{"id":"F2025L00504","name":"Statement of Principles concerning discoid lupus erythematosus (Reasonable Hypothesis) (No. 49 of 2025)","slug":"statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442819,"registerId":"F2025L00504-fast-fetch-1775957747967","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 (Reasonable Hypothesis) (No. 49 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  (Reasonable Hypothesis)\n\n(No. 49 of 2025)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated    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   \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 (Reasonable Hypothesis) (No. 49 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning discoid lupus erythematosus (Reasonable Hypothesis) (No. 126 of 2015) (Federal Register of Legislation No. F2015L01680) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that discoid lupus erythematosus and death from discoid lupus erythematosus can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.                Factors that must exist\n\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 discoid lupus erythematosus or death from discoid lupus erythematosus 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.           immune checkpoint inhibitors;\n  3.           intravenous or subcutaneous immunoglobulin G;\n  4.           leflunomide;\n  5.           palbociclib;\n  6.            secukinumab;\n  7.           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.           taking estradiol menopausal hormone therapy for at least the 2 years before clinical onset;\n2.           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.           having posttraumatic stress disorder for at least the 3 months before clinical onset or clinical worsening;\n2.           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(2) 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)          operational service under the VEA;\n\n(b)          peacekeeping service under the VEA;\n\n(c)          hazardous service under the VEA;\n\n(d)          British nuclear test defence service under the VEA;\n\n(e)          warlike service under the MRCA; or\n\n(f)           non-warlike service under the MRCA.\n\nNote: MRCA and VEA are 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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument updating the 2015 version. It maintains the same scope: establishing medical criteria for service connection of a specific skin condition. The structure and purpose remain consistent with the Repatriation Medical Authority's ongoing function under the VEA."},"complexity_factors":["Multiple nested lists and sub-paragraphs (section 9 has 7 main factors with some containing sub-lists up to 7 items deep)","Cross-references to two separate Acts (VEA and MRCA) and their specific service definitions","Technical medical terminology requiring definition (ICD-10-AM codes, specific drug classes)","Temporal conditions attached to factors (e.g., 'at least 24 hours but not more than 30 days', 'at least 3 months before', 'at least 2 years before')","Mathematical calculation required for pack-years definition with conversion notes for non-cigarette tobacco","Conditional logic in section 10(2) restricting clinical worsening claims to pre-existing conditions","Incorporation by reference to other Statements of Principles for linked conditions (section 11)"],"plain_english_summary":"This instrument updates the medical rules for linking discoid lupus erythematosus to Australian military service, replacing the 2015 version. It sets out eight specific service-related factors that, if proven, create a \"reasonable hypothesis\" the condition was caused or worsened by service and applies to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004.\n\nIt affects current and former ADF members, veterans, peacekeepers and their families (for death claims), and matters because it guides compensability decisions for this chronic skin disease."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This 2025 instrument expressly repeals the 2015 Statement of Principles (section 4) and replaces it. Compared with a generic replacement, the new SoP updates and clarifies several substantive points: it restates a specific clinical definition of discoid lupus erythematosus and its exclusions (section 7(2)); it lists an expanded and modernised set of medication‑related factors (section 9.2 includes agents such as immune checkpoint inhibitors, palbociclib and secukinumab not typically listed a decade earlier); it formally recognises non‑exposure factors such as prolonged estradiol therapy, PTSD, and inability to obtain appropriate clinical management (sections 9.4–9.7). These changes broaden the range of factual scenarios that can raise a reasonable hypothesis (relative to an older list focused only on classical exposures) and therefore modify practical scope: more contemporary drug exposures and health‑system access/mental‑health pathways are now explicit grounds for a plausible service link. The instrument does not expand the population covered (still limited to claims under the VEA/MRCA) nor change the legal test (reasonable hypothesis), but it materially updates the factors that can satisfy that test."},"complexity_factors":["Relatively short instrument (11 main sections plus Schedule 1)","About 6 defined terms in Schedule 1 (MRCA, one pack‑year, relevant service with 6 subcategories, discoid lupus erythematosus reference, terminal event, VEA)","Section 9 contains 7 primary factors with nested subparts (including a 7‑item drug list under 9.2 and timing/withdrawal conditions under 9.3)","Timing constraints and thresholds (e.g. UV exposure 24 hours–30 days before onset; 3‑month improvement after stopping a drug; 2 years estradiol; 10 pack‑years smoking) create conditional logic","Cross‑references to other SoPs (section 11) and to external classifications (ICD‑10‑AM reference in section 7(3))","Moderate medical judgement required to apply terms like “sufficient to induce erythema”, “clinical onset or clinical worsening”, and “appropriate clinical management”"],"plain_english_summary":"**What this instrument does (mechanics)**\n\n- It is a Statement of Principles (SoP) about discoid lupus erythematosus (DLE) and death from DLE for the purposes of veterans’ compensation law. It replaces the earlier 2015 Statement of Principles (see section 4). The instrument takes effect on 19 May 2025 (section 2).\n\n- It defines the medical condition covered: DLE is a chronic skin form of cutaneous lupus that typically causes red, scaly plaques which may scar, usually on the ear concha, head or neck (section 7(2)). It expressly excludes other forms of lupus such as systemic lupus erythematosus (section 7(2)‑2).\n\n- It sets out the minimum factual matters that must exist before a “reasonable hypothesis” can be formed that a person’s DLE (or death contributed to by DLE) is related to their relevant service (section 9). Those factors include, for example:\n  - a recent sufficient exposure to sunlight/UV causing sunburn within 24 hours to 30 days before clinical onset or worsening (section 9.1);\n  - taking specific drugs or drug classes at the time of onset or worsening (a listed group of systemic medicines is given in section 9.2 and includes items such as fluorouracils (non‑topical), immune checkpoint inhibitors, leflunomide, tumour necrosis factor‑alpha inhibitors, palbociclib and secukinumab);\n  - taking a medication that is known to cause DLE during therapy and where stopping the drug leads to improvement within three months, provided treatment included the 3 days before onset/worsening (section 9.3);\n  - at least two years of estradiol menopausal hormone therapy before clinical onset (section 9.4);\n  - ongoing smoking of at least 10 pack‑years at onset/worsening (section 9.5, definition of pack‑year in Schedule 1);\n  - having post‑traumatic stress disorder (PTSD) for at least three months before onset/worsening (section 9.6);\n  - inability to obtain appropriate clinical management before clinical worsening (section 9.7).\n\n- The instrument requires that any of the listed factors relied on must be related to the person’s relevant service (section 10(1)). It also clarifies that the clinical‑worsening aspects of these factors only apply if the person’s DLE existed before or during service but did not arise out of service (section 10(2)).\n\n- If a factor in this SoP refers to another disease or injury that itself has its own SoP, the rules in that other SoP apply as well (section 11).\n\n- The Schedule supplies definitions used in the instrument (Schedule 1), including definitions of “relevant service”, “terminal event” (examples listed), “one pack‑year” and references to VEA and MRCA.\n\n**Who is affected**\n\n- Veterans, current or former members of the Australian Defence Force, members of Peacekeeping Forces, and others whose claims fall under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) and who claim that DLE (or death from DLE) is connected to their service (section 5).  \n\n- Medical providers and decision‑makers who provide or assess medical evidence in support of such claims, because the SoP specifies the kinds of exposures, medicines and clinical histories that are relevant to establishing a reasonable hypothesis of service connection (sections 7 and 9).\n\n**Why this matters (official purpose and how it operates in practice)**\n\n- Officially, the Repatriation Medical Authority (RMA) states there is sound medical‑scientific evidence that DLE and death from DLE can be related to relevant service (section 8). Practically, this SoP sets the evidentiary threshold for claims: it lists the types of exposure or history that, if shown and linked to service, will satisfy the minimum factual basis for a plausible service connection (section 9 and section 10).\n\n**Practical effects, incentives and administrative considerations**\n\n- Evidence burden and what is decisive: decision‑makers will look for clinical records showing the timing of onset/worsening, documented exposures (sunburn, drug prescriptions, smoking history, PTSD diagnosis, failure to obtain care), and linkage to service periods (sections 9 and 10). The SoP does not itself grant compensation; it establishes whether a reasonable hypothesis exists that justifies further consideration under the VEA/MRCA processes.\n\n- Who pays / who benefits: benefits flow to successful claimants under the VEA/MRCA framework. The cost implications fall to the Department administering those Acts if the SoP leads to more established links between service and DLE claims (sections 5 and 8). Benefits are concentrated (to claimants who meet the specific factors listed); costs are borne by the compensating scheme.\n\n- Administrative discretion and medical judgement: application of the SoP depends on clinical interpretation (for example, whether a listed drug was taken “at the time” of onset, or whether UV exposure was sufficient to induce erythema) and on linking that factor to the person’s service (sections 9 and 10). That means decision makers and treating clinicians exercise medical judgement when applying the timing and causal rules.\n\n- Compliance and evidence collection costs: claimants and their clinicians will need to document medication histories, smoking pack‑years, timing of sun/UV exposure, PTSD diagnosis timing, and whether appropriate clinical management was unavailable before worsening (sections 9 and Schedule 1 definitions). That creates record‑keeping and evidentiary costs for claimants and the department.\n\n- Interaction with other SoPs: where a listed factor points to another disease that has its own SoP, that other SoP’s rules will apply (section 11). This can create cross‑reference complexity in claims that involve multiple conditions.\n\n**Key specific rules to note (section pointers)**\n\n- Definition of DLE and exclusions: section 7(2).\n- Minimum factors that raise a reasonable hypothesis (a claimant needs at least one): section 9.\n- Requirement that the factor be related to relevant service, and the limit on clinical‑worsening rules: section 10.\n- Cross‑application of other SoPs: section 11.\n- Definitions (including pack‑year, relevant service, terminal event): Schedule 1.\n\n**Trade‑offs and implementation risks**\n\n- The SoP narrows factual routes to a reasonable hypothesis by listing specific exposures and treatments; that increases predictability for decision makers but may exclude plausible mechanisms not listed in section 9 unless captured by another SoP via section 11.\n\n- Adding medically specific drug classes (e.g. immune checkpoint inhibitors, palbociclib, secukinumab) modernises the instrument to reflect newer therapies but may increase claims complexity because adjudicators must verify precise drug exposure timing and systemic (non‑topical) use (section 9.2).\n\n- The inclusion of non‑exposure items such as inability to obtain appropriate management or PTSD introduces broader social/health‑systems and mental‑health considerations into causation assessments (sections 9.6–9.7). That can increase evidentiary disputes about service linkage and the sufficiency of clinical records.\n\nOverall, this SoP provides a compact, evidence‑based checklist that tells claimants and decision makers which factual scenarios will, if linked to service, satisfy the minimum test for a reasonable hypothesis connecting DLE (or death from DLE) to relevant service."},"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-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025","history":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-discoid-lupus-erythematosus-reasonable-hypothesis-no-49-of-2025/documents"}}