{"id":"F2021L01632","name":"Statement of Principles concerning gender dysphoria (Balance of Probabilities) (No. 114 of 2021)","slug":"statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441081,"registerId":"F2021L01632-fast-fetch-1775956490546","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gender dysphoria (Balance of Probabilities) (No. 114 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\nGENDER DYSPHORIA (Balance of Probabilities)\n\n(No. 114 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 26 November 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 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 gender dysphoria (Balance of Probabilities) (No. 114 of 2021).\n\n2 Commencement\n\n This instrument commences on 20 December 2021.\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 gender dysphoria and death from gender dysphoria.\n\nMeaning of gender dysphoria\n\n(2) For the purposes of this Statement of Principles, gender dysphoria:\n\n(a) means a disorder of mental health that meets the following criteria (derived from DSM-5):\n\n(i) a marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least two of the following:\n\n a marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics);\n\n a strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics);\n\n a strong desire for the primary and/or secondary sex characteristics of the other gender;\n\n a strong desire to be of the other gender (or some alternative gender different from one's assigned gender);\n\n a strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender); or\n\n a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender); and\n\n(ii) the condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning; and\n\n(b) excludes gender dysphoria associated with inherited or congenital disorders of sex development.\n\nNote 1: Examples of congenital disorders of sex development include congenital adrenal hyperplasia and androgen insensitivity syndrome.\n\nNote 2: DSM-5 is defined in the Schedule 1 - Dictionary.\n\nDeath from gender dysphoria\n\n(3) For the purposes of this Statement of Principles, gender dysphoria, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gender dysphoria.\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 gender dysphoria and death from gender dysphoria 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, gender dysphoria or death from gender dysphoria is connected with the circumstances of a person's relevant service:\n\n(1) experiencing severe childhood abuse before the clinical worsening of gender dysphoria;\n\nNote: severe childhood abuse is defined in the Schedule 1 - Dictionary.\n\n(2) being subject to a serious physical attack or assault, including rape and sexual molestation, within the 5 years before the clinical worsening of gender dysphoria;\n\n(3) experiencing a category 2 stressor within the 1 year before the clinical worsening of gender dysphoria;\n\nNote 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.\n\nNote 2: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(4) inability to obtain appropriate clinical management for gender dysphoria.\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 factors set out in subsections 8(1) to 8(4) apply only to material contribution to, or aggravation of, gender dysphoria where the person's gender dysphoria 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 category 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel ongoing distress, concern or worry:\n\n(a) being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, medical illness or psychiatric symptomatology;\n\n(b) experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation or divorce;\n\n(c) having concerns in the work or school environment including ongoing disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful workloads, experiencing demotion at work, or experiencing bullying in the workplace or school environment;\n\n(d) experiencing serious legal issues including being detained or held in custody, ongoing involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;\n\n(e) having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property, or bankruptcy;\n\n(f) having a family member or significant other experience a major deterioration in their health; or\n\n(g) being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability.\n\nNote: significant other is also defined in the Schedule 1 - Dictionary.\n\n DSM-5 means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.\n\n gender dysphoria—see subsection 6(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 severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or\n\n(b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;\n\nwhere such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.\n\n significant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.\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":6,"scope_assessment":{"changed":false,"description":"The instrument itself defines its scope: it applies to gender dysphoria and death from gender dysphoria for claims under the VEA or MRCA (s4, s6). It requires factors related to the person's relevant service and limits application to cases where dysphoria was suffered or contracted before or during (but did not arise out of) service (s9(2)). The instrument does not indicate any change from a prior scope within its text."},"complexity_factors":["Clinical definition relies on DSM‑5 criteria and a two-part diagnostic test (s6(2)(a)-(b)), requiring medical assessment of symptoms and functional impairment.","Temporal thresholds and windows: 6 months diagnostic duration (s6(2)(a)(i)), 5‑year window for serious assault (s8(2)), and 1‑year window for Category 2 stressor (s8(3)), complicating causal timelines.","Causation standard is 'balance of probabilities' (s7) but connection requires the factor to be 'related to' relevant service (s9(1)) and only applies where dysphoria pre‑existed or was present during service but did not arise out of service (s9(2)), creating nuanced legal distinctions.","Category 2 stressor is a composite, broad list of chronic negative life events (Schedule 1), increasing evidential variety and interpretation risk.","Cross‑reference to other Statements of Principles (s10) means injuries/diseases linked to factors may invoke additional SOPs, adding procedural linkage and dependency.","Exclusion of congenital/inherited disorders of sex development (s6(2)(b)) requires differential diagnosis and potentially specialised evidence.","Vague standard 'inability to obtain appropriate clinical management' (s8(4)) permits administrative discretion and may impose documentary or expert proof burdens.","Inclusion of 'death from gender dysphoria' via contribution to a terminal event (s6(3) and Schedule 1 terminal event list) adds complexity to proximate/ultimate cause analysis in mortality cases."],"plain_english_summary":"This instrument sets the Repatriation Medical Authority’s test for whether gender dysphoria (and death from it) is connected to a veteran’s or serving member’s relevant service for VEA/MRCA claims. It defines gender dysphoria by DSM‑5 criteria and requires at least one listed factor—severe childhood abuse, serious assault within five years, a Category 2 chronic stressor within one year, or inability to obtain appropriate clinical management—that is related to the person's service. The Authority decides connection on the balance of probabilities, affecting entitlement outcomes and evidentiary requirements."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles made under the Veterans' Entitlements Act 1986. It follows the established template and purpose for such instruments: establishing medical criteria for determining service connection. The scope remains tightly focused on the specific condition (gender dysphoria) and the standard framework for aggravation claims. No evidence of scope creep beyond the original statutory purpose."},"complexity_factors":["Moderate cross-referencing: references DSM-5 diagnostic criteria, the Veterans' Entitlements Act 1986, and the Military Rehabilitation and Compensation Act 2004","Nested definitions: 'category 2 stressor' contains 7 sub-categories with their own conditions, and 'severe childhood abuse' has two limbs with perpetrator requirements","Temporal conditions: multiple time limits (5 years, 1 year, 'before clinical worsening') that must be precisely tracked","Exclusion clause: explicitly excludes gender dysphoria associated with congenital disorders of sex development, creating a boundary condition","Dual application framework: operates across two different compensation schemes (VEA and MRCA) with different service definitions","Incorporation by reference: imports external medical standard (DSM-5) rather than defining the condition entirely within the instrument"],"plain_english_summary":"This Statement of Principles sets the medical and legal tests for when Australian Defence Force members and veterans can claim compensation for gender dysphoria under the VEA and MRCA. It adopts the DSM‑5 definition, applies a \"balance of probabilities\" causation standard, and recognises that service can aggravate pre‑existing gender dysphoria through specific stressors (including abuse, assault, serious social or financial stress, or lack of appropriate treatment). It guides DVA and the AAT in deciding claims."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021","history":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-gender-dysphoria-balance-of-probabilities-no-114-of-2021/documents"}}