{"id":"F2022L00003","name":"Statement of Principles concerning narcolepsy (Balance of Probabilities) (No. 12 of 2022)","slug":"statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441154,"registerId":"F2022L00003-fast-fetch-1775956529192","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning narcolepsy (Balance of Probabilities) (No. 12 of 2022)","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\nNARCOLEPSY (Balance of Probabilities)\n\n(No. 12 of 2022)\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 December 2021\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 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 narcolepsy (Balance of Probabilities) (No. 12 of 2022).\n\n2 Commencement\n\n This instrument commences on 31 January 2022.\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 narcolepsy No. 8 of 2014 (Federal Register of Legislation No. F2014L00025) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 narcolepsy and death from narcolepsy.\n\nMeaning of narcolepsy\n\n(2) For the purposes of this Statement of Principles, narcolepsy:\n\n(a) means a chronic neurological disorder of sleep regulation and wakefulness characterised by disabling, excessive and irresistible daytime sleepiness lasting for at least 3 months, with varying amounts of cataplexy, hypnagogic hallucinations, and sleep paralysis; and\n\n(b) includes:\n\n(i) narcolepsy with cataplexy (narcolepsy type 1); and\n\n(ii) narcolepsy without cataplexy (narcolepsy type 2); and\n\n(c) excludes:\n\n(iii) early onset narcolepsy; and\n\n(iv) daytime sleepiness caused by another condition which disrupts the duration or quality of sleep.\n\nNote 1: Narcolepsy type 1 is characterised by cataplexy along with sleepiness at the onset of the disorder. It is related to a deficiency of orexin due to selective loss of orexin-secreting neurons in the hypothalamus, with little or no detectable orexin in the cerebrospinal fluid.\n\nNote 2: Narcolepsy type 2 is characterised by sleepiness that may occur with hypnagogic hallucinations and sleep paralysis, but cataplexy is not present. Levels of cerebrospinal fluid orexin are usually normal.\n\nNote 3: The diagnosis of narcolepsy is established by appropriate clinical testing, including sleep studies, the multiple sleep latency test (MSLT) and measurement of orexin levels in the cerebrospinal fluid.\n\nNote 4: Examples of other conditions that can cause daytime sleepiness include circadian rhythm sleep-wake disorders (for example, rotating shift work), insufficient sleep, and the effect of medication or substances or their withdrawal.\n\nNote 5: cataplexy, hypnagogic hallucinations and sleep paralysis are defined in the Schedule 1 - Dictionary.\n\n(3) While narcolepsy attracts ICD‑10‑AM code G47.4, in applying this Statement of Principles the meaning of narcolepsy 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 narcolepsy\n\n(5) For the purposes of this Statement of Principles, narcolepsy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's narcolepsy.\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 narcolepsy and death from narcolepsy 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, narcolepsy or death from narcolepsy is connected with the circumstances of a person's relevant service:\n\n(1) having concussion or moderate to severe traumatic brain injury within the 2 years before the clinical onset of narcolepsy, and in the case of sustained unconsciousness following injury to the head, the clinical onset of narcolepsy occurred within 2 years of regaining consciousness;\n\n(2) having a neurosurgical procedure involving the hypothalamus, midbrain or brainstem, within the 2 years before the clinical onset of narcolepsy;\n\n(3) undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, within the 3 years before the clinical onset of narcolepsy;\n\n(4) having a neurological disease, neurodegenerative disease or a paraneoplastic neurological syndrome, where the disease or syndrome involves the hypothalamus, midbrain or brainstem, within the 2 years before the clinical onset of narcolepsy;\n\nNote: Examples of neurological diseases, neurodegenerative diseases or paraneoplastic neurological syndromes that can involve the hypothalamus, midbrain or brainstem include:\n\n(i) cerebrovascular accident;\n\n(ii) disseminated encephalomyelitis;\n\n(iii) hypoxic cerebral insult;\n\n(iv) multiple sclerosis;\n\n(v) neuromyelitis optica spectrum disorder; and\n\n(vi) Parkinson's disease.\n\n(5) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-malignant space occupying lesion;\n\ninvolving the hypothalamus, midbrain or brainstem within the 2 years before the clinical onset of narcolepsy;\n\nNote 1: Examples of neoplasms that can involve the hypothalamus, midbrain or brainstem include lymphoma, glioma and craniopharyngioma.\n\nNote 2: Examples of non-malignant space occupying lesions that can involve the hypothalamus, midbrain or brainstem include neurosarcoidosis and vascular malformations.\n\n(6) receiving the adjuvanted influenza H1N1 vaccine PandemrixTM within the 2 years before the clinical onset of narcolepsy;\n\n(7) having infection of the pharynx with Streptococcus pyogenes within the 3 years before the clinical onset of narcolepsy;\n\n(8) having concussion or moderate to severe traumatic brain injury within the 2 years before the clinical worsening of narcolepsy, and in the case of sustained unconsciousness following injury to the head, the clinical worsening of narcolepsy occurred within 2 years of regaining consciousness;\n\n(9) having a neurosurgical procedure involving the hypothalamus, midbrain or brainstem, within the 2 years before the clinical worsening of narcolepsy;\n\n(10) undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, within the 3 years before the clinical worsening of narcolepsy;\n\n(11) having a neurological disease, neurodegenerative disease or a paraneoplastic neurological syndrome, where the disease or syndrome involves the hypothalamus, midbrain or brainstem, within the 2 years before the clinical worsening of narcolepsy;\n\nNote: Examples of neurological diseases, neurodegenerative diseases or paraneoplastic neurological syndromes that can involve the hypothalamus, midbrain or brainstem include:\n\n(i) cerebrovascular accident;\n\n(ii) disseminated encephalomyelitis;\n\n(iii) hypoxic cerebral insult;\n\n(iv) multiple sclerosis;\n\n(v) neuromyelitis optica spectrum disorder; and\n\n(vi) Parkinson's disease.\n\n(12) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-malignant space occupying lesion;\n\ninvolving the hypothalamus, midbrain or brainstem within the 2 years before the clinical worsening of narcolepsy;\n\nNote 1: Examples of neoplasms that can involve the hypothalamus, midbrain or brainstem include lymphoma, glioma and craniopharyngioma.\n\nNote 2: Examples of non-malignant space occupying lesions that can involve the hypothalamus, midbrain or brainstem include neurosarcoidosis and vascular malformations.\n\n(13) receiving the adjuvanted influenza H1N1 vaccine PandemrixTM within the 2 years before the clinical worsening of narcolepsy;\n\n(14) having infection of the pharynx with Streptococcus pyogenes within the 3 years before the clinical worsening of narcolepsy;\n\n(15) inability to obtain appropriate clinical management for narcolepsy.\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(8) to 9(15) apply only to material contribution to, or aggravation of, narcolepsy where the person's narcolepsy 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 cataplexy means a transient attack of extreme generalised weakness, often precipitated by an emotional response, such as surprise, fear or anger.\n\n hypnagogic hallucinations means vivid, often frightening visual, tactile or auditory hallucinations that occur as the person is falling asleep.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n narcolepsy—see subsection 7(2).\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 sleep paralysis means the complete inability to move for 1 or 2 minutes immediately after awakening. It may also occur just before falling asleep.\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":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles concerning narcolepsy No. 8 of 2014 (s4) and replaces it with the current definition, exclusions, and a revised list of causal and aggravating factors with specified timeframes (s7, s9). Consequently, the statutory criteria applied to VEA/MRCA claims (s5) change from the earlier instrument to the terms set out here."},"complexity_factors":["Medical and diagnostic detail: clinical definition of narcolepsy and reliance on sleep studies, MSLT and orexin measurement (s7, notes 1–3).","Multiple temporal windows and event types for causation and aggravation (2‑year and 3‑year limits in s9).","Distinction between clinical onset and clinical worsening and separate factor lists for each (s9(1)–(7) vs s9(8)–(15); s10(2)).","Overlap and cross‑reference to other Statements of Principles when a factor refers to another injury or disease (s11).","Requirement that factors be related to \"relevant service\", invoking VEA/MRCA definitions (s5, s10; Schedule).","Explicit exclusions and scope limits (eg. early onset narcolepsy and other causes of daytime sleepiness) (s7(2)(c); s7(2)(b)–(c) notes).","Legal standard and evidentiary framing: 'balance of probabilities' guided by RMA's view of medical‑scientific evidence (s8).","Repeal and replacement of prior Statement (s4), creating potential transitional/interpretive issues where claims span instruments."],"plain_english_summary":"This instrument (s3, s5) defines \"narcolepsy\" for veterans' claims (s7) and lists the specific medical events and timeframes (s9) that, on the balance of probabilities informed by sound medical‑scientific evidence (s8), can connect narcolepsy or death from narcolepsy to a person’s relevant service. It matters to veterans and serving members lodging VEA/MRCA claims because claim success depends on a clinical diagnosis (s7 note 3) plus proof that at least one listed factor occurred within the prescribed period (s9)."},"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 2014 predecessor and other SOPs — establishing causation factors for a specific medical condition in the veterans' compensation scheme. The update reflects new medical evidence (particularly the Pandemrix vaccine association) but does not expand beyond the original purpose of determining service-related causation for narcolepsy claims."},"complexity_factors":["15 distinct factual factors with varying time limits (2-year vs 3-year windows)","Parallel structure for 'clinical onset' (factors 1-7) and 'clinical worsening' (factors 8-14), essentially duplicating the logic","Cross-references to other Statements of Principles for underlying conditions (section 11)","Technical medical terminology requiring definitions (cataplexy, hypnagogic hallucinations, sleep paralysis, orexin, etc.)","Specific anatomical requirements ('hypothalamus, midbrain or brainstem') that require medical evidence to establish","Conditional logic in section 10(2) restricting factors 8-15 to aggravation cases only","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"This legislation sets the medical test for awarding compensation for narcolepsy to veterans and current/former defence members, requiring proof on the balance of probabilities that service caused or worsened the condition. It identifies specific medical links — for example recent head injury, certain brain surgery or radiation, infections, and receipt of the Pandemrix H1N1 vaccine — that, if evidenced, support a claim. \n\nIt replaces the 2014 guidance to reflect updated medical science and tells the Department what evidence to require."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022","history":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-narcolepsy-balance-of-probabilities-no-12-of-2022/documents"}}