{"id":"F2018L00017","name":"Statement of Principles concerning hepatitis C (Balance of Probabilities) (No. 14 of 2018)","slug":"statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439450,"registerId":"F2018L00017-fast-fetch-1775955471894","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hepatitis C (Balance of Probabilities) (No. 14 of 2018)","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\nHEPATITIS C (Balance of Probabilities)\n\n(No. 14 of 2018)\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 22 December 2017\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 Revocation\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 hepatitis C (Balance of Probabilities) (No. 14 of 2018).\n\n2 Commencement\n\n This instrument commences on 29 January 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning hepatitis C No. 55 of 2008, made under subsection 196B(3) of the VEA is revoked.\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 hepatitis C and death from hepatitis C.\n\nMeaning of hepatitis C\n\n(2) For the purposes of this Statement of Principles, hepatitis C means infection with the hepatitis C virus resulting in:\n\n(a) an acute, symptomatic, clinical illness characterised by inflammation of the liver, and which is confirmed by laboratory testing for hepatitis C serological or nucleic acid markers; or\n\n(b) a chronic infection of at least six months duration, and which is confirmed by laboratory testing for hepatitis C nucleic acid markers.\n\nNote 1: Acute hepatitis C infection is commonly accompanied by fever, tiredness, loss of appetite, nausea, vomiting, abdominal discomfort and jaundice.\n\nNote 2: Chronic hepatitis C infection may involve both inflammation of the liver and the development of fibrosis in the longer term.\n\n(3) While hepatitis C attracts ICD‑10‑AM code B17.1 or B18.2, in applying this Statement of Principles the meaning of hepatitis C 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 hepatitis C\n\n(5) For the purposes of this Statement of Principles, hepatitis C, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hepatitis C.\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 hepatitis C and death from hepatitis C 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, hepatitis C or death from hepatitis C is connected with the circumstances of a person's relevant service:\n\n(1) being exposed to the hepatitis C virus at least one week before the clinical onset of hepatitis C;\n\nNote: being exposed to the hepatitis C virus is defined in the Schedule 1 - Dictionary. \n\n(2) being infected with the hepatitis A, hepatitis B, hepatitis D or hepatitis E virus before the clinical worsening of hepatitis C;\n\n(3) for chronic infection only:\n\n(a) being infected with human immunodeficiency virus before the clinical worsening of hepatitis C;\n\n(b) undergoing solid organ, stem cell or bone marrow transplantation before the clinical worsening of hepatitis C;\n\n(c) for females only, consuming a total of at least 75 kilograms of alcohol within the ten years before the clinical worsening of hepatitis C;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(d) for males only, consuming a total of at least 100 kilograms of alcohol within the ten years before the clinical worsening of hepatitis C;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(e) having severe hepatic iron overload at the time of the clinical worsening of hepatitis C; or\n\nNote: iron overload is defined in the Schedule 1 - Dictionary. \n\n(f) having evidence of chronic infection with schistosomiasis involving the liver before the clinical worsening of hepatitis C;\n\n(4) inability to obtain appropriate clinical management for hepatitis C.\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(2) to 9(4) apply only to material contribution to, or aggravation of, hepatitis C where the person's hepatitis C 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 being exposed to the hepatitis C virus means:\n\n(a) having percutaneous exposure (intravenous, intramuscular, subcutaneous or intradermal) or permucosal exposure to a specified body substance which is derived from a person infected with the hepatitis C virus; or\n\n(b) having a tissue or organ transplant, where the tissue or organ is derived from a person infected with the hepatitis C virus.\n\nNote: specified body substance is also defined in the Schedule 1 - Dictionary.\n\n hepatitis C—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. \n\nNote: Causes include haemochromatosis or blood transfusions.\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 specified body substance means:\n\n(a) blood, blood products or any body fluid containing blood; or\n\n(b) semen or vaginal secretions.\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":{"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 2008 version (No. 55 of 2008) with updated medical criteria but does not expand beyond the original purpose of determining service-relatedness of hepatitis C for veterans' compensation purposes. The structure and approach remain consistent with the legislative framework established under section 196B(3) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Multiple defined terms in Schedule 1 (8 explicit definitions including nested definitions)","Conditional logic requiring at least one factor from section 9 to be satisfied","Gender-specific thresholds for alcohol consumption (75kg female/100kg male)","Distinction between acute and chronic infection with different factor sets applying","Temporal requirements ('at least one week before', 'within the ten years before')","Cross-reference to other Statements of Principles in section 11","Dual legislative framework application (VEA and MRCA with different service definitions)","Specific medical measurement standards (Australian Standard of 10g alcohol per drink, ICD-10-AM coding)","Exception in section 10(2) limiting application of worsening factors to pre-existing conditions"],"plain_english_summary":"This Statement of Principles sets the medical tests used to decide, on the balance of probabilities, whether hepatitis C in veterans and current/former Defence members is caused or worsened by military service. It replaces the 2008 rules and defines exposure, co‑infections, comorbidities, and treatment access as relevant evidence. Its findings determine entitlement to compensation, treatment and benefits under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument does not significantly change the statutory purpose: it remains a Statement of Principles specifying how hepatitis C (and death from it) may be connected to relevant service for veterans' compensation. Compared with earlier versions (the 2008 instrument is revoked), it updates and clarifies medical criteria — for example, setting lab confirmation standards, adding or specifying chronic‑disease co‑factors (HIV, transplants, iron overload, schistosomiasis), sex‑specific alcohol thresholds, and including inability to obtain appropriate clinical management as a factor (sections 4, 7, 9, Schedule 1). Those are refinements and modest expansions of the evidentiary criteria rather than a material broadening beyond the original purpose of defining medical causation for compensation decisions."},"complexity_factors":["Relatively short instrument (11 main sections plus a small Dictionary)","About 6 technical defined terms in Schedule 1 (e.g. being exposed to the hepatitis C virus, iron overload, relevant service, specified body substance, terminal event)","Clear structure: definition of disease (7), basis (8), qualifying factors (9), relationship to service (10)","Some conditional logic and exceptions (e.g. subsections 9(2)–9(4) apply only where hepatitis C was contracted before or during service as per 10(2))","Sex‑specific, quantitative alcohol thresholds (9(3)(c),(d)) add numerical criteria","Requirement for laboratory confirmation and reference to ICD‑10‑AM codes and clinical markers (7(2), 7(3)–(4))","Cross‑references to external statutes for claim application (VEA s120B, MRCA s339 referenced in section 5)","Moderate implementation complexity because some qualifying factors (e.g. inability to obtain clinical management, historical alcohol consumption) are evidentially difficult to verify"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- Replaces an earlier Repatriation Medical Authority (RMA) Statement of Principles about hepatitis C and sets the medical criteria that must be met for a veteran or serving member to link hepatitis C (or death from it) to their military \"relevant service\" for purposes of veterans' compensation (sections 3–5, 7). \n- Defines \"hepatitis C\" for these purposes as either an acute, symptomatic, lab‑confirmed infection or a chronic infection lasting at least six months with lab confirmation (7(2)). \n- Lists the factual factors that must be present, on the balance of probabilities (more likely than not), before a link to service can be accepted (section 9). \n- Explains how those factors must relate to the person's relevant service, and limits some factors to cases where hepatitis C was suffered or contracted before or during service (section 10). \n- Revokes the previous Statement of Principles on hepatitis C (No. 55 of 2008) and commences on 29 January 2018 (sections 2, 4).\n\nWho is affected\n\n- Primary: veterans and current/former members of the Australian Defence Force who lodge a claim under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act that invokes hepatitis C as a disease or cause of death (section 5). \n- Secondary: medical practitioners and administrators who provide the clinical and laboratory evidence used in claims, and the claims officers who apply these Rules. \n- Government: the decision maker (through the RMA's standards and the veterans' compensation system) bears the fiscal consequences of accepted claims.\n\nKey factual rules (what claimants must show)\n\n- At least one of the listed factors in section 9 must exist. Examples include: \n - documented exposure to hepatitis C virus at least one week before clinical onset (9(1)); \n - prior infection with other hepatitis viruses (A, B, D, E) before worsening (9(2)); \n - for chronic infections, pre‑existing HIV infection, prior organ/stem cell/bone marrow transplant, severe hepatic iron overload, or chronic schistosomiasis in the liver (9(3)(a),(b),(e),(f)); \n - sex‑specific alcohol consumption thresholds over the prior ten years (75 kg total alcohol for females, 100 kg for males) before clinical worsening (9(3)(c),(d)); \n - inability to obtain appropriate clinical management for hepatitis C (9(4)). \n- Definitions are provided for critical terms such as \"being exposed to the hepatitis C virus,\" \"iron overload,\" \"relevant service,\" and \"specified body substance\" (Schedule 1).\n\nWhy this matters (stated purpose and practical implications)\n\n- The RMA states it is more probable than not that hepatitis C can be related to relevant service; the Statement sets the medical conditions and evidence thresholds used to decide claims (section 8). \n- Practically, these rules determine which claimants can meet the medical causation test for entitlements under the veterans' compensation laws; they standardise what lab tests, clinical histories and supporting facts are needed.\n\nTesting the stated purpose against costs, incentives and implementation risks\n\n- Who pays and who decides: the veterans' compensation system (government) pays accepted claims; claimants must produce the clinical/laboratory evidence and factual material demonstrating the listed factors. Adjudicators apply the RMA's Statement when deciding causation. (sections 5, 7–11). \n- Compliance and evidentiary burden: claimants must provide laboratory confirmation (serology or nucleic acid tests as defined in 7(2)), evidence of exposure timing, and where relevant, proof of prior infections, transplants, iron overload tests, alcohol consumption history, or inability to access treatment. Some items (e.g. alcohol history, \"inability to obtain appropriate clinical management\") may be hard to verify objectively and could increase administrative work for both claimants and decision makers (sections 7(2), 9(3)(c),(d), 9(4), Schedule 1). \n- Bureaucratic discretion and implementation risk: the Statement supplies medical standards but requires adjudicators to evaluate sometimes indirect or retrospective evidence (exposure windows, cumulative alcohol use, treatment access), which introduces room for interpretation and potential variability in outcomes (sections 9, 10). \n- Effects on private parties and markets: there is minimal direct effect on private businesses. Indirectly, the Statement may increase demand for diagnostic testing and specialist assessments (affecting clinicians and pathology providers). It does not regulate commercial pricing, competition, or contract freedom. \n- Concentration of benefits and diffuse costs: accepted claimants receive benefits (concentrated benefit). Costs are public (entitlement payments and administrative processing), spread across the government budget (diffuse). \n- Substitution/unintended effects: inclusion of \"inability to obtain appropriate clinical management\" as a qualifying factor could shift some causation outcomes toward claimants who lacked treatment access, potentially expanding the set of claims that succeed; similarly, sex‑specific alcohol thresholds introduce a measurable behavioural threshold but rely on historical reporting that could be contested. (section 9(4), 9(3)(c),(d)).\n\nNet practical effect\n\n- This instrument does not create new entitlements; it clarifies and updates the medical criteria used to decide whether hepatitis C (or death from it) is connected to service. Claimants will need to meet the specified medical and factual conditions; decision makers will apply these rules and must assess sometimes subjective evidence (exposure timing, alcohol history, access to care)."},"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-c-balance-of-probabilities-no-14-of-2018","history":"/api/acts/statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-hepatitis-c-balance-of-probabilities-no-14-of-2018/documents"}}