{"id":"F2025L00505","name":"Statement of Principles concerning Discoid Lupus Erythematosus (Balance of Probabilities) (No. 50 of 2025)","slug":"statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442824,"registerId":"F2025L00505-fast-fetch-1775957750124","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Discoid Lupus Erythematosus (Balance of Probabilities) (No. 50 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nDISCOID LUPUS ERYTHEMATOSUS  (Balance of Probabilities)\n\n(No. 50 of 2025)\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 15 April 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning discoid lupus erythematosus (Balance of Probabilities) (No. 50 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 19 May 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning discoid lupus erythematosus (Balance of Probabilities) (No. 127 of 2015) (Federal Register of Legislation No. F2015L01681) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about discoid lupus erythematosus and death from discoid lupus erythematosus.\n\n\nMeaning of discoid lupus erythematosus\n\n1.           For the purposes of this Statement of Principles, discoid lupus erythematosus:\n  1.           means a form of chronic cutaneous lupus erythematosus that commonly presents with erythematous, scaly plaques which often heal with scarring and atrophy, with a preference for the concha of the ear, head or neck; and\n  2.           excludes:\n    1.             acute cutaneous lupus erythematosus;\n    2.          chilblain lupus erythematosus;\n    3.        lupus erythematosus-lichen planus overlap syndrome;\n    4.         lupus erythematosus panniculitis;\n    5.           lupus erythematosus profundus;\n    6.         lupus erythematosus tumidus;\n    7.      subacute cutaneous lupus erythematosus;\n    8.    systemic lupus erythematosus.\n2.           While discoid lupus erythematosus attracts ICD‑10‑AM code L93.0, in applying this Statement of Principles the meaning of discoid lupus erythematosus is that given in subsection (2).\n3.           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\n\nDeath from discoid lupus erythematosus\n\n1.           For the purposes of this Statement of Principles, discoid lupus erythematosus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's discoid lupus erythematosus.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that discoid lupus erythematosus and death from discoid lupus erythematosus 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, discoid lupus erythematosus or death from discoid lupus erythematosus is connected with the circumstances of a person's relevant service:\n\n1.           being exposed to sunlight or ultraviolet light at a level sufficient to induce erythema (sunburn) at least 24 hours, but not more than 30 days, before clinical onset or clinical worsening;\n2.           taking any of the following medications at the time of clinical onset or clinical worsening:\n  1.           fluorouracils (including 5-fluorouracil, capecitabine and tegafur), excluding topical agents;\n  2.           tumour necrosis factor-alpha inhibitors.\n3.           taking a medication which is associated with:\n  1.           the development of discoid lupus erythematosus during medication therapy; and\n  2.           the improvement in discoid lupus erythematosus within 3 months of discontinuing medication therapy;\n\n\nwhere treatment with the drug continued for at least the 3 days before clinical onset or clinical worsening;\n\n1.           where smoking has not ceased before clinical onset or clinical worsening, smoking at least 10 pack-years before clinical onset or clinical worsening;\n\n\nNote: one pack-year is defined in the Schedule 1 – Dictionary.\n\n1.           inability to obtain appropriate clinical management for discoid lupus erythematosus before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 9 apply only  to material contribution to, or aggravation of, discoid lupus erythematosus where the person's discoid lupus erythematosus was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               one 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\nNote 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\nNote 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\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                               discoid lupus erythematosus—see subsection 7(2).\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":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2015 Statement of Principles and replaces it with an updated text (section 4). Compared with a generic earlier Statement model, it makes several concrete scope adjustments: it defines discoid lupus erythematosus narrowly and lists specific exclusions (section 7(2)); it specifies a precise UV exposure window (24 hours to 30 days) (section 9.1); it identifies particular drug classes (systemic fluorouracils and TNF‑alpha inhibitors) and sets conditions for medication‑related causation including minimum exposure and demonstrable improvement on stopping (sections 9.2–9.3); it sets an explicit smoking threshold of 10 pack‑years (section 9.4); and it recognises inability to obtain appropriate clinical management as a factor (section 9.5). These changes adjust who can meet the medical causation test and how claimants must prove it, so the operational scope of entitlement decisions is meaningfully altered from the prior instrument’s text."},"complexity_factors":["Single relatively short Schedule 1 with about 6 explicit defined terms (MRCA, VEA, relevant service, one pack‑year, terminal event, discoid lupus erythematosus cross‑referencing subsection 7(2))","Moderate conditional logic in factors (timing windows: 24 hours–30 days for UV exposure; 3‑day minimum drug exposure; 3‑month improvement period after drug cessation) (section 9)","Several nested subclauses listing medications and exclusions (section 7(2); section 9.2–9.3)","Cross‑references to other instruments and codes (ICD‑10‑AM, other Statements of Principles under subsection 196B(3)) (section 7(3); section 11)","Requirement that any listed factor be related to 'relevant service' introduces factual inquiry beyond pure medical causation (section 10)","Repeal and replacement of prior Statement of Principles (section 4) — administrative crossover risk for existing claims"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- Replaces the earlier Statement of Principles for discoid lupus erythematosus (DLE) and takes effect 19 May 2025 (sections 2 and 4).  The Repatriation Medical Authority (RMA) made it under the Veterans' Entitlements Act 1986 (section 3).\n- Applies to claims made under the Veterans' Entitlements Act (VEA) and the Military Rehabilitation and Compensation Act (MRCA) (section 5).\n- Defines what is meant by \"discoid lupus erythematosus\" for the purpose of claims, including a short list of related conditions that are excluded from this definition (section 7(2)).  It also treats death from DLE as covered where the terminal event or condition was contributed to by DLE (section 7(4); Schedule 1).\n- Lists the specific factual factors that must exist for a claimant to establish, on the balance of probabilities, that their DLE (or death from it) is connected with relevant service. At least one of the listed factors must be present (section 9).\n- Requires that any of those factors be related to the person’s relevant service (section 10(1)).  The rules governing clinical worsening apply only where DLE existed before or during service but did not arise out of service (section 10(2)).\n- Cross‑references ICD‑10‑AM codes and other Statements of Principles where a listed factor refers to another injury or disease (section 7(3); section 11).\n\nWho this affects and how it matters\n\n- Veterans or serving members who make claims under the VEA or MRCA for discoid lupus erythematosus, and their dependants where death is alleged to be related to DLE (sections 5 and 7(4)).\n- The Department of Veterans’ Affairs (DVA) and case officers who assess entitlement, because they will apply this Statement of Principles as the medical test for service connection when adjudicating claims (whole instrument; see sections 9 and 10).\n- Treating clinicians and records custodians, because claimants will need medical records, medication histories, timing of symptom onset/worsening, smoking histories and evidence about access to clinical care to meet the factors in section 9.\n\nKey factual gates the law sets (section references)\n\n- Definition of DLE: chronic cutaneous form with scaly, scarring plaques; excludes several other lupus subtypes (section 7(2)).\n- Covered death: includes death from a terminal event contributed to by DLE (section 7(4); Schedule 1).\n- Required factors (one or more must exist) (section 9):\n  - Recent exposure to sunlight or ultraviolet light sufficient to cause sunburn between 24 hours and 30 days before clinical onset or worsening (section 9.1);\n  - Taking specified systemic fluorouracil medications or tumour necrosis factor‑alpha inhibitors at the time of onset/worsening (section 9.2);\n  - Taking a medication that is known to cause DLE during therapy and where DLE improves within 3 months of stopping that medication, where the drug was taken for at least the 3 days before onset/worsening (section 9.3);\n  - Active smoking of at least 10 pack‑years if smoking had not ceased before onset/worsening (section 9.4; Schedule 1 definition of \"one pack‑year\");\n  - Inability to obtain appropriate clinical management before clinical worsening (section 9.5).\n- Relationship to service: any of the above factors must be related to the person’s relevant service (section 10(1)). Clinical-worsening factors apply only where DLE pre‑existed service or occurred during service but did not arise out of service (section 10(2)).\n\nThe RMA’s stated medical basis and practical testing of that claim\n\n- The RMA states that, on available medical‑scientific evidence, it is more probable than not that DLE (and death from it) can be related to relevant service (section 8). That is the legal predicate for publishing the Statement of Principles.\n\nCosts, incentives, trade‑offs and implementation risks (practical consequences)\n\n- Who pays: if a claimant satisfies the medical causation test in this Statement and the statutory entitlement conditions, DVA will pay the pension/entitlements provided under the VEA or MRCA. The instrument itself does not set payment rates; it sets the medical test used in deciding liability (sections 5, 9, 10).\n- Who decides: the RMA sets this Statement of Principles; DVA adjudicators apply it to individual claims. Courts can review adverse decisions under the usual administrative law paths, but the Statement is the starting medical standard (section 3; whole instrument).\n- Evidence and compliance burden: claimants must provide medical records, medication histories, evidence of timing (onset/worsening), and often occupational/service records to show the factor was related to relevant service. Lack of contemporaneous documentation (for sunlight exposure, medication timing, or smoking history) will increase the difficulty of proving connection (sections 9 and 10). This creates administrative burden for claimants and for DVA caseworkers.\n- Behavioural incentives: veterans and clinicians will have incentives to document onset dates, medication use and smoking history more carefully; service records to show relevant exposures during service will become more valuable. There is no direct private‑sector restriction here — the effect is evidentiary (sections 9 and Schedule 1).\n- Trade‑offs and opportunity costs: the Statement narrows the universe of medically relevant factors to a defined list. That sharpens adjudication (reduces discretion on undefined causal paths) but may exclude less well‑documented or non‑listed causal hypotheses (see the exclusory definition in section 7(2) and the finite list in section 9).\n- Bureaucratic discretion and implementation risk: while the Statement standardises medical causation, adjudicators must still evaluate linkage between listed factors and \"relevant service\" (section 10(1)), which requires factual inquiry and judgment. Evidence gaps, retrospective recall, or disputed onset dates can create inconsistency and litigation risk.\n- Concentrated benefits and diffuse costs: the direct financial benefit accrues to claimants who meet the specified factors; administrative and fiscal costs are borne by DVA/the Commonwealth. The instrument does not itself create new taxes or fees; it alters eligibility criteria used in assessing existing entitlements.\n\nConcrete practical effects on private choices and providers\n\n- Claimants: will need to show one or more listed factors and evidence that the factor is related to relevant service; failure to document those will reduce likelihood of successful claims (sections 9, 10).\n- Clinicians: better contemporaneous record‑keeping of onset, sun/UV exposure, medication start/stop dates, and smoking history will materially affect claim outcomes (section 9; Schedule 1).\n- Employers and record‑keepers: service records or workplace exposure records that show sun/UV exposure or medication provision during service will be decisive evidence for some claims (section 9).\n\nBottom line\n\n- Mechanically, this instrument updates and replaces the prior RMA Statement for discoid lupus erythematosus, narrows and specifies the medical factors that can establish a service connection (exposure windows, specific medications, smoking threshold, and inability to obtain care), and requires those factors to be tied to relevant service. It matters because it defines the medical test that DVA will use to decide whether veterans or serving members have entitlement for DLE or death from DLE under the VEA and MRCA (sections 2–5, 7–10)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established scope of determining service connection for a specific medical condition under veterans' compensation law. It updates the 2015 version without expanding beyond the original purpose of setting medical evidentiary requirements for discoid lupus erythematosus claims."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Medical terminology requiring clinical knowledge (erythema, atrophy, fluorouracils, TNF-alpha inhibitors)","Mathematical calculation required for 'pack-years' with conversion rules for non-cigarette tobacco","Nested definitions: 'discoid lupus erythematosus' defined by exclusion of 8 other conditions","Conditional logic in factor 9(c) requiring both causation AND improvement timelines","Temporal constraints (24 hours–30 days for sun exposure; 3 days minimum for medication; 3 months improvement window)","Dual legislative framework application (VEA and MRCA with different service definitions)","Specific ICD-10-AM coding reference with edition and ISBN citation"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding whether discoid lupus erythematosus (and deaths from it) is connected to service for veterans and current/former ADF members, replacing the 2015 version. It requires proof of one of five specified causal factors (e.g., recent sun/UV exposure, certain cancer or immunosuppressant drugs, smoking, or inability to access treatment). Meeting a factor is needed to succeed on balance of probabilities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202","history":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202/history","analysis":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202/analysis","conflicts":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202/important-cases","documents":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-balance-of-probabilities-no-50-of-202/documents"}}