{"id":"F2019L00222","name":"Statement of Principles concerning methaemoglobinaemia (Reasonable Hypothesis) (No. 17 of 2019)","slug":"statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439939,"registerId":"F2019L00222-fast-fetch-1775955767896","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning methaemoglobinaemia (Reasonable Hypothesis) (No. 17 of 2019)","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\nMETHAEMOGLOBINAEMIA (Reasonable Hypothesis)\n\n(No. 17 of 2019)\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 1 March 2019\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 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 methaemoglobinaemia (Reasonable Hypothesis) (No. 17 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning methaemoglobinaemia No. 47 of 2010 (Federal Register of Legislation No. F2010L01660) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 methaemoglobinaemia and death from methaemoglobinaemia.\n\nMeaning of methaemoglobinaemia\n\n(2) For the purposes of this Statement of Principles, methaemoglobinaemia:\n\n(a) means a greater than normal amount of methaemoglobin in the blood as a result of the oxidation of haem iron to the ferric state, making it less able to bind with oxygen; and\n\n(b) causes clinical manifestations such as cyanosis, headache or fatigue; and\n\n(c) includes the heterozygous form of NADH-methaemoglobin reductase deficiency restricted to red blood cells but excludes other forms of congenital methaemoglobinaemia.\n\n(3) While methaemoglobinaemia attracts ICD‑10‑AM code D74, in applying this Statement of Principles the meaning of methaemoglobinaemia 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 methaemoglobinaemia\n\n(5) For the purposes of this Statement of Principles, methaemoglobinaemia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's methaemoglobinaemia.\n\nNote: 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 methaemoglobinaemia and death from methaemoglobinaemia 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\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 methaemoglobinaemia or death from methaemoglobinaemia with the circumstances of a person's relevant service:\n\n(1) taking or being treated with a drug that causes oxidation of haemoglobin, within the two days before the clinical onset of methaemoglobinaemia;\n\nNote: Drugs that cause methaemoglobinaemia include, but are not limited to, dapsone; 8‑aminoquinolines such as primaquine or tafenoquine; chloroquine; nitrates such as nitroglycerine; nitrites such as amyl nitrite; local anaesthetics such as benzocaine; and sulphonamide antibiotics.\n\n(2) inhaling, ingesting or having cutaneous contact with a chemical agent that causes oxidation of haemoglobin, within the two days before the clinical onset of methaemoglobinaemia;\n\nNote: Chemicals that cause methaemoglobinaemia include, but are not limited to, aniline and its derivatives (for example, found in dyes); naphthalene (for example, found in mothballs); nitrobenzenes (for example, found in solvents and paints); nitrogen oxide (for example, found in smoke from fires); paraquat (for example, found in herbicides); and chlorates, nitrates and nitrotoluenes (for example, found in explosives).\n\n(3) ingesting food or fluid contaminated by excess levels of nitrates or nitrites, within the two days before the clinical onset of methaemoglobinaemia;\n\n(4) being exposed to dialysis fluid contaminated with chloramine or hydrogen peroxide, within the two days before the clinical onset of methaemoglobinaemia;\n\n(5) taking or being treated with a drug that causes oxidation of haemoglobin, within the two days before the clinical worsening of methaemoglobinaemia;\n\nNote: Drugs that cause methaemoglobinaemia include, but are not limited to, dapsone; 8‑aminoquinolines such as primaquine or tafenoquine; chloroquine; nitrates such as nitroglycerine; nitrites such as amyl nitrite; local anaesthetics such as benzocaine; and sulphonamide antibiotics.\n\n(6) inhaling, ingesting or having cutaneous contact with a chemical agent that causes oxidation of haemoglobin, within the two days before the clinical worsening of methaemoglobinaemia;\n\nNote: Chemicals that cause methaemoglobinaemia include, but are not limited to, aniline and its derivatives (for example, found in dyes); naphthalene (for example, found in mothballs); nitrobenzenes (for example, found in solvents and paints); nitrogen oxide (for example, found in smoke from fires); paraquat (for example, found in herbicides); and chlorates, nitrates and nitrotoluenes (for example, found in explosives).\n\n(7) ingesting food or fluid contaminated by excess levels of nitrates or nitrites, within the two days before the clinical worsening of methaemoglobinaemia;\n\n(8) being exposed to dialysis fluid contaminated with chloramine or hydrogen peroxide, within the two days before the clinical worsening of methaemoglobinaemia;\n\n(9) inability to obtain appropriate clinical management for methaemoglobinaemia.\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(9) apply only to material contribution to, or aggravation of, methaemoglobinaemia where the person's methaemoglobinaemia 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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n methaemoglobinaemia—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 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 is a standard replacement instrument that maintains the established scope of Repatriation Medical Authority Statements of Principles. It repeals the 2010 version (No. 47 of 2010) and updates the ICD-10-AM reference to the Tenth Edition (2017). The structure and purpose remain consistent with the original legislative framework established under section 196B(2) of the Veterans' Entitlements Act 1986 — to provide medical criteria for determining service-relatedness of specific conditions. No significant scope creep is evident."},"complexity_factors":["Moderate cross-referencing between the VEA and MRCA compensation schemes","Dual application structure — distinguishes between causing new condition (factors 1-4) versus aggravating pre-existing condition (factors 5-9)","Nested definitions requiring lookup in Schedule 1 Dictionary (terminal event, relevant service, MRCA, VEA)","Temporal limitation language ('within the two days before') repeated across 8 factors","Exclusion clause in definition — specifically excludes 'other forms of congenital methaemoglobinaemia' while including one specific genetic form","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Incorporation by reference mechanism in section 11 — defers to other Statements of Principles for related conditions"],"plain_english_summary":"This Statement of Principles sets the medical test for linking methaemoglobinaemia — a blood disorder that impairs oxygen delivery — to service for veterans, peacekeepers, and current/former ADF members claiming under VECA or MRCA. \n\nIt applies the lower \"reasonable hypothesis\" standard and identifies service-related exposures and treatment failures (medications, chemical or nitrate exposure, contaminated dialysis/food/water, or inadequate care) that, if connected to service, support a compensable claim."},"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":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the prior 2010 Statement (s4) and replaces it with a Statement that: clarifies the medical definition and ICD coding approach (s7(2)–(4)); explicitly includes one inherited form and excludes others (s7(2)(c)); sets specific two‑day exposure windows for onset and worsening (s9(1)–(8)); adds inability to obtain appropriate clinical management as a factor (s9(9)); and clarifies when aggravation/material contribution rules apply to pre‑existing conditions (s10(2)). It also specifies application to VEA s120A and MRCA s338 claims (s5)."},"complexity_factors":["Technical medical definitions and coding: detailed definition of methaemoglobinaemia and reference to ICD-10-AM (s7(2)–(4)).","Tight temporal windows for causation: most exposure factors require occurrence within two days before clinical onset or worsening (s9(1)–(8)).","Multiple distinct exposure pathways: drugs, airborne/dermal/ingested chemicals, contaminated food/fluid, contaminated dialysis fluid, and clinical management failures (s9(1)–(8), s9(9)).","Nuanced relation-to-service rules: factors must be related to 'relevant service' (s10(1)); aggravation/material contribution rules apply only where condition existed before or during service (s10(2)).","Cross-references to other Statements of Principles where a factor concerns another injury/disease (s11).","Exclusions and inclusions: includes heterozygous NADH‑methaemoglobin reductase deficiency restricted to red blood cells but excludes other congenital forms (s7(2)(c)).","Administrative determination standard: RMA bases the Statement on 'sound medical‑scientific evidence' and applies discretion in linking condition to service (s8).","Application limits and repeal: instrument applies only to claims under VEA s120A or MRCA s338 (s5) and repeals the 2010 Statement (s4), creating potential transitional interpretation issues."],"plain_english_summary":"This instrument sets the medical criteria used to decide when methaemoglobinaemia (including certain inherited forms) and deaths from it can be connected to a person's military or peacekeeping service for VEA/MRCA claims. It replaces the prior 2010 Statement of Principles.\n\nIt lists specific triggers—drug or chemical exposure, contaminated food or dialysis fluid, and lack of appropriate clinical management—and requires those exposures to be related to relevant service and generally to occur within two days of onset or worsening. The Repatriation Medical Authority applies these rules when assessing claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019","history":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-methaemoglobinaemia-reasonable-hypothesis-no-17-of-2019/documents"}}