{"id":"F2022L00916","name":"Statement of Principles concerning dermatomyositis (Balance of Probabilities) (No. 71 of 2022)","slug":"statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441450,"registerId":"F2022L00916-fast-fetch-1775956738385","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning dermatomyositis (Balance of Probabilities) (No. 71 of 2022)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nDERMATOMYOSITIS (Balance of Probabilities)\n\n(No. 71 of 2022)\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 June 2022\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 Terence Campbell AM
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 dermatomyositis (Balance of Probabilities) (No. 71 of 2022).\n\n2 Commencement\n\n This instrument commences on 25 July 2022.\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 dermatomyositis No. 10 of 2014 (Federal Register of Legislation No. F2014L00011) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 dermatomyositis and death from dermatomyositis.\n\nMeaning of dermatomyositis\n\n(2) For the purposes of this Statement of Principles, dermatomyositis:\n\n(a) means a chronic inflammatory disease characterised by inflammatory skin changes, usually accompanied by progressive and symmetric skeletal muscle weakness; and\n\n(b) includes amyopathic dermatomyositis.\n\nNote 1: Typical skin changes include a heliotrope rash, and red or violet, sometimes scaly, slightly raised papules that erupt on the finger joints or other bony extremities (Gottron papules). Typical muscle disease involves progressive and symmetrical weakness of the limb-girdle muscles, with or without dysphagia and respiratory muscle weakness.\n\nNote 2: The diagnosis may be confirmed by elevation of serum levels of muscle-associated enzymes, biopsy, imaging or the presence of myositis-associated antibodies.\n\n \n\nNote 3: Amyopathic dermatomyositis is a variant of dermatomyositis that is characterised by the typical skin rash but without muscle abnormalities. Clinically, amyopathic dermatomyositis may be hypomyopathic, with no objective weakness but with evidence of subclinical muscle involvement on testing, or amyopathic, with no evidence of muscle involvement on examination or testing.\n\nDeath from dermatomyositis\n\n(3) For the purposes of this Statement of Principles, dermatomyositis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's dermatomyositis.\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 dermatomyositis and death from dermatomyositis 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, dermatomyositis or death from dermatomyositis is connected with the circumstances of a person's relevant service:\n\n(1) taking a drug from the specified list of drugs for at least the 4 weeks before the clinical onset of dermatomyositis;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(2) taking hydroxyurea for at least the 6 months before the clinical onset of dermatomyositis;\n\n(3) taking an immune checkpoint inhibitor or interferon alfa within the 1 year before the clinical onset of dermatomyositis;\n\nNote: Examples of immune checkpoint inhibitors include ipilimumab, nivolumab, pembrolizumab and tremelimumab.\n\n(4) taking a drug which is associated in the individual with the clinical onset of dermatomyositis during drug therapy and either:\n\n(a) the improvement of dermatomyositis within 2 months of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of dermatomyositis on rechallenge with the same drug; and\n\nwhere taking the drug continued for at least the 7 days before the clinical onset of dermatomyositis;\n\n(5) having a malignant neoplasm, other than non-melanotic malignant neoplasm of the skin, within 5 years of the clinical onset of dermatomyositis;\n\n(6) taking a drug from the specified list of drugs for at least the 4 weeks before the clinical worsening of dermatomyositis;\n\nNote: specified list of drugs is defined in the Schedule 1 – Dictionary.\n\n(7) taking hydroxyurea for at least the 6 months before the clinical worsening of dermatomyositis;\n\n(8) taking an immune checkpoint inhibitor or interferon alfa within the 1 year before the clinical worsening of dermatomyositis;\n\nNote: Examples of immune checkpoint inhibitors include ipilimumab, nivolumab, pembrolizumab and tremelimumab.\n\n(9) taking a drug which is associated in the individual with:\n\n(a) the clinical worsening of dermatomyositis during drug therapy; and\n\n(b) the improvement of dermatomyositis within 2 months of discontinuing or tapering drug therapy; and\n\nwhere taking the drug continued for at least the 7 days before the clinical worsening of dermatomyositis;\n\n(10) having a malignant neoplasm, other than non-melanotic malignant neoplasm of the skin, within 5 years of the clinical worsening of dermatomyositis;\n\n(11) inability to obtain appropriate clinical management for dermatomyositis.\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(6) to 9(11) apply only to material contribution to, or aggravation of, dermatomyositis where the person's dermatomyositis 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 dermatomyositis—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 specified list of drugs means:\n\n(a) 5-fluorouracil;\n\n(b) capecitabine;\n\n(c) D-penicillamine;\n\n(d) statins; or\n\n(e) tumour necrosis factor-alpha inhibitors.\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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical-determination instrument for a specific disease. It updates the 2014 version with current medical evidence (adding modern cancer immunotherapies like checkpoint inhibitors) but does not expand beyond its core function of establishing service-connection factors for dermatomyositis claims."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 dictionary (6 defined terms)","Dual application framework — applies to two different Acts (VEA and MRCA) with different service definitions","Conditional logic in factors 9(4) and 9(9) requiring multiple conjunctive elements (drug association + improvement on cessation OR rechallenge)","Temporal requirements vary across factors (4 weeks, 6 months, 1 year, 5 years, 7 days)","Nested definitions: 'terminal event' includes a non-exhaustive list of 5 specific conditions","Section 11 creates dynamic incorporation of other Statements of Principles by reference"],"plain_english_summary":"This instrument sets the medical test for linking dermatomyositis to military service on the balance of probabilities, replacing a 2014 version and listing specific medical factors (drug exposures, cancer history, treatment access and patterns of symptom recurrence) that can establish a service connection. \n\nIt affects veterans and current/former defence members claiming under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act, giving the Department clear evidence standards for consistent compensation decisions."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2014 Statement (s4) and replaces it with an updated set of qualifying factors and temporal thresholds for linking dermatomyositis to relevant service (s9). It retains application to VEA and MRCA claims (s5) but changes the enumerated conditions and evidentiary tests claimants must meet."},"complexity_factors":["Technical medical definitions and variants (dermatomyositis, amyopathic dermatomyositis) that determine diagnosis and eligibility (s7(2)).","Multiple specified drug classes and precise temporal thresholds (e.g. 4 weeks, 6 months, 1 year, 7 days) that create discrete evidentiary windows (s9; Schedule).","Causation standard is the civil 'balance of probabilities' and requires linking factors to relevant service, adding an evidentiary and legal threshold (s8, s10(1)).","Requirements about clinical response to drug cessation or rechallenge (improvement within 2 months or redevelopment on rechallenge) impose specific clinical-record burdens (s9(4),(9)).","Interaction and cross-reference with other Statements of Principles where factors refer to other injuries/diseases (s11) increases interpretive complexity.","Repeal of the 2014 Statement and application to claims under both the VEA and MRCA means administrators must apply the updated criteria across existing claim streams (s4, s5)."],"plain_english_summary":"This instrument updates the Repatriation Medical Authority’s Statement of Principles for dermatomyositis, repealing the 2014 version and fixing the medical and timing criteria that, on the balance of probabilities, must exist to link dermatomyositis or death from it to a person’s relevant service. It applies to claims under the VEA or the MRCA (ss3–5,7).\n\nIt identifies qualifying factors such as specified drug exposures, hydroxyurea, immune checkpoint inhibitors/interferon alfa, recent malignancy, or inability to obtain appropriate clinical management, which means claimants must supply clinical and drug-history evidence to meet those thresholds (s9, 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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022","history":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-dermatomyositis-balance-of-probabilities-no-71-of-2022/documents"}}