increases evidentiary complexity (Schedule 1 definitions)"],"plain_english_summary":"**What this instrument is and does**\n\n- This is a Statement of Principles (SoP) made by the Repatriation Medical Authority under the Veterans' Entitlements Act 1986. It sets out the medical and causal factors that, if present, raise a \"reasonable hypothesis\" that a person's cirrhosis of the liver (or death from it) is connected to their relevant military service (see s.3, s.7, s.9).\n\n- In practice this SoP is used by decision-makers assessing veteran compensation and rehabilitation claims: if at least one of the specified factors existed and is related to the person's relevant service, a \"reasonable hypothesis\" is said to be raised and the claim proceeds to further consideration under the VEA or MRCA (see s.5, s.10).\n\n**Who this affects**\n\n- Veterans, members of Peacekeeping Forces and other members of the Forces covered by the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) who are claiming that their cirrhosis (or death from cirrhosis) is connected to their service (s.5, Schedule 1 definition of \"relevant service\").\n\n- Medical practitioners, occupational health assessors and the Department/tribunal staff who must apply the SoP when assessing claims.\n\n- Potentially employers, record-holders and labs: claim assessment may require employment exposure records, medical test results (e.g. hepatitis serology), or radiation dose reconstructions (Schedule 1, definition of \"cumulative equivalent dose\").\n\n**Mechanics — what must be shown**\n\n- The instrument defines \"cirrhosis of the liver\" clinically (s.7(2)) and lists discrete factors that, if present before the clinical onset (or before clinical worsening) of cirrhosis, satisfy the minimum evidential threshold for a reasonable hypothesis (s.9).\n\n- Factors include: quantitatively defined alcohol consumption thresholds (different for males and females) (s.9(1)-(2), (28)-(29)); specific infectious causes (HBV, HCV, HDV, HEV) and chronic hepatitis (s.9(4)-(6), (31)-(36)); genetic and metabolic disorders (hemochromatosis/iron overload, Wilson's disease, alpha-1 antitrypsin deficiency, Gaucher's disease) (s.9(17), (18), (19), (20), (44), (45), (46), (47)); specified drug or toxin exposures and occupational thresholds (radiation at 0.4 sievert cumulative to the liver, vinyl chloride exposures, carbon tetrachloride, methotrexate, dideoxynucleoside analogues, vitamin A levels) (s.9(3), (22)-(27), (30), (50)-(54)); cardiac and vascular causes (Budd–Chiari, veno-occlusive disease, severe right-sided cardiac failure) and biliary obstruction (s.9(14)-(16), (21), (41)-(43), (48)).\n\n- The same set of factors is repeated for establishing a link to \"clinical worsening\" of pre-existing cirrhosis (s.9(28)-(55)).\n\n- Most defined clinical terms and measurement rules (e.g. how to calculate alcohol intake, what counts as \"chronic\" infection, what \"ppm‑years\" means, and guidance on calculating cumulative radiation dose) are in Schedule 1 (Schedule 1 definitions). The radiation dose recourse points to an external ARPANSA guide for dose reconstruction.\n\n**Legal effect and decision pathway**\n\n- This SoP does not itself grant compensation. It specifies the factual/medical thresholds that raise a reasonable hypothesis connecting the condition to service; that threshold directs the statutory decision-maker to consider the claim further under the VEA or MRCA (s.5, s.9, s.10).\n\n- If a listed factor applies but it is also an injury/disease covered by another SoP, that other SoP governs how the factor is applied (s.11).\n\n**Why the authority says this matters**\n\n- The Repatriation Medical Authority states there is sound medical-scientific evidence that cirrhosis and death from cirrhosis can be related to relevant service (s.8). That is the stated purpose of listing the factors.\n\n**Costs, incentives and implementation trade-offs**\n\n- Who pays: financial consequences (if a reasonable hypothesis is established and the statutory test is subsequently satisfied) fall on the veterans' entitlement schemes (VEA/MRCA) — i.e. public expenditure for any accepted claims (s.5). The SoP itself imposes no direct charge but influences claim outcomes.\n\n- Who decides: the Repatriation Medical Authority sets the SoP (s.3). Administrative decision-makers and medical assessors apply it when deciding claims. Technical judgements (for example whether an exposure threshold is met, or whether a radiation dose reconstruction supports 0.4 Sv to the liver) require clinical and occupational expertise (Schedule 1, \"cumulative equivalent dose\" definition).\n\n- Claimant burden and compliance costs: claimants must provide medical records, laboratory confirmation for chronic infections (Schedule 1 definitions require laboratory confirmation), histories of alcohol use, drug treatments, and occupational exposure records. Dose reconstruction (radiation) can be complex and requires specialist assessment and use of an external ARPANSA guide (Schedule 1). These requirements create information and evidentiary costs for claimants and assessing agencies.\n\n- Administrative discretion & implementation risk: the SoP sets thresholds but still requires linking the factor to \"relevant service\" (s.10). Determining that relationship, and performing technical reconstructions (radiation, ppm‑years of vinyl chloride, cumulative hours of exposure), introduces discretion and a risk of contested assessments.\n\n- Effects on private actors and markets: the SoP is a claim-assessment tool rather than a regulation of industry. It may, however, increase demand for specific medical tests and for occupational hygiene records or consulting services (dose reconstruction, workplace exposure documentation). It does not directly change employer legal liability or occupational safety standards but can make certain past exposures more salient in claims.\n\n**Concentrated benefits and diffuse costs**\n\n- Concentrated benefits: veterans whose medical history meets the numeric or diagnostic thresholds (s.9) obtain a lower evidentiary barrier to have their claims progressed, which is concentrated on those specific claimants.\n\n- Diffuse costs: potential increase in compensation payments funded by the public purse and administrative costs of complex medical and occupational assessments (radiation dose reconstructions, serology confirmations). Compliance burdens for claimants can be spread across many individuals seeking supporting evidence.\n\n**Implementation notes and practical points**\n\n- The SoP repeals the earlier SoP from 2007 (s.4), and includes a definition of cumulative radiation dose that refers to an ARPANSA guide (Schedule 1). For exposure-based factors, the instrument gives precise quantitative thresholds (e.g. 0.4 Sv radiation, 110 kg alcohol for males over 10 years) which are mechanically straightforward but may be difficult to prove historically.\n\n- If a factor listed in this SoP is itself an injury/disease covered by another SoP, the other SoP's terms apply (s.11). That can shift which medical guidance and thresholds are used in assessment.\n\n**Bottom line**\n\n- Mechanically, the instrument lists the medical diagnoses and exposure thresholds that are sufficient to raise a reasonable hypothesis connecting cirrhosis (or its worsening or resulting death) to relevant military service (s.7–s.9). It matters because it sets the minimum evidentiary rules that trigger further statutory consideration of veterans' claims. The practical effects are on claim evidence-gathering, on technical assessments (especially radiation dose reconstruction and laboratory confirmation of infections), and on the administrative costs and potential fiscal exposure of the veterans' compensation schemes (s.5, Schedule 1)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles that maintains the same scope as its 2007 predecessor. It updates medical criteria and definitions but does not expand beyond the original purpose of establishing liability factors for cirrhosis of the liver in veterans' compensation claims."},"complexity_factors":["27 defined terms in Schedule 1 Dictionary, many requiring specific medical or technical definitions (e.g., 'cumulative equivalent dose', 'chronic infection with hepatitis B virus')","55 distinct factors in section 9, with parallel structure for onset (factors 1-27) and worsening (factors 28-54) plus a standalone factor (55)","Precise quantitative thresholds throughout (e.g., '110 kilograms of alcohol', '0.4 sievert', '500 ppm-years', '7.5 milligrams of vitamin A')","Cross-referencing requirement in section 11 where factors referring to other diseases must use those separate Statements of Principles","Dual legislative framework application (VEA and MRCA) requiring understanding of different service types defined in the Dictionary","Specific temporal requirements ('within any ten year period', 'for a continuous period of at least six months', 'within the five years before')","Medical terminology requiring specialist knowledge (e.g., 'steatohepatitis', 'veno-occlusive disease', 'Budd-Chiari syndrome')"],"plain_english_summary":"This law replaces the 2007 rules and sets the medical test for compensating veterans and defence members for cirrhosis of the liver. It lists specific clinical factors that, if proven, create a \"reasonable hypothesis\" that the disease is related to service, covering onset and worsening and including lack of access to treatment.\n\nIt affects claims under the Veterans' Entitlements Act 1986 and MRCA 2004 and matters because the reasonable-hypothesis standard gives veterans the benefit of the doubt when linking liver disease to service."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017","history":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017/history","analysis":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017/important-cases","documents":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-reasonable-hypothesis-no-1-of-2017/documents"}}