{"id":"F2020L00823","name":"Statement of Principles concerning diabetes mellitus (Reasonable Hypothesis) (No. 48 of 2020)","slug":"statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":145423,"registerId":"commonwealth-F2020L00823-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 (Reasonable Hypothesis) (No. 48 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning diabetes mellitus (Reasonable Hypothesis) (No. 48 of 2020)\n\nmade under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 48 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 (Reasonable Hypothesis) (No. 48 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that diabetes mellitus and death from diabetes mellitus 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diabetes mellitus or death from diabetes mellitus 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 six weeks 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) undergoing splenectomy for trauma before the clinical onset of diabetes mellitus;\n\n(c) undergoing a course of therapeutic radiation for cancer, where the pancreas was in the field of radiation, before the clinical onset of diabetes mellitus;\n\n(d) 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(e) 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(f) ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical onset of diabetes mellitus;\n\n(g) taking an immune checkpoint inhibitor or an interferon within the one year before the clinical onset of diabetes mellitus; or\n\nNote: immune checkpoint inhibitor is defined in the Schedule 1 - Dictionary.\n\n(h) having infection with a Coxsackie B virus within the three years before the clinical onset of diabetes mellitus;\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 hypertension at the time of the clinical onset of diabetes mellitus;\n\n(j) having chronic renal failure at the time of the clinical onset of diabetes mellitus;\n\n> Note: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(k) having gout or hyperuricaemia at the time of the clinical onset of diabetes mellitus;\n\n> Note: hyperuricaemia is defined in the Schedule 1 - Dictionary.\n\n(l) having posttraumatic stress disorder at the time of the clinical onset of diabetes mellitus;\n\n(m) having depressive disorder at the time of the clinical onset of diabetes mellitus;\n\n(n) having bipolar disorder at the time of the clinical onset of diabetes mellitus;\n\n(o) having schizophrenia at the time of the clinical onset of diabetes mellitus;\n\n(p) having bilateral orchiectomy before the clinical onset of diabetes mellitus;\n\n(q) having anti-androgen therapy as specified for at least the one year before the clinical onset of diabetes mellitus;\n\n> Note: anti-androgen therapy as specified is defined in the Schedule 1 - Dictionary.\n\n(r) 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(s) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):\n\n(i) for a cumulative period of at least 500 hours, within a consecutive period of ten years before the clinical onset of diabetes mellitus; and\n\n(ii) where the first exposure occurred at least five years before the clinical onset of diabetes mellitus; and\n\n(iii) where that exposure has ceased, the clinical onset of diabetes mellitus has occurred within 25 years of cessation; or\n\n> Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.\n\n(t) for parous women only, inability to breast feed for a cumulative period of at least six months before the clinical onset of diabetes mellitus;\n\n> Note: The period of breastfeeding could be cumulative over a number of pregnancies.\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 six weeks 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) undergoing splenectomy for trauma before the clinical worsening of diabetes mellitus;\n\n(16) undergoing a course of therapeutic radiation for cancer, where the pancreas was in the field of radiation, before the clinical worsening of diabetes mellitus;\n\n(17) 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(18) 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(19) ingesting N-3-pyridyl methyl-N'-p-nitrophenyl urea (Vacor) within the 30 days before the clinical worsening of diabetes mellitus;\n\n(20) having depressive disorder at the time of the clinical worsening of diabetes mellitus;\n\n(21) having bipolar disorder at the time of the clinical worsening of diabetes mellitus;\n\n(22) having schizophrenia at the time of the clinical worsening of diabetes mellitus;\n\n(23) 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 hypertension at the time of the clinical worsening of diabetes mellitus;\n\n(j) having chronic renal failure at the time of the clinical worsening of diabetes mellitus;\n\n> Note: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(k) having gout or hyperuricaemia at the time of the clinical worsening of diabetes mellitus;\n\n> Note: hyperuricaemia is defined in the Schedule 1 - Dictionary.\n\n(l) having posttraumatic stress disorder at the time of the clinical worsening of diabetes mellitus;\n\n(m) having bilateral orchiectomy before the clinical worsening of diabetes mellitus;\n\n(n) having anti-androgen therapy as specified for at least the one year before the clinical worsening of diabetes mellitus;\n\n> Note: anti-androgen therapy as specified is defined in the Schedule 1 - Dictionary.\n\n(o) being exposed to arsenic as specified before the clinical worsening of diabetes mellitus; or\n\n> Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.\n\n(p) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):\n\n(i) for a cumulative period of at least 500 hours, within a consecutive period of ten years before the clinical worsening of diabetes mellitus; and\n\n(ii) where the first exposure occurred at least five years before the clinical worsening of diabetes mellitus; and\n\n(iii) where that exposure has ceased, the clinical worsening of diabetes mellitus has occurred within 25 years of cessation;\n\n> Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.\n\n(24) for gestational diabetes mellitus and type 2 diabetes mellitus only, being pregnant at the time of the clinical worsening of diabetes mellitus;\n\n(25) 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(25) 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(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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nanti-androgen therapy as specified means taking a drug from one of the following classes of drugs:\n\n(a) androgen receptor blockers, including cyproterone acetate, flutamide and bicalutamide; or\n\n(b) gonadotrophin releasing hormone agonists, including goserelin and leuprorelin.\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\nchronic renal failure means having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months.\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\nhyperuricaemia means having a serum urate level persistently greater than 0.40 millimoles per litre.\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\ninhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means:\n\n(a) decanting or spraying;\n\n(b) cleaning or maintaining equipment used to apply;\n\n(c) being sprayed with;\n\n(d) handling or sawing timber treated with;\n\n(e) being in an environment shrouded in dust from timber treated with; or\n\n(f) using cutting oils contaminated with;\n\none of the following chemicals:\n\n(i) 2,4,5-trichlorophenoxyacetic acid;\n\n(ii) 2,4,5-trichlorophenoxypropionic acid;\n\n(iii) 2,4,5-trichlorophenol;\n\n(iv) 2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionionate;\n\n(v) o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;\n\n(vi) pentachlorophenol;\n\n(vii) 2,3,4,6-tetrachlorophenol;\n\n(viii) 2,4,6-trichlorophenol;\n\n(ix) 1,3,5-trichloro-2-(4-nitrophenoxy)benzene;\n\n(x) 2,4-dichloro-1-(4-nitrophenoxy)benzene; or\n\n(xi) 2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.\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) 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\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 (Reasonable Hypothesis) (No. 48 of 2020)                                 | 29 June 2020F2020L00823   | 27 July 2020      |                                                 |\n| Amendment Statement of Principles concerning diabetes mellitus (Reasonable Hypothesis) (No. 83 of 2021)                       | 30 June 2021F2021L00926   | 26 July 2021      |                                                 |\n| Amendment Statement of Principles concerning diabetes mellitus (Reasonable Hypothesis) (No. 49 of 2022)                       | 2 May 2022F2022L00665     | 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)(g)…….                                                   | rs No. 83 of 2021  |\n| Subsection 9(6)(h)…….                                                   | am No. 83 of 2021  |\n| Subsection 9(13a).…….                                                   | ad No. 83 of 2021  |\n| Schedule 1 – Dictionary – having infection with a Coxsackie B virus…….. | rep No. 83 of 2021 |\n| Subsection 9(6)(g)...…..                                                | rs No. 49 of 2022  |\n| Subsection 9(13a)……..                                                   | rs No. 49 of 2022  |\n| Schedule 1 – Dictionary – immune checkpoint inhibitor……………...….         | ad No. 49 of 2022  |\n| Subsection 9(7)(a) note                                                 | rs No. 94 of 2022  |\n| Subsection 9(23)(a) note……………………..                                      | rs No. 94 of 2022  |\n| Schedule 1 – Dictionary – one pack-year...……..                          | rs No. 94 of 2022  |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"The instrument’s substantive scope has been changed by later amendments recorded in the compilation: new or revised causal factors and definitions were added or altered (see Endnote 4). Examples include addition and revision of immune checkpoint inhibitor‑related factors (subsection 9(13a) and Schedule 1 entries) and changes to the pack‑year definition and notes (subsection 9(7)(a) note; Schedule 1 – one pack‑year) as reflected in the listed amendment determinations. These amendments adjust which exposures, drugs and time windows can ground a reasonable hypothesis of service connection."},"complexity_factors":["Multiple diagnostic thresholds and laboratory criteria for defining diabetes mellitus (subsection 7(2)(a)(i)–(ii) and (2)(a)(ii)); inclusion/exclusion rules (subsection 7(2)(b)–(c)).","Separate, detailed factor lists and timing requirements for type 1, type 2 and gestational diabetes, and for onset versus clinical worsening (section 9, subsections 9(6)–9(8), 9(9)–9(25)).","Extensive drug and therapy-based triggers with defined minimum durations/doses (Specified List 1 and 2; glucocorticoid therapy definitions in Schedule 1).","Precise exposure windows and cessation cut-offs (eg. smoking pack-year and 15‑year cessation rule in 9(7)(a); TCDD cumulative and latency rules in 9(7)(s) and 9(23)(p)).","Numerical, measurement-based definitions used as legal thresholds (BMI, METs, GFR, pack‑year) in Schedule 1, requiring clinical or quantitative proof.","Cross-references to external classifications and other Statements of Principles (ICD‑10‑AM codes in 7(3); interaction rule in section 11), increasing interpretive dependencies.","Numerous defined medical and chemical terms (immune checkpoint inhibitor, haemolytic uraemic syndrome, Vacor, arsenic exposure) that are highly technical and medically specific (Schedule 1).","Amendment history and compilation notes (Endnotes 3–4) require attention to versioning for which criteria are in force."],"plain_english_summary":"This Statement of Principles sets the medical and exposure criteria used to form a ‘reasonable hypothesis’ that a person’s diabetes mellitus (or death from it) is related to their relevant military service for claims under the Veterans’ Entitlements Act or the MRCA. It specifies diagnostic thresholds, time windows, drugs, therapies and exposure definitions that claimants must meet to establish a service connection. It affects veterans, former service members and decision-makers who assess entitlement to service‑related benefits."},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The legislation maintains its original scope as a medical-scientific instrument for determining service connection for diabetes mellitus. While the 2022 amendments added definitions (e.g., 'immune checkpoint inhibitor') and refined existing ones (e.g., 'one pack-year'), these represent technical updates to medical understanding rather than expansion beyond the original purpose of establishing causation links between diabetes and military service."},"complexity_factors":["47+ defined terms in Schedule 1 Dictionary including complex medical definitions (e.g., 'equivalent glucocorticoid therapy' with specific dosage tables)","Nested conditional logic with multiple qualifiers: temporal requirements ('within 30 days', 'at least five years'), cessation clauses ('where smoking has permanently ceased'), and cumulative exposure calculations ('5,000 hours', '500 hours within ten years')","Disease-specific sub-factors: section 9 splits requirements by diabetes type (type 1, type 2, gestational) with mutually exclusive conditions","Cross-references to other Statements of Principles (section 11) creating interdependent legal framework","Dual application structure: separate factors for 'clinical onset' (sections 9(1)-9(8)) versus 'clinical worsening' (sections 9(9)-9(25)) with slightly different requirements","Technical medical thresholds requiring expert interpretation (e.g., BMI calculations, METs for physical activity, specific drug classes, ICD-10-AM coding)","Chemical exposure definitions with specific compound names (TCDD, 2,4,5-trichlorophenoxyacetic acid) and exposure pathways (decanting, spraying, cutaneous contact)","Mathematical conversion requirements for tobacco consumption ('pack-years' with specific formula: cigarettes per day ÷ 20 × years smoked)"],"plain_english_summary":"This Statement of Principles sets the medical-scientific rules for deciding whether diabetes mellitus (or death from it) was caused or aggravated by Australian military service. It applies to veterans and current/former defence members claiming under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004.\n\nBy listing factors that can link diabetes to service and using a “reasonable hypothesis” standard, it determines eligibility for pensions, treatment and other veteran benefits."},"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-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020","history":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-diabetes-mellitus-reasonable-hypothesis-no-48-of-2020/documents"}}