{"id":"F2025L01283","name":"Statement of Principles concerning fibromuscular dysplasia (Reasonable Hypothesis) (No. 81 of 2025)","slug":"statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443003,"registerId":"F2025L01283-fast-fetch-1775957922273","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning fibromuscular dysplasia (Reasonable Hypothesis) (No. 81 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\nFIBROMUSCULAR DYSPLASIA  (Reasonable Hypothesis)\n\n(No. 81 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    24 October 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 fibromuscular dysplasia (Reasonable Hypothesis) (No. 81 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 24 November 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 fibromuscular dysplasia (Reasonable Hypothesis) (No. 79 of 2016) (Federal Register of Legislation No. F2016L01674) 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 fibromuscular dysplasia and death from fibromuscular dysplasia.\n\n\nMeaning of fibromuscular dysplasia\n\n1.           For the purposes of this Statement of Principles, fibromuscular dysplasia means a non-atherosclerotic and non-inflammatory segmental disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries and either:\n  1.           warrants medical treatment; or\n  1.           results in at least one of the following clinical manifestations involving a small or medium sized artery (most commonly renal or carotid):\n    1.             partial or complete occlusion;\n    2.          aneurysm;\n    3.        dissection; or\n    4.         ischaemia to an organ; and\n  2.           excludes carotid web.\n\n\nNote: Clinical features of fibromuscular dysplasia vary widely, depending on what artery is affected, for example moderate to severe or poorly controlled hypertension when a renal artery is affected or headache and pulsatile tinnitus when a carotid artery is affected.\n\n1.           While fibromuscular dysplasia attracts ICD‑10‑AM code I77.3, in applying this Statement of Principles the meaning of fibromuscular dysplasia is that given in subsection (2).\n2.           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 fibromuscular dysplasia\n\n1.           For the purposes of this Statement of Principles, fibromuscular dysplasia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's fibromuscular dysplasia.\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 fibromuscular dysplasia and death from fibromuscular dysplasia 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 fibromuscular dysplasia or death from fibromuscular dysplasia with the circumstances of a person's relevant service:\n\n1.           having smoked at least 5 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 fibromuscular dysplasia 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 aspect of factors set out in section 9 apply to material contribution to, or aggravation of, fibromuscular dysplasia where the person's fibromuscular dysplasia 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                                fibromuscular dysplasia—see subsection 7(2).\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                               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":"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"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2016 version of the same instrument without expanding beyond the original purpose of establishing the reasonable hypothesis test for fibromuscular dysplasia claims. The scope remains tightly focused on determining eligibility criteria for veterans' compensation for this specific arterial disease."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with a single medical condition","Only 2 substantive factors in section 9 (smoking history and clinical management access)","7 defined terms in Schedule 1 Dictionary, all straightforward (MRCA, VEA, pack-year calculation, terminal event, relevant service)","Clear structure following standard Repatriation Medical Authority template (Name, Commencement, Authority, Repeal, Application, Definitions, Disease definition, Factors, Relationship to service)","Minimal cross-referencing—primarily internal references to the Dictionary and the two principal Acts (VEA and MRCA)","Single layer of conditional logic (section 9 factors must exist, and section 10 requires connection to service)","No nested exceptions or complex provisos; the exclusion of \"carotid web\" is explicit and simple","Medical definition in section 7(2) is technical but clearly structured with bullet points for clinical manifestations"],"plain_english_summary":"This replacement Statement of Principles sets the medical test for fibromuscular dysplasia (FMD) claims by Australian veterans under the VEA and MRCA. It adopts the easier “reasonable hypothesis” standard and requires a plausible service link — for example, significant smoking during service or service‑related inability to obtain treatment causing worsening. It excludes carotid web."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles No. 79 of 2016 (see section 4) and replaces it with updated criteria: it sets specific qualifying factors (section 9), clarifies the medical meaning of fibromuscular dysplasia and inclusion of death from FMD (section 7(2) and section 7(4)), defines key terms including pack‑years and terminal event (Schedule 1), and specifies application to claims under section 120A of the VEA and section 338 of the MRCA (section 5)."},"complexity_factors":["Medical definition and diagnostic scope of FMD (see section 7(2)) — requires clinical interpretation of non‑atherosclerotic, non‑inflammatory arterial disease and exclusion of carotid web.","Binary-factor threshold for reasonable hypothesis (see section 9) — entitlement hinges on presence of at least one specified factor, creating evidentiary pressure on claimants and assessors.","Relation-to-service requirement (see section 10) — each factor must be linked to the person's relevant service, importing causal and temporal analysis.","Cross‑references to other Statements of Principles (see section 11) — factors that refer to other injuries/diseases defer to those Statements, adding dependency and possible overlap.","Definitions and quantification rules (Schedule 1) — inclusion of 'one pack‑year' and 'terminal event' definitions affects calculation and death attribution.","Application and repeal mechanics (sections 4 and 5) — replaces No.79 of 2016 and applies to claims under specific statutory provisions, requiring administrative update.","Operationalised standard 'reasonable hypothesis' (instrument made under s196B(2) VEA) — subjective legal standard that requires medical‑administrative judgment."],"plain_english_summary":"This Statement of Principles sets out when fibromuscular dysplasia (FMD) and death from FMD can be reasonably connected to a person’s military or veteran service for claims under the Veterans’ Entitlements Act or the Military Rehabilitation and Compensation Act. It defines FMD medically, includes death from FMD, and repeals the 2016 Statement. A reasonable hypothesis requires at least one listed factor—either a smoking history of at least 5 pack‑years before clinical onset/worsening, or inability to obtain appropriate clinical management before worsening—and that the factor be related to the person’s relevant service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025","history":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-fibromuscular-dysplasia-reasonable-hypothesis-no-81-of-2025/documents"}}