{"id":"F2021L00602","name":"Statement of Principles concerning gastro-oesophageal reflux disease (Balance of Probabilities) (No. 62 of 2021)","slug":"statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440850,"registerId":"F2021L00602-fast-fetch-1775956331348","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gastro-oesophageal reflux disease (Balance of Probabilities) (No. 62 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\nGASTRO-OESOPHAGEAL REFLUX DISEASE (Balance of Probabilities)\n\n(No. 62 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 21 May 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 gastro-oesophageal reflux disease (Balance of Probabilities) (No. 62 of 2021).\n\n2 Commencement\n\n This instrument commences on 21 June 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 gastro-oesophageal reflux disease No. 66 of 2013 (Federal Register of Legislation No. F2013L01654) 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 gastro-oesophageal reflux disease and death from gastro-oesophageal reflux disease.\n\nMeaning of gastro-oesophageal reflux disease\n\n(2) For the purposes of this Statement of Principles, gastro-oesophageal reflux disease:\n\n(a) means a chronic condition involving retrograde flow of gastro-duodenal contents into the oesophagus, larynx or pharynx, resulting in:\n\n(i) symptoms sufficient to warrant regular medical treatment; or\n\n(ii) histological evidence of oesophageal inflammation; and\n\n(b) includes reflux oesophagitis and reflux with oesophageal ulceration; and\n\n(c) excludes Barrett's oesophagus, non-reflux oesophagitis, non-reflux oesophageal ulceration, traumatic oesophageal perforation or tear and oesophageal varices.\n\nNote: Symptoms of gastro-oesophageal reflux disease include heartburn, regurgitation with or without excess salivation, chest pain, difficulty with or pain when swallowing, chronic cough, hoarseness, wheezing and nausea.\n\n(3) While gastro-oesophageal reflux disease attracts ICD‑10‑AM code K21, in applying this Statement of Principles the meaning of gastro-oesophageal reflux disease 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 gastro-oesophageal reflux disease\n\n(5) For the purposes of this Statement of Principles, gastro-oesophageal reflux disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gastro-oesophageal reflux disease.\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 gastro-oesophageal reflux disease and death from gastro-oesophageal reflux disease 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, gastro-oesophageal reflux disease or death from gastro-oesophageal reflux disease is connected with the circumstances of a person's relevant service:\n\n(1) having a hiatus hernia at the time of the clinical onset of gastro-oesophageal reflux disease;\n\n(2) being overweight or obese at the time of the clinical onset of gastro-oesophageal reflux disease;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(3) having smoked tobacco products:\n\n(a) in an amount of at least 3 pack-years before the clinical onset of gastro-oesophageal reflux disease; and\n\n(b) commencing at least 5 years before the clinical onset of gastro-oesophageal reflux disease; and\n\nif smoking has ceased before the clinical onset of gastro-oesophageal reflux disease, then that onset occurred within 1 year of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(4) consuming an average of at least 500 grams of alcohol per week for at least the 1 year before the clinical onset of gastro-oesophageal reflux disease;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(5) undergoing surgery to the region of the oesophageal hiatus or surgery involving the fundus or body of the stomach, within the 6 months before the clinical onset of gastro-oesophageal reflux disease;\n\nNote: Examples of surgery include oesophageal dilatation, bariatric surgery (such as laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy) and per oral endoscopic myotomy (POEM).\n\n(6) taking a drug from the Specified List 1 of drugs at the time of the clinical onset of gastro-oesophageal reflux disease;\n\nNote: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(7) having a disease from the specified list of diseases at the time of the clinical onset of gastro-oesophageal reflux disease;\n\nNote: specified list of diseases is defined in the Schedule 1 - Dictionary.\n\n(8) being pregnant at the time of the clinical onset of gastro-oesophageal reflux disease;\n\n(9) having a hiatus hernia at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\n(10) being overweight or obese at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(11) having smoked tobacco products:\n\n(a) in an amount of at least 3 pack-years before the clinical worsening of gastro-oesophageal reflux disease; and\n\n(b) commencing at least 5 years before the clinical worsening of gastro-oesophageal reflux disease; and\n\nif smoking has ceased before the clinical worsening of gastro-oesophageal reflux disease, then that worsening occurred within 1 year of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(12) consuming an average of at least 500 grams of alcohol per week for at least the 1 year before the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(13) undergoing surgery to the region of the oesophageal hiatus or surgery involving the fundus or body of the stomach, within the 6 months before the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: Examples of surgery include oesophageal dilatation, bariatric surgery (such as laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy) and per oral endoscopic myotomy (POEM).\n\n(14) taking a drug from the Specified List 1 of drugs at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(15) having a disease from the specified list of diseases at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: specified list of diseases is defined in the Schedule 1 - Dictionary.\n\n(16) being pregnant at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\n(17) having a disorder of mental health from the specified list of disorders of mental health at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: specified list of disorders of mental health is defined in the Schedule 1 - Dictionary.\n\n(18) taking orally a drug from the Specified List 2 of drugs at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\nNote: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.\n\n(19) taking orally a drug which is associated in the individual with the clinical worsening of gastro-oesophageal reflux disease during drug therapy and either:\n\n(a) the improvement of gastro-oesophageal reflux disease within 3 months of discontinuing or tapering drug therapy; or\n\n(b) the clinical worsening of gastro-oesophageal reflux disease on rechallenge with the same drug; and\n\nwhere the drug was being taken at the time of the clinical worsening of gastro-oesophageal reflux disease;\n\n(20) inability to obtain appropriate clinical management for gastro-oesophageal reflux disease.\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(9) to 9(20) apply only to material contribution to, or aggravation of, gastro-oesophageal reflux disease where the person's gastro-oesophageal reflux disease 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 being overweight or obese means:\n\n(a) having a Body Mass Index (BMI) of 25 or greater; or\n\n(b) having a waist circumference of greater than 80 centimetres in women or greater than 94 centimetres in men.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n gastro-oesophageal reflux disease—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) 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 Specified List 1 of drugs means:\n\n(a) aminophylline;\n\n(b) anti-cholinergic drugs;\n\n(c) benzodiazepines;\n\n(d) beta-adrenergic receptor agonists;\n\n(e) calcium channel blocker drugs;\n\n(f) nitrate drugs;\n\n(g) theophylline; or\n\n(h) tricyclic antidepressants.\n\n Specified List 2 of drugs means:\n\n(a) anti-arrhythmic agents including quinidine and mexiletine;\n\n(b) antibiotics including amoxicillin, cefotiam, ciprofloxacin, clindamycin, erythromycin, metronidazole, rifampicin and tetracyclines especially doxycycline;\n\n(c) anti-convulsants including phenytoin and valproic acid;\n\n(d) anti-hypertensives including alprenolol and captopril;\n\n(e) ascorbic acid;\n\n(f) bisphosphonates including alendronate, ibandronate and risedronate;\n\n(g) chemotherapeutic agents including bevacizumab, bleomycin, cytarabine, dactinomycin, daunorubicin, doxorubicin, 5-fluorouracil, methotrexate, pemetrexed, sunitinib and vincristine;\n\n(h) cyproterone acetate;\n\n(i) dabigatran;\n\n(j) esomeprazole;\n\n(k) female hormones including estrogen, hormone replacement therapy and oral contraceptives;\n\n(l) ferrous sulphate;\n\n(m) glibenclamide (glyburide);\n\n(n) glucocorticoids;\n\n(o) incretins including exenatide, liraglutide and sitagliptin;\n\n(p) isotretinoin;\n\n(q) mycophenolate mofetil;\n\n(r) nonsteroidal anti-inflammatory agents including aspirin, diclofenac and naproxen;\n\n(s) paracetamol (acetaminophen);\n\n(t) phenothiazines;\n\n(u) potassium chloride;\n\n(v) selective serotonin re-uptake inhibitors including fluoxetine and paroxetine; or\n\n(w) warfarin.\n\n specified list of diseases means:\n\n(a) dermatomyositis;\n\n(b) mixed connective tissue disease;\n\n(c) polymyositis;\n\n(d) Sjögren syndrome;\n\n(e) systemic lupus erythematosus;\n\n(f) systemic sclerosis (scleroderma); or\n\n(g) Zollinger-Ellison syndrome.\n\n specified list of disorders of mental health means:\n\n(a) anxiety disorder;\n\n(b) depressive disorder; or\n\n(c) posttraumatic stress disorder.\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":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2013 Statement of Principles (s4) and substitutes a new set of criteria. It governs claims under section 120B of the VEA and section 339 of the MRCA (s5) and updates definitions, factor lists and temporal rules (see s7, s9 and Schedule 1), thereby altering the operative tests used to link GORD or death from GORD to relevant service."},"complexity_factors":["Multiple conditional factors (19 distinct factor types in s9) creating combinatorial assessment complexity","Detailed medical definitions and exclusions for GORD (s7(2)–(4)) requiring clinical evidence","Temporal linking to clinical onset or clinical worsening (s9, s10) with different rules for onset vs aggravation","Numeric thresholds and measurements in the Dictionary (BMI, waist circumference, pack‑years, alcohol grams) requiring objective measurement","Two separate Specified Drug Lists with many named agents (Schedule 1) and a discontinuation/rechallenge test for some drugs (s9(19))","Cross‑references to other Statements of Principles where factors relate to other injuries/diseases (s11)","Requirement that listed factors be related to the person's relevant service (s10) introducing causation and attribution burdens","Application limited to claims under particular statutory sections (s5) and repeal of the prior instrument (s4)","Evidence burden and administrative work for claimants and decision‑makers to establish timing, exposures and medical management (eg. s9(5),(13),(19),(20))","Potential interaction with other medical conditions and mental health disorders listed in Schedule 1 (specified diseases and disorders)"],"plain_english_summary":"This Statement of Principles (No. 62 of 2021) replaces the 2013 instrument and sets the medical rules the Repatriation Medical Authority uses to decide if gastro-oesophageal reflux disease (GORD) or death from it is connected to a person’s relevant service under the VEA or MRCA. It defines GORD, lists required risk factors and timing conditions, and names excluded conditions.\n\nIt affects veterans and serving members claiming entitlement: the Authority decides connection to service, and claimants must supply clinical and exposure evidence (eg. BMI, smoking pack‑years, surgeries, drug use), shifting evidentiary and administrative tasks to claimants and the claims system."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical determination instrument for a specific condition under the Veterans' Entitlements Act framework. While it updates medical evidence from the 2013 version and expands the lists of specified drugs and diseases based on new research, it remains tightly scoped to establishing causation criteria for GORD compensation claims. The structure of identifying specific risk factors connected to service has not fundamentally changed."},"complexity_factors":["20 distinct factual factors with specific quantitative thresholds (e.g., '3 pack-years', '500 grams per week', '6 months before')","Bifurcated structure distinguishing between 'clinical onset' (factors 1-8) and 'clinical worsening' (factors 9-20) with different applicable rules","Nested definitions requiring cross-reference to Schedule 1 for 7 undefined terms used in the operative provisions","Incorporation by reference of external medical classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Complex temporal requirements combining cumulative exposure (pack-years), minimum periods (5 years, 1 year), and recency windows (within 1 year of cessation, within 6 months of surgery)","Mathematical formula for BMI (W/H²) and specific anthropometric thresholds (waist circumference 80cm women/94cm men)","Conditional logic in factor 19 requiring both drug association AND either improvement on discontinuation OR worsening on rechallenge","Section 11 creates interdependence with other Statements of Principles, requiring simultaneous consultation of multiple instruments"],"plain_english_summary":"This instrument sets the medical criteria for veterans and current/former defence personnel claiming compensation for gastro-oesophageal reflux disease (GORD). It replaces the 2013 guidance, defines what counts as compensable GORD, and requires proof on the balance of probabilities that specified service-related risk factors caused or worsened the condition.\n\nBy listing 20 risk factors (split between new onset and worsening), it functions as the practical gatekeeper determining which claims will succeed."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-","history":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-/history","analysis":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-/important-cases","documents":"/api/acts/statement-of-principles-concerning-gastro-oesophageal-reflux-disease-balance-of-probabilities-no-62-/documents"}}