{"id":"F2021L01631","name":"Statement of Principles concerning gender dysphoria (Reasonable Hypothesis) (No. 113 of 2021)","slug":"statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441080,"registerId":"F2021L01631-fast-fetch-1775956490545","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gender dysphoria (Reasonable Hypothesis) (No. 113 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 (Reasonable Hypothesis)\n\n(No. 113 of 2021)\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 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 (Reasonable Hypothesis) (No. 113 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Application\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that gender dysphoria and death from gender dysphoria 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\n8 Factors that must exist\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 gender dysphoria or death from gender dysphoria 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(2) 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) 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 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":5,"scope_assessment":{"changed":false,"description":"This instrument defines diagnostic criteria, timeframes and service‑connection factors for assessing gender dysphoria claims and applies to claims under VEA s120A or MRCA s338 (section 4). The text does not state it alters the statutory scope of entitlement; it specifies how the Repatriation Medical Authority will determine a reasonable hypothesis and cross‑references other Statements where relevant (sections 7, 10)."},"complexity_factors":["Use of clinical diagnostic criteria derived from DSM‑5 to define the condition (section 6(2))","Temporal and causal constraints requiring factors to relate to 'relevant service' and to materially contribute or aggravate where dysphoria pre‑existed (sections 8, 9(1)–(2))","Different time windows for relevant factors (e.g. 5 years for assault, 1 year for category 2 stressors) and varied factor types (section 8(1)–(3))","Detailed, multi‑part definitions in the Schedule (e.g. category 2 stressor, severe childhood abuse, terminal event) that affect application and proof (Schedule; sections 5–6, 8)","Interplay with other Statements of Principles: factors that refer to other injuries/diseases import those other Statements (section 10)","Legal threshold is the statutory 'reasonable hypothesis' standard under subsection 196B(2) — administrative/medical judgment mix (header, section 3, section 7)","Exclusion of congenital/inherited disorders of sex development narrows medical coverage (section 6(2)(b))","Application limited to specific claim types under VEA s120A and MRCA s338, constraining scope of affected claim processes (section 4)"],"plain_english_summary":"This Statement of Principles sets the medical definition of \"gender dysphoria\" (using DSM‑5 criteria), includes death caused by it, and lists the specific service‑related factors that, if present, raise a reasonable hypothesis linking the condition to relevant service for claims under the Veterans' Entitlements Act and the MRCA. It affects veterans and service members making entitlement claims by fixing who decides (the Repatriation Medical Authority via these criteria) and what evidence or circumstances (e.g. severe childhood abuse, recent assault, category‑2 stressors, or inability to obtain appropriate clinical care) must be shown to connect the condition to service."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a new Statement of Principles for a specific condition (gender dysphoria) under the established framework of the Veterans' Entitlements Act. It follows the standard template for such instruments and does not represent scope creep from an original purpose. The instrument is tightly focused on establishing the reasonable hypothesis test for this particular condition."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary) for defined terms","Nested definitions: 'category 2 stressor' contains 7 sub-categories with their own conditions","Conditional logic in section 9 limiting application to aggravation/pre-existing conditions only, not causation","Incorporation by reference to external medical standard (DSM-5) for diagnostic criteria","Interaction with other Statements of Principles via section 10 (dynamic referencing 'as in force from time to time')","Specific temporal requirements (5 years, 1 year, 'before clinical worsening') creating multiple timing conditions"],"plain_english_summary":"This Statement of Principles sets DSM‑5–based medical criteria for gender dysphoria and defines four service‑related circumstances that create a “reasonable hypothesis” the condition is connected to service—lowering the proof needed for compensation. It applies to current and former Australian Defence Force members seeking benefits under the VEA or MRCA, but only where gender dysphoria pre‑existed service and was worsened or materially contributed to by service."},"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-gender-dysphoria-reasonable-hypothesis-no-113-of-2021","history":"/api/acts/statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-gender-dysphoria-reasonable-hypothesis-no-113-of-2021/documents"}}