{"id":"F2021L00487","name":"Statement of Principles concerning endometriosis (Balance of Probabilities) (No. 52 of 2021)","slug":"statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440824,"registerId":"F2021L00487-fast-fetch-1775956318335","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning endometriosis (Balance of Probabilities) (No. 52 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nENDOMETRIOSIS (Balance of Probabilities)\n\n(No. 52 of 2021)\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 23 April 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning endometriosis (Balance of Probabilities) (No. 52 of 2021).\n\n2 Commencement\n\n This instrument commences on 24 May 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning endometriosis No. 42 of 2012 (Federal Register of Legislation No. F2012L01356) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about endometriosis and death from endometriosis.\n\nMeaning of endometriosis\n\n(2) For the purposes of this Statement of Principles, endometriosis:\n\n(a) means a condition in females in which functional endometrial tissue occurs outside the uterus, resulting in clinical symptoms and signs or warranting treatment; and\n\n(b) excludes adenomyosis.\n\nNote: Endometriosis commonly manifests with abdominal pain, a pelvic mass or infertility.\n\n(3) While endometriosis attracts ICD‑10‑AM code N80, in applying this Statement of Principles the meaning of endometriosis 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 endometriosis\n\n(5) For the purposes of this Statement of Principles, endometriosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's endometriosis.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that endometriosis and death from endometriosis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, endometriosis or death from endometriosis is connected with the circumstances of a person's relevant service:\n\n(1) having penetrating trauma or surgery involving the site of subsequent endometriosis before the clinical onset of endometriosis;\n\n(2) taking tamoxifen for the six months before the clinical onset of endometriosis;\n\n(3) taking tamoxifen for the six months before the clinical worsening of endometriosis;\n\n(4) inability to obtain appropriate clinical management for endometriosis.\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(3) to 9(4) apply only to material contribution to, or aggravation of, endometriosis where the person's endometriosis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n endometriosis—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n 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":3,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the earlier Statement of Principles (s4) and replaces it with a Statement that (a) explicitly includes death contributed to by endometriosis (s7(5)); (b) sets a specific, limited list of factors that can establish a service connection (s9); and (c) applies to claims under the VEA and the MRCA (s5). It therefore alters the operative Statement of Principles in force and clarifies the definitional and causal tests claimants and decision-makers must apply."},"complexity_factors":["Legal causation standard is the civil ‘balance of probabilities’ applied to medical evidence (s8)","Specific, limited list of causal factors rather than an open-ended test (s9) — reduces interpretive breadth but requires precise factual proof","Requirement that any listed factor must be related to the person's relevant service (s10(1)) — introduces a distinct service-link element","Some factors apply only where endometriosis pre‑existed service and is alleged to be materially contributed to or aggravated (s10(2)) — conditional application increases factual complexity","Includes ‘inability to obtain appropriate clinical management’ as a compensable factor (s9(4)) — proof may be evidentially burdensome","Cross-references to other Statements of Principles where factors concern other injuries/diseases (s11) — requires document cross-checking","Defines death from endometriosis to include contribution to a terminal event and lists terminal events (Schedule 1) — expands scope into mortality adjudication","Explicit citation to ICD-10-AM code but with a separate statutory definition of endometriosis (s7(2)–(4)) — dual reference to clinical coding and statutory meaning","Applies across two legislative claim frameworks (VEA and MRCA) which have different eligibility concepts (s5) — administrative coordination required","Repeals a prior instrument (s4) and fixes a commencement date (s2) — transitional interpretation and updating are required"],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the legal test for linking endometriosis (including death from it) to veterans’ or defence members’ relevant service for VEA and MRCA claims. \n\nIt defines endometriosis and prescribes the medical and service-connection factors decision‑makers must find on the balance of probabilities (for example, prior pelvic surgery/trauma, recent tamoxifen exposure, or inability to obtain appropriate clinical management) and requires those factors be related to the person’s relevant service."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This is a straightforward replacement of a 2012 Statement of Principles with the same scope. It maintains the same purpose: establishing medical criteria for linking endometriosis to veterans' service. The factors listed (trauma/surgery, tamoxifen, lack of clinical management) represent standard medical-scientific evidence for this condition and do not represent scope creep beyond the original intent of providing compensation guidelines for this specific gynaecological condition."},"complexity_factors":["Short document (approximately 1,500 words)","Only 4 substantive factors in section 9 determining liability","Minimal cross-referencing (only to other Statements of Principles in section 11 and defined terms in Schedule 1)","Simple conditional structure with clear 'at least one of' logic in section 9","Only 6 defined terms in the Dictionary (endometriosis, MRCA, relevant service, terminal event, VEA)","Single exception/exclusion (adenomyosis excluded from definition of endometriosis)","Clear temporal limitations (6-month windows for tamoxifen, 'before clinical onset' requirements)","Straightforward application provisions linking to specific sections of two principal Acts"],"plain_english_summary":"The Repatriation Medical Authority has updated its medical guideline for endometriosis (replacing the 2012 version), setting when veterans and current/former defence members can claim compensation for endometriosis or death from endometriosis under veterans’ legislation. It covers peacetime and non‑operational service.\n\nCompensation requires proving, on the balance of probabilities, that service was related to at least one qualifying factor — e.g. prior penetrating trauma/surgery at the site, six‑month tamoxifen exposure causing onset or worsening, or inadequate access to treatment — including death from related complications."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021","history":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-endometriosis-balance-of-probabilities-no-52-of-2021/documents"}}