{"id":"F2019L00637","name":"Statement of Principles concerning gout (Reasonable Hypothesis) (No. 59 of 2019)","slug":"statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440051,"registerId":"F2019L00637-fast-fetch-1775955834962","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning gout (Reasonable Hypothesis) (No. 59 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 (Reasonable Hypothesis)\n\n(No. 59 of 2019)\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 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 (Reasonable Hypothesis) (No. 59 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning gout No. 30 of 2010 (Federal Register of Legislation No. F2010L01046) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that gout and death from gout 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\n9 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 gout or death from gout 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 hypertension before the clinical onset of gout;\n\n(23) having dyslipidaemia before the clinical onset of gout;\n\nNote: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(24) undergoing total parenteral nutrition within the 48 hours before the clinical onset of gout;\n\n(25) having trauma to the affected joint or tissue within the 48 hours before the clinical onset of gout;\n\n(26) 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(27) 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(28) 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(29) 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(30) undergoing chemotherapy for a malignant neoplasm within the seven days before the clinical worsening of gout;\n\n(31) being overweight at the time of the clinical worsening of gout;\n\nNote: being overweight is defined in the Schedule 1 - Dictionary. \n\n(32) 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(33) 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(34) 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(35) consuming at least 300 grams of meat or offal within the 48 hours before the clinical worsening of gout;\n\n(36) 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(37) 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(38) 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(39) fasting for a continuous period of at least 24 hours within the 48 hours before the clinical worsening of gout;\n\n(40) 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(41) being postmenopausal at the time of the clinical worsening of gout;\n\n(42) having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical worsening of gout;\n\n(43) having surgery within the 48 hours before the clinical worsening of gout;\n\n(44) having lead nephropathy before the clinical worsening of gout;\n\n(45) having psoriasis or psoriatic arthritis at the time of the clinical worsening of gout;\n\n(46) 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(47) having hypertension before the clinical worsening of gout;\n\n(48) having dyslipidaemia before the clinical worsening of gout;\n\nNote: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(49) undergoing total parenteral nutrition within the 48 hours before the clinical worsening of gout;\n\n(50) having trauma to the affected joint or tissue within the 48 hours before the clinical worsening of gout;\n\n(51) 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(26) to 9(51) 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(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 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 dyslipidaemia means persistently abnormal blood lipid levels, diagnosed by a medical practitioner and evidenced by:\n\n(a) a total serum cholesterol level greater than 5.5 mmol/L; or\n\n(b) a serum low density lipoprotein level greater than 4.0 mmol/L; or\n\n(c) a serum high density lipoprotein cholesterol level less than 1.0 mmol/L; or\n\n(d) the regular administration of drug therapy to normalise blood lipid levels.\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) 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 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) 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) gemcitabine;\n\n(f) levodopa;\n\n(g) mycophenolate;\n\n(h) non-losartan angiotensin II receptor blockers (ARBs);\n\n(i) probenecid;\n\n(j) pyrazinamide;\n\n(k) sildenafil; or\n\n(l) 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) gemcitabine;\n\n(g) levodopa;\n\n(h) mycophenolate;\n\n(i) non-losartan angiotensin II receptor blockers (ARBs);\n\n(j) probenecid;\n\n(k) pyrazinamide;\n\n(l) sildenafil; or\n\n(m) 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":{"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":false,"description":"The instrument repeals the earlier Statement (s 4) but the text does not state an expansion or narrowing of the subject matter. It continues to cover gout and death from gout (s 7) and applies to claims under the VEA and MRCA (s 5). There is no express textual indication in this instrument that the statutory scope of covered conditions or eligible service was altered compared with the repealed instrument."},"complexity_factors":["Numerous, detailed quantitative thresholds for exposures and measurements (alcohol grams, meat/seafood grams, aspirin dose ≤325 mg, BMI ≥25, GFR <60 mL/min/1.73 m2) — Schedule 1; ss 9(3), 9(6), 9(7)-(13), Schedule 1 definitions.","Tight temporal windows that differ by factor (48 hours, 7 days, 3 months, continuous 24 hours, two consecutive days) requiring precise event timing — ss 9(2)-(5), (11)-(15), (24), (30), (34)-(40).","Separate treatment of clinical onset vs clinical worsening with overlapping but distinct factor lists and applicability rules — ss 9, 10(2).","Multiple enumerated drug lists (Specified List 1 and Specified List 2) with small differences (e.g. febuxostat present in List 2) and classes of antihypertensives (ACE inhibitors, beta‑blockers, diuretics) — Schedule 1; ss 9(2), 9(4), 9(29).","Cross‑references to other Statements of Principles and to statutory provisions governing claims, requiring administratively linked analysis — ss 5, 11.","Medical and technical definitions concentrated in Schedule 1 (chronic kidney disease, dyslipidaemia, dehydration, haematological disorders), increasing dependence on clinical records and expert interpretation — Schedule 1; ss 6–7, 9.","Legal standard is the statutory ‘reasonable hypothesis’ test (RMA determination under s196B(2) VEA), which is lower than causation on the balance of probabilities but still requires factual linkage — ss 3, 8, 9.","Replaces a previous Statement (repeal) but requires claimants to map historical records to the new enumerated factors — s 4.","Administrative burden on claimants to establish specific factor existence and timing (e.g. exact consumption amounts, recent medications, surgery dates) — ss 9, 10.","Discretion in applying factors to service linkage and where a factor is itself subject to another Statement — ss 10, 11."],"plain_english_summary":"This instrument (No. 59 of 2019) sets the medical criteria the Repatriation Medical Authority uses to decide whether gout, or death from gout, can be linked to a person’s relevant service. It lists specific medical conditions, drugs, procedures, dietary and alcohol exposures with quantitative thresholds and time windows that, if present, raise a “reasonable hypothesis” of service‑connection. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established framework for determining service-related gout. It updates the 2010 version with current medical evidence but does not expand beyond the original purpose of establishing medical-scientific connections between gout and military service for compensation purposes."},"complexity_factors":["51 distinct factors with specific temporal requirements (e.g., 'within 48 hours', 'for at least three months', 'continuous period of at least seven days')","Multiple defined terms in Schedule 1 (approximately 15 definitions) including nested definitions (e.g., 'chronic kidney disease' depends on 'abnormality of kidney structure or function')","Two separate drug lists (Specified List 1 and Specified List 2) with 12 and 13 items respectively, differing slightly in content","Cross-references between the main body and the Dictionary (Schedule 1)","Dual application structure: factors 1-25 for clinical onset, factors 26-50 for clinical worsening, with factor 51 as a standalone provision","Specific quantitative thresholds (e.g., BMI ≥25, alcohol grams per week, millilitres of soft drink per day)","Conditional logic in section 10(2) restricting factors 26-51 to aggravation cases only"],"plain_english_summary":"This Statement of Principles sets the medical and scientific criteria for deciding whether gout (or death from gout) is connected to Australian military service, replacing the 2010 version. It affects veterans, peacekeepers, and current or former defence members claiming under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004. The instrument lists 51 risk or trigger factors that can establish a “reasonable hypothesis” of service connection—but each factor must be shown to be linked to the person’s service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019","history":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-gout-reasonable-hypothesis-no-59-of-2019/documents"}}