{"id":"F2024L00754","name":"Statement of Principles concerning gastric ulcer and gastric erosion (Balance of Probabilities) (No. 52 of 2024)","slug":"statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442453,"registerId":"F2024L00754-fast-fetch-1775957453650","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gastric ulcer and gastric erosion (Balance of Probabilities) (No. 52 of 2024)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nGASTRIC ULCER AND GASTRIC EROSION (Balance of Probabilities)\n\n(No. 52 of 2024)\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 21 June 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n|
Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority
|\n| --- |\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\n1 Name\n\nThis is the Statement of Principles concerning gastric ulcer and gastric erosion (Balance of Probabilities) (No. 52 of 2024).\n\n2 Commencement\n\n This instrument commences on 23 July 2024.\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 gastric ulcer and duodenal ulcer No. 62 of 2015 (Federal Register of Legislation No. F2015L00658) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 gastric ulcer and gastric erosion and death from gastric ulcer and gastric erosion.\n\nMeaning of gastric ulcer and gastric erosion\n\n(2) For the purposes of this Statement of Principles, gastric ulcer and gastric erosion:\n\n(a) means a non-malignant disruption in the mucosal surface of the stomach and includes ulcers or erosions due to gastric foreign bodies; and\n\n(b) excludes:\n\n(i) acute haemorrhagic gastritis; and\n\n(ii) stomach perforations from external trauma such as stabbing, explosive blast injury or gunshot injury.\n\nNote: A gastric erosion is a disruption in the mucosal surface of the stomach above the lamina propria, and a gastric ulcer is a disruption in the mucosal surface of stomach that extends past the lamina propria and through the muscularis mucosa into the submucosa.\n\n(3) While gastric ulcer and gastric erosion attracts ICD‑10‑AM code K25, in applying this Statement of Principles the meaning of gastric ulcer and gastric erosion 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 gastric ulcer and gastric erosion\n\n(5) For the purposes of this Statement of Principles, gastric ulcer and gastric erosion, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gastric ulcer and gastric erosion.\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 gastric ulcer and gastric erosion and death from gastric ulcer and gastric erosion 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, gastric ulcer and gastric erosion or death from gastric ulcer and gastric erosion is connected with the circumstances of a person's relevant service:\n\n(1) having Helicobacter pylori infection of the stomach at the time of clinical onset or clinical worsening;\n\n(2) having an infection of the gastric mucosa by one of the following organisms:\n\n(a) Anisakis simplex (causing anisakiasis);\n\n(b) cytomegalovirus;\n\n(c) herpes simplex virus;\n\n(d) fungi (such as Candida species or Mucormycetes);\n\n(e) Helicobacter heilmannii;\n\n(f) Mycobacterium tuberculosis;\n\n(g) Strongyloides stercoralis (causing strongyloidiasis); or\n\n(h) Treponema pallidum (causing syphilis);\n\nat the time of clinical onset or clinical worsening;\n\n(3) having a critical illness or injury within the 14 days before clinical onset or clinical worsening;\n\nNote: critical illness or injury is defined in the Schedule 1 - Dictionary.\n\n(4) undergoing a course of radiotherapy for cancer, where the stomach or duodenum was in the field of radiation, within the 6 months before clinical onset or clinical worsening;\n\n(5) undergoing 90Yttrium microsphere therapy for primary and metastatic liver tumours, within the 6 months before clinical onset or clinical worsening;\n\n(6) having contact with a nasogastric tube or other foreign objects or extraneous material at the site of the ulcer or erosion at the time of clinical onset or clinical worsening;\n\n(7) having partial gastrectomy within the 5 years before clinical onset or clinical worsening;\n\n(8) having endoscopic mucosal resection or endoscopic sub-mucosal dissection of the gastric mucosa at the time of clinical onset or clinical worsening;\n\n(9) having bariatric surgery involving sleeve gastrectomy or gastric banding within the 5 years before clinical onset or clinical worsening;\n\n(10) having a gastrin-secreting tumour at the time of clinical onset or clinical worsening;\n\n(11) smoking at least 10 cigarettes per day, or the equivalent thereof in other tobacco products, for at least 1 year within the 1.5 years before clinical onset or clinical worsening;\n\n(12) being treated with a non-topical non-steroidal anti-inflammatory drug, or aspirin, at least every other day during a continuous period of at least 14 days, within the 3 months before clinical onset or clinical worsening;\n\n(13) being treated with an antineoplastic agent within the 3 months before clinical onset or clinical worsening;\n\nNote: antineoplastic agent is defined in the Schedule 1 - Dictionary.\n\n(14) having a solid organ or bone marrow transplant before clinical onset or clinical worsening;\n\n(15) being treated with one of the following drugs or class of drugs at the time of clinical onset or clinical worsening:\n\n(a) bisphosphonate, including alendronate;\n\n(b) chemotherapeutic agents delivered by hepatic arterial infusion; or\n\n(c) potassium chloride tablet (enteric coated or wax formulation);\n\n(16) being treated with one of the following drugs or class of drugs for at least 2 weeks, within the 3 months before clinical onset;\n\n(a) clopidogrel;\n\n(b) glucocorticoid, excluding topical or inhaled;\n\n(c) deferasirox;\n\n(d) nicorandil;\n\n(e) paracetamol of more than 2 grams daily; or\n\n(f) selective serotonin re-uptake inhibitors;\n\n(17) taking one of the following drugs or class of drugs for at least 2 weeks, within the 3 months before clinical worsening;\n\n(a) anticoagulants;\n\n(b) clopidogrel;\n\n(c) corticosteroids, excluding topical or inhaled;\n\n(d) lanthanum;\n\n(e) levodopa with benserazide or carbidopa;\n\n(f) methylnaltrexone;\n\n(g) nicotinic acid;\n\n(h) paracetamol of more than 2 grams daily;\n\n(i) pentoxifylline;\n\n(j) selective serotonin re-uptake inhibitors;\n\n(k) spironolactone;\n\n(l) tocilizumab;\n\n(m) tofacitinib; or\n\n(n) upadacitinib;\n\n(18) having cirrhosis of the liver at the time of clinical onset or clinical worsening;\n\n(19) having alcohol use disorder or drinking at least 4 standard drinks per day for at least 6 months at the time of bleeding of a gastric ulcer;\n\nNote 1: The bleeding of a gastric ulcer is considered to be a clinical worsening.\n\nNote 2: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(20) having Crohn disease (a type of inflammatory bowel disease) at the time of clinical onset or clinical worsening;\n\n(21) having one of the following medical conditions at the time of clinical onset or clinical worsening;\n\n(a) amyloidosis;\n\n(b) eosinophilic gastroenteritis;\n\n(c) sarcoidosis;\n\n(d) systemic mastocytosis;\n\nNote : systemic mastocytosis is defined in the Schedule 1 – Dictionary.\n\n(22) inability to obtain appropriate clinical management for gastric ulcer or gastric erosion before clinical worsening.\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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, gastric ulcer and gastric erosion where the person's gastric ulcer and gastric erosion 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 antineoplastic agent means any of the following:\n\n(a) alkylating agents;\n\n(b) antimetabolites;\n\n(c) antineoplastic antibodies; or\n\n(d) kinase inhibitors.\n\n critical illness or injury means:\n\n(a) any physical injury or illness requiring mechanical ventilation support or admission to an intensive care unit;\n\n(b) acute renal tubular necrosis;\n\n(c) adult respiratory distress syndrome;\n\n(d) 2nd degree burns covering a total burn area of 50-70%, or 3rd degree burns covering an area >20% of total body surface;\n\n(e) disseminated intravascular coagulation;\n\n(f) multiple organ failure; or\n\n(g) septicaemia.\n\n gastric ulcer and gastric erosion—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 systemic mastocytosis means a mast cell hyperplasia that is generally detected in the bone marrow, skin, gastrointestinal mucosa, liver or spleen.\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":5,"scope_assessment":{"changed":true,"description":"The original 2015 instrument covered both gastric ulcer AND duodenal ulcer together. This 2024 version narrows scope to gastric ulcer and gastric erosion only, suggesting duodenal ulcer is now treated separately (likely under a different SOP). This represents a 'splitting' of the original instrument's scope rather than expansion, likely reflecting evolving medical understanding that these conditions have different etiologies and risk factors warranting separate analysis."},"complexity_factors":["22 distinct causal factors with varying timeframes (14 days to 5 years) and different thresholds for 'clinical onset' versus 'clinical worsening'","Multiple nested definitions: 7 defined terms in Schedule 1, plus inline definitions in section 7(2) for the condition itself","Cross-referencing structure: section 11 creates dynamic links to other Statements of Principles that may apply","Dual legislative framework application (VEA and MRCA) with different service definitions","Specific medical terminology requiring clinical interpretation (e.g., 'lamina propria', 'muscularis mucosa', '90Yttrium microsphere therapy')","Conditional logic distinguishing between factors applying to 'clinical onset' versus 'clinical worsening' (notably factors 16 vs 17 have different drug lists and thresholds)","Note references requiring navigation between sections (e.g., 'Note: terminal event is defined in Schedule 1')","ICD-10-AM coding reference with specific edition requirements (Tenth Edition, 1 July 2017)"],"plain_english_summary":"This Statement of Principles from the Repatriation Medical Authority sets the medical criteria used to decide whether Australian veterans and defence members can get compensation for gastric ulcers and erosions under the VEA and MRCA. \n\nOn the balance of probabilities, claimants must show at least one listed service‑related factor caused or worsened the condition. It replaces the 2015 SOP, narrows focus to gastric conditions, and is the decisive gatekeeper for awards."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement (s4) and alters scope: it governs gastric ulcer and gastric erosion and death from those conditions (s7(1)–(5)), whereas the repealed instrument concerned gastric ulcer and duodenal ulcer. The new Statement expressly excludes acute haemorrhagic gastritis and stomach perforations from external trauma (s7(2)(b)). Application remains to claims under the VEA and MRCA (s5)."},"complexity_factors":["Large number of discrete medical, infectious, surgical and pharmacological factors listed as alternative routes to causation (s9)","Multiple precise timing windows and exposure thresholds (e.g. 14 days, 3 months, 5 years, 1.5 years) that require documentary proof (s9)","Cross-references to defined technical terms in the Schedule (e.g. antineoplastic agent, critical illness, terminal event, relevant service) increasing interpretive steps (Schedule 1, s6)","Explicit exclusions and ICD‑10‑AM code note requiring clinical diagnostic alignment (s7(2)–(4))","Interaction with other Statements of Principles where an invoked factor is itself covered by another SOP (s11), creating potential layering of criteria","Application limited to statutory claims processes under the VEA and MRCA, requiring administrative adjudication (s5)","Medical-scientific standard declared (balance of probabilities) and reliance on RMA's view of evidence, concentrating decisional authority (s8, heading)","Requirement that listed factors be related to \"relevant service,\" including differing categories of service, which may demand complex service-history linkage (Schedule 1 definitions; s10)"],"plain_english_summary":"This Statement of Principles sets medical criteria that link gastric ulcer and gastric erosion (and related death) to a person's relevant service. It replaces the 2015 Statement and applies to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 (s3, s4, s5).\n\nThe Repatriation Medical Authority specifies that a single listed factor — infections, certain surgeries, specified drugs, critical illness, alcohol use, or timing windows — must exist and be related to service to establish connection (s9–10)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-","history":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-/history","analysis":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-/important-cases","documents":"/api/acts/statement-of-principles-concerning-gastric-ulcer-and-gastric-erosion-balance-of-probabilities-no-52-/documents"}}