{"id":"F2019L00231","name":"Statement of Principles concerning neurocognitive disorder with Lewy bodies (Balance of Probabilities) (No. 36 of 2019)","slug":"statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439946,"registerId":"F2019L00231-fast-fetch-1775955772342","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning neurocognitive disorder with Lewy bodies (Balance of Probabilities) (No. 36 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\nNEUROCOGNITIVE DISORDER WITH LEWY BODIES (Balance of Probabilities)\n\n(No. 36 of 2019)\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 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 neurocognitive disorder with Lewy bodies (Balance of Probabilities) (No. 36 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(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning Alzheimer-type dementia No. 23 of 2010 (Federal Register of Legislation No. F2014C00072) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 neurocognitive disorder with Lewy bodies and death from neurocognitive disorder with Lewy bodies.\n\nMeaning of neurocognitive disorder with Lewy bodies\n\n(2) For the purposes of this Statement of Principles, neurocognitive disorder with Lewy bodies means a central nervous system neurodegenerative disorder meeting the following clinical diagnostic criteria (derived from DSM-5):\n\n1. Evidence of major neurocognitive disorder or mild neurocognitive disorder.\n2. The disorder has an insidious onset and gradual progression.\n3. The disorder meets at least two of the following diagnostic features:\n\n\n(i) fluctuating cognition with pronounced variations in attention and alertness;\n\n(ii) recurrent visual hallucinations that are well formed and detailed;\n\n(iii) spontaneous features of Parkinson's disease or secondary Parkinsonism at least one year after the clinical onset of cognitive symptoms; or\n\n(iv) rapid eye movement (REM) sleep behaviour disorder.\n\nD. The cognitive deficits in Criteria A, B and C are not primarily due to any of the following:\n\n(i) delirium;\n\n(ii) another mental disorder (for example, major depressive disorder, schizophrenia); or\n\n(iii) cerebrovascular disease, another neurodegenerative disease (for example, Alzheimer disease, Parkinson's disease, Huntington's chorea), brain tumour, subdural haematoma, the effects of a substance, or systemic disorder (for example, hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcaemia, neurosyphilis, human immunodeficiency virus infection).\n\nNote: DSM-5, major neurocognitive disorder and mild neurocognitive disorder are defined in the Schedule 1 – Dictionary.\n\n(3) While neurocognitive disorder with Lewy bodies attracts ICD‑10‑AM code G31.3 with F02.8, in applying this Statement of Principles the meaning of neurocognitive disorder with Lewy bodies 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 neurocognitive disorder with Lewy bodies\n\n(5) For the purposes of this Statement of Principles, neurocognitive disorder with Lewy bodies, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's neurocognitive disorder with Lewy bodies.\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 neurocognitive disorder with Lewy bodies and death from neurocognitive disorder with Lewy bodies 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, neurocognitive disorder with Lewy bodies or death from neurocognitive disorder with Lewy bodies is connected with the circumstances of a person's relevant service:\n\n(1) being treated with an antipsychotic drug at the time of the clinical worsening of neurocognitive disorder with Lewy bodies;\n\n(2) inability to obtain appropriate clinical management for neurocognitive disorder with Lewy bodies.\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(1) and 9(2) apply only to material contribution to, or aggravation of, neurocognitive disorder with Lewy bodies where the person's neurocognitive disorder with Lewy bodies 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 DSM-5 means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.\n\n major neurocognitive disorder means:\n\n(a) evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:\n\n(i) concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and\n\n(ii) a substantial impairment in cognitive performance, documented by standardised neuropsychological testing or another qualified clinical assessment; and\n\n(b) the cognitive deficits interfere with independence in everyday activities (that is, at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).\n\n mild neurocognitive disorder means evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:\n\n(a) concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and\n\n(b) a modest impairment in cognitive performance, documented by standardised neuropsychological testing.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neurocognitive disorder with Lewy bodies—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 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":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This Statement replaces the prior Alzheimer-type dementia Statement (s.4) and creates a distinct, DSM‑5-based definition and causation framework for neurocognitive disorder with Lewy bodies (s.1; s.7). It narrows the legal pathway for service connection to specified linking circumstances and applies only to VEA/MRCA claims and relevant service categories (s.5; Schedule 1). It also clarifies that death from the disorder (via listed terminal events) is included (s.7(5))."},"complexity_factors":["Medical-standard definitions rely on DSM‑5 diagnostic criteria and neuropsychological testing, requiring specialist clinical evidence to establish diagnosis (Schedule 1; s.7(2); Schedule 1 definitions of major/mild neurocognitive disorder).","Causation hinges on a short, specific list of linking factors (antipsychotic treatment at clinical worsening; inability to obtain appropriate clinical management), concentrating evidentiary burden on demonstrating those circumstances (s.9).","Standard of proof is the civil 'balance of probabilities' and the Authority finds it 'more probable than not' that the disorder can be related to relevant service (s.8; title).","Interplay with other Statements of Principles requires cross-application where a linking factor refers to another disease covered by a separate Statement, producing potential dependency on other instruments (s.11).","Instrument replaces an earlier Alzheimer-type dementia Statement, changing the legal framing of dementia-related claims and requiring attention to repeal effects (s.4).","Application is limited to claims under the VEA and MRCA and to relevant service categories, so scope is legally channelled to specific claimant cohorts (s.5; Schedule 1 definition of relevant service).","Inclusion of death via terminal events requires causal linking of terminal causes (e.g. pneumonia, respiratory failure) to the disorder, expanding evidentiary lines beyond neurological diagnosis (s.7(5); Schedule 1 terminal event)."],"plain_english_summary":"This instrument sets how neurocognitive disorder with Lewy bodies is defined and when it is linked to military or veteran service for VEA/MRCA claims. It adopts DSM‑5 diagnostic criteria, treats death from the disorder as included, and identifies service‑related linking circumstances such as treatment effects or inability to obtain appropriate clinical management. Decisions about causation are made by the Repatriation Medical Authority and determine entitlement under the VEA and MRCA."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It is a specific medical-determination tool for a single disease (Lewy body dementia) under the Repatriation Medical Authority's statutory framework. The repeal of the 2010 Alzheimer-type dementia instrument and replacement with this separate Lewy body dementia instrument actually represents a refinement and narrowing of scope — recognising these as distinct clinical entities rather than grouping them together."},"complexity_factors":["Medical diagnostic criteria imported from external source (DSM-5) with four specific clinical features plus exclusion criteria","Cross-references to two separate Acts (VEA and MRCA) with three distinct service categories defined","Conditional logic in section 10 limiting application to aggravation of pre-existing conditions only, not original causation","Incorporation by reference of ICD-10-AM coding system with specific edition and ISBN","Nested definitions: 'neurocognitive disorder with Lewy bodies' refers to 'major' and 'mild' neurocognitive disorders, which are themselves defined","Section 11 creates dynamic incorporation of other Statements of Principles by reference 'as in force from time to time'"],"plain_english_summary":"This Statement of Principles sets the medical test for whether neurocognitive disorder with Lewy bodies (Lewy body dementia) is compensable for veterans and current/former Defence members, using the balance-of-probabilities standard. It links service to the condition where service exposed someone with a pre‑existing Lewy body dementia to harmful antipsychotic treatment or prevented access to proper care, and replaces the 2010 Alzheimer's-type dementia statement."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities","history":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities/history","analysis":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities/analysis","conflicts":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities/important-cases","documents":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-balance-of-probabilities/documents"}}