{"id":"F2019L00225","name":"Statement of Principles concerning dental malocclusion (Balance of Probabilities) (No. 20 of 2019)","slug":"statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439943,"registerId":"F2019L00225-fast-fetch-1775955770213","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning dental malocclusion (Balance of Probabilities) (No. 20 of 2019)","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\nDENTAL MALOCCLUSION (Balance of Probabilities)\n\n(No. 20 of 2019)\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 1 March 2019\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:
|\n| --- |\n| 
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 dental malocclusion (Balance of Probabilities) (No. 20 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 2019.\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 dental malocclusion No. 18 of 2011 (Federal Register of Legislation No. F2011L00499) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 dental malocclusion and death from dental malocclusion.\n\nMeaning of dental malocclusion\n\n(2) For the purposes of this Statement of Principles, dental malocclusion:\n\n(a) means acquired malposition of maxillary or mandibular teeth resulting in abnormal contact; and\n\n(b) includes acquired dental hyperocclusion.\n\nNote 1: Dental malocclusion can result in a range of complications, including, but not limited to, difficulty with mastication or speech, and mobility of the affected teeth.\n\nNote 2: dental hyperocclusion is defined in the Schedule 1 – Dictionary.\n\n(3) While dental malocclusion attracts ICD‑10‑AM code K07.2 or K07.4, in applying this Statement of Principles the meaning of dental malocclusion 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 dental malocclusion\n\n(5) For the purposes of this Statement of Principles, dental malocclusion, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's dental malocclusion.\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 dental malocclusion and death from dental malocclusion 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, dental malocclusion or death from dental malocclusion is connected with the circumstances of a person's relevant service:\n\n(1) having an injury resulting in distortion of the temporomandibular joint or fracture of the maxilla or mandible before the clinical onset of dental malocclusion;\n\n(2) having surgery involving the temporomandibular joint, maxilla or mandible before the clinical onset of dental malocclusion;\n\n(3) having loss of one or more teeth for at least the two years before the clinical onset of dental malocclusion;\n\n(4) having a maxillofacial disease at the time of the clinical onset of dental malocclusion;\n\nNote: maxillofacial disease is defined in the Schedule 1 - Dictionary. \n\n(5) having a peripheral odontogenic fibroma or a peripheral ossifying fibroma adjacent to the affected tooth or teeth, at the time of the clinical onset of dental malocclusion;\n\nNote: peripheral odontogenic fibroma and peripheral ossifying fibroma are defined in the Schedule 1 - Dictionary.\n\n(6) using a mandibular repositioning appliance for treatment of snoring or obstructive sleep apnoea for at least five hours per night, on at least five days per week, for at least the four months before the clinical onset of dental malocclusion;\n\nNote: mandibular repositioning appliance is defined in the Schedule 1 - Dictionary. \n\n(7) having an ill-fitting dental restoration or orthodontic device applied to the affected tooth or teeth at the time of the clinical onset of dental malocclusion;\n\nNote: Examples of dental restorations and orthodontic devices include, but are not limited to, dental fillings, crowns, bridges, implants, retainers and braces.\n\n(8) having advanced periodontitis involving the affected tooth or teeth at the time of the clinical onset of dental malocclusion;\n\n(9) having macroglossia for at least the two years before the clinical onset of dental malocclusion;\n\nNote: macroglossia is defined in the Schedule 1 - Dictionary. \n\n(10) having an injury resulting in distortion of the temporomandibular joint or fracture of the maxilla or mandible before the clinical worsening of dental malocclusion;\n\n(11) having surgery involving the temporomandibular joint, maxilla or mandible before the clinical worsening of dental malocclusion;\n\n(12) having loss of one or more teeth for at least the two years before the clinical worsening of dental malocclusion;\n\n(13) having a maxillofacial disease at the time of the clinical worsening of dental malocclusion;\n\nNote: maxillofacial disease is defined in the Schedule 1 - Dictionary. \n\n(14) having a peripheral odontogenic fibroma or a peripheral ossifying fibroma adjacent to the affected tooth or teeth, at the time of the clinical worsening of dental malocclusion;\n\nNote: peripheral odontogenic fibroma and peripheral ossifying fibroma are defined in the Schedule 1 - Dictionary.\n\n(15) using a mandibular repositioning appliance for treatment of snoring or obstructive sleep apnoea for at least five hours per night, on at least five days per week, for at least the four months before the clinical worsening of dental malocclusion;\n\nNote: mandibular repositioning appliance is defined in the Schedule 1 - Dictionary. \n\n(16) having an ill-fitting dental restoration or orthodontic device applied to the affected tooth or teeth at the time of the clinical worsening of dental malocclusion;\n\nNote: Examples of dental restorations and orthodontic devices include, but are not limited to, dental fillings, crowns, bridges, implants, retainers and braces.\n\n(17) having advanced periodontitis involving the affected tooth or teeth at the time of the clinical worsening of dental malocclusion;\n\n(18) having macroglossia for at least the two years before the clinical worsening of dental malocclusion;\n\nNote: macroglossia is defined in the Schedule 1 - Dictionary. \n\n(19) inability to obtain appropriate clinical management for dental malocclusion.\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(10) to 9(19) apply only to material contribution to, or aggravation of, dental malocclusion where the person's dental malocclusion 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 dental hyperocclusion means premature contact between any maxillary and mandibular teeth during oral cavity closure that manifests as bite sensitivity or occlusal trauma.\n\n dental malocclusion—see subsection 7(2).\n\n macroglossia means excessive size of the tongue.\n\n mandibular repositioning appliance means an oral device that splints the upper airway open mechanically by anterior displacement of the mandible and other oropharyngeal structures.\n\n maxillofacial disease means any disease causing distortion of the temporomandibular joint, maxilla or mandible.\n\nNote: Examples of diseases causing distortion of the temporomandibular joint, maxilla or mandible include, but are not limited to:\n\n(a) acromegaly;\n\n(b) central bony pathology of the jaw;\n\n(c) condylar hyperplasia;\n\n(d) infiltration by primary or secondary malignancy;\n\n(e) osteoarthritis;\n\n(f) osteonecrosis;\n\n(g) Paget's disease of bone;\n\n(h) space-occupying lesion within the temporomandibular joint space or within the bones of the jaw; and\n\n(i) tuberculosis.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n peripheral odontogenic fibroma means a gingival mass of vascularised fibrous connective tissue with strands of odontogenic epithelium.\n\n peripheral ossifying fibroma means a gingival fibroma consisting of cellular connective tissue with focal areas of calcification or ossification.\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\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"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument updates and modestly broadens the previous 2011 Statement by (a) explicitly including dental hyperocclusion and death contributed to by malocclusion (section 7(2), 7(5)); (b) adding or clarifying a range of treatment‑ and device‑related factors (for example, ill‑fitting restorations or orthodontic devices in 9(7)/(16), and specific thresholds for mandibular repositioning appliance use in 9(6)/(15) with a definition in Schedule 1); (c) specifying precise temporal thresholds for tooth loss and appliance use (sections 9(3)/(12) and 9(6)/(15)); and (d) adding inability to obtain appropriate clinical management as a listed factor (9(19)). These changes broaden the evidentiary pathways by which a claimant may establish service connection and tighten the evidentiary standards in others (via fixed durations), so the instrument’s practical scope of application has changed compared with the earlier instrument it repealed (section 4)."},"complexity_factors":["Single-purpose instrument (one injury/disease) with 1 main schedule of definitions","19 discrete causation factors listed in section 9, several with duration or timing thresholds (e.g. 2 years, 4 months, 5 hours/night)","8 defined terms in Schedule 1 (dental hyperocclusion, macroglossia, mandibular repositioning appliance, maxillofacial disease, peripheral odontogenic fibroma, peripheral ossifying fibroma, terminal event, relevant service, plus MRCA/VEA acronyms)","Two-tier conditional logic: factors that establish primary causation (9(1)–9(9)) vs factors limited to aggravation/material contribution for pre-existing conditions (9(10)–9(19) and section 10(2))","Cross-references to other legal instruments and clinical classifications (ICD‑10‑AM in 7(3)–(4), other Statements of Principles in section 11)","Precise evidentiary thresholds create conditional complexity (timing/duration requirements)","Relatively short length and limited number of sections reduce overall complexity"],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- This is a medical “Statement of Principles” used to decide veteran and defence-member claims where dental malocclusion (a problem with how the teeth meet) is alleged to be connected to their service. (See sections 3 and 5.)\n- It replaces the earlier 2011 Statement for the same condition (section 4) and takes effect for claims governed by section 120B of the Veterans’ Entitlements Act 1986 (VEA) or section 339 of the Military Rehabilitation and Compensation Act 2004 (MRCA) (section 5).\n- The instrument defines what is meant by “dental malocclusion” (section 7(2)), explicitly includes dental hyperocclusion and death that a malocclusion contributed to (section 7(5)), and points to the ICD‑10‑AM codes for reference (section 7(3)–(4)).\n- It lists the specific medical and treatment-related factors that must be present before a claimant can show, on the balance of probabilities (more likely than not), that their dental malocclusion (or death from it) is connected with their relevant service (section 9). At least one listed factor must be present.\n- Section 10 requires that any factor relied on be related to the person’s relevant service; and it limits certain factors (those in subsections 9(10)–9(19)) to claims about a material contribution to or aggravation of pre‑existing malocclusion.\n- If any listed factor refers to another injury or disease covered by a different Statement of Principles, that other Statement applies as written (section 11).\n\n**Who is affected**\n\n- Primary affected persons: veterans or serving members who lodge claims under the VEA or MRCA alleging dental malocclusion (section 5). Decision-makers assessing those claims (Department of Veterans’ Affairs staff, reviewers and medical panels) use this document as the medical standard.\n- Secondary affected parties: treating clinicians and dentists (who must provide records or opinions), manufacturers or prescribers of mandibular repositioning appliances, and taxpayers (paying any successful entitlements).\n\n**How it matters in practice**\n\n- Causation test: The Statement fixes a checklist of medical facts that, if present and shown to be related to service, make it more probable than not that dental malocclusion is service‑connected (sections 8–9).\n- Evidentiary thresholds: Several factors include precise timing or duration thresholds (examples: loss of teeth for at least two years before onset—9(3) and 9(12); use of a mandibular repositioning appliance for at least five hours per night on at least five days per week for at least four months before onset—9(6) and 9(15)). These create clear evidentiary rules for claimants and decision-makers.\n- Narrowing vs broadening: The document both defines the condition in clinical terms (7(2)) and sets multiple alternative pathways to establish connection to service — physical trauma, surgery, disease, certain treatments, or inability to obtain treatment (9(1)–(19)). Death is included where malocclusion contributed (7(5)).\n\n**Stated purpose and testing it against practical trade-offs**\n\n- Purpose-claim: The RMA’s stated medical view is that, based on available evidence, dental malocclusion and death from it can be related to relevant service (section 8). That is a medical‑causation position, not an administrative or fiscal one.\n\n- Who pays: Successful claims create entitlement liabilities for the Australian Government (VEA/MRCA). The instrument does not set benefit amounts; it defines medical connection only (sections 3 and 5). The cost falls on government budgets and ultimately taxpayers.\n\n- Who decides and discretion: The RMA supplies the medical criteria; adjudicators (DVA) apply them to evidence. Where a factor cross‑refers to another Statement, adjudicators must apply that separate instrument (section 11). This structure centralises medical criteria with the RMA and leaves factual application to decision-makers.\n\n- Compliance and evidentiary burden: Claimants must prove the listed factor and its relation to service. The instrument’s time and usage thresholds (for tooth loss, appliance use, macroglossia duration, etc.) may require long-term dental records or specialist reports. That increases administrative/medical documentation costs for claimants and providers (see factors in section 9 and definitions in Schedule 1).\n\n- Incentives and behavioural effects on private actors:\n - Claimants: may prioritise collecting dental records, specialist opinions, or treatment histories that meet the specific thresholds.\n - Clinicians/dentists: increased demand for forensic-style notes (dates of tooth loss, appliance usage, surgery). That may raise practitioners’ administrative workload and documentation costs.\n - Appliance manufacturers and suppliers: the instrument’s explicit mention of mandibular repositioning appliances (section 9(6) and 9(15); definition in Schedule 1) creates a linkage between appliance use and entitlement assessments, which could affect prescribing practice or patient counselling.\n\n- Competition, prices, and private choice: The instrument does not regulate private dental markets directly. However, by requiring evidence of prior treatments or devices, it may indirectly influence consumer choices (e.g., whether to accept certain appliances) and clinician recommendations. It may increase demand for specialist dental assessments and thus affect service prices for those reports.\n\n- Opportunity costs and trade‑offs: The RMA’s clearer criteria reduce uncertainty in claims but may shift costs into medical evidence‑gathering, and create winners (claimants who can document one of the listed factors) and losers (claimants lacking records). The instrument’s reliance on medical thresholds trades administrative clarity for possible exclusion of borderline cases.\n\n**Implementation risks and likely frictions**\n\n- Record gaps: Some veterans may lack the dental or appliance usage records needed to meet the specified durations, creating disputes about whether lack of records equals absence of the factor.\n- Medical interpretation: Terms like “advanced periodontitis” or “maxillofacial disease” are defined but require clinical judgment; decision-makers will rely on treating clinicians’ interpretations.\n- Cross-references: Where a listed factor points to another Statement of Principles, additional cross‑instrument analysis is required (section 11), which may slow decision-making.\n\n**Concrete behavioural rule examples (with sections)**\n\n- If a claimant lost one or more teeth and can show the loss lasted at least two years before clinical onset, that single fact could establish service connection if related to service (9(3)).\n- If a claimant used a mandibular repositioning appliance with the specified nightly duration and days-per-week for at least four months before onset, that qualifies as a factor (9(6); Schedule 1 definition).\n- For claimants whose malocclusion pre-existed service, only subsections 9(10)–9(19) can be used to show material contribution or aggravation by service (section 10(2)).\n\n**Net effect (mechanical, not evaluative)**\n\n- The instrument gives decision-makers a discrete list of medical circumstances that, if proved and tied to relevant service, establish a service connection for dental malocclusion (or death from it). It clarifies terminology, fixes time thresholds for some factors, includes treatment‑related causes (e.g. ill‑fitting restorations, appliances), and incorporates cross-references to other Statements where relevant (sections 7–11; Schedule 1)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Statements of Principles under the Veterans' Entitlements Act 1986. It replaces a 2011 version (No. 18 of 2011) with updated medical criteria but does not expand beyond the original purpose of determining service-related causation for dental malocclusion claims. The structure mirrors other Repatriation Medical Authority instruments, with the same 19-factor format split between onset and aggravation that is standard for this class of legislation."},"complexity_factors":["19 distinct factors with specific temporal requirements (e.g., 'at least two years before', 'at least four months before', 'at the time of')","Split structure between 'clinical onset' (factors 1-9) and 'clinical worsening' (factors 10-18) with nearly identical factor pairs","10 defined terms in Schedule 1, including technical medical terms (peripheral odontogenic fibroma, macroglossia, mandibular repositioning appliance)","Cross-reference to external classification system (ICD-10-AM Tenth Edition) for disease coding","Nested definitions: some defined terms refer to other defined terms (e.g., 'dental malocclusion—see subsection 7(2)')","Conditional application in section 10(2) limiting factors 10-19 to aggravation cases where condition pre-existed service","Section 11 creates dynamic incorporation of other Statements of Principles by reference ('as in force from time to time')","Specific quantitative thresholds (5 hours/night, 5 days/week, 4 months; 2 years duration)"],"plain_english_summary":"This Statement of Principles sets the medical rules for linking dental malocclusion (and death from it) to Australian military service. It lists 19 qualifying factors—events or conditions that can cause or worsen malocclusion—and applies to veterans and current/former defence members claiming under the VEA or MRCA for eligible war, defence or peacetime service. A claim needs at least one listed factor and a service connection on the balance of probabilities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019","history":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-dental-malocclusion-balance-of-probabilities-no-20-of-2019/documents"}}