{"id":"F2020L00822","name":"Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020)","slug":"statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":145421,"registerId":"commonwealth-F2020L00822-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020)\n\nmade under subsection 196B(3) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 3\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020) that shows the text of the law as amended and in force on 19 September 2022.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1 Name\n\nThis is the Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\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 diabetes mellitus and death from diabetes mellitus.\n\nMeaning of diabetes mellitus\n\n(2) For the purposes of this Statement of Principles, diabetes mellitus:\n\n(a) means persistent hyperglycaemia characterised by either:\n\n(i) two positive laboratory blood tests on separate days showing:\n\n1.  a fasting plasma glucose concentration of at least 7.0 millimoles per litre; or\n2.  a plasma glucose concentration of at least 11.1 millimoles per litre two hours after ingestion of 75 grams of glucose on a baseline fasting state (glucose tolerance test); or\n3.  an HbA1c level of at least 6.5%; or\n\n(ii) an episode of diabetic ketoacidosis or hyperosmolar hyperglycaemic state with a blood glucose level of at least 11.1 millimoles per litre; and\n\n(b) includes:\n\n(i) drug-induced diabetes mellitus;\n\n(ii) gestational diabetes mellitus;\n\n(iii) primary diabetes mellitus;\n\n(iv) secondary diabetes mellitus;\n\n(v) type 1 diabetes mellitus; and\n\n(vi) type 2 diabetes mellitus; and\n\n> Note: type 1 diabetes mellitus and type 2 diabetes mellitus are defined in the Schedule 1 – Dictionary.\n\n(c) excludes impaired glucose tolerance.\n\n(3) While diabetes mellitus attracts ICD‑10‑AM code E10, E11, E12, E13 or E14, in applying this Statement of Principles the meaning of diabetes mellitus 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 diabetes mellitus\n\n(5) For the purposes of this Statement of Principles, diabetes mellitus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's diabetes mellitus.\n\n> Note: 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 diabetes mellitus and death from diabetes mellitus can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: 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, diabetes mellitus or death from diabetes mellitus is connected with the circumstances of a person's relevant service:\n\n(1) having an endocrine disorder from the specified list of endocrine disorders before the clinical onset of diabetes mellitus;\n\n> Note: specified list of endocrine disorders is defined in the Schedule 1 \\- Dictionary.\n\n(2) having a solid organ transplant or bone marrow transplant before the clinical onset of diabetes mellitus;\n\n(3) having glucocorticoid therapy as specified, before the clinical onset of diabetes mellitus, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the 30 days before the clinical onset of diabetes mellitus;\n\n> Note: glucocorticoid therapy as specified is defined in the Schedule 1 \\- Dictionary.\n\n(4) being treated with a drug from the Specified List 1 of drugs, which cannot be ceased or substituted, for at least the seven days before the clinical onset of diabetes mellitus;\n\n> Note: Specified List 1 of drugs is defined in the Schedule 1 \\- Dictionary.\n\n(5) being treated with a drug from the antidepressant or antipsychotic classes of drugs, which cannot be ceased or substituted, for at least the three months before the clinical onset of diabetes mellitus;\n\n(6) for type 1 diabetes mellitus only:\n\n(a) undergoing surgery to the pancreas before the clinical onset of diabetes mellitus;\n\n(b) having a specified pathological condition involving the pancreas before the clinical onset of diabetes mellitus;\n\n> Note: specified pathological condition involving the pancreas is defined in the Schedule 1 \\- Dictionary.\n\n(c) having haemolytic uraemic syndrome before the clinical onset of diabetes mellitus;\n\n> Note: haemolytic uraemic syndrome is defined in the Schedule 1 - Dictionary.\n\n(d) ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical onset of diabetes mellitus; or\n\n(e) taking an immune checkpoint inhibitor or an interferon within the one year before the clinical onset of diabetes mellitus;\n\nNote: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary\n\n(7) for type 2 diabetes mellitus only:\n\n(a) having smoked at least five pack-years of tobacco products before the clinical onset of diabetes mellitus, and where smoking has permanently ceased, the clinical onset of diabetes mellitus has occurred within 15 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(b) being exposed to second-hand smoke for at least 5,000 hours before the clinical onset of diabetes mellitus, and where exposure to second-hand smoke has permanently ceased, the clinical onset of diabetes mellitus has occurred within 15 years of cessation;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(c) being overweight or obese for at least five years before the clinical onset of diabetes mellitus;\n\n> Note: being overweight or obese is defined in the Schedule 1 \\- Dictionary.\n\n(d) an inability to undertake moderate physical activity of at least four METs for at least the five years before the clinical onset of diabetes mellitus;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n(e) having cirrhosis of the liver at the time of the clinical onset of diabetes mellitus;\n\n(f) having non-alcoholic steatohepatitis at the time of the clinical onset of diabetes mellitus;\n\n(g) having infection with human immunodeficiency virus before the clinical onset of diabetes mellitus;\n\n(h) having infection with hepatitis C virus before the clinical onset of diabetes mellitus;\n\n(i) having depressive disorder at the time of the clinical onset of diabetes mellitus;\n\n(j) having bipolar disorder at the time of the clinical onset of diabetes mellitus;\n\n(k) having schizophrenia at the time of the clinical onset of diabetes mellitus;\n\n(l) having bilateral orchiectomy before the clinical onset of diabetes mellitus;\n\n(m) having anti-androgen therapy with a gonadotrophin releasing hormone agonist, including goserelin and leuprorelin, for at least the one year before the clinical onset of diabetes mellitus; or\n\n(n) being exposed to arsenic as specified before the clinical onset of diabetes mellitus;\n\n> Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.\n\n(8) for gestational diabetes mellitus and type 2 diabetes mellitus only, being pregnant at the time of the clinical onset of diabetes mellitus;\n\n(9) having an endocrine disorder from the specified list of endocrine disorders before the clinical worsening of diabetes mellitus;\n\n> Note: specified list of endocrine disorders is defined in the Schedule 1 \\- Dictionary.\n\n(10) having a solid organ transplant or bone marrow transplant before the clinical worsening of diabetes mellitus;\n\n(11) having glucocorticoid therapy as specified, before the clinical worsening of diabetes mellitus, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the 30 days before the clinical worsening of diabetes mellitus;\n\n> Note: glucocorticoid therapy as specified is defined in the Schedule 1 \\- Dictionary.\n\n(12) being treated with a drug from the Specified List 1 of drugs, which cannot be ceased or substituted, for at least the seven days before the clinical worsening of diabetes mellitus;\n\n> Note: Specified List 1 of drugs is defined in the Schedule 1 \\- Dictionary.\n\n(13) being treated with a drug from the antidepressant or antipsychotic classes of drugs, which cannot be ceased or substituted, for at least the three months before the clinical worsening of diabetes mellitus;\n\n(13a) taking an immune checkpoint inhibitor or an interferon within the one year before the clinical worsening of diabetes mellitus;\n\nNote: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.\n\n(14) undergoing surgery to the pancreas before the clinical worsening of diabetes mellitus;\n\n(15) having a specified pathological condition involving the pancreas before the clinical worsening of diabetes mellitus;\n\n> Note: specified pathological condition involving the pancreas is defined in the Schedule 1 \\- Dictionary.\n\n(16) having haemolytic uraemic syndrome before the clinical worsening of diabetes mellitus;\n\n> Note: haemolytic uraemic syndrome is defined in the Schedule 1 - Dictionary.\n\n(17) ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical worsening of diabetes mellitus;\n\n(18) having depressive disorder at the time of the clinical worsening of diabetes mellitus;\n\n(19) having bipolar disorder at the time of the clinical worsening of diabetes mellitus;\n\n(20) having schizophrenia at the time of the clinical worsening of diabetes mellitus;\n\n(21) for type 2 diabetes mellitus only:\n\n(a) having smoked at least five pack-years of tobacco products before the clinical worsening of diabetes mellitus, and where smoking has permanently ceased, the clinical worsening of diabetes mellitus has occurred within 15 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(b) being exposed to second-hand smoke for at least 5,000 hours before the clinical worsening of diabetes mellitus, and where exposure to second-hand smoke has permanently ceased, the clinical worsening of diabetes mellitus has occurred within 15 years of cessation;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(c) being overweight or obese for at least five years before the clinical worsening of diabetes mellitus;\n\n> Note: being overweight or obese is defined in the Schedule 1 \\- Dictionary.\n\n(d) an inability to undertake moderate physical activity of at least four METs for at least the five years before the clinical worsening of diabetes mellitus;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n(e) having cirrhosis of the liver at the time of the clinical worsening of diabetes mellitus;\n\n(f) having non-alcoholic steatohepatitis at the time of the clinical worsening of diabetes mellitus;\n\n(g) having infection with human immunodeficiency virus before the clinical worsening of diabetes mellitus;\n\n(h) having infection with hepatitis C virus before the clinical worsening of diabetes mellitus;\n\n(i) having bilateral orchiectomy before the clinical worsening of diabetes mellitus;\n\n(j) having anti-androgen therapy with a gonadotrophin releasing hormone agonist, including goserelin and leuprorelin, for at least the one year before the clinical worsening of diabetes mellitus; or\n\n(k) being exposed to arsenic as specified before the clinical worsening of diabetes mellitus;\n\n> Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.\n\n(22) for gestational diabetes mellitus and type 2 diabetes mellitus only, being pregnant at the time of the clinical worsening of diabetes mellitus;\n\n(23) inability to obtain appropriate clinical management for diabetes mellitus.\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(9) to 9(23) apply only to material contribution to, or aggravation of, diabetes mellitus where the person's diabetes mellitus 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nbeing exposed to arsenic as specified means:\n\n(a) consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least ten years; or\n\n(b) consuming drinking water resulting in a cumulative total arsenic exposure equivalent to having consumed drinking water containing at least 50 micrograms per litre for at least ten years; or\n\n(c) having clinical evidence of chronic arsenic toxicity.\n\nbeing exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\nbeing overweight or obese means:\n\n(a) having a Body Mass Index (BMI) of 25 or greater; or\n\n(b) having a waist circumference of greater than 80 centimetres in women or greater than 94 centimetres in men.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\ndiabetes mellitus—see subsection 7(2).\n\nequivalent glucocorticoid therapy means a glucocorticoid in the following table, at the doses specified in the table, or a therapeutically equivalent dose of another glucocorticoid:\n\n| Glucocorticoid     | Minimum cumulative dose (milligrams) | Minimum average rate (milligrams/day) |\n| ------------------ | ------------------------------------ | ------------------------------------- |\n| betamethasone      | 60                                   | 2                                     |\n| cortisone          | 1,875                                | 62.5                                  |\n| dexamethasone      | 50                                   | 1.67                                  |\n| methylprednisolone | 300                                  | 10                                    |\n| paramethasone      | 150                                  | 5                                     |\n| prednisone         | 375                                  | 12.5                                  |\n| prednisolone       | 375                                  | 12.5                                  |\n| triamcinolone      | 300                                  | 10                                    |\n\nequivalent inhaled glucocorticoid means:\n\n(a) 8,000 micrograms of triamcinolone;\n\n(b) 1,600 micrograms of budesonide;\n\n(c) 1,000 micrograms of fluticasone; or\n\n(d) a therapeutically equivalent dose of another inhaled glucocorticoid.\n\nglucocorticoid therapy as specified means:\n\n(a) taking:\n\n(i) hydrocortisone, orally, by injection, or per rectum:\n\n1.  to a cumulative dose of at least 1,500 milligrams, and\n2.  at a minimum dose rate averaging 50 milligrams per day; or\n\n(ii) equivalent glucocorticoid therapy, orally, by injection, or per rectum; or\n\n(b) inhaling at least 1,600 micrograms of beclomethasone, or equivalent inhaled glucocorticoid, daily, for at least six months; or\n\n(c) using an ocular or intranasal glucocorticoid at above the maximum therapeutic dosage level, daily, for at least six months; or\n\n(d) applying a high or very high potency topical glucocorticoid to at least 20% of total skin surface area, daily, for at least six months; or\n\n(e) using a glucocorticoid concurrently with a drug from the Specified List 2 of drugs, daily, for at least 30 days.\n\n> Note: equivalent glucocorticoid therapy, equivalent inhaled glucocorticoid, high or very high potency topical glucocorticoid and Specified List 2 of drugs are also defined in the Schedule 1 – Dictionary.\n\nhaemolytic uraemic syndrome means a clinical syndrome characterised by renal failure, microangiopathic haemolytic anaemia and thrombocytopaenia.\n\nhigh or very high potency topical glucocorticoid means:\n\n(a) betamethasone dipropionate 0.05%;\n\n(b) betamethasone valerate 0.1%;\n\n(c) clobetasol proprionate 0.05%;\n\n(d) diflucortolone valerate 0.1%;\n\n(e) fluocinolone acetonide 0.025%; or\n\n(f) another topical glucocorticoid of equivalent potency.\n\nimmune checkpoint inhibitor means a form of cancer immunotherapy that uses monoclonal antibodies targeting the immune checkpoint proteins. Examples include ipilimumab, tremelimumab, nivolumab and pembrolizumab.\n\nMET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nSpecified List 1 of drugs means:\n\n(a) abacavir;\n\n(b) alpha and beta agonists, including adrenaline and noradrenaline;\n\n(c) amiodarone;\n\n(d) beta-blockers;\n\n(e) bortezomib;\n\n(f) cyclophosphamide;\n\n(g) cyclosporine;\n\n(h) decitabine;\n\n(i) diadanosine;\n\n(j) diazoxide;\n\n(k) docetaxel;\n\n(l) emtricitabine;\n\n(m) everolimus;\n\n(n) gatifloxacin;\n\n(o) growth hormone;\n\n(p) imatinib;\n\n(q) isoniazid;\n\n(r) L-asparaginase;\n\n(s) lamivudine;\n\n(t) levofloxacin;\n\n(u) moxifloxacin;\n\n(v) nicotinic acid for the treatment of dyslipidaemia;\n\n(w) nilotinib;\n\n(x) pentamidine;\n\n(y) phenytoin;\n\n(z) protease inhibitors;\n\n(aa) rifampicin;\n\n(bb) sirolimus;\n\n(cc) sodium valproate;\n\n(dd) somatostatin analogues;\n\n(ee) statins;\n\n(ff) stavudine;\n\n(gg) streptozotocin;\n\n(hh) tacrolimus;\n\n(ii) temsirolimus;\n\n(jj) temzolomibe;\n\n(kk) theophylline;\n\n(ll) thiazide diuretics;\n\n(mm) thyroid hormones;\n\n(nn) vorinostat; or\n\n(oo) zidovudine.\n\nSpecified List 2 of drugs means:\n\n(a) amprenavir;\n\n(b) atazanavir;\n\n(c) darunavir;\n\n(d) fosamprenavir;\n\n(e) indinavir;\n\n(f) itraconazole;\n\n(g) ketoconazole;\n\n(h) lopinavir;\n\n(i) nelfinavir;\n\n(j) ritonavir;\n\n(k) saquinavir; or\n\n(l) tipranavir.\n\nspecified list of endocrine disorders means:\n\n(a) acromegaly;\n\n(b) Cushing syndrome;\n\n(c) glucagonoma;\n\n(d) hyperthyroidism;\n\n(e) phaeochromocytoma;\n\n(f) primary hyperaldosteronism; or\n\n(g) somatostatinoma.\n\nspecified pathological condition involving the pancreas means:\n\n(a) acute pancreatitis;\n\n(b) chronic pancreatitis;\n\n(c) cystic fibrosis;\n\n(d) haemochromatosis; or\n\n(e) malignant neoplasm of the pancreas.\n\nterminal 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\ntype 1 diabetes mellitus means a form of diabetes mellitus caused by complete or near-total insulin deficiency and requiring daily administration of insulin.\n\ntype 2 diabetes mellitus means a form of diabetes mellitus caused by variable degrees of insulin resistance and impaired insulin secretion.\n\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                          | Registration              | Commencement      | Application, saving and transitional provisions |\n| ----------------------------------------------------------------------------------------------------------------------------- | ------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 49 of 2020)                              | 29 June 2020F2020L00822   | 27 July 2020      |                                                 |\n| Amendment Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 84 of 2021)                    | 30 June 2021F2021L00927   | 26 July 2021      |                                                 |\n| Amendment Statement of Principles concerning diabetes mellitus (Balance of Probabilities) (No. 50 of 2022)                    | 2 May 2022F2022L00666     | 30 May 2022       |                                                 |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128 | 19 September 2022 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                                              | How affected      |\n| --------------------------------------------------------------- | ----------------- |\n| Section 2……………….                                                | rep LA s 48D      |\n| Section 4……………….                                                | rep LA s 48C      |\n| Subsection 9(6)(e)…….                                           | rs No. 84 of 2021 |\n| Subsection 9(13a).…….                                           | ad No. 84 of 2021 |\n| Subsection 9(6)(e)…….                                           | rs No. 50 of 2022 |\n| Subsection 9(13a).…….                                           | rs No. 50 of 2022 |\n| Schedule 1 – Dictionary – immune checkpoint inhibitor……………...…. | ad No. 50 of 2022 |\n| Subsection 9(7)(a) note                                         | rs No. 94 of 2022 |\n| Subsection 9(21)(a) note……………………..                              | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...……..                  | rs No. 94 of 2022 |","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":7,"scope_assessment":{"changed":false,"description":"The instrument remains focused on its original purpose: establishing the medical nexus requirements for diabetes mellitus claims under veterans' compensation legislation. The amendments shown in the endnotes (Nos. 84 of 2021, 50 of 2022, and 94 of 2022) are technical updates—refining definitions (particularly 'one pack-year' and 'immune checkpoint inhibitor') and adjusting specific factor references—rather than expansions into new substantive areas. The core structure and scope established in the original 2020 instrument remain intact."},"complexity_factors":["23 separate factors in section 9, many with sub-factors (a)-(n), creating a dense conditional matrix","Type-specific applicability—factors are restricted to 'type 1 diabetes mellitus only', 'type 2 diabetes mellitus only', or 'gestational diabetes mellitus and type 2 diabetes mellitus only', requiring careful parsing","Temporal requirements throughout—precise lookback periods (7 days, 30 days, 3 months, 1 year, 5 years, 10 years, 15 years) that vary by factor","Extensive defined terms in Schedule 1 (approximately 20+ definitions), including complex medical calculations like BMI formula, pack-year calculations, and equivalent glucocorticoid dosing tables","Nested definitions—terms like 'glucocorticoid therapy as specified' incorporate other defined terms ('equivalent glucocorticoid therapy', 'equivalent inhaled glucocorticoid', 'Specified List 2 of drugs')","Two-column medication tables with specific dosage thresholds and therapeutic equivalencies","Cross-referencing mechanism in section 11 that imports factors from other Statements of Principles dynamically ('as in force from time to time')","Dual regime application—applies to both VEA and MRCA claims with different service definitions","Distinction between 'clinical onset' and 'clinical worsening' with partially overlapping but distinct factor sets","Specific exclusion of 'impaired glucose tolerance' from the definition despite ICD-10-AM code overlap"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding when diabetes mellitus is accepted as caused or aggravated by military service. It affects veterans and current/former defence members making claims and the Department of Veterans’ Affairs decision-makers.\n\nIt distinguishes diabetes types and uses two tests (new onset vs worsening), lists service-related medical, drug, surgical, lifestyle and mental-health factors, applies precise thresholds and timeframes, and cross-references other Statements of Principles."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The Statement has been amended since the original instrument: amendments added and altered specific causal factors (for example, immune checkpoint inhibitors were added—see subsection 9(13a) and Schedule 1 definition; subsection 9(6)(e) was amended), and the technical definition of 'one pack‑year' and related notes were revised (Endnote 4; Endnote 3 lists amendment instruments and dates). These changes expand and clarify the list of exposures/therapies and update measurement definitions that determine whether diabetes is connected to relevant service."},"complexity_factors":["Detailed diagnostic thresholds and laboratory criteria for diabetes (subsection 7(2)): multiple test types and numeric cut-offs (fasting glucose, glucose tolerance, HbA1c).","Large, condition-specific list of causal/contributing factors across onset and worsening (section 9): different tests, exposures and therapies for type 1, type 2 and gestational diabetes.","Extensive technical definitions and dose/ duration rules in the Schedule (glucocorticoid therapy as specified; equivalent glucocorticoid/inhaled glucocorticoid; BMI; MET) that require clinical interpretation (Schedule 1 - Dictionary).","Enumerated drug lists (Specified List 1 and Specified List 2 in Schedule 1) that must be checked against a claimant’s medication history to establish exposure (Schedule 1).","Multiple timing windows and cut-offs (e.g. last glucocorticoid dose within 30 days of onset, immune checkpoint inhibitor within one year, smoking pack‑years and 15‑year cessation rule) increase evidentiary complexity (subsections 9(3), 9(6)(e), 9(7)(a), 9(13a)).","Different standards for 'onset' versus 'worsening' and restrictions on when contribution or aggravation tests apply (section 10(2) and section 9 headers).","Cross-reference to other Statements of Principles where factors overlap, requiring consult of separate instruments (section 11).","Decision basis set by the Repatriation Medical Authority on 'sound medical‑scientific evidence' and applied 'more probable than not' standard — legal-medical judgement with delegated expert discretion (section 8; section 3 authority).","Application limited to claims under VEA/MRCA, so administrative law and benefits processes under those Acts interact with these medical rules (section 5; Schedule 1 definitions MRCA/VEA/relevant service).","Evidentiary and compliance burden on claimants and administrators to document exposures, treatments, clinical measurements and timings to meet the instrument’s numeric and temporal thresholds (sections 7, 9; Schedule 1)."],"plain_english_summary":"This instrument sets the medical definition of diabetes mellitus and lists the specific clinical, exposure and treatment factors that, if present, make it more likely than not that a person’s diabetes (or death from it) is related to their relevant service. It applies to veterans and current or former members making claims under the Veterans’ Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004, and therefore determines which medical circumstances support entitlement decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020","history":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-balance-of-probabilities-no-49-of-2020/documents"}}