{"id":"F2016L01678","name":"Statement of Principles concerning complex regional pain syndrome (Balance of Probabilities) (No. 98 of 2016)","slug":"statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439005,"registerId":"F2016L01678-fast-fetch-1775955192749","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning complex regional pain syndrome (Balance of Probabilities) (No. 98 of 2016)","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![RMA-Red](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nCOMPLEX REGIONAL PAIN SYNDROME  (Balance of Probabilities)\n\n(No. 98 of 2016)\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               28 October 2016\n\n \n\n \n\n \n\n \n\n \n\nThe Common Seal of the  Repatriation Medical Authority  was affixed to this instrument  at the direction of:\n\n![](image.002.png)\n\n \n\n \n\n \n\n \n\nProfessor Nicholas Saunders AO\n\nChairperson\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 complex regional pain syndrome (Balance of Probabilities) (No. 98 of 2016).\n\n2               Commencement\n\n              This instrument commences on 28 November 2016.\n\n3               Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4               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\n5               Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6               Kind of injury, disease or death to which this Statement of Principles relates\n\n(1)          This Statement of Principles is about complex regional pain syndrome and death from complex regional pain syndrome.\n\nMeaning of complex regional pain syndrome\n\n(2)          For the purposes of this Statement of Principles, complex regional pain syndrome means a disorder of a body region or regions which meets the following criteria:\n\n(a)          continuing pain, which is disproportionate to any inciting event; and\n\n(b)          at least one symptom in two of the four following categories:\n\n(i)            sensory: hyperalgesia or allodynia;\n\n(ii)         vasomotor: temperature asymmetry or skin colour changes or skin colour asymmetry;\n\n(iii)       sudomotor/oedema: oedema or sweating changes or sweating asymmetry; or\n\n(iv)        motor/trophic: decreased range of motion or motor dysfunction (weakness, tremor, dystonia) or trophic changes (hair, nails, skin); and\n\n(c)          at least one sign at the time of evaluation in two or more of the following categories:\n\n(i)            sensory: evidence of hyperalgesia (to pinprick) or allodynia (to light touch and/or deep somatic pressure or joint movement);\n\n(ii)         vasomotor: evidence of temperature asymmetry or skin colour changes or asymmetry;\n\n(iii)       sudomotor/oedema: evidence of oedema or sweating changes or sweating asymmetry; or\n\n(iv)        motor/trophic: evidence of decreased range of motion or motor dysfunction (weakness, tremor, dystonia) or trophic changes (hair, nails, skin).\n\nDeath from complex regional pain syndrome\n\n(3)          For the purposes of this Statement of Principles, complex regional pain syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's complex regional pain syndrome.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7               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 complex regional pain syndrome and death from complex regional pain syndrome can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is defined in the Schedule 1 – Dictionary.\n\n8               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, complex regional pain syndrome or death from complex regional pain syndrome is connected with the circumstances of a person's relevant service:\n\n(1)          having an injury or a disease involving a major peripheral nerve in the six months before the clinical onset of complex regional pain syndrome, where the pain originates in the region of the affected peripheral nerve;\n\n(2)          having an injury or a disease from the specified list of injuries or diseases in the six months before the clinical onset of complex regional pain syndrome, where the pain originates in the region of the body affected by the injury or disease;\n\nNote: specified list of injuries or diseases is defined in the Schedule 1 - Dictionary.               \n\n(3)          having surgery in the six months before the clinical onset of complex regional pain syndrome, where the pain originates in the region of the surgical procedure;\n\n(4)          being treated with phenobarbital at the time of the clinical onset of complex regional pain syndrome;\n\n(5)          inability to obtain appropriate clinical management for complex regional pain syndrome.\n\n9               Relationship to service\n\n(1)          The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2)          The factor set out in subsection 8(5) applies only to material contribution to, or aggravation of, complex regional pain syndrome where the person's complex regional pain syndrome was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10           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 8 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 5\n\n1               Definitions\n\nIn this instrument:\n\n                             complex regional pain syndrome—see subsection 6(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                             specified list of injuries or diseases means:\n\n(a)          acute myocardial infarction;\n\n(b)          crush injury;\n\n(c)          cut, stab, abrasion or laceration;\n\n(d)          electrical injury;\n\n(e)          external bruise;\n\n(f)           fracture;\n\n(g)          hemiplegia of the limb due to cerebrovascular accident;\n\n(h)          herpes zoster;\n\n(i)            intramuscular injection;\n\n(j)            intravenous injection or cannulation;\n\n(k)          joint dislocation;\n\n(l)            leprosy;\n\n(m)        physical injury due to munitions discharge;\n\n(n)          snakebite;\n\n(o)          spinal cord injury;\n\n(p)          sprain or strain;\n\n(q)          venepuncture; or\n\n(r)           any other injury or disease which causes acute tissue damage.\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":3,"scope_assessment":{"changed":false,"description":"This instrument stays within the statutory purpose of a Statement of Principles under subsection 196B(3) of the VEA: it defines the medical condition (CRPS), prescribes the diagnostic signs/symptoms, and lists causal factors and temporal limits for establishing a service connection. It does not add matters outside that remit or substantially expand the range of covered conditions beyond CRPS and death from CRPS; rather, it narrows and operationalises assessment criteria (see sections 6–10 and the Schedule)."},"complexity_factors":["Relatively short instrument (10 sections + Schedule)","Single medical definition with structured diagnostic criteria (section 6(2))","Five discrete causal factors with a common six‑month timing rule for most (section 8)","One detailed \"specified list of injuries or diseases\" in the Schedule (18 named items plus a catch‑all) requiring cross-checking","Limited cross-referencing to other Statements of Principles (section 10) and to defined terms in the Schedule (e.g. \"relevant service\", \"terminal event\")","A conditional and somewhat nuanced application for the \"inability to obtain appropriate clinical management\" factor (sections 8(5) and 9(2))"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- It sets a formally prescribed definition of \"complex regional pain syndrome\" (CRPS) and the medical signs and symptoms required for a finding that CRPS exists for the purposes of veterans' compensation (see section 6(2)).\n- It lists which medical or treatment events (\"factors\")—and the timing required—are acceptable triggers or contributors so that, on the balance of probabilities, CRPS can be said to be connected with a veteran's or serving member's relevant service (see section 8).\n- It requires that any of those factors be related to the person's \"relevant service\" (see section 9 and the Schedule definition of \"relevant service\").\n- It expressly includes death where CRPS contributed to a terminal event or condition (section 6(3)).\n\nWho it affects\n\n- Veterans, former members and current serving members who lodge compensation or rehabilitation claims under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) alleging CRPS (section 4).\n- Medical practitioners and medico-legal assessors who provide clinical evidence for claims, because the Statement sets out the signs, symptoms and timing that decision-makers are to accept (section 6 and section 8).\n- Decision-makers in the Department (or authorised decision bodies) who apply this Statement when deciding entitlement to benefits, because it establishes the medical criteria to be used in determining service connection (sections 7–10).\n\nWhy it matters (stated purpose, and practical implications)\n\n- The Repatriation Medical Authority says the Statement is based on medical-scientific evidence and that it is \"more probable than not\" that CRPS can be related to relevant service (section 7). That is, if the prescribed criteria and factor(s) are present and connected to service, the legal test for a service connection (balance of probabilities) is met.\n- Practically, the instrument standardises the medical thresholds decision-makers use. It therefore affects which claimants will be accepted as having service‑connected CRPS and so eligible for entitlements and rehabilitation.\n\nKey clinical and causal rules (what you need to show)\n\n- Diagnosis: continuing pain disproportionate to any inciting event, plus at least one symptom in two of the four categories (sensory; vasomotor; sudomotor/oedema; motor/trophic) and at least one clinical sign in two or more of those categories on evaluation (section 6(2)).\n- Causal/factual triggers (at least one required, generally within six months before CRPS onset):\n  - an injury or disease involving a major peripheral nerve where the pain originates in that nerve region (s 8(1));\n  - one of a specified list of injuries or diseases (for example, fracture, crush injury, injection, spinal cord injury, etc.) where the pain originates in the region affected (s 8(2) and Schedule definition of \"specified list\");\n  - surgery in the same body region (s 8(3));\n  - treatment with phenobarbital at the time of clinical onset (s 8(4)); or\n  - inability to obtain appropriate clinical management for CRPS (s 8(5)) — note that this last factor only applies to claims of material contribution or aggravation where CRPS existed before or during (but did not arise out of) relevant service (s 9(2)).\n- Interaction with other Statements of Principles: if a factor in section 8 refers to an injury/disease covered by another Statement, the factors in that other Statement apply as they are in force (s 10).\n\nCosts, incentives, trade-offs and implementation issues (practical testing of the stated purpose)\n\n- Who pays and who decides: entitlement payments and rehabilitation are public costs if connection is established; departmental decision-makers apply the Statement, relying on medical evidence prepared by treating or independent clinicians (sections 4, 7, 6).\n- Incentives for claimants and clinicians: the Statement creates a clear checklist of diagnostic signs and allowable causal links and a six‑month timing rule for many triggers (s 8). That incentivises thorough contemporaneous clinical records of signs/symptoms, precise documentation of injuries/surgery, and noting drug treatment (phenobarbital) and management access.\n- Burden of proof and administrative burden: the Statement operates on the \"balance of probabilities\" test (s 7) but requires clinical evidence matching its signs/symptoms and the specified causal factors. This may increase the need for specialist assessments and records retrieval, creating administrative and evidentiary burdens for claimants and treating clinicians.\n- Discretion and medical judgment: while the Statement specifies required signs and factors, application still requires clinical judgment (e.g. whether pain is \"disproportionate\", or whether signs observed meet the listed categories), so decision-makers retain judgement in borderline cases (s 6(2), s 8).\n- Overlap with other conditions and cross-reference risk: the instrument explicitly cross-references other Statements where a factor refers to another injury/disease (s 10). This avoids double-counting but requires decision-makers to navigate multiple instruments.\n- Concentrated benefits, diffuse costs: benefits accrue to claimants who can meet the diagnostic and causal rubric; public expenditure impact depends on numbers of successful claims. The instrument narrows eligible causal pathways (specified list, six‑month windows), which focuses benefit concentration on claimants who can document those pathways.\n- Potential unintended operational consequences: cases that lack the listed factors or contemporaneous clinical signs may be harder to establish as service‑related even if the claimant reports chronic pain—this shifts value toward documented, proximate events (s 8). The \"inability to obtain appropriate clinical management\" factor (s 8(5)) is conditional and limited (s 9(2)), so it provides a narrow route for claims where care access was deficient but CRPS pre‑existed service.\n\nBottom line\n\n- Mechanically, this Statement sets the medical definition of CRPS for veterans' claims, lists the acceptable causal factors (with timing), and tells decision-makers how to treat related injuries covered by other Statements. It standardises how service connection for CRPS is to be assessed, changing the evidentiary landscape for claimants, clinicians and decision-makers (see sections 6–10 and the Schedule)."},"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":"This instrument appears to maintain its original scope as a specific medical-determination tool for CRPS under the veterans compensation scheme. The structure follows the standard template for Repatriation Medical Authority Statements of Principles, with no evidence of scope creep beyond the original purpose of establishing service connection criteria for this specific condition."},"complexity_factors":["Medical diagnostic criteria with four symptom categories and nested sub-categories (sensory, vasomotor, sudomotor/oedema, motor/trophic)","Cross-referencing mechanism in section 10 that incorporates other Statements of Principles by reference","Conditional logic requiring 'at least one symptom in two of four categories' AND 'at least one sign in two or more categories'","18-item specified list of injuries/diseases in the Dictionary","Dual statutory framework application (VEA and MRCA with different service definitions)","Temporal limitation clauses ('six months before clinical onset') requiring precise dating","Exception in section 9(2) restricting factor 8(5) to aggravation cases only"],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide if Complex Regional Pain Syndrome (CRPS) is service-related for compensation claims. It defines CRPS for legal purposes and requires one of five specified circumstances (e.g., recent nerve injury, certain injuries, surgery, specific drug exposure, or inadequate treatment) to link the condition to service.\n\nIt applies to veterans and current/former defence members claiming under the VEA or MRCA for non-operational service, and is the gateway to entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-","history":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-/history","analysis":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-/important-cases","documents":"/api/acts/statement-of-principles-concerning-complex-regional-pain-syndrome-balance-of-probabilities-no-98-of-/documents"}}