{"id":"F2023L00489","name":"Statement of Principles concerning melioidosis (Balance of Probabilities) (No. 56 of 2023)","slug":"statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441833,"registerId":"F2023L00489-fast-fetch-1775957025268","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning melioidosis (Balance of Probabilities) (No. 56 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nMELIOIDOSIS (Balance of Probabilities)\n\n(No. 56 of 2023)\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 24 April 2023.\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:
|\n| --- |\n|
Professor Terence Campbell AM
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 melioidosis (Balance of Probabilities) (No. 56 of 2023).\n\n2 Commencement\n\n This instrument commences on 23 May 2023.\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 melioidosis No. 61 of 2014 (Federal Register of Legislation No. F2014L00934) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 melioidosis and death from melioidosis.\n\nMeaning of melioidosis\n\n(2) For the purposes of this Statement of Principles, melioidosis means an illness caused by infection with the bacterium Burkholderia pseudomallei.\n\nNote: Melioidosis may present as an acute, chronic or latent infection. Clinical manifestations may be local or systemic, and include pulmonary infection, septicaemia, meningoencephalitis and chronic suppurative infection.\n\n(3) While melioidosis attracts ICD‑10‑AM codes A24.1, A24.2, A24.3 or A24.4, in applying this Statement of Principles the meaning of melioidosis 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 melioidosis\n\n(5) For the purposes of this Statement of Principles, melioidosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's melioidosis.\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 melioidosis and death from melioidosis 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, melioidosis or death from melioidosis is connected with the circumstances of a person's relevant service:\n\n(1) being exposed to Burkholderia pseudomallei before the clinical onset of melioidosis;\n\nNote: being exposed to Burkholderia pseudomallei is defined in the Schedule 1 – Dictionary.\n\n(2) being in an immunocompromised state as specified at the time of the clinical onset of melioidosis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary. \n\n(3) having a medical condition from the specified list of medical conditions at the time of the clinical onset of melioidosis;\n\nNote: specified list of medical conditions is defined in the Schedule 1 – Dictionary.\n\n(4) for males, having consumed at least 65 kilograms of alcohol within the 3 years before the clinical onset of melioidosis;\n\nNote: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(5) for females, having consumed at least 44 kilograms of alcohol within the 3 years before the clinical onset of melioidosis;\n\nNote: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(6) having alcohol use disorder at the time of the clinical onset of melioidosis;\n\n(7) inability to obtain appropriate clinical management for melioidosis.\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 factor set out in subsection 9(7) applies only to material contribution to, or aggravation of, melioidosis where the person's melioidosis 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 albuminuria means an albumin to creatinine ratio of at least 3 mg/mmol.\n\n being exposed to Burkholderia pseudomallei means:\n\n(a) consuming water or food contaminated with Burkholderia pseudomallei;\n\n(b) having direct contact of the skin or mucous membranes with:\n\n(i) a fluid contaminated with Burkholderia pseudomallei;\n\n(ii) blood, body fluid or tissue from an animal or person infected with Burkholderia pseudomallei; or\n\n(iii) water or soil contaminated with Burkholderia pseudomallei;\n\n(c) inhaling dust, water or an aerosol contaminated with Burkholderia pseudomallei; or\n\n(d) undergoing a medical procedure involving an object contaminated with Burkholderia pseudomallei.\n\nNote: direct contact is defined in Schedule 1 – Dictionary.\n\n chronic kidney disease means:\n\n(a) having a glomerular filtration rate of less than 60 ml/min/1.73 m2 for at least 3 months;\n\n(b) having albuminuria for at least 3 months;\n\n(c) having kidney damage, as evidenced by renal biopsy, imaging studies, urinary sediment abnormalities or other markers of abnormal renal function; or\n\n(d) having had a kidney transplant.\n\nNote: albuminuria is defined in the Schedule 1 - Dictionary.\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 ml/min/1.73 m2 for a period of at least 3 months; \n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n direct contact means physical contact where no protective or impermeable barrier is used.\n\n immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) having a haematological or solid organ malignancy;\n\n(b) having chronic renal failure;\n\n(c) having severe malnutrition;\n\n(d) taking an immunosuppressive drug; or\n\n(e) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure and immunosuppressive drug are defined in the Schedule 1 - Dictionary.\n\n immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\nNote: Examples of an immunosuppressive drug include:\n\n(a) chemotherapeutic agents used for the treatment of cancer;\n\n(b) corticosteroids, other than inhaled or topical corticosteroids;\n\n(c) drugs used to prevent transplant rejection; and\n\n(d) tumour necrosis factor-α inhibitors.\n\n melioidosis—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 defined in the Schedule 1 - Dictionary.\n\n specified list of medical conditions means:\n\n(a) chronic kidney disease;\n\n(b) chronic lung disease including bronchiectasis and chronic obstructive pulmonary disease;\n\n(c) cirrhosis of the liver;\n\n(d) diabetes mellitus;\n\n(e) heart failure; or\n\n(f) rheumatic heart disease.\n\nNote: chronic kidney disease is 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\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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument maintaining the established scope of Repatriation Medical Authority Statements of Principles. It updates the 2014 version with current medical evidence but does not expand beyond the traditional function of defining service-connected disease factors for veterans' compensation purposes. The structure and purpose remain consistent with the legislative scheme established under section 196B(3) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Moderate definitional density: 12 defined terms in Schedule 1, with several terms (albuminuria, chronic kidney disease, chronic renal failure) containing nested medical thresholds","Cross-referential structure: definitions rely on other definitions (e.g., 'immunocompromised state' references 'chronic renal failure' which references 'glomerular filtration rate')","Quantified thresholds requiring calculation: alcohol consumption factors specify exact kilogram amounts requiring conversion from standard drinks (10g alcohol per drink)","Conditional gender bifurcation: separate alcohol thresholds for males (65kg) and females (44kg) over 3-year lookback period","Temporal restrictions: Factor 9(7) has a specific temporal limitation (applies only to pre-existing conditions, not new onset during service)","External document incorporation: references ICD-10-AM Tenth Edition with specific ISBN and effective date for coding purposes","Dual statutory framework application: instrument operates across two separate Acts (VEA and MRCA) with different service definitions"],"plain_english_summary":"This instrument updates the test for when Australian veterans and defence members can claim compensation for melioidosis, replacing the 2014 guidance and applying a \"balance of probabilities\" standard. It sets a closed list of seven risk factors — at least one must be proven and connected to service — and governs claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It matters because melioidosis can remain latent for years after tropical deployments."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning melioidosis No. 61 of 2014 (s4) and substitutes a new Statement setting out updated definitions and qualifying factors. The instrument itself does not provide a textual comparison to show substantive differences from the repealed instrument, so whether and how the legal scope of entitlement has been expanded or narrowed cannot be determined from this text alone."},"complexity_factors":["Interplay between administrative law and medical evidence: decision rule is 'balance of probabilities' (s8) applied by the Repatriation Medical Authority (s3).","Multiple cross‑referenced statutes and instruments: relies on VEA and MRCA for application (s5, Schedule 1 definitions).","Technical medical definitions and numeric thresholds in the Schedule (e.g. GFR cutoffs for chronic kidney disease and chronic renal failure, albuminuria) requiring clinical interpretation.","Behavioral/quantitative thresholds for alcohol consumption expressed in kilograms over 3 years and gender‑specific limits (s9(4)–(5); Schedule 1 alcohol note).","Broad definition of 'being exposed' to Burkholderia pseudomallei covering ingestion, inhalation, direct contact and contaminated medical objects (Schedule 1).","Temporal and causation framing: factors must exist at clinical onset and must be related to 'relevant service' (s9, s10), creating evidentiary and timing issues.","Cross‑application to other Statements of Principles where a factor refers to another injury/disease (s11), creating dependency on other instruments' terms.","Specific exception for factor 9(7) (inability to obtain appropriate clinical management) which only applies to material contribution or aggravation where melioidosis pre‑dated or was contracted before/during service but did not arise out of it (s10(2))."],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the medical criteria used to determine, on the balance of probabilities, whether melioidosis (including death from melioidosis) is connected to a person’s relevant service under the Veterans’ Entitlements Act or the Military Rehabilitation and Compensation Act. It lists specific qualifying factors — exposure to Burkholderia pseudomallei, certain medical conditions or immunocompromised states, measured alcohol consumption thresholds, alcohol use disorder, or inability to obtain appropriate clinical management — and requires at least one factor to be related to service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023","history":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-melioidosis-balance-of-probabilities-no-56-of-2023/documents"}}