{"id":"F2021L01908","name":"Statement of Principles concerning Hashimoto thyroiditis (Balance of Probabilities) (No. 2 of 2022)","slug":"statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441145,"registerId":"F2021L01908-fast-fetch-1775956524491","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Hashimoto thyroiditis (Balance of Probabilities) (No. 2 of 2022)","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\nHASHIMOTO THYROIDITIS (Balance of Probabilities)\n\n(No. 2 of 2022)\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 24 December 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:
|\n| --- |\n|
Professor Terence Campbell AM
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 Hashimoto thyroiditis (Balance of Probabilities) (No. 2 of 2022).\n\n2 Commencement\n\n This instrument commences on 31 January 2022.\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 Hashimoto's thyroiditis No. 32 of 2013 (Federal Register of Legislation No. F2013L00731) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Hashimoto thyroiditis and death from Hashimoto thyroiditis.\n\nMeaning of Hashimoto thyroiditis\n\n(2) For the purposes of this Statement of Principles, Hashimoto thyroiditis:\n\n(a) means a chronic, inflammatory, autoimmune disease of the thyroid gland characterised by varying degrees of lymphocytic infiltration and fibrosis of the thyroid gland, and typically presenting with a high titre of circulating antibodies against thyroid peroxidase (TPO) or thyroglobulin (Tg); and\n\n(b) includes:\n\n(i) goitrous thyroiditis;\n\n(ii) atrophic thyroiditis; and\n\n(iii) chronic autoimmune thyroiditis with transient thyrotoxicosis (Hashitoxicosis); and\n\n(c) excludes:\n\n(i) Graves disease;\n\n(ii) non-autoimmune chronic thyroiditis;\n\n(iii) postpartum thyroiditis;\n\n(iv) secondary hypothyroidism; and\n\n(v) subacute thyroiditis.\n\nNote 1: Presenting features typically include a goitre and hypothyroidism, although some patients may be hyperthyroid during the course of the disease.\n\nNote 2: Hashimoto thyroiditis is also known as chronic autoimmune thyroiditis or chronic lymphocytic thyroiditis.\n\nNote 3: Hashimoto thyroiditis may present as myxoedema coma.\n\nNote 4: myxoedema coma is defined in the Schedule 1 - Dictionary.\n\n(3) While Hashimoto thyroiditis attracts ICD‑10‑AM codes E03.4, E03.5 or E06.3, in applying this Statement of Principles the meaning of Hashimoto thyroiditis 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 Hashimoto thyroiditis\n\n(5) For the purposes of this Statement of Principles, Hashimoto thyroiditis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Hashimoto thyroiditis.\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 Hashimoto thyroiditis and death from Hashimoto thyroiditis 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, Hashimoto thyroiditis or death from Hashimoto thyroiditis is connected with the circumstances of a person's relevant service:\n\n(1) having iodine excess within the 3 months before the clinical onset of Hashimoto thyroiditis;\n\nNote 1: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.\n\nNote 2: iodine excess is defined in the Schedule 1 - Dictionary.\n\n(2) taking a drug from the Specified List 1 of drugs within the 1 year before the clinical onset of Hashimoto thyroiditis;\n\nNote: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(3) undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the 10 years before the clinical onset of Hashimoto thyroiditis;\n\n(4) having received iodine-131 (radioactive iodine) treatment within the 10 years before the clinical onset of Hashimoto thyroiditis;\n\n(5) being obese for at least 5 years before the clinical onset of Hashimoto thyroiditis;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(6) having postpartum thyroiditis within the 10 years before the clinical onset of Hashimoto thyroiditis;\n\n(7) for Hashimoto thyroiditis first presenting as myxoedema coma only, having an acute precipitating event within the 48 hours before the clinical onset of Hashimoto thyroiditis;\n\nNote: acute precipitating event and myxoedema coma are defined in the Schedule 1 - Dictionary.\n\n(8) having iodine excess within the 3 months before the clinical worsening of Hashimoto thyroiditis;\n\nNote 1: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.\n\nNote 2: iodine excess is defined in the Schedule 1 - Dictionary.\n\n(9) taking a drug from the Specified List 2 of drugs for a continuous period of at least 2 weeks, within the 1 year before the clinical worsening of Hashimoto thyroiditis;\n\nNote: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.\n\n(10) undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the 10 years before the clinical worsening of Hashimoto thyroiditis;\n\n(11) having received iodine-131 (radioactive iodine) treatment within the 10 years before the clinical worsening of Hashimoto thyroiditis;\n\n(12) being obese for at least 5 years before the clinical worsening of Hashimoto thyroiditis;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(13) having postpartum thyroiditis within the 10 years before the clinical worsening of Hashimoto thyroiditis;\n\n(14) being pregnant or within the 12 months postpartum at the time of the clinical worsening of Hashimoto thyroiditis;\n\n(15) for myxoedema coma only, having an acute precipitating event within the 48 hours before that clinical worsening of Hashimoto thyroiditis;\n\nNote: acute precipitating event and myxoedema coma are defined in the Schedule 1 - Dictionary.\n\n(16) inability to obtain appropriate clinical management for Hashimoto thyroiditis.\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(8) to 9(16) apply only to material contribution to, or aggravation of, Hashimoto thyroiditis where the person's Hashimoto thyroiditis 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 acute precipitating event means a physical stimulus or event that causes a sudden, intense physical response.\n\nNote: Examples of an acute precipitating event include:\n\n(a) abrupt cessation of thyroxine therapy;\n\n(b) acute illness including cerebrovascular accident, gastrointestinal bleed, myocardial infarction and pulmonary embolism;\n\n(c) acute iodine load including iodine-containing drugs;\n\n(d) drugs including sedatives, opioids, antipsychotics, selective serotonin reuptake inhibitors, phenytoin, beta blockers, diuretics and chemotherapeutic agents;\n\n(e) hypothermia;\n\n(f) infection including pneumonia, urinary tract infections and septicaemia;\n\n(g) physical trauma including burns; and\n\n(h) surgery.\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI 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 Hashimoto thyroiditis—see subsection 7(2).\n\n iodine excess means:\n\n(a) an average intake of more than 1,100 micrograms of iodine per day for adults, or more than 900 micrograms per day for those aged 18 years and under, for a continuous period of at least 3 months; or\n\n(b) having a urinary iodine concentration of greater than 300 micrograms per litre, or greater than 500 micrograms per litre for pregnant women.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n myxoedema coma means a constellation of severe and life-threatening symptoms of rapid onset in a patient with biochemical evidence of decreased thyroxine level. Characteristic symptoms and signs are decreased mental status and hypothermia, and hypotension, bradycardia, hyponatremia, hypoglycaemia and hypoventilation are typically present.\n\nNote 1: Myxoedema coma is also known as decompensated hypothyroidism.\n\nNote 2: Myxoedema coma may be the first presentation of undiagnosed Hashimoto thyroiditis, or may complicate existing Hashimoto thyroiditis.\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) interferon alpha;\n\n(b) interleukin-2; or\n\n(c) sunitinib.\n\n Specified List 2 of drugs means:\n\n(a) amiodarone;\n\n(b) interferon alpha;\n\n(c) interleukin-2;\n\n(d) lithium; or\n\n(e) sunitinib.\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_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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2013 version (No. 32 of 2013) with updated medical evidence and refined factor lists, but does not expand beyond the traditional purpose of establishing service connection criteria for a specific disease. The structure — covering both onset and aggravation, with defined terms in a schedule — follows the standard template for such instruments."},"complexity_factors":["16 distinct factors with varying timeframes (3 months, 1 year, 5 years, 10 years, 48 hours) and different applicability (onset vs. worsening)","Two separate drug lists (Specified List 1 and Specified List 2) with partially overlapping but distinct contents","Nested definitions: 12 defined terms in Schedule 1, with some definitions referring to other defined terms (e.g., 'being obese' refers to 'BMI', 'acute precipitating event' has 8 example categories)","Conditional logic in section 10(2) restricting factors 8–16 to aggravation claims only, and section 9(7) and 9(15) restricting certain factors to myxoedema coma presentations only","Cross-referencing mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Dual statutory framework applying to both VEA and MRCA with slightly different service definitions","Medical specificity requiring ICD-10-AM code awareness but overriding it with a bespoke statutory definition in section 7(2)"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding whether Hashimoto thyroiditis (and related presentations) — and deaths from it — are compensable for veterans under the VEA and current/former defence members under the MRCA.\n\nIt applies a \"balance of probabilities\" test: claimants must show at least one listed, service-related factor linking the condition to service, with different criteria for new versus worsening disease. It replaces the 2013 instrument, tightening evidence and clarifying included and excluded thyroid conditions."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles concerning Hashimoto's thyroiditis No. 32 of 2013 (s.4) and commences as the controlling Statement (commencement s.2). It therefore replaces the prior instrument and establishes the current clinical definition, factor lists, thresholds and application to VEA/MRCA claims (see s.5, s.7–9). The source text does not set out a clause‑by‑clause comparison, only that the earlier instrument is repealed and superseded."},"complexity_factors":["Technical clinical definition and specific inclusions/exclusions for Hashimoto thyroiditis (see s.7(2)–(3)).","Multiple precise temporal thresholds for causal factors (e.g. 3 months, 1 year, 10 years, 5 years, 48 hours) across s.9 subsections.","Quantitative exposure thresholds (iodine intake and urinary iodine concentrations) defined in Schedule 1 (see Schedule 1: iodine excess).","Specified drug lists split into two categories with differing time/duration requirements (see Schedule 1: Specified List 1 and Specified List 2; s.9(2),(9)).","Medical-event definitions that require clinical interpretation (myxoedema coma, acute precipitating event, terminal event) in Schedule 1.","Objective biometric measure (BMI ≥ 30) used to define obesity and linked to 5‑year exposure periods (s.9(5),(12); Schedule 1).","Cross-reference to other Statements of Principles where a listed factor refers to another injury/disease (s.11), adding referral complexity.","A discretionary / evidentiary element where inability to obtain appropriate clinical management is a factor (s.9(16)), creating potential for case-by-case assessment.","Statutory application to specific claims frameworks (VEA/MRCA) and repeal of the prior instrument (s.3–5, s.4), requiring administratively switching to the new criteria.","Reliance on the Repatriation Medical Authority's view of 'sound medical‑scientific evidence' and balance‑of‑probabilities standard for causation (s.8)."],"plain_english_summary":"This instrument defines the medical criteria the Repatriation Medical Authority uses to decide whether Hashimoto thyroiditis (and deaths from it) is service‑related for claims under the VEA or MRCA. It replaces the 2013 Statement of Principles, gives a clinical definition, lists risk and exposure factors (iodine excess, specified drugs, radiation, obesity, postpartum/pregnancy, etc.), and sets timeframes and thresholds. These criteria determine evidentiary requirements for veteran entitlement decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022","history":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-balance-of-probabilities-no-2-of-2022/documents"}}