{"id":"F2021L01907","name":"Statement of Principles concerning Hashimoto thyroiditis (Reasonable Hypothesis) (No. 1 of 2022)","slug":"statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441144,"registerId":"F2021L01907-fast-fetch-1775956524490","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Hashimoto thyroiditis (Reasonable Hypothesis) (No. 1 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 (Reasonable Hypothesis)\n\n(No. 1 of 2022)\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 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 (Reasonable Hypothesis) (No. 1 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning Hashimoto's thyroiditis No. 31 of 2013 (Federal Register of Legislation No. F2013L00732) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that Hashimoto thyroiditis and death from Hashimoto thyroiditis 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 Hashimoto thyroiditis or death from Hashimoto thyroiditis with the circumstances of a person's relevant service:\n\n(1) having iodine excess within the 6 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) having infection with hepatitis C virus at the time of the clinical onset of Hashimoto thyroiditis;\n\n(6) 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(7) in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke within the 5 years before the clinical onset of Hashimoto thyroiditis;\n\nNote: regular smoking habit as specified is defined in the Schedule 1 - Dictionary.\n\n(8) having postpartum thyroiditis within the 10 years before the clinical onset of Hashimoto thyroiditis;\n\n(9) having posttraumatic stress disorder at the time of the clinical onset of Hashimoto thyroiditis;\n\n(10) 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(11) having iodine excess within the 6 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(12) 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(13) 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(14) having received iodine-131 (radioactive iodine) treatment within the 10 years before the clinical worsening of Hashimoto thyroiditis;\n\n(15) having infection with hepatitis C virus at the time of the clinical worsening of Hashimoto thyroiditis;\n\n(16) 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(17) in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke within the 5 years before the clinical worsening of Hashimoto thyroiditis;\n\nNote: regular smoking habit as specified is defined in the Schedule 1 - Dictionary.\n\n(18) having postpartum thyroiditis within the 10 years before the clinical worsening of Hashimoto thyroiditis;\n\n(19) having posttraumatic stress disorder at the time of the clinical worsening of Hashimoto thyroiditis;\n\n(20) being pregnant or within the 12 months postpartum at the time of the clinical worsening of Hashimoto thyroiditis;\n\n(21) 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(22) 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(11) to 9(22) 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(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 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 one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\nNote 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\nNote 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\n regular smoking habit as specified means having smoked at least 3 pack-years of tobacco products, within a continuous 3 year period.\n\nNote: one pack-year is also defined in the Schedule 1 - Dictionary.\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 Specified List 1 of drugs means:\n\n(a) dasatinib;\n\n(b) imatinib;\n\n(c) interferon alpha;\n\n(d) interferon beta;\n\n(e) interleukin-2;\n\n(f) nilotinib;\n\n(g) nivolumab;\n\n(h) pembrolizumab; or\n\n(i) sunitinib.\n\n Specified List 2 of drugs means:\n\n(a) amiodarone;\n\n(b) dasatinib;\n\n(c) imatinib;\n\n(d) interferon alpha;\n\n(e) interferon beta;\n\n(f) interleukin-2;\n\n(g) lithium;\n\n(h) nilotinib;\n\n(i) nivolumab;\n\n(j) pembrolizumab; or\n\n(k) 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":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2013 Statement of Principles (s 4) and replaces it with an updated list of qualifying factors (s 9) and detailed definitions (Schedule 1). Changes include codified numeric thresholds for iodine excess and BMI, two specified drug lists, added or clarified triggers (e.g. PTSD, inability to obtain appropriate clinical management, pregnancy/postpartum provisions) and explicit rules about when factors operate to materially contribute or aggravate disease (s 10). These textual changes alter the scope and evidentiary detail used to assess service connection."},"complexity_factors":["Numerous discrete, conditional factors with different look‑back or exposure windows for disease onset and worsening (section 9(1)–(22)).","Technical medical thresholds and measures (iodine excess numerical intake and urinary concentrations; BMI definition) requiring clinical/biochemical evidence (Schedule 1).","Two overlapping specified drug lists with slightly different inclusion criteria and time windows (Specified List 1 and 2 in Schedule 1; sections 9(2), 9(12)).","Interaction rules with other Statements of Principles where a factor refers to another injury/disease (section 11), creating cross-instrument dependencies.","Distinction between factors that can cause vs. aggravate disease and limitation that some factors apply only where disease pre‑existed service (section 10(2)).","Detailed clinical definitions (Hashimoto thyroiditis, myxoedema coma, acute precipitating event, terminal event) that require medical interpretation (section 7; Schedule 1).","Requirement that at least one listed factor exist to raise the reasonable hypothesis standard (section 9) — evidential threshold for claims examiners.","Repeal and replacement of the 2013 Statement (section 4) — potential procedural/administrative transition issues for existing claims."],"plain_english_summary":"This Statement of Principles lists the medical findings, exposures and time limits that, if present, raise a “reasonable hypothesis” that Hashimoto thyroiditis (or death from it) is connected to a person’s relevant military service. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act and repeals the earlier 2013 Statement (ss 3–5, 4). \n\nThe instrument names specific risk factors and triggers with numeric thresholds and windows—examples include iodine excess, specified drugs and radiation, hepatitis C, obesity, recent smoking cessation, postpartum status, PTSD, pregnancy and inability to obtain appropriate clinical management—which determine whether a service link may be made (s 9; Schedule 1)."},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It updates the 2013 version with current medical evidence but maintains the same fundamental scope: establishing service connection for Hashimoto thyroiditis. The structure and purpose remain consistent with the original legislative intent of the Repatriation Medical Authority system."},"complexity_factors":["22 separate factors with varying timeframes (6 months to 10 years before onset/worsening)","Dual structure: separate factors for 'clinical onset' (factors 1-10) versus 'clinical worsening' (factors 11-22)","Conditional application: factors 11-22 only apply to aggravation cases where disease pre-existed service","Nested definitions: 14 defined terms in Schedule 1, with some definitions referring to other defined terms (e.g., 'regular smoking habit as specified' refers to 'one pack-year', which has its own mathematical formula)","Specific exclusions in the disease definition (5 excluded conditions) and inclusions (3 subtypes)","Two different drug lists (Specified List 1 and Specified List 2) with overlapping but distinct contents","Special limitation clauses: factor 10 only applies to myxoedema coma presentations; factor 21 only applies to myxoedema coma worsening","Cross-referencing mechanism in section 11 linking to other Statements of Principles for related conditions","Mathematical calculations required for obesity (BMI formula) and smoking history (pack-year formula)"],"plain_english_summary":"This Statement of Principles updates medical guidance used to decide when Hashimoto thyroiditis is considered related to military service, replacing the 2013 version with current evidence and a set of specified risk and exposure factors that can create a \"reasonable hypothesis\" of service connection.\n\nIt affects veterans and current/former defence members claiming benefits under the Veterans' Entitlements Act 1986 or MRCA 2004, and guides the Repatriation Medical Authority in awarding disability entitlements for this potentially serious, chronic thyroid condition."},"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-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022","history":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-hashimoto-thyroiditis-reasonable-hypothesis-no-1-of-2022/documents"}}