{"id":"F2020L00489","name":"Statement of Principles concerning coeliac disease (Reasonable Hypothesis) (No. 29 of 2020)","slug":"statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440461,"registerId":"F2020L00489-fast-fetch-1775956072710","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning coeliac disease (Reasonable Hypothesis) (No. 29 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\nStatement of Principles\n\nconcerning\n\nCOELIAC DISEASE (Reasonable Hypothesis)\n\n(No. 29 of 2020)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 29 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning coeliac disease No. 1 of 2011 (Federal Register of Legislation No. F2010L03248) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that coeliac disease and death from coeliac disease 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting coeliac disease or death from coeliac disease 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 ribavirin within the six months before the clinical worsening of coeliac disease;\n\n(3) 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(4) being treated with a non-selective, non-steroidal, anti-inflammatory agent, on more days than not, for at least the six months before the clinical worsening of coeliac disease;\n\nNote: Examples of non-selective, non-steroidal, anti-inflammatory agents include aspirin, diclofenac, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic acid, naproxen, piroxicam and sulindac.\n\n(5) inability to maintain a gluten-free diet at the time of the clinical worsening of coeliac disease;\n\n(6) 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(6) 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(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\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) 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\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":"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":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a determinative instrument for veterans' compensation claims. The 2020 revision updates medical factors and replaces the 2011 version, but does not expand beyond the established framework of connecting specific diseases to military service through Statements of Principles under the VEA and MRCA."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Conditional logic in section 10 limiting application to aggravation/pre-existing cases only, not causation","Medical terminology requiring specialist knowledge (villous atrophy, crypt hyperplasia, tTG-IgA, EMA-IgA)","Nested definitions: 'coeliac disease' defined in section 7(2), then referenced in Schedule 1","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Interaction with other Statements of Principles via section 11 (dynamic incorporation by reference)","Temporal requirements ('within six months', 'on more days than not, for at least six months') creating calculation burdens"],"plain_english_summary":"This Statement of Principles sets the medical-legal test for when coeliac disease in veterans and current/former defence members is attributable to service, replacing the 2011 version with updated evidence. It governs claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004.\n\nTo qualify, a person must show at least one specified service‑related factor (for example, certain long‑term medications, inability to maintain a gluten‑free diet, or lack of treatment) and that service aggravated pre‑existing or concurrent coeliac disease — it does not cover service as the original cause."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the 2011 Statement (s4) and replaces it with revised definitions and an updated list of factors that can raise a reasonable hypothesis connecting coeliac disease (and death from it) to service (s7(2); s9). It retains the same statutory application to VEA and MRCA claims and continues to include death from a terminal event contributed to by coeliac disease (s5; s7(5))."},"complexity_factors":["Repeals prior Statement and replaces it with updated criteria (s4)","Technical medical definition and explicit exclusions for coeliac disease (s7(2)–(4))","Enumerated treatment-related factors with specific drug examples in s9 (e.g. interferon alpha, ribavirin, PPIs, H2 antagonists, non-selective NSAIDs)","Non-medication, access and behaviour factors: inability to maintain a gluten-free diet or obtain appropriate clinical management (s9(5)–(6))","Causation standard relies on a \"reasonable hypothesis\" and requires factors to be related to relevant service (s8; s10(1))","Limited to material contribution or aggravation where disease existed before or during (but did not arise out of) service (s10(2))","Cross-reference to other Statements of Principles where factors overlap (s11)","Evidentiary and administrative burden on claimants to prove medication exposure, diet adherence or lack of access to care (s9, s10)"],"plain_english_summary":"This instrument repeals the 2011 Statement of Principles and sets the medical criteria that must exist to raise a \"reasonable hypothesis\" linking coeliac disease (or death from it) to a person’s relevant military service for claims under the VEA or MRCA. It defines coeliac disease (excluding non‑coeliac gluten/wheat sensitivity and wheat allergy) and lists treatment-, diet- and access-related factors (certain medications, prolonged antacid or NSAID use, or inability to maintain a gluten‑free diet or obtain appropriate care) that must be related to service to support entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020","history":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-coeliac-disease-reasonable-hypothesis-no-29-of-2020/documents"}}