{"id":"F2025L01633","name":"Statement of Principles concerning hepatitis B infection (Balance of Probabilities) (No. 10 of 2026)","slug":"statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443111,"registerId":"F2025L01633-fast-fetch-1775958030111","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hepatitis B infection (Balance of Probabilities) (No. 10 of 2026)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nHEPATITIS B INFECTION  (Balance of Probabilities)\n\n(No. 10 of 2026)\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 19 December 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning hepatitis B infection (Balance of Probabilities) (No. 10 of 2026).\n\n1.                Commencement\n\n\n              This instrument commences on 19 January 2026.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning hepatitis B (Balance of Probabilities) (No. 14 of 2017) (Federal Register of Legislation No. F2017L00007) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about hepatitis B infection and death from hepatitis B infection.\n\n\nMeaning of hepatitis B infection\n\n1.           For the purposes of this Statement of Principles, hepatitis B infection:\n  1.           means infection with the hepatitis B virus resulting in an illness characterised by inflammation of the liver, and which is confirmed by laboratory testing for hepatitis B serological or nucleic acid markers; and\n  2.           includes acute and chronic hepatitis B infection.\n\n\nNote 1: Signs and symptoms of acute hepatitis B infection include fever, tiredness, loss of appetite, nausea, vomiting, abdominal discomfort and jaundice. Chronic hepatitis B is an infection lasting for at least 6 months which may involve both inflammation of the liver and development of fibrosis in the longer term.\n\nNote 2: Clinical worsening may be indicated by the development of chronic hepatitis B from acute hepatitis B, reactivation of past hepatitis B or a hepatitis B flare-up.\n\nNote 3: It will usually be the case that the date of the confirmation of laboratory evidence of hepatitis B serological or nucleic acid markers is after the date of clinical onset.\n\nNote 4: Clinical onset is defined in the schedule 1 – Dictionary.\n\n1.           While hepatitis B infection attracts ICD‑10‑AM code B16, B18.0 or B18.1, in applying this Statement of Principles the meaning of hepatitis B infection is that given in subsection (2).\n2.           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\n\nDeath from hepatitis B infection\n\n1.           For the purposes of this Statement of Principles, hepatitis B infection, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hepatitis B infection.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that hepatitis B infection and death from hepatitis B infection 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, hepatitis B infection or death from hepatitis B infection is connected with the circumstances of a person's relevant service:\n\n1.           having percutaneous (intravenous, intramuscular, subcutaneous or intradermal) or permucosal exposure to a body substance which is derived from a person infected with the hepatitis B virus at least 30 days before clinical onset;\n\n\nNote: The body substance may include blood, blood products or any body fluid containing blood, saliva, semen or vaginal secretions, serum-derived fluids (serous discharge, amniotic, cerebrospinal, pericardial, peritoneal, pleural or synovial fluids), tissues or organs.\n\n1.           living or working for a continuous period of at least 180 days in an area which, at that time, has a population prevalence of hepatitis B chronic infection of at least 2% before clinical onset;\n2.           inability to access appropriate hepatitis B vaccination before exposure to hepatitis B virus, or appropriate hepatitis B post-exposure prophylaxis, in accordance with contemporary medical standards, before clinical onset;\n\n\nNote: post-exposure prophylaxis is defined in the Schedule 1 - Dictionary.\n\n1.           taking an immunosuppressive medication in the 5 years immediately preceding clinical worsening of chronic hepatitis B infection;\n\n\nNote: Examples of immunosuppressive medications include corticosteroids other than inhaled or topical corticosteroids, medications used to prevent transplant rejection, tumour necrosis factor-α inhibitors and chemotherapeutic agents used for the treatment of cancer.\n\n1.           having infection with human immunodeficiency virus before clinical worsening of chronic hepatitis B infection;\n2.           having a solid organ transplant (excluding corneal transplant), stem cell transplant or bone marrow transplant before clinical worsening of chronic hepatitis B infection;\n3.           undergoing a course of radiotherapy for cancer, where the liver was in the field of radiation, before clinical worsening of chronic hepatitis B infection;\n4.           for females only, drinking at least 75 kilograms of alcohol in the 10 years immediately preceding clinical worsening of chronic hepatitis B infection;\n\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.           for males only, drinking at least 150 kilograms of alcohol in the 10 years immediately preceding clinical worsening of chronic hepatitis B infection;\n\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.       undergoing surgical resection of hepatocellular carcinoma in the 2 years immediately preceding clinical worsening of chronic hepatitis B infection;\n2.       being pregnant or within the 6 month postpartum period at the time of clinical worsening of chronic hepatitis B infection;\n3.       having severe hepatic iron overload at the time of clinical worsening of chronic hepatitis B infection;\n\n\nNote: iron overload is defined in the Schedule 1 - Dictionary.\n\n1.       having chronic schistosomiasis involving the liver before clinical worsening of chronic hepatitis B infection;\n2.       having hepatitis A, hepatitis C, hepatitis D or hepatitis E infection before clinical worsening of chronic hepatitis B infection;\n3.       inability to obtain appropriate clinical management for hepatitis B infection before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The factors set out in subsections 9(4) to 9(15) apply only to material contribution to, or aggravation of, hepatitis B infection where the person's hepatitis B infection was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                             clinical onset means the point backwards in time from the first date of confirmation of laboratory evidence of hepatitis B serological or nucleic acid markers, to the date at which the symptoms of hepatitis B were persistently present, as assessed by a registered medical practitioner.\n\n                               hepatitis b infection—see subsection 7(2).\n\n                             iron overload means an accumulation of excess iron in tissues and organs which has been confirmed by elevated ferritin or transferrin saturation levels. Causes include haemochromatosis and blood transfusions.\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               post-exposure prophylaxis means providing immunoglobulin or a vaccine to a person who has been exposed to an infectious agent, in an effort to prevent them from developing the disease.\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                             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":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2017 Statement and restates the hepatitis B principles for VEA/MRCA claims, clarifying and adding specific, time‑bounded exposure and risk criteria (e.g. ≥30‑day lag to clinical onset, 180‑day residence in ≥2% prevalence areas, defined clinical‑onset assessment, gendered alcohol thresholds, explicit immunosuppression/ transplant/ radiotherapy/co‑infection and clinical‑management access factors). It therefore updates the evidentiary and eligibility contours claimants and decision makers must apply."},"complexity_factors":["Legal‑evidential standard is the balance of probabilities (s8) rather than a higher criminal standard, which affects proof strategies for claimants and decision‑makers.","Clinical onset must be assessed backwards from laboratory confirmation to the date symptoms were persistently present, and requires a registered medical practitioner's assessment (Schedule—clinical onset), adding medical‑record dependency.","Detailed, time‑bound exposure rules (e.g. percutaneous/permucosal exposure to infected body substance at least 30 days before clinical onset) require precise event dating and appropriate laboratory linkage (s9(1)).","Population prevalence threshold for residence/work (continuous 180 days in an area with ≥2% chronic infection) requires epidemiological evidence about location and timing (s9(2)).","Proof of inability to access appropriate vaccination or post‑exposure prophylaxis invokes contemporary medical standards and may require records or contemporaneous evidence of access constraints (s9(3); Schedule—post‑exposure prophylaxis).","A set of medical risk modifiers (immunosuppressive medications within 5 years, HIV coinfection, organ/stem‑cell transplant, liver‑targeted radiotherapy, specified alcohol consumption thresholds) create multiple conditional pathways and documentary burdens (s9(4)–s9(15)).","Gender‑specific alcohol thresholds (female 75 kg alcohol; male 150 kg alcohol over 10 years) require retrospective quantification of consumption against Australian standard drink measures (s9(7)–s9(8)).","Interplay with other Statements of Principles where a listed factor refers to another disease requires cross‑reference to and reliance on separate SOPs (s11), increasing legal‑medical cross‑linking.","Administrative change: repeal of the 2017 Statement and commencement date mean practitioners and decision makers must apply the new instrument to applicable claims (s4, commencement).","Scope limitation rule: many listed risk factors in s9(4)–s9(15) apply only where infection was suffered or contracted before or during (but did not arise out of) relevant service, affecting causation analysis (s10(2))."],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the medical criteria and types of evidence required to link hepatitis B infection (including death) to a person’s eligible military service for claims under the VEA and MRCA. \n\nIt lists specific exposure, timing and medical risk factors which, if shown to be related to relevant service on the balance of probabilities, establish a service connection; this matters because it defines who must supply what clinical and documentary proof to succeed in a claim."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement/update of an existing Statement of Principles (replacing No. 14 of 2017). It maintains the same scope: establishing medical criteria for hepatitis B compensation claims under veterans' legislation. The structure and purpose align with the original intent of the Veterans' Entitlements Act framework for determining service-related medical conditions."},"complexity_factors":["15 distinct factual factors with specific temporal requirements (e.g., 'at least 30 days before', '5 years immediately preceding', '2 years immediately preceding')","8 defined terms in Schedule 1 Dictionary including nested definitions (clinical onset, iron overload, post-exposure prophylaxis, terminal event)","Conditional application rules in section 10 distinguishing between causation of initial infection versus aggravation of pre-existing condition","Cross-reference mechanism in section 11 linking to other Statements of Principles for related conditions","Gender-specific thresholds for alcohol consumption (75kg vs 150kg)","Dual statutory framework application (VEA and MRCA with different service definitions)","Medical coding reference (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"The Repatriation Medical Authority’s updated framework sets medical rules for when hepatitis B infection or death is “connected to military service” for compensation, replacing the 2017 version. It affects veterans and current/former defence members claiming under the Veterans’ Entitlements Act or MRCA, using the balance‑of‑probabilities test.\n\nIt lists 15 factors—e.g., needlestick/exposure, extended service in high‑prevalence areas, vaccine/post‑exposure failures, and conditions that worsen hepatitis B—and requires proof of at least one factor linked to service."},"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-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026","history":"/api/acts/statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026/history","analysis":"/api/acts/statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026/important-cases","documents":"/api/acts/statement-of-principles-concerning-hepatitis-b-infection-balance-of-probabilities-no-10-of-2026/documents"}}