{"id":"F2024L01712","name":"Statement of Principles concerning Lyme disease/Lyme borreliosis (Balance of Probabilities) (No. 18 of 2025)","slug":"statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442690,"registerId":"F2024L01712-fast-fetch-1775957643429","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Lyme disease/Lyme borreliosis (Balance of Probabilities) (No. 18 of 2025)","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\nLYME DISEASE/LYME BORRELIOSIS  (Balance of Probabilities)\n\n(No. 18 of 2025)\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 17 December 2024.\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 Lyme disease/Lyme borreliosis (Balance of Probabilities) (No. 18 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 28 January 2025.\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 Lyme disease (Balance of Probabilities) (No. 26 of 2016) (Federal Register of Legislation No. F2016L00255) 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 Lyme disease/Lyme borreliosis and death from Lyme disease/Lyme borreliosis.\n\n\nMeaning of Lyme disease/Lyme borreliosis\n\n1.           For the purposes of this Statement of Principles, Lyme disease/Lyme borreliosis:\n  1.           means an infection with spirochete bacteria of the Borrelia burgdorferi sensu lato complex, which has been transmitted by the bite of a tick of the genus Ixodes, in a geographic location where Lyme disease/Lyme borreliosis is endemic.\n  2.           includes chronic untreated Lyme disease;\n  3.           excludes Lyme-like illness;\n\n\nNote 1: Borrelia species which are members of the Borrelia burgdorferi sensu lato complex include Borrelia burgdorferi, B. afzelii, B. americana, B. andersonii, B. bavariensis, B. bissettii, B. californiensis, B. carolinensis, B. finlandensis, B. garinii, B. japonica, B. kurtenbachii, B. lanei, B. lusitaniae, B.  mayonii, B. maritima, B sinica, B. spielmanii, B. tanukii, B. turdi, B. valaisiana, and B yangtzensis.\n\n \n\nNote 2: Ixodes species of tick known to transmit Borrelia spp. to humans include Ixodes dentatus, I. granulatus, I. jellisonii, I. minor, I. ovatus, I. pacificus, I. persulcatus, I. nipponensis, I. ricinus, I. scapularis, I. spinipalpis, I. tanukii, and I. turdus.\n\nNote 3: Geographic locations where Lyme disease/Lyme borreliosis is endemic include the United States of America, southern Canada, Europe, the United Kingdom, Russia, Japan, and north-eastern China.\n\nNote 4: Clinical manifestations of Lyme disease/Lyme borreliosis include a skin rash expanding out from the site of the tick bite (erythema migrans), headache, fatigue, joint pain and swelling, heart palpitations, irregular heartbeat, nerve pain, and facial palsy.\n\nNote 5: Lyme disease infection can be confirmed through laboratory testing of blood. The usual method is IgM and IgG serology (by enzyme-linked immunosorbent assay or immunofluorescence antibody test) followed by a Western blot if the serology was positive. Though Borrelia culture is considered the gold standard of diagnosis, it is difficult to achieve.\n\n1.           While Lyme disease/Lyme borreliosis attracts ICD‑10‑AM code A69.2, in applying this Statement of Principles the meaning of Lyme disease/Lyme borreliosis 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 Lyme disease/Lyme borreliosis\n\n1.           For the purposes of this Statement of Principles, Lyme disease/Lyme borreliosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Lyme disease/Lyme borreliosis.\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 Lyme disease/Lyme borreliosis and death from Lyme disease/Lyme borreliosis 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, Lyme disease/Lyme borreliosis or death from Lyme disease/Lyme borreliosis is connected with the circumstances of a person's relevant service:\n\n1.           being exposed to spirochetes of the Borrelia burgdorferi sensu lato complex within the 33 days before clinical onset;\n\n\n1.           being bitten by a tick of the genus Ixodes infected with spirochetes of the Borrelia burgdorferi sensu lato complex within the 33 days before clinical onset;\n\n\n1.           being in a geographic location where human Lyme disease/Lyme borreliosis was endemic within the 33 days before clinical onset;\n2.           inability to obtain appropriate clinical management for Lyme disease/Lyme borreliosis 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 factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, Lyme disease/Lyme borreliosis where the person's Lyme disease/Lyme borreliosis 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                               Lyme disease/Lyme borreliosis—see subsection 7(2).\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                             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 same scope as its predecessor (No. 26 of 2016). It continues to apply to specific service categories under the VEA and MRCA, uses the same balance of probabilities standard, and addresses the same disease. While it updates the scientific nomenclature (expanding the list of Borrelia species and tick vectors) and clarifies the exclusion of 'Lyme-like illness,' these are refinements within the original scope rather than expansions beyond it. The fundamental purpose—determining service connection for Lyme disease compensation—remains unchanged."},"complexity_factors":["Multiple defined terms in Schedule 1 (5 explicit definitions plus referenced terms like 'clinical onset' and 'clinical worsening' implied but not explicitly defined in the provided text)","Cross-references to two separate Acts (VEA and MRCA) and their specific service categories","Nested conditions in section 9(4) and section 10(2) limiting the application of the 'inability to obtain appropriate clinical management' factor to pre-existing conditions aggravated by service","Scientific specificity requiring identification of specific Borrelia species, Ixodes tick species, and endemic geographic locations","Exclusion clause ('excludes Lyme-like illness') creating a boundary condition that requires medical-legal interpretation","Dual application framework (balance of probabilities standard for both disease and death)","Incorporation by reference of ICD-10-AM coding system (Tenth Edition, 2017) with specific ISBN"],"plain_english_summary":"This instrument updates the compensation rules for Lyme disease claims by Australian veterans and defence members, replacing the 2016 Statement of Principles and narrowing the medical definition to infections from Borrelia burgdorferi complex transmitted by Ixodes ticks in specified regions while excluding “Lyme‑like illness.” \n\nIt matters because it clarifies who can prove service‑causation (peacetime and non‑operational service) and sets a medically significant 33‑day exposure window for establishing a connection 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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the 2016 Statement of Principles (s4) and replaces it with a version that defines Lyme disease as infection by Borrelia burgdorferi sensu lato transmitted by Ixodes ticks in specified endemic locations, sets a 33‑day exposure-to-onset window and alternative exposure-based factors, and limits the 'inability to obtain appropriate clinical management' factor to material contribution or aggravation where disease pre-existed or occurred during (but did not arise out of) relevant service (s7(2); s9; s10). These elements redefine the operative legal criteria used to determine entitlement under the VEA/MRCA (s5)."},"complexity_factors":["Technical infectious-disease taxonomy and species list for Borrelia (s7(2) and Notes)","Strict, short temporal threshold for exposure-to-onset (33 days) that governs causal linkage (s9(1)–(3))","Multiple alternative factual factors required (tick bite, exposure to infected spirochetes, presence in endemic location, inability to obtain care) creating varied evidentiary paths (s9)","Interaction with other Statements of Principles where a factor refers to another disease (s11) — requires cross-referencing and layered application","Service-connection requirement and limitation on the ‘inability to obtain clinical management’ factor to material contribution/aggravation where disease pre-existed or occurred during but not arising from service (s10)","Exclusion of 'Lyme-like illness' while tying the condition to a narrow microbiological definition (s7(2)(a)–(c))","Replaces a prior Statement of Principles, so decisions must account for commencement and repeal timing (s2, s4)","Application limited to claims under the VEA and MRCA (s5) — administrative scope and claimant pool defined","Non-normative diagnostic note (serology/Western blot/culture) present but not framed as mandatory proof (s7(2) Note 5) — evidentiary ambiguity for practitioners and decision-makers","Inclusion of death-by-terminal-event linkage and a defined list of terminal events in the Schedule, affecting causation assessments (Death from Lyme; Schedule)"],"plain_english_summary":"This Statement of Principles replaces the 2016 version and sets medical and service-linked criteria for recognising Lyme disease (infection by Borrelia burgdorferi sensu lato transmitted by Ixodes ticks in listed endemic areas) or death as connected to veterans’ relevant service under the VEA and MRCA. It requires evidence of tick exposure, endemic-location exposure, or inability to obtain appropriate clinical management within 33 days before clinical onset, and excludes \"Lyme‑like illness\". It matters because those criteria determine entitlement and the evidentiary burden on claimants."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2","history":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2/history","analysis":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2/analysis","conflicts":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2/important-cases","documents":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-balance-of-probabilities-no-18-of-2/documents"}}