{"id":"F2024L01711","name":"Statement of Principles concerning Lyme disease/Lyme borreliosis (Reasonable Hypothesis) (No. 17 of 2025)","slug":"statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442692,"registerId":"F2024L01711-fast-fetch-1775957643458","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 (Reasonable Hypothesis) (No. 17 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  (Reasonable Hypothesis)\n\n(No. 17 of 2025)\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    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   \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  (Reasonable Hypothesis) (No. 17 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning Lyme disease (Reasonable Hypothesis) (No. 25 of 2016) (Federal Register of Legislation No. F2016L00254) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that Lyme disease/Lyme borreliosis  and death from Lyme disease/Lyme borreliosis  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\n1.                Factors that must exist\n\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 Lyme disease/Lyme borreliosis  or death from Lyme disease/Lyme borreliosis  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;\n2.           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;\n3.           being in a geographic location where human Lyme disease/Lyme borreliosis was endemic within the 33 days before clinical onset;\n4.           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(2) 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)          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 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_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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the Statement of Principles concerning Lyme disease (No. 25 of 2016) (section 4) and replaces it with new, source‑specific definitions and criteria. It defines Lyme disease as infection by Borrelia burgdorferi sensu lato transmitted by Ixodes ticks in listed endemic locations, expressly includes chronic untreated Lyme disease and excludes 'Lyme‑like illness' (subsection 7(2) and Notes). It sets a 33‑day exposure/onset window and a factor for inability to obtain appropriate care with a limited nexus rule (section 9; section 10(2)). The instrument applies to claims under the VEA and MRCA (section 5)."},"complexity_factors":["Technical biological scope: precise definition of causative organisms (Borrelia burgdorferi sensu lato) and listed Ixodes vector species increases specialist interpretation needs (see subsection 7(2) and Notes 1–2).","Temporal rule: a strict 33‑day window for exposure/onset creates a bright‑line but narrow evidentiary timeframe (section 9(1)–(3)).","Interaction with service law: applies to VEA and MRCA claims and requires the factors to be related to 'relevant service', implicating statutory service definitions and claim pathways (sections 3, 5, Schedule 1 definitions of relevant service).","Nexus nuance for management failings: the inability to obtain appropriate clinical management (section 9(4)) is limited to material contribution or aggravation and only where the disease was suffered or contracted before/during but did not arise out of service (section 10(2)), adding interpretive complexity.","Cross‑references to other Statements of Principles: factors that implicate other injuries/diseases defer to those Statements as in force, requiring cross‑instrument reading (section 11).","Death inclusion and terminal event definition: includes death from a terminal event contributed to by Lyme disease and defines 'terminal event', affecting causation assessments (section 7(5); Schedule 1).","Diagnostic standard references: references to ICD‑10‑AM coding and serology/WB testing methods create reliance on external clinical standards and lab evidence (subsection 7(3)–(5) and Notes).","Repeal and replacement: repeal of the 2016 Statement requires reviewing differences and administrative transition for ongoing claims (section 4)."],"plain_english_summary":"This Statement of Principles sets the legal test used to decide whether Lyme disease (or death from it) can be connected to a veteran’s or serving member’s relevant service for VEA/MRCA claims. It replaces the 2016 Statement and, in practical terms, defines the infection (organisms, tick vectors and endemic places), includes chronic untreated cases, excludes “Lyme‑like illness”, and specifies four factual factors (notably a 33‑day exposure/onset window and inability to obtain appropriate care) that, if linked to service, raise a reasonable hypothesis."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same scope as its 2016 predecessor. It remains a specific medical determination for a single disease under the veterans' compensation framework. The update reflects new medical knowledge (expanded list of Borrelia species and tick vectors, updated endemic regions) but does not expand beyond the original purpose of establishing service connection criteria for Lyme disease claims."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (Lyme disease/Lyme borreliosis, MRCA, relevant service, terminal event, VEA)","Simple conditional structure: four alternative factors in section 9, only one of which must be satisfied","Minimal cross-referencing — primarily internal references to the Dictionary and the two principal Acts (VEA and MRCA)","Clear delineation between what is included (chronic untreated Lyme disease) and excluded (Lyme-like illness)","Straightforward temporal limitation (33 days before clinical onset) with no nested exceptions","Single purpose instrument with no subsidiary provisions or regulatory mechanisms"],"plain_english_summary":"This instrument sets when Australian veterans and defence members can claim Lyme disease as service‑related for compensation, replacing a 2016 rule with updated medical evidence. It defines Lyme disease as Borrelia infection from Ixodes ticks in recognised endemic regions, excludes unproven “Lyme‑like” diagnoses, and establishes criteria (including a 33‑day exposure window, tick/geographic links, and treatment access considerations) the Repatriation Medical Authority will use to form a “reasonable hypothesis” for benefits and care."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025","history":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-lyme-disease-lyme-borreliosis-reasonable-hypothesis-no-17-of-2025/documents"}}