{"id":"F2022L00265","name":"Statement of Principles concerning exertional heat illness (Balance of Probabilities) (No. 32 of 2022)","slug":"statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441254,"registerId":"F2022L00265-fast-fetch-1775956615018","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning exertional heat illness (Balance of Probabilities) (No. 32 of 2022)","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\nEXERTIONAL HEAT ILLNESS (Balance of Probabilities)\n\n(No. 32 of 2022)\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 4 March 2022\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:
|\n| --- |\n|
Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 exertional heat illness (Balance of Probabilities) (No. 32 of 2022).\n\n2 Commencement\n\n This instrument commences on 4 April 2022.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about exertional heat illness and death from exertional heat illness.\n\nMeaning of exertional heat illness\n\n(2) For the purposes of this Statement of Principles, exertional heat illness:\n\n(a) means an illness caused by an increase in body temperature that exceeds the body's ability to lose heat, due to exposure to physical activity in a setting of high environmental temperatures; and\n\n(b) includes:\n\n(i) heat exhaustion (also known as heat fatigue, heat intolerance and heat stress);\n\n(ii) heat injury;\n\n(iii) heat stroke; and\n\n(iv) heat syncope; and\n\n(c) excludes:\n\n(i) drug hypersensitivity reactions;\n\n(ii) exertional hyponatraemia;\n\n(iii) isolated exertional rhabdomyolysis (without evidence of heat-related illness);\n\n(iv) malignant hyperthermia associated with anaesthetic agents;\n\n(v) neuroleptic malignant syndrome;\n\n(vi) pyrogenic hyperthermia; and\n\n(vii) serotonin syndrome.\n\nNote1: Pyrogenic hyperthermia is an adaptive, physiologic response in which the hypothalamus increases the core body temperature set point. Common causes include infection, inflammation, trauma and cancer.\n\nNote 2: heat exhaustion, heat injury, heat stroke and heat syncope are defined in the Schedule 1- Dictionary.\n\n(3) While exertional heat illness attracts ICD‑10‑AM codes T67.0, T67.1, T67.2, T67.3, T67.4 or T67.5, in applying this Statement of Principles the meaning of exertional heat illness 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 exertional heat illness\n\n(5) For the purposes of this Statement of Principles, exertional heat illness, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's exertional heat illness.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n7 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 exertional heat illness and death from exertional heat illness 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\n8 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, exertional heat illness or death from exertional heat illness is connected with the circumstances of a person's relevant service:\n\n(1) undertaking physical activity at a minimum intensity of at least 3 METs in a hot environment at the time of the clinical onset of exertional heat illness;\n\nNote 1: Exertional heat illness generally occurs at higher levels of physical activity and environmental heat. The likelihood of developing exertional heat illness can be increased in milder environmental temperatures in the presence of other contributing factors. These include prolonged activity, high humidity, lack of breezes, wearing heavy protective clothing or combat clothing, carrying heavy loads, poor physical fitness, lack of acclimatisation, being overweight or obese, and taking drugs which affect thermoregulation.\n\nNote 2: MET is defined in the Schedule 1 - Dictionary.\n\n(2) inability to obtain appropriate clinical management for exertional heat illness.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factor set out in subsection 8(2) applies only to material contribution to, or aggravation of, exertional heat illness where the person's exertional heat illness was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n exertional heat illness—see subsection 6(2).\n\n heat exhaustion means tiredness or weakness due to an inability to maintain adequate cardiac output in a situation of strenuous physical activity in a hot environment.\n\nNote: Typical symptoms and signs of heat exhaustion include an inability to continue activities, core body temperature elevation around 38.3 to 40.0°C, and mild neurologic and gastrointestinal symptoms.\n\n heat injury means a multisystem, life-threatening illness characterised by end organ damage and a core body temperature that is usually above 40°C, but without any significant neurological manifestations.\n\nNote: Typical clinical and laboratory signs of heat injury include metabolic acidosis, rhabdomyolysis, acute kidney injury and liver failure.\n\n heat stroke means a multisystem, life-threatening illness characterised by central nervous system dysfunction and a core body temperature that is usually above 40°C.\n\nNote: Typical symptoms and signs of heat stroke include disorientation, headache, irritability, emotional instability, confusion, altered consciousness, coma and seizure.\n\n heat syncope means fainting after prolonged exposure to heat or exertion in a hot environment, where fainting is not better accounted for by cardiovascular, neurologic, metabolic or other causes.\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\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\n \n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument defines its own scope: it covers exertional heat illness and deaths contributed to by it and applies to claims under the VEA and MRCA. Nothing in the instrument purports to broaden or narrow coverage beyond those definitions and application limits; it specifies inclusions, exclusions and two factual routes to establish connection (sections 4, 6 and 8)."},"complexity_factors":["Technical medical definitions and thresholds (e.g. heat exhaustion, heat stroke, MET unit) require clinical interpretation (Schedule 1; subsections 6(2), Schedule 1).","Binary legal standard: causation on the balance of probabilities but operationalised by specified factors rather than open‑ended tests (section 7 and section 8).","Numeric exertion threshold (minimum 3 METs) tied to environmental heat at clinical onset — requires retrospective estimation of activity intensity (section 8(1); Schedule 1 MET definition).","Alternative connection route via 'inability to obtain appropriate clinical management' creates evidentiary questions about access to care and timing (section 8(2) and section 9(2)).","Explicit inclusions and exclusions (e.g. excludes isolated exertional rhabdomyolysis, malignant hyperthermia, pyrogenic hyperthermia) narrow medical scope and demand differential diagnosis (subsection 6(2)(b)–(c)).","Cross‑reference to other Statements of Principles means overlap and precedence issues where comorbid conditions exist (section 10).","References to ICD‑10‑AM codes and defined terms require use of external clinical classification and statutory definitions (subsection 6(3)–(4); Schedule 1).","Application limited to specific claim pathways under VEA and MRCA; administrative boundaries affect who may rely on the instrument (section 4)."],"plain_english_summary":"This Statement of Principles sets the medical criteria for deciding when exertional heat illness, and death contributed to by it, is connected to veterans’ or defence members’ service for claims under the VEA and MRCA. It defines what counts as exertional heat illness, lists specific medical exclusions, and sets two routes to connection: activity in a hot environment at a defined exertion level, or inability to obtain appropriate clinical care. It matters because it governs entitlement decisions and what evidence claimants must meet."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This Statement of Principles appears tightly focused on its original purpose of establishing medical criteria for exertional heat illness claims. It follows the standard template for Repatriation Medical Authority determinations without significant scope creep. The definitions, factors, and exclusions are all directly relevant to determining service connection for this specific condition."},"complexity_factors":["Multiple defined terms in Schedule 1 (approximately 8 key definitions including technical medical terms like 'MET', 'heat injury', 'heat stroke')","Cross-references between the main body and dictionary (e.g., 'see subsection 6(2)' for exertional heat illness definition)","Conditional logic in section 8 requiring 'at least one' of two alternative factors to exist","Nested exclusions in section 6(2)(c) listing 7 specific conditions that are excluded from the definition","Specific limitation in section 9(2) restricting the application of the second factor (medical management) to aggravation cases only","Reference to external classification system (ICD-10-AM codes with specific edition and ISBN)","Incorporation by reference of other Statements of Principles in section 10"],"plain_english_summary":"This instrument sets medical rules for when veterans and current/former defence personnel can receive compensation for exertional heat illness (including heat exhaustion, injury, stroke, syncope, and death). It requires a service connection and, broadly, evidence of significant physical activity in heat or inadequate medical care, while excluding similar non-heat causes. It matters because it clarifies when heat-related conditions from training or deployment qualify for benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022","history":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-exertional-heat-illness-balance-of-probabilities-no-32-of-2022/documents"}}