{"id":"F2021L00017","name":"Statement of Principles concerning hereditary haemochromatosis (Reasonable Hypothesis) (No. 23 of 2021)","slug":"statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440735,"registerId":"F2021L00017-fast-fetch-1775956268672","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning hereditary haemochromatosis (Reasonable Hypothesis) (No. 23 of 2021)","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\nHEREDITARY HAEMOCHROMATOSIS (Reasonable Hypothesis)\n\n(No. 23 of 2021)\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 2020\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:
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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 hereditary haemochromatosis (Reasonable Hypothesis) (No. 23 of 2021).\n\n2 Commencement\n\n This instrument commences on 25 January 2021.\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 haemochromatosis No. 21 of 2012 (Federal Register of Legislation No. F2012L00450) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 hereditary haemochromatosis and death from hereditary haemochromatosis.\n\nMeaning of hereditary haemochromatosis\n\n(2) For the purposes of this Statement of Principles, hereditary haemochromatosis:\n\n(a) means any genetic disorder of iron transport and metabolism which results in accumulation of excess iron, and with:\n\n(i) documented iron overload in parenchymatous organs; or\n\n(ii) clinical evidence of iron-related organ or tissue dysfunction; and\n\n(b) includes:\n\n(i) classical (type 1) hereditary haemochromatosis due to a mutation of the HFE gene; and\n\n(ii) non-classical hereditary haemochromatosis due to a mutation of a non-HFE related gene.\n\nNote: Hereditary haemochromatosis is characterised by the gradual increase in body iron stores in organs and tissues, which can lead to various clinical disorders, including lethargy, hepatic fibrosis or cirrhosis, hepatocellular carcinoma, heart failure, diabetes mellitus, hypogonadism, arthritis, hypopituitarism and skin pigmentation.\n\n(3) While hereditary haemochromatosis attracts ICD‑10‑AM code E83.1, in applying this Statement of Principles the meaning of hereditary haemochromatosis 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 hereditary haemochromatosis\n\n(5) For the purposes of this Statement of Principles, hereditary haemochromatosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hereditary haemochromatosis.\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 hereditary haemochromatosis and death from hereditary haemochromatosis 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 hereditary haemochromatosis or death from hereditary haemochromatosis with the circumstances of a person's relevant service:\n\n(1) for males, consuming a total of at least 60 kilograms of alcohol within any five year period before the clinical worsening of hereditary haemochromatosis;\n\nNote 1: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\nNote 2: The clinical worsening of hereditary haemochromatosis typically manifests as hepatic fibrosis or cirrhosis.\n\n(2) for females, consuming a total of at least 40 kilograms of alcohol within any five year period before the clinical worsening of hereditary haemochromatosis;\n\nNote 1: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\nNote 2: The clinical worsening of hereditary haemochromatosis typically manifests as hepatic fibrosis or cirrhosis.\n\n(3) having infection with hepatitis C virus at the time of the clinical worsening of hereditary haemochromatosis;\n\nNote: The clinical worsening of hereditary haemochromatosis typically manifests as hepatic fibrosis or cirrhosis.\n\n(4) having steatohepatitis at the time of the clinical worsening of hereditary haemochromatosis;\n\nNote: The clinical worsening of hereditary haemochromatosis typically manifests as hepatic fibrosis or cirrhosis.\n\n(5) inability to obtain appropriate clinical management for hereditary haemochromatosis.\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(1) to 9(5) apply only to material contribution to, or aggravation of, hereditary haemochromatosis where the person's hereditary haemochromatosis 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 hereditary haemochromatosis—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 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 appears consistent with the original purpose of Statements of Principles under the Veterans' Entitlements Act 1986. It replaces a 2012 instrument on the same topic (haemochromatosis), updating the medical criteria and definitions without expanding beyond the established framework for determining service-related aggravation of genetic conditions. The scope remains tightly focused on the specific medical factors connecting pre-existing hereditary haemochromatosis to military service."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Conditional logic in section 10 limiting application to aggravation/pre-existing conditions only, not causation","Nested definitions: 'hereditary haemochromatosis' defined in section 7(2), then referenced in Dictionary; 'terminal event' defined with 5 sub-categories","Dual legislative framework application (VEA and MRCA) requiring understanding of two different veterans' compensation schemes","Specific quantitative thresholds (60kg/40kg alcohol over 5 years) requiring calculation using Australian Standard of 10g per drink","Reference to external medical classification system (ICD-10-AM Tenth Edition) for coding purposes"],"plain_english_summary":"This Statement of Principles sets the medical test for when hereditary haemochromatosis (an inherited iron‑overload disorder) can be compensated as connected to military service. It affects veterans, peacekeepers and other Defence personnel claiming under veterans’ laws.\n\nA successful claim requires evidence that the veteran already had the genetic condition and that service‑related factors (for example heavy alcohol use, hepatitis C, fatty liver/inflammation, or inadequate treatment) were present and materially worsened the disease."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2012 Statement (s4) and replaces it with current definitions and a specified set of factors for raising a reasonable hypothesis (s7, s9). It applies to claims under the VEA and MRCA (s5) and limits the listed factors to material contribution or aggravation where the condition pre‑existed or was present during service (s10(2)). The repeal indicates updated scope, though the text itself does not compare substantive differences with the prior instrument."},"complexity_factors":["Medical definition and scope: precise clinical definition of hereditary haemochromatosis (including HFE and non‑HFE variants) and inclusion of death via terminal events (s7(2),(5)).","Quantitative thresholds: sex‑specific alcohol consumption thresholds (60 kg male, 40 kg female over any five years) require retrospective calculation and evidentiary proof (s9(1)–(2)).","Temporal and causal link: factors must be related to the person’s relevant service and apply only where the condition was suffered or contracted before or during (but did not arise out of) service — legal and factual causation issues (s10(1)–(2)).","Cross‑instrument interaction: factors that overlap with other Statements of Principles defer to those Statements as in force, creating dependency on other instruments (s11).","Evidence burden and proof standard: the ‘reasonable hypothesis’ threshold demands assembling clinical, behavioural and service‑related evidence to raise a plausible link, not proof on the balance of probabilities (instrument purpose, s8–9).","Administrative discretion: the Repatriation Medical Authority sets and applies the criteria; decision‑makers will assess relevance of factors to service (s3, s8).","Diagnosis and comorbidity complexity: items like hepatitis C, steatohepatitis, and ‘inability to obtain appropriate clinical management’ require clinical interpretation and may overlap with other liver disease causes (s9(3)–(5))."],"plain_english_summary":"This Statement of Principles sets the medical test the Repatriation Medical Authority uses to decide whether hereditary haemochromatosis (a genetic iron‑overload disorder) or death from it can be reasonably connected to a person’s military service. It replaces the prior 2012 Statement and applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. It lists specific causal or aggravating factors (sexed alcohol thresholds, hepatitis C, steatohepatitis, lack of appropriate management) and requires those factors be related to the person’s relevant service (ss3–5,7,9–10)."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021","history":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-hereditary-haemochromatosis-reasonable-hypothesis-no-23-of-2021/documents"}}