{"id":"F2019L00224","name":"Statement of Principles concerning dental malocclusion (Reasonable Hypothesis) (No. 19 of 2019)","slug":"statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439945,"registerId":"F2019L00224-fast-fetch-1775955770263","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning dental malocclusion (Reasonable Hypothesis) (No. 19 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 (Reasonable Hypothesis)\n\n(No. 19 of 2019)\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 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 (Reasonable Hypothesis) (No. 19 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning dental malocclusion No. 17 of 2011 (Federal Register of Legislation No. F2011L00489) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that dental malocclusion and death from dental malocclusion 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 dental malocclusion or death from dental malocclusion 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(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\nDefinitions\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) 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\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2011 predecessor and other SOPs — determining service connection for a specific medical condition. The 2019 update appears to be a routine refresh based on updated medical evidence rather than an expansion of scope."},"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')","Dual structure: factors 1-9 for clinical onset, factors 10-18 for clinical worsening, with factor 19 applying to both","Cross-referencing mechanism in section 11 linking to other Statements of Principles for underlying conditions","12 defined terms in Schedule 1, including nested definitions (e.g., 'relevant service' has 6 sub-categories)","Specific medical terminology requiring definition (peripheral odontogenic fibroma, macroglossia, mandibular repositioning appliance)","Conditional logic in section 10(2) limiting factors 10-19 to aggravation cases where condition pre-existed service","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"This Statement of Principles defines when acquired dental malocclusion is treated as connected with military service, replacing the 2011 version with updated medical evidence. It lists specific medical factors (including jaw trauma, dental surgery, tooth loss, sleep-apnoea devices and infections) that, if related to relevant service, establish a reasonable hypothesis of service connection.\n\nIt affects veterans and current/former ADF members covered by the VEA or MRCA and determines eligibility for compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument repeals the earlier Statement (section 4) and reissues a Statement that defines dental malocclusion, lists the clinical factors that raise a reasonable hypothesis of service connection, and applies to VEA/MRCA claims (sections 5–9). On its face, the text sets out the same kind of scope (medical factors linking condition to relevant service) without an explicit statement in this instrument that it expands or narrows that statutory purpose."},"complexity_factors":["Numerous alternative clinical triggers and thresholds to meet the reasonable‑hypothesis test (section 9) increase evidentiary complexity.","Distinct temporal categories—clinical onset versus clinical worsening—with different applicable factors (sections 9 and 10(2)).","Requirement that any listed factor be related to the person’s relevant service, which allows assessor discretion about service linkage (section 10(1)).","Cross‑references where a listed factor concerns an injury/disease covered by another Statement of Principles, requiring consultation of other instruments (section 11).","Extensive medical definitions in Schedule 1 (eg. macroglossia, mandibular repositioning appliance, maxillofacial disease) that narrow how terms are applied (section 6; Schedule 1).","Inclusion of death from dental malocclusion and defined ‘terminal events’ broadens outcome scope and evidential requirements (section 7(5); Schedule 1).","Use of ICD‑10‑AM codes for identification but an independent statutory definition governs application, creating potential mapping issues between clinical coding and legal interpretation (section 7(3)–(4)).","Instrument repeals the prior Statement, so practitioners must adopt the new criteria (section 4), affecting transition and evidentiary practices.","Application limited to claims under the VEA or MRCA, constraining administrative scope but requiring interface with those regimes (section 5).","Factor 19 (inability to obtain appropriate clinical management) introduces non‑medical, access‑related evidence considerations (section 9(19))."],"plain_english_summary":"This instrument replaces the prior Statement and sets the medical criteria used to decide whether dental malocclusion (including death from it) can be plausibly connected to a person’s military service for claims under the VEA or MRCA. It lists specific clinical factors, timing rules (onset versus worsening), and medical definitions that claims assessors and treating clinicians must apply when testing a “reasonable hypothesis” of service-related causation."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019","history":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-dental-malocclusion-reasonable-hypothesis-no-19-of-2019/documents"}}