{"id":"F2018L00886","name":"Statement of Principles concerning macular degeneration (Balance of Probabilities) (No. 60 of 2018)","slug":"statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439675,"registerId":"F2018L00886-fast-fetch-1775955610415","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning macular degeneration (Balance of Probabilities) (No. 60 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\nMACULAR DEGENERATION (Balance of Probabilities)\n\n(No. 60 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 June 2018\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 macular degeneration (Balance of Probabilities) (No. 60 of 2018).\n\n2 Commencement\n\n This instrument commences on 23 July 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning macular degeneration No. 14 of 2009 (Federal Register of Legislation No. F2009L01581) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 macular degeneration and death from macular degeneration.\n\nMeaning of macular degeneration\n\n(2) For the purposes of this Statement of Principles, macular degeneration:\n\n(a) means a group of degenerative diseases of the macula of the eye that may cause progressive, painless loss of central vision; and\n\n(b) includes:\n\n(i) early macular degeneration; and\n\n(ii) late macular degeneration; and\n\n(c) excludes toxic retinopathy.\n\nNote: early macular degeneration and late macular degeneration are defined in the Schedule 1 – Dictionary.\n\nDeath from macular degeneration\n\n(3) For the purposes of this Statement of Principles, macular degeneration, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's macular degeneration.\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 macular degeneration and death from macular degeneration 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, macular degeneration or death from macular degeneration is connected with the circumstances of a person's relevant service:\n\n(1) smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of macular degeneration, and:\n\n(a) smoking commenced at least five years before the clinical onset of macular degeneration; and\n\n(b) where smoking has ceased, the clinical onset of macular degeneration has occurred within 20 years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(2) consuming a cumulative total of at least 20 kilograms of alcohol in a continuous period of two years, within the five years before the clinical onset of macular degeneration;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(3) being obese for at least the five years before the clinical onset of macular degeneration;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(4) having chronic kidney disease within the five years before the clinical onset of macular degeneration;\n\nNote: chronic kidney disease is defined in the Schedule 1 - Dictionary. \n\n(5) smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of macular degeneration, and:\n\n(a) smoking commenced at least five years before the clinical worsening of macular degeneration; and\n\n(b) where smoking has ceased, the clinical worsening of macular degeneration has occurred within 20 years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(6) consuming a cumulative total of at least 20 kilograms of alcohol in a continuous period of two years, within the five years before the clinical worsening of macular degeneration;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(7) being obese for at least the five years before the clinical worsening of macular degeneration;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(8) having chronic kidney disease within the five years before the clinical worsening of macular degeneration;\n\nNote: chronic kidney disease is defined in the Schedule 1 - Dictionary. \n\n(9) for clinical worsening of wet macular degeneration manifesting as subretinal haemorrhage only, having anticoagulant therapy or thrombolytic therapy, within the seven days before the clinical worsening of macular degeneration;\n\nNote: anticoagulant therapy and thrombolytic therapy are defined in the Schedule 1 - Dictionary.\n\n(10) inability to obtain appropriate clinical management for macular degeneration.\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(5) to 9(10) apply only to material contribution to, or aggravation of, macular degeneration where the person's macular degeneration 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 an abnormality of kidney structure or function means:\n\n(a) having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or\n\n(b) having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or\n\n(c) having had a kidney transplant.\n\n anticoagulant therapy means therapeutic administration of a pharmacological agent which suppresses, delays or nullifies blood coagulation (such as heparin, warfarin or dicumarol), but excludes antiplatelet therapy (such as aspirin, clopidogrel, ticlopidine or monoclonal antibodies and recombinant and chemically synthesised peptides that block platelet adhesion or aggregation).\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 – Dictionary.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n chronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.\n\nNote: an abnormality of kidney structure or function is also defined in the Schedule 1 – Dictionary.\n\n early macular degeneration means:\n\n(a) drusen of at least medium size (≥63 μm); or\n\n(b) retinal pigmentary abnormalities; or\n\n(c) soft indistinct or reticular drusen.\n\n late macular degeneration means dry macular degeneration (geographic atrophy) or wet macular degeneration.\n\nNote: wet macular degeneration is also defined in the Schedule 1 – Dictionary.\n\n macular degeneration—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\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 thrombolytic therapy means therapeutic administration of a pharmacological agent which breaks up or dissolves blood clots (such as streptokinase or tissue plasminogen activator).\n\n VEA means the Veterans' Entitlements Act 1986.\n\n wet macular degeneration means choroidal neovascularisation and retinal angiomatous proliferation. It is also known as neovascular or exudative macular degeneration. Complications include subretinal haemorrhage.\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2009 predecessor and other similar instruments—establishing medical connection factors for a specific disease. The content is tightly focused on macular degeneration and does not expand into unrelated areas."},"complexity_factors":["15 defined terms in Schedule 1, including nested definitions (e.g., 'chronic kidney disease' depends on 'abnormality of kidney structure or function')","Mathematical calculations required: pack-years formula, BMI formula, alcohol conversion (10g per standard drink)","Temporal conditions throughout: multiple 'within X years' and 'for at least Y years' requirements that must be precisely calculated","Dual structure: factors repeated separately for 'clinical onset' and 'clinical worsening' with subtle variations","Cross-references to other Statements of Principles (section 11) and external legislation (VEA, MRCA)","Specific exclusion: toxic retinopathy is explicitly excluded from the definition","Conditional logic in section 10(2) restricting application of worsening factors to pre-existing conditions"],"plain_english_summary":"This instrument updates the 2009 guidance setting the medical \"factors\" used to decide, on the balance of probabilities, whether a veteran’s macular degeneration (or death from it) is connected to service. It affects claimants under the Veterans' Entitlements Act 1986 and MRCA 2004 and lists risk/causal circumstances (notably heavy smoking, heavy alcohol use, obesity, chronic kidney disease, certain treatments, and lack of care). Worsening-related factors apply only if the condition pre‑existed or arose during service. It is the practical gatekeeper for claims."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles concerning macular degeneration (No. 14 of 2009) (section 4) and replaces it with a new list of factors, timing windows and definitions. Compared with the earlier instrument (by implication), the 2018 SoP appears to broaden and clarify the set of relevant risk factors and add specific temporal thresholds and new items (for example, explicit alcohol consumption criteria, an explicit obesity (BMI) threshold, chronic kidney disease timing, a treatment‑related worsening factor for anticoagulant/thrombolytic therapy, and an \"inability to obtain appropriate clinical management\" criterion). It also distinguishes factors that support new onset from those that support material contribution or aggravation of a pre‑existing condition (section 10(2)). These changes indicate a substantive adjustment in scope and evidentiary framing relative to the earlier instrument, increasing the range of accepted pathways by which macular degeneration might be found service‑related and adding detailed evidentiary thresholds."},"complexity_factors":["Approximately 15 defined terms in Schedule 1 (e.g. chronic kidney disease, pack‑years, BMI, wet macular degeneration, anticoagulant/thrombolytic therapy, terminal event, MRCA, VEA).","Multiple temporal conditions and windows: 5 years (smoking onset and alcohol lookback), 20 years (smoking cessation window), 2 years continuous alcohol period, 7 days (anticoagulant/thrombolytic therapy) (section 9).","Separate rules for 'clinical onset' and 'clinical worsening' with largely duplicated factor lists and timing requirements (subsections 9(1)–9(9)).","A clause limiting some factors to material contribution or aggravation where the disease pre‑existed service (section 10(2)), introducing conditional application.","Cross‑reference to other Statements of Principles for overlapping injuries/diseases (section 11), requiring coordination across instruments.","Objective thresholds (e.g. 15 pack‑years, BMI ≥30) reduce some ambiguity but require historical evidence that may be hard to verify.","Repeal and replacement of an earlier 2009 SoP (section 4), implying possible substantive updating rather than purely clerical changes."],"plain_english_summary":"**What this instrument does (mechanics)\n\n- This is a Statement of Principles (SoP) used to decide whether macular degeneration (a disease of the central part of the retina) is connected to a person's \"relevant service\" for the purpose of veteran compensation and rehabilitation law (applies to claims under section 120B of the VEA or section 339 of the MRCA) (see sections 3 and 5).\n\n- It defines the disease covered: \"macular degeneration\" (including early and late forms, and excluding toxic retinopathy) and includes deaths where macular degeneration contributed to the terminal event (section 7).\n\n- The Repatriation Medical Authority states that, on the available medical evidence, it is \"more probable than not\" (the legal standard called the balance of probabilities) that macular degeneration can be related to relevant service (section 8).\n\n- The instrument lists specific risk factors. If at least one of those factors existed in the claimant and can be related to their relevant service, then macular degeneration (or death from it) can be considered connected with service on the balance of probabilities (sections 9 and 10).\n\n- The instrument repeals the earlier macular degeneration SoP from 2009 and commences on 23 July 2018 (sections 2 and 4).\n\n\nWho is affected and how it is applied\n\n- Who benefits: veterans or current/former members of the Forces who make claims under the VEA or MRCA for macular degeneration or death contributed to by macular degeneration. Establishing one of the listed factors increases the chance the condition will be accepted as service‑related (sections 5, 8–10).\n\n- Who decides: decision makers (primarily the Department of Veterans' Affairs and medical officers acting under the SoP) apply these principles. The Repatriation Medical Authority sets the list of factors and definitions (sections 3, 6 and Schedule 1).\n\n- Evidence required: medical and other documentary evidence to show the timing and existence of the listed factors (for example, medical records showing chronic kidney disease, records or testimony supporting smoking pack‑years, BMI records, alcohol consumption history, medication records for anticoagulant or thrombolytic therapy, or evidence of inability to obtain appropriate clinical management) (section 9 and Schedule 1 definitions).\n\n\nThe listed factors (summary of section 9 and Schedule 1)\n\n- Smoking: at least 15 pack‑years (with smoking starting at least 5 years before clinical onset or worsening, and if smoking ceased, onset/worsening must be within 20 years of cessation) (subsections 9(1) and 9(5)).\n\n- Alcohol: cumulative consumption of at least 20 kilograms of alcohol in a continuous two‑year period within the five years before clinical onset or worsening (subsections 9(2) and 9(6)). The instrument uses the Australian standard of 10 grams of alcohol per standard drink to calculate this (notes to section 9).\n\n- Obesity: being obese (BMI 30 or greater) for at least five years before clinical onset or worsening (subsections 9(3) and 9(7); Schedule 1).\n\n- Chronic kidney disease (CKD): having CKD within five years before clinical onset or worsening (subsections 9(4) and 9(8); Schedule 1 defines CKD and criteria).\n\n- Anticoagulant or thrombolytic therapy: for clinical worsening of wet macular degeneration that presents as subretinal haemorrhage only, receiving anticoagulant or thrombolytic therapy within seven days before the clinical worsening (subsection 9(9); Schedule 1 defines these therapies).\n\n- Inability to obtain appropriate clinical management for macular degeneration (subsection 9(10)).\n\n\nKey legal and operational limits\n\n- Causation standard: the SoP operates under the \"balance of probabilities\" standard — it lists factors that, if proved and related to service, allow decision makers to find a service connection (section 8).\n\n- Relationship to service: the listed factor must be related to the person's relevant service (section 10(1)). Some factors (9(5) to 9(10)) apply only when they materially contributed to or aggravated macular degeneration that the person already had before or during service (section 10(2)).\n\n- Interaction with other SoPs: if a listed factor refers to an injury/disease covered by another SoP, the terms of that other SoP apply (section 11).\n\n\nWhy this matters (stated purpose and practical implications)\n\n- The stated medical basis is that the RMA considers it more probable than not that macular degeneration can be related to relevant service (section 8). The SoP therefore creates objective thresholds and time windows that can be used to accept or reject claims.\n\n- Practical implications for claimants: claimants or their representatives must produce records or credible evidence showing the factor(s) and the timing requirements (for example, documentation of smoking history, alcohol consumption, BMI history, CKD diagnosis, medication records or evidence about access to care).\n\n- Administrative effects and evidentiary friction: the SoP reduces some medical discretion by giving concrete thresholds (pack‑years, BMI, defined time windows), but it also creates evidentiary burdens and areas of interpretation (for instance, proving historical alcohol consumption or past BMI). The \"inability to obtain appropriate clinical management\" criterion is open to factual assessment and could require contextual evidence (section 9(10)).\n\n\nAnalytical test of the instrument's claimed purpose (costs, incentives, trade‑offs and implementation risks)\n\n- Who pays: if connection to service is established, the Department of Veterans' Affairs may be liable for pensions, treatment and related benefits. The instrument itself does not alter rates or entitlements but changes the evidentiary gateway to them (sections 5 and 8).\n\n- Who decides and discretion: the RMA prescribes factors and definitions; decision makers apply them. Objective thresholds reduce some subjective medical judgment but still require medical interpretation of records, so administrative discretion remains in assessing evidence quality and timing (sections 6, 9, Schedule 1).\n\n- Compliance and verification burden: proving past exposure (pack‑years, alcohol over a two‑year window, five‑year BMI history, CKD present for three months, or recent anticoagulant therapy) may be straightforward where good records exist and difficult where they do not. This creates an evidence‑gathering burden for claimants and an assessment workload for the Department.\n\n- Incentives and private behaviour: any effect on private behaviour (e.g. smoking or drinking) is indirect and speculative. The immediate behavioral effect is likely on claims behaviour: people with the listed risk factors will be more likely to pursue claims; decision makers will request focussed historical evidence.\n\n- Concentrated benefits and diffuse costs: beneficiaries with the specified risk factors obtain clearer routes to acceptance; fiscal costs of additional accepted claims are spread across the veterans' compensation system. The instrument narrows causation to particular risk profiles rather than creating broad open‑ended liabilities.\n\n- Implementation risks: difficulty in proving historic exposures, potential disputes about the timing of clinical onset or worsening, and the interpretive scope of \"inability to obtain appropriate clinical management\" are the main operational risks. The cross‑application rule (section 11) requires coordination when a factor is covered elsewhere.\n\n\nBottom line in one sentence\n\n- This SoP sets objective medical thresholds and time windows (smoking pack‑years, alcohol limits, obesity, chronic kidney disease, recent anticoagulant/thrombolytic therapy, and lack of appropriate care) that, if proved and linked to relevant service, permit a finding that macular degeneration (or death from it) is service‑related on the balance of probabilities (sections 7–11 and Schedule 1)."},"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-macular-degeneration-balance-of-probabilities-no-60-of-2018","history":"/api/acts/statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-macular-degeneration-balance-of-probabilities-no-60-of-2018/documents"}}