{"id":"F2019L00638","name":"Statement of Principles concerning gout (Balance of Probabilities) (No. 60 of 2019)","slug":"statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440050,"registerId":"F2019L00638-fast-fetch-1775955834956","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gout (Balance of Probabilities) (No. 60 of 2019)","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\nGOUT (Balance of Probabilities)\n\n(No. 60 of 2019)\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 April 2019\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:
|\n| --- |\n| 
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 gout (Balance of Probabilities) (No. 60 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 2019.\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 gout No. 31 of 2010 (Federal Register of Legislation No. F2010L01047) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 gout and death from gout.\n\nMeaning of gout\n\n(2) For the purposes of this Statement of Principles, gout means a metabolic condition characterised by deposition of urate crystals in the joints or tissues, generally following raised serum uric acid levels.\n\nNote: Clinical manifestations typically include recurrent episodes of monoarticular or polyarticular acute inflammatory arthritis, tenosynovitis, bursitis, chronic erosive arthritis and periarticular or subcutaneous urate deposits known as tophi.\n\n(3) While gout attracts ICD‑10‑AM code M10, in applying this Statement of Principles the meaning of gout 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 gout\n\n(5) For the purposes of this Statement of Principles, gout, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's gout.\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 gout and death from gout 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, gout or death from gout is connected with the circumstances of a person's relevant service:\n\n(1) having a haematological disorder from the specified list of haematological disorders at the time of the clinical onset of gout;\n\nNote: specified list of haematological disorders is defined in the Schedule 1 - Dictionary. \n\n(2) being treated with a drug from a class of drugs from the specified list of antihypertensive drugs for a continuous period of at least seven days, before the clinical onset of gout, where the last dose of the drug was taken within the three months before the clinical onset of gout;\n\nNote: specified list of antihypertensive drugs is defined in the Schedule 1 - Dictionary. \n\n(3) being treated with daily doses of low-dose aspirin (≤ 325 milligrams) for two consecutive days, before the clinical onset of gout, where the last dose of the drug was taken within the 48 hours before the clinical onset of gout;\n\n(4) being treated with a drug or a drug from a class of drugs from the Specified List 1 of drugs within the 48 hours before the clinical onset of gout;\n\nNote: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(5) undergoing chemotherapy for a malignant neoplasm within the seven days before the clinical onset of gout;\n\n(6) being overweight at the time of the clinical onset of gout;\n\nNote: being overweight is defined in the Schedule 1 - Dictionary. \n\n(7) consuming an average of at least 120 grams per week of alcohol, for at least the three months before the clinical onset of gout;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(8) consuming at least 70 grams of alcohol within the 48 hours before the clinical onset of gout;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(9) consuming an average of at least 750 grams per week of meat or offal, for at least the three months before the clinical onset of gout;\n\n(10) consuming at least 300 grams of meat or offal within the 48 hours before the clinical onset of gout;\n\n(11) consuming an average of at least 120 grams per week of seafood, for at least the three months before the clinical onset of gout;\n\nNote: seafood is defined in the Schedule 1 - Dictionary.\n\n(12) consuming at least 120 grams of seafood within the 48 hours before the clinical onset of gout;\n\nNote: seafood is defined in the Schedule 1 - Dictionary.\n\n(13) consuming an average of at least 400 millilitres per day of:\n\n(a) fruit juice; or\n\n(b) non-diet soft drink or other manufactured drink sweetened with fructose or sucrose;\n\nalone or in any combination, for at least the three months before the clinical onset of gout;\n\n(14) fasting for a continuous period of at least 24 hours within the 48 hours before the clinical onset of gout;\n\n(15) being dehydrated for a continuous period of at least 24 hours within the 48 hours before the clinical onset of gout;\n\nNote: being dehydrated is defined in the Schedule 1 - Dictionary.\n\n(16) being postmenopausal at the time of the clinical onset of gout;\n\n(17) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical onset of gout;\n\n(18) having surgery within the 48 hours before the clinical onset of gout;\n\n(19) having lead nephropathy before the clinical onset of gout;\n\n(20) having psoriasis or psoriatic arthritis at the time of the clinical onset of gout;\n\n(21) having chronic kidney disease at the time of the clinical onset of gout;\n\nNote: chronic kidney disease is defined in the Schedule 1 - Dictionary.\n\n(22) having a haematological disorder from the specified list of haematological disorders at the time of the clinical worsening of gout;\n\nNote: specified list of haematological disorders is defined in the Schedule 1 - Dictionary. \n\n(23) being treated with a drug from a class of drugs from the specified list of antihypertensive drugs for a continuous period of at least seven days, before the clinical worsening of gout, where the last dose of the drug was taken within the three months before the clinical worsening of gout;\n\nNote: specified list of antihypertensive drugs is defined in the Schedule 1 - Dictionary. \n\n(24) being treated with daily doses of low-dose aspirin (≤ 325 milligrams) for two consecutive days, before the clinical worsening of gout, where the last dose of the drug was taken within the 48 hours before the clinical worsening of gout;\n\n(25) being treated with a drug or a drug from a class of drugs from the Specified List 2 of drugs at the time of the clinical worsening of gout;\n\nNote: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.\n\n(26) undergoing chemotherapy for a malignant neoplasm within the seven days before the clinical worsening of gout;\n\n(27) being overweight at the time of the clinical worsening of gout;\n\nNote: being overweight is defined in the Schedule 1 - Dictionary. \n\n(28) consuming an average of at least 120 grams per week of alcohol, for at least the three months before the clinical worsening of gout;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(29) consuming at least 70 grams of alcohol within the 48 hours before the clinical worsening of gout;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(30) consuming an average of at least 750 grams per week of meat or offal, for at least the three months before the clinical worsening of gout;\n\n(31) consuming at least 300 grams of meat or offal within the 48 hours before the clinical worsening of gout;\n\n(32) consuming an average of at least 120 grams per week of seafood, for at least the three months before the clinical worsening of gout;\n\nNote: seafood is defined in the Schedule 1 - Dictionary.\n\n(33) consuming at least 120 grams of seafood within the 48 hours before the clinical worsening of gout;\n\nNote: seafood is defined in the Schedule 1 - Dictionary.\n\n(34) consuming an average of at least 400 millilitres per day of:\n\n(a) fruit juice; or\n\n(b) non-diet soft drink or other manufactured drink sweetened with fructose or sucrose;\n\nalone or in any combination, for at least the three months before the clinical worsening of gout;\n\n(35) fasting for a continuous period of at least 24 hours within the 48 hours before the clinical worsening of gout;\n\n(36) being dehydrated for a continuous period of at least 24 hours within the 48 hours before the clinical worsening of gout;\n\nNote: being dehydrated is defined in the Schedule 1 - Dictionary.\n\n(37) being postmenopausal at the time of the clinical worsening of gout;\n\n(38) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical worsening of gout;\n\n(39) having surgery within the 48 hours before the clinical worsening of gout;\n\n(40) having lead nephropathy before the clinical worsening of gout;\n\n(41) having psoriasis or psoriatic arthritis at the time of the clinical worsening of gout;\n\n(42) having chronic kidney disease at the time of the clinical worsening of gout;\n\nNote: chronic kidney disease is defined in the Schedule 1 - Dictionary.\n\n(43) inability to obtain appropriate clinical management for gout.\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(22) to 9(43) apply only to material contribution to, or aggravation of, gout where the person's gout 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 abnormality of kidney structure or function means:\n\n(a) having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or\n\n(b) having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or\n\n(c) having had a kidney transplant.\n\n being dehydrated means being deficient in body water, such as could occur after strenuous physical activity, vomiting, diarrhoea or febrile illness, without adequate rehydration.\n\n being overweight means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n chronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.\n\nNote: abnormality of kidney structure or function is also defined in the Schedule 1 - Dictionary.\n\n gout—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 seafood means shellfish or fish.\n\n specified list of antihypertensive drugs means:\n\n(a) angiotensin converting enzyme (ACE) inhibitors;\n\n(b) beta-adrenergic blocking agents; or\n\n(c) thiazide and loop diuretics.\n\n specified list of haematological disorders means:\n\n(a) a lymphoproliferative disorder;\n\n(b) a myeloproliferative disorder;\n\n(c) haemolytic anaemia; or\n\n(d) secondary polycythaemia.\n\n Specified List 1 of drugs means:\n\n(a) allopurinol;\n\n(b) azathioprine;\n\n(c) cyclosporine;\n\n(d) ethambutol;\n\n(e) mycophenolate;\n\n(f) non-losartan angiotensin II receptor blockers (ARBs);\n\n(g) probenecid;\n\n(h) pyrazinamide; or\n\n(i) tacrolimus (excluding topical application).\n\n Specified List 2 of drugs means:\n\n(a) allopurinol;\n\n(b) azathioprine;\n\n(c) cyclosporine;\n\n(d) ethambutol;\n\n(e) febuxostat;\n\n(f) mycophenolate;\n\n(g) non-losartan angiotensin II receptor blockers (ARBs);\n\n(h) probenecid;\n\n(i) pyrazinamide; or\n\n(j) tacrolimus (excluding topical application).\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\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles, which serves a specific, narrow purpose: establishing medical causation for a single condition (gout) under veterans' compensation law. It replaces a 2010 version but maintains the same fundamental scope and structure typical of these instruments. There is no evidence of scope creep beyond the original purpose of determining service-relatedness for this specific medical condition."},"complexity_factors":["43 distinct factors with specific quantitative thresholds (e.g., '120 grams per week', '48 hours before', 'BMI of 25')","Two separate Specified Lists of drugs (List 1 has 9 items, List 2 has 10 items) with subtle differences (e.g., febuxostat only appears in List 2)","Multiple defined terms in Schedule 1 (15+ definitions) including nested definitions (e.g., 'chronic kidney disease' depends on 'abnormality of kidney structure or function')","Dual application structure: factors 1-21 for initial onset, factors 22-42 for worsening of existing condition, plus factor 43 for treatment access","Cross-referencing requirement in section 11: if a factor refers to another disease covered by a different Statement of Principles, that other instrument applies too","Temporal complexity: multiple overlapping timeframes (7 days, 3 months, 48 hours, 24 hours within 48 hours)","Section 10 creates a bifurcated test for relationship to service with different rules for aggravation vs. initial onset"],"plain_english_summary":"This instrument updates the medical rules for deciding if gout (or death from gout) is compensable for veterans and current/former defence members, replacing a 2010 version and applying the \"balance of probabilities\" test. \n\nIt sets a precise checklist of 43 risk factors—medical conditions, medications, BMI, diet, alcohol amounts, dehydration, surgery, inability to get treatment, etc.—so proving at least one service-related factor creates a clear pathway to a claim."},"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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the earlier Statement of Principles concerning gout No. 31 of 2010 (s4) and replaces it with updated criteria. It restates the RMA's determination criteria under subsection 196B(3) (s3, s8), expands/organises enumerated risk factors into onset and worsening categories (s9), introduces two specified drug lists and quantified behavioural/clinical thresholds (Schedule 1; s9), and applies to VEA and MRCA claims (s5)."},"complexity_factors":["Many enumerated, quantified exposure thresholds for onset and worsening (alcohol grams, meat/seafood grams, juice/soft-drink volume, fasting/dehydration durations) — s9(7–16),(28–36)","Separate lists and temporal windows for clinical onset versus clinical worsening of gout, and an overarching link-to-service requirement — s9; s10(1)–(2)","Multiple prescribed drug lists and antihypertensive classes with different effect windows (Specified List 1, Specified List 2, antihypertensives, low‑dose aspirin) — Schedule 1; s9(2)–(5),(22)–(26)","Technical medical definitions requiring measurements or clinical evidence (BMI, GFR/renal abnormality, chronic kidney disease, dehydration, terminal event) — Schedule 1","Cross-reference to other Statements of Principles where factors overlap, creating dependency on external instruments — s11","Application limited to claims under two separate Acts (VEA and MRCA), requiring check of statutory coverage — s5","Replaces a prior Statement of Principles (repeal), so practitioners must track versioning — s4","Presence of a catch‑all factor (inability to obtain appropriate clinical management) that may invite discretionary assessments — s9(43)","Evidentiary standard set as 'balance of probabilities' while the instrument is the authoritative list of factors for causation decisions — s8"],"plain_english_summary":"This instrument prescribes the medical rules the Repatriation Medical Authority uses, on the balance of probabilities, to decide whether gout (or death to which gout contributed) is connected to a person’s relevant service. It lists specific measurable risk factors (medical conditions, drugs, surgery, diet, alcohol, dehydration, BMI and time windows) and applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act (ss 5, 7, 9). The outcome determines whether a veteran/member is eligible for statutory benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019","history":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-gout-balance-of-probabilities-no-60-of-2019/documents"}}