{"id":"F2018L00903","name":"Statement of Principles concerning cluster headache (Balance of Probabilities) (No. 58 of 2018)","slug":"statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439684,"registerId":"F2018L00903-fast-fetch-1775955614648","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cluster headache (Balance of Probabilities) (No. 58 of 2018)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCLUSTER HEADACHE (Balance of Probabilities)\n\n(No. 58 of 2018)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 22 June 2018\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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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 cluster headache (Balance of Probabilities) (No. 58 of 2018).\n\n2 Commencement\n\n This instrument commences on 23 July 2018.\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 cluster headache No. 21 of 2010 (Federal Register of Legislation No. F2010L01037) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 cluster headache and death from cluster headache.\n\nMeaning of cluster headache\n\n(2) For the purposes of this Statement of Principles, cluster headache:\n\n(a) means a headache condition in which there are multiple attacks of severe, unilateral headache in the orbital, supraorbital or temporal region, where each headache typically lasts from 15 to 180 minutes. The headache is accompanied by a sense of restlessness or agitation, or at least one of the following autonomic symptoms occurring on the same side as the pain:\n\n(i) conjunctival injection or lacrimation;\n\n(ii) eyelid oedema;\n\n(iii) forehead and facial sweating;\n\n(iv) miosis or ptosis; or\n\n(v) nasal congestion or rhinorrhoea; and\n\n(b) includes episodic cluster headache and chronic cluster headache; and\n\n(c) excludes:\n\n(i) headache attributable to inflammatory disorders of the head and neck;\n\n(ii) headache attributable to structural abnormalities;\n\n(iii) headache attributable to systemic disease;\n\n(iv) hemicrania continua;\n\n(v) migraine;\n\n(vi) paroxysmal hemicrania;\n\n(vii) short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT);\n\n(viii) short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA);\n\n(ix) tension-type headache; and\n\n(x) trigeminal neuralgia.\n\nNote: Headache attacks in cluster headache typically occur at a frequency between one every other day and eight per day. In episodic cluster headache disorder only, cluster headache attacks occur in bouts separated by asymptomatic periods which are free from cluster headache attacks.\n\n(3) While cluster headache attracts ICD‑10‑AM code G44.0, in applying this Statement of Principles the meaning of cluster headache 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 cluster headache\n\n(5) For the purposes of this Statement of Principles, cluster headache, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cluster headache.\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 cluster headache and death from cluster headache 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, cluster headache or death from cluster headache is connected with the circumstances of a person's relevant service:\n\n(1) taking glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate within the 24 hours before the clinical worsening of cluster headache;\n\n(2) consuming alcohol within the 24 hours before the clinical worsening of cluster headache;\n\n(3) inability to obtain appropriate clinical management for cluster headache.\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(1) to 9(3) apply only to material contribution to, or aggravation of, cluster headache where the person's cluster headache 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 cluster headache—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n 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":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the prior Statement of Principles (s4) and replaces it with a Statement that: (a) applies to claims under VEA s120B or MRCA s339 (s5); (b) defines cluster headache with specific inclusions and exclusions (s7(2)–(4)); (c) requires at least one of three specified factors to link the condition to service (s9); and (d) limits application to material contribution or aggravation where the condition existed before or during relevant service (s10(2))."},"complexity_factors":["Detailed medical definition with explicit inclusions and a long list of exclusions (s7(2)–(4)) increasing diagnostic precision.","Limited, discrete list of causation/aggravation factors that must be present (nitrates; alcohol; inability to obtain appropriate clinical management) (s9(1)–(3)).","Requirement that any listed factor be related to the person's relevant service (s10(1)), and that the factors only apply to material contribution or aggravation where the condition pre‑existed before or during service (s10(2)).","Interaction rule requiring dependence on other Statements of Principles when factors refer to other injuries/diseases (s11).","Applies only to claims under specified statutory provisions (VEA s120B or MRCA s339) — limits administrative scope (s5).","Repeals an earlier Statement of Principles for the same condition (s4), creating potential administrative transition issues.","Standard of proof and evidentiary framing tied to 'balance of probabilities' and the medical‑scientific view of the Authority (title and s8).","Definition of death from cluster headache tied to 'terminal event' concept with enumerated examples (Schedule 1).","Authority for the instrument sourced to subsection 196B(3) of the VEA, placing decision‑making power with the Repatriation Medical Authority (s3)."],"plain_english_summary":"This instrument, made by the Repatriation Medical Authority, defines “cluster headache” and sets the specific factual factors that must exist for cluster headache (or death from it) to be accepted as connected with a person’s relevant service for claims under the VEA or MRCA. It affects veterans and current/former service members seeking service‑related entitlements by prescribing three trigger/causation factors and limiting application to material contribution or aggravation of a pre‑existing condition."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2010 predecessor and other Statements of Principles under the VEA. It addresses a single medical condition (cluster headache) for a specific cohort (veterans/defence members) under established statutory frameworks. There is no evidence of scope creep; it performs the same function as the original 2010 instrument it replaces."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 6 defined terms in the Dictionary (cluster headache, MRCA, relevant service, terminal event, VEA, plus the self-referential definition of cluster headache)","Simple conditional structure: three alternative factors in section 9, with only one threshold test (\"at least one must exist\")","Limited cross-referencing: only refers to parent Acts (VEA and MRCA) and one repealed instrument","Medical definitions are detailed but contained within a single subsection (7(2))","No nested exceptions or complex temporal calculations beyond the 24-hour windows in factors 9(1) and 9(2)","Clear delineation between what is included and excluded in the definition of cluster headache"],"plain_english_summary":"This rulebook sets the medical test for Australian veterans and current/former defence personnel seeking compensation for cluster headache under the Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004. It applies a \"balance of probabilities\" standard to decide if service aggravated a pre‑existing cluster headache.\n\nCredit is given if, before worsening, the claimant had cluster headache and service-related factors made it worse — notably recent use of certain nitrates, recent alcohol use, or inability to obtain proper treatment. Replaces the 2010 Statement to ensure consistent decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018","history":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-cluster-headache-balance-of-probabilities-no-58-of-2018/documents"}}