{"id":"F2020L01388","name":"Statement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020)","slug":"statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":130608,"registerId":"commonwealth-F2020L01388-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020) that shows the text of the law as amended and in force on 19 September 2022.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1 Name\n\nThis is the Statement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\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 inflammatory bowel disease and death from inflammatory bowel disease.\n\nMeaning of inflammatory bowel disease\n\n(2) For the purposes of this Statement of Principles, inflammatory bowel disease:\n\n(a) means a chronic, relapsing and remitting inflammatory autoimmune disorder of the gastrointestinal tract; and\n\n(b) includes:\n\n(i) Crohn disease;\n\n(ii) ulcerative colitis; and\n\n(iii) inflammatory bowel disease of unspecified type; and\n\n(c) excludes bowel inflammation that is unrelated to autoimmunity.\n\n> Note 1: Symptoms of inflammatory bowel disease typically include abdominal pain, diarrhoea and weight loss.\n\n> Note 2: Inflammatory bowel disease may be associated with extra-intestinal manifestations, including episcleritis, erythema nodosum, peripheral arthritis and pyoderma gangrenosum.\n\n> Note 3: Crohn disease and ulcerative colitis are defined in the Schedule 1 \\- Dictionary.\n\n(3) While inflammatory bowel disease attracts ICD‑10‑AM code K50 or K51, in applying this Statement of Principles the meaning of inflammatory bowel disease 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 inflammatory bowel disease\n\n(5) For the purposes of this Statement of Principles, inflammatory bowel disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's inflammatory bowel disease.\n\n> Note: 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 inflammatory bowel disease and death from inflammatory bowel disease 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\n> Note: 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 inflammatory bowel disease or death from inflammatory bowel disease with the circumstances of a person's relevant service:\n\n(1) taking a drug from the Specified List 1 of drugs for at least the seven days before the clinical onset of inflammatory bowel disease;\n\n> Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.\n\n(2) taking a nonsteroidal anti-inflammatory drug on at least ten days per month, for a continuous period of at least two months before the clinical onset of inflammatory bowel disease and the last dose of the drug was taken within the 14 days before the clinical onset of inflammatory bowel disease;\n\n(3) taking an immune checkpoint inhibitor within the one year before the clinical onset of inflammatory bowel disease;\n\n(4) taking a combined oral contraceptive pill for a continuous period of at least six months before the clinical onset of inflammatory bowel disease and where taking the combined oral contraceptive pill has ceased, the clinical onset of inflammatory bowel disease has occurred within one year of cessation;\n\n(5) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of inflammatory bowel disease;\n\n> Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(6) experiencing a category 1A stressor within the three months before the clinical onset of inflammatory bowel disease;\n\n> Note: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(7) experiencing a category 1B stressor within the three months before the clinical onset of inflammatory bowel disease;\n\n> Note: category 1B stressor is defined in the Schedule 1 - Dictionary.\n\n(8) experiencing a category 2 stressor within the 30 days before the clinical onset of inflammatory bowel disease;\n\n> Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.\n\n> Note 2: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(9) having a clinically significant depressive disorder or a clinically significant anxiety disorder for at least the one year before the clinical onset of inflammatory bowel disease;\n\n> Note: clinically significant is defined in the Schedule 1 - Dictionary.\n\n(10) for Crohn disease only:\n\n(a) having smoked at least one pack-year of tobacco products before the clinical onset of Crohn disease, and where smoking has permanently ceased, the clinical onset of Crohn disease has occurred within four years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 \\- Dictionary.\n\n(b) where exposure to second-hand smoke has not permanently ceased:\n\n(i) being exposed to second-hand smoke for at least 5,000 hours before the clinical onset of Crohn disease; and\n\n(ii) the first exposure to second-hand smoke commenced at least one year before the clinical onset of Crohn disease;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 \\- Dictionary.\n\n(c) where exposure to second-hand smoke has permanently ceased before the clinical onset of Crohn disease:\n\n(i) being exposed to second-hand smoke for at least 5,000 hours; and\n\n(ii) the first exposure to second-hand smoke commenced at least one year before the clinical onset of Crohn disease; and\n\n(iii) the clinical onset of Crohn disease has occurred within four years of the last exposure to second-hand smoke;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 \\- Dictionary.\n\n(d) taking at least three courses of antibiotics within the five years before the clinical onset of Crohn disease, and the last course of antibiotics was completed at least six months before the clinical onset of Crohn disease;\n\n(e) inability to consume an average daily intake of at least ten grams of fibre in food for a period of at least five consecutive years within the ten years before the clinical onset of Crohn disease;\n\n(f) consuming an average of at least 100 grams per day of sucrose, for at least two consecutive years within the five years before the clinical onset of Crohn disease;\n\n> Note: The consumption of sucrose includes sucrose in soft drinks.\n\n(g) inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of Crohn disease;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n(h) being obese for at least five years within the 20 years before the clinical onset of Crohn disease;\n\n> Note: being obese is defined in the Schedule 1 - Dictionary.\n\n(11) for ulcerative colitis only, in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke between one and 20 years before the clinical onset of ulcerative colitis;\n\n> Note: regular smoking habit as specified is defined in the Schedule 1 \\- Dictionary.\n\n(12) taking a drug from the Specified List 2 of drugs for at least the seven days before the clinical worsening of inflammatory bowel disease;\n\n> Note: Specified List 2 of drugs is defined in the Schedule 1 - Dictionary.\n\n(13) taking an immune checkpoint inhibitor within the one year before the clinical worsening of inflammatory bowel disease;\n\n(14) taking a combined oral contraceptive pill for a continuous period of at least six months before the clinical worsening of inflammatory bowel disease and where taking the combined oral contraceptive pill has ceased, the clinical worsening of inflammatory bowel disease has occurred within one year of cessation;\n\n(15) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical worsening of inflammatory bowel disease;\n\n> Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(16) having a bowel infection within the 30 days before the clinical worsening of inflammatory bowel disease;\n\n(17) experiencing a category 1A stressor within the three months before the clinical worsening of inflammatory bowel disease;\n\n> Note: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(18) experiencing a category 1B stressor within the three months before the clinical worsening of inflammatory bowel disease;\n\n> Note: category 1B stressor is defined in the Schedule 1 - Dictionary.\n\n(19) experiencing a category 2 stressor within the 30 days before the clinical worsening of inflammatory bowel disease;\n\n> Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.\n\n> Note 2: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(20) having a clinically significant depressive disorder or a clinically significant anxiety disorder for at least the one year before the clinical worsening of inflammatory bowel disease;\n\n> Note: clinically significant is defined in the Schedule 1 - Dictionary.\n\n(21) for Crohn disease only:\n\n(a) having smoked at least one pack-year of tobacco products before the clinical worsening of Crohn disease, and where smoking has permanently ceased, the clinical worsening of Crohn disease has occurred within four years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 \\- Dictionary.\n\n(b) where exposure to second-hand smoke has not permanently ceased:\n\n(i) being exposed to second-hand smoke for at least 5,000 hours before the clinical worsening of Crohn disease; and\n\n(ii) the first exposure to second-hand smoke commenced at least one year before the clinical worsening of Crohn disease;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 \\- Dictionary.\n\n(c) where exposure to second-hand smoke has permanently ceased before the clinical worsening of Crohn disease:\n\n(i) being exposed to second-hand smoke for at least 5,000 hours; and\n\n(ii) the first exposure to second-hand smoke commenced at least one year before the clinical worsening of Crohn disease; and\n\n(iii) the clinical worsening of Crohn disease occurs within four years of the last exposure to second-hand smoke;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 \\- Dictionary.\n\n(d) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of Crohn disease;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n(22) for ulcerative colitis only, in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke between one and 20 years before the clinical worsening of ulcerative colitis;\n\n> Note: regular smoking habit as specified is defined in the Schedule 1 \\- Dictionary.\n\n(23) inability to obtain appropriate clinical management for inflammatory bowel disease.\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(12) to 9(23) apply only to material contribution to, or aggravation of, inflammatory bowel disease where the person's inflammatory bowel disease 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nbeing exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\nbeing obese means having a Body Mass Index (BMI) of 30 or greater.\n\n> Note: 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\ncategory 1A stressor means one of the following severe traumatic events:\n\n(a) being subject to a serious physical attack or assault including rape and sexual molestation;\n\n(b) being threatened with a weapon, being held captive, being kidnapped or being tortured; or\n\n(c) experiencing a life-threatening event.\n\ncategory 1B stressor means one of the following severe traumatic events:\n\n(a) being an eyewitness to a person being killed or critically injured;\n\n(b) being an eyewitness to atrocities inflicted on another person;\n\n(c) killing or maiming a person;\n\n(d) participating in the clearance of a corpse or a critically injured casualty; or\n\n(e) viewing a corpse or a critically injured casualty as an eyewitness.\n\n> Note: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.\n\ncategory 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel ongoing distress, concern or worry:\n\n(a) being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability;\n\n(b) being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;\n\n(c) experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation or divorce;\n\n(d) experiencing serious legal issues including being detained or held in custody, ongoing involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;\n\n(e) having a family member or significant other experience a major deterioration in their health;\n\n(f) having concerns in the work or school environment including ongoing disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful workloads, or experiencing bullying in the workplace or school environment; or\n\n(g) having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property or bankruptcy.\n\n> Note: significant other is also defined in the Schedule 1 - Dictionary.\n\nclinically significant means sufficient to warrant ongoing management. Management of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.\n\n> Note: To warrant ongoing management does not require that any actual management was received or given for the condition.\n\ncorpse means the human remains or body parts of one or more persons who have met a violent or horrific death.\n\n> Note: Examples of a violent or horrific death may include death due to suicide, gunshot, improvised explosive devices, natural and technological disasters, terrorist attacks or motor vehicle accidents. Seeing a closed body bag or viewing a body in an open-casket coffin are excluded from this definition.\n\nCrohn disease means a form of inflammatory bowel disease characterised by transmural inflammation and discontinuous areas of involvement along the bowel. The inflammation may lead to any of the following:\n\n(a) fibrosis;\n\n(b) fistulas;\n\n(c) obstructive clinical presentations;\n\n(d) sinus tracts; or\n\n(e) strictures.\n\neyewitness means a person who experiences an incident first-hand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.\n\ninflammatory bowel disease—see subsection 7(2).\n\nMET means a unit of measurement of the level of physical exertion. 1 MET \\= 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none 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\n> Note 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\n> Note 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\norgan or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\nregular smoking habit as specified means having smoked at least five pack-years of tobacco products, within a continuous five year period.\n\n> Note: pack-year of tobacco products is also defined in the Schedule 1 - Dictionary.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nsignificant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.\n\nSpecified List 1 of drugs means:\n\n(a) interferons;\n\n(b) isotretinoin; or\n\n(c) tumour necrosis factor antagonists.\n\nSpecified List 2 of drugs means:\n\n(a) interferons;\n\n(b) isotretinoin;\n\n(c) nonsteroidal anti-inflammatory drugs; or\n\n(d) tumour necrosis factor antagonists.\n\nterminal 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\nulcerative colitis means a form of inflammatory bowel disease characterised by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon. It almost invariably involves the rectum, and often involves more proximal portions of the colon in a continuous fashion.\n\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                          | Registration               | Commencement      | Application, saving and transitional provisions |\n| ----------------------------------------------------------------------------------------------------------------------------- | -------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning inflammatory bowel disease (Reasonable Hypothesis) (No. 90 of 2020)                        | 2 November 2020F2020L01388 | 30 November 2020  |                                                 |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128  | 19 September 2022 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                             | How affected      |\n| ---------------------------------------------- | ----------------- |\n| Section 2……………….                               | rep LA s 48D      |\n| Section 4……………….                               | rep LA s 48C      |\n| Subsection 9(10)(a) note……………………..             | rs No. 94 of 2022 |\n| Subsection 9(21)(a) note……………………..             | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument appears to maintain its original scope as a specific medical-determination tool for IBD under the Veterans' Entitlements Act framework. The 2022 amendment was minor — it simply updated the definition of 'one pack-year' to clarify tobacco measurement calculations. The core purpose (establishing service-connection factors for IBD compensation) remains unchanged from the 2020 original."},"complexity_factors":["23 distinct factors in section 9, many with nested sub-conditions (e.g., factor 9(10) has 8 sub-factors for Crohn's disease alone)","Disease-specific branching logic — different rules apply for Crohn's disease vs. ulcerative colitis vs. unspecified IBD","Multiple cross-references to defined terms in Schedule 1 Dictionary (approximately 20+ defined terms including 'one pack-year', 'MET', 'category 1A/1B/2 stressor', 'clinically significant')","Temporal requirements with precise windows (e.g., 'within 30 days', 'at least 5,000 hours', 'between one and 20 years')","Conditional logic with multiple prerequisites (e.g., factor 9(10)(c) requires three cumulative conditions plus a timing window)","Interaction with other Statements of Principles via section 11 (incorporation by reference)","Dual application structure — separate factors for 'clinical onset' (sections 9(1)-9(11)) vs 'clinical worsening' (sections 9(12)-9(23))","Specific exclusion in definition ('excludes bowel inflammation unrelated to autoimmunity') requiring medical diagnostic distinction"],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide when inflammatory bowel disease (including Crohn’s and ulcerative colitis) can be plausibly linked to Australian military service, so affected members can seek compensation. It identifies service‑related exposures, treatments, stressors and lifestyle factors that, if present, create a “reasonable hypothesis” of service causation.\n\nIt matters because it’s the rulebook that determines entitlement under veterans’ compensation law."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The instrument as compiled incorporates amending changes (Veterans' Entitlements (Statements of Principles—definition of \"one pack‑year\") Amendment Determination 2022 (No. 94 of 2022)) that altered the note to subsection 9(10)(a) and 9(21)(a) and the Schedule definition of one pack‑year (see Endnotes 3 and 4). Those amendments change the smoking‑related measurement used to qualify under the smoking‑linked factors and therefore modify who may meet those specific factors."},"complexity_factors":["Numerous discrete qualifying factors with tight temporal thresholds (see s.9(1)–(4), (6)–(9), (12)–(20)): multiple different time windows for onset and worsening.","Separate and conditionally applied factors for Crohn disease and ulcerative colitis with different thresholds (see s.9(10), (11), (21), (22)).","Multiple drug lists and categories (Specified List 1 and 2; immune checkpoint inhibitors; NSAIDs; oral contraceptives) cross‑referenced to onset or worsening (see s.9(1), (2), (3), (12)–(15)).","Heavy reliance on defined technical terms and measurements in the Schedule (pack‑year, BMI, MET, clinically significant, stressor categories), requiring factual proof and calculation (Schedule 1).","Service‑connection requirement: every listed factor must be related to relevant service to raise the reasonable hypothesis (see s.10(1)).","Conditional application rules where factors apply only to material contribution or aggravation if disease pre‑existed service (see s.10(2)).","Cross-reference mechanism to other Statements of Principles for overlapping injuries/diseases (see s.11).","Administrative interpretation and implementation discretion by medical and claims assessors (Repatriation Medical Authority determinations under s.196B(2) referenced at s.3 and s.8)."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide whether inflammatory bowel disease (IBD) or death from IBD can be connected to a person's military service for veterans’ benefit claims under the VEA and MRCA. It lists specific exposures, drug uses, stressors, medical and lifestyle factors and precise time windows that, if present and linked to relevant service, raise a “reasonable hypothesis” of service connection and so trigger consideration of entitlement."},"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-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020","history":"/api/acts/statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-inflammatory-bowel-disease-reasonable-hypothesis-no-90-of-2020/documents"}}