{"id":"F2020L00498","name":"Statement of Principles concerning coeliac disease (Balance of Probabilities) (No. 30 of 2020)","slug":"statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440467,"registerId":"F2020L00498-fast-fetch-1775956074859","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning coeliac disease (Balance of Probabilities) (No. 30 of 2020)","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\n \n\nStatement of Principles\n\nconcerning\n\nCOELIAC DISEASE (Balance of Probabilities)\n\n(No. 30 of 2020)\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 24 April 2020\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 coeliac disease (Balance of Probabilities) (No. 30 of 2020).\n\n2 Commencement\n\n This instrument commences on 25 May 2020.\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 coeliac disease No. 2 of 2011 (Federal Register of Legislation No. F2010L03249) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 coeliac disease and death from coeliac disease.\n\nMeaning of coeliac disease\n\n(2) For the purposes of this Statement of Principles, coeliac disease:\n\n(a) means a malabsorption disorder in susceptible people due to immune-mediated mucosal inflammation of the small intestine, characterised by villous atrophy and crypt hyperplasia, and triggered by hypersensitivity to ingested gluten; and\n\n(b) excludes:\n\n(i) non-coeliac gluten sensitivity;\n\n(ii) non-coeliac wheat protein sensitivity; and\n\n(iii) wheat allergy.\n\nNote 1: Coeliac disease is associated with autoantibodies to tissue transglutaminase (tTG-IgA) and to endomysium (EMA-IgA).\n\nNote 2: Coeliac disease is characterised by other gastrointestinal manifestations in addition to malabsorption, and by extraintestinal manifestations involving a wide range of organ systems.\n\n(3) While coeliac disease attracts ICD‑10‑AM code K90.0, in applying this Statement of Principles the meaning of coeliac 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 coeliac disease\n\n(5) For the purposes of this Statement of Principles, coeliac disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's coeliac 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 coeliac disease and death from coeliac 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, coeliac disease or death from coeliac disease is connected with the circumstances of a person's relevant service:\n\n(1) being treated with interferon alpha within the six months before the clinical worsening of coeliac disease;\n\n(2) being treated with a proton pump inhibitor or a histamine-2 receptor antagonist, on more days than not, for at least the six months before the clinical worsening of coeliac disease;\n\nNote 1: Examples of proton pump inhibitors include esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole.\n\nNote 2: Examples of histamine-2 receptor antagonists include cimetidine, famotidine, nizatidine and ranitidine.\n\n(3) inability to maintain a gluten-free diet at the time of the clinical worsening of coeliac disease;\n\n(4) inability to obtain appropriate clinical management for coeliac 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(1) to 9(4) apply only to material contribution to, or aggravation of, coeliac disease where the person's coeliac 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 coeliac disease—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_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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose. It remains focused specifically on determining compensation eligibility for coeliac disease aggravation in the veteran/military context. The 2020 update appears to be a routine medical evidence refresh (replacing the 2011 version) rather than an expansion of scope. The four-factor structure and limitation to aggravation of pre-existing conditions (not new onset) preserves the original intent of providing a controlled gateway for claims."},"complexity_factors":["Multiple nested definitions: 'coeliac disease' defined in section 7(2), then referenced in Schedule 1, with cross-references to ICD-10-AM medical coding system","Conditional logic in section 10: factors only apply to aggravation of pre-existing disease, not new onset — creates a two-step test (factor existence + temporal relationship to service + pre-existing condition status)","External legislative references: operates across two different Acts (VEA and MRCA) with different service definitions","Section 11 creates dynamic incorporation: factors from other Statements of Principles can be 'imported' if referenced, meaning the full legal picture requires checking multiple instruments","Medical terminology requiring specialist knowledge: 'villous atrophy', 'crypt hyperplasia', 'interferon alpha', 'proton pump inhibitors' — though plain English examples are provided for drug classes","Temporal precision requirements: 'within six months before', 'on more days than not, for at least six months' — creates evidentiary burden for claimants"],"plain_english_summary":"This instrument updates the medical rules for claiming that coeliac disease was aggravated by Australian defence service, replacing the 2011 version. It narrows eligibility to true coeliac disease (excluding non‑coeliac gluten sensitivity and wheat allergy) and requires one of four specified medical factors—recent interferon alpha, prolonged acid‑suppressant use, inability to maintain a gluten‑free diet, or inability to access proper care—to link pre‑existing disease to service. \n\nIt affects veterans and current/former defence members seeking compensation; new onset disease from service is excluded."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2011 Statement and replaces it with updated definitions and explicit qualifying factors (interferon‑alpha, prolonged PPI/H2 antagonist use, inability to maintain a gluten‑free diet, inability to obtain appropriate clinical management), excludes non‑coeliac gluten/wheat sensitivities and wheat allergy, and confines application to material contribution or aggravation of pre‑existing coeliac disease (see ss4,7(2),9,10)."},"complexity_factors":["Technical medical definitions and exclusions (coeliac disease vs non‑coeliac gluten/wheat sensitivity and allergy) (see s7(2))","Requirement to prove one of several medical or access-related factors (interferon‑alpha, prolonged PPI/H2 use, inability to maintain diet, inability to obtain management) (see s9)","Necessity that any qualifying factor be causally related to the person's relevant service (see s10(1))","Applies only to material contribution or aggravation of pre‑existing disease (did not arise out of service) (see s10(2))","Cross-reference to other Statements of Principles when a factor refers to another injury/disease (potential for layered evidentiary rules) (see s11)","Inclusion of death from coeliac disease via terminal events increases scope of compensable outcomes (see s7(5) and Schedule definition of terminal event)","Repeal of previous 2011 Statement means claimants and decision-makers must apply updated criteria (see s4)"],"plain_english_summary":"Replaces the 2011 Statement and sets legal criteria under the Veterans' Entitlements Act for when coeliac disease (including death) is linked to military service on the balance of probabilities. It defines coeliac disease (excluding non‑coeliac gluten/wheat sensitivities and allergy) and lists qualifying factors: recent interferon‑alpha, prolonged PPI or H2‑antagonist use, inability to maintain a gluten‑free diet, or inability to obtain appropriate clinical management.\n\nIt affects veterans and serving members making entitlement claims; the Repatriation Medical Authority decides causation and claimants must prove a service‑related qualifying factor, creating evidentiary burdens."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020","history":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-coeliac-disease-balance-of-probabilities-no-30-of-2020/documents"}}