{"id":"F2019L00229","name":"Statement of Principles concerning neurocognitive disorder with Lewy bodies (Reasonable Hypothesis) (No. 35 of 2019)","slug":"statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439949,"registerId":"F2019L00229-fast-fetch-1775955772347","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 (Reasonable Hypothesis) (No. 35 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 (Reasonable Hypothesis)\n\n(No. 35 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 neurocognitive disorder with Lewy bodies (Reasonable Hypothesis) (No. 35 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 Alzheimer-type dementia No. 22 of 2010 (Federal Register of Legislation No. F2017C00820) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that neurocognitive disorder with Lewy bodies and death from neurocognitive disorder with Lewy bodies 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 neurocognitive disorder with Lewy bodies or death from neurocognitive disorder with Lewy bodies with the circumstances of a person's relevant service:\n\n(1) having major depressive disorder at least ten years before the clinical onset of neurocognitive disorder with Lewy bodies;\n\n(2) having posttraumatic stress disorder at least ten years before the clinical onset of neurocognitive disorder with Lewy bodies;\n\n(3) being treated with an antipsychotic drug at the time of the clinical worsening of neurocognitive disorder with Lewy bodies;\n\n(4) being treated with an anticholinergic drug from the specified list of anticholinergic drugs, at the time of the clinical worsening of neurocognitive disorder with Lewy bodies;\n\nNote: specified list of anticholinergic drugs is defined in the Schedule 1 - Dictionary. \n\n(5) 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(3) to 9(5) 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(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 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) 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 specified list of anticholinergic drugs means:\n\n(a) antidepressants (amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, paroxetine, protriptyline and trimipramine);\n\n(b) antiparkinson agents (benztropine, biperiden, chlorphenoxamine, cycrimine, ethopropazine, procyclidine and trihexyphenidyl); or\n\n(c) bladder antimuscarinics (darifenacin, fesoterodine, flavoxate, oxybutynin, solifenacin, tolterodine and trospium).\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":"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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument replaces an earlier Alzheimer‑type dementia Statement of Principles with a disease‑specific Statement of Principles for neurocognitive disorder with Lewy bodies and updates the diagnostic criteria and the causation factors used to raise a reasonable hypothesis. That replacement refines and clarifies the instrument’s application to a particular clinical syndrome rather than expanding the statutory scope of veterans’ entitlements. It does not materially grow the legislation beyond its original purpose of defining medical/causal criteria for service‑related conditions, so it is better characterised as a targeted update rather than a scope expansion (see sections 4 and 7)."},"complexity_factors":["Relatively short instrument (11 sections plus one schedule).","About 9 defined terms in Schedule 1 (DSM‑5, major/mild neurocognitive disorder, MRCA, relevant service, specified list of anticholinergic drugs, terminal event, VEA, neurocognitive disorder with Lewy bodies).","A small set of conditional rules (notably section 10(2) limiting application of factors 9(3)–9(5)).","Cross‑references to external classifications and sources (DSM‑5; ICD‑10‑AM code reference).","A specified list of medicines (three sublists) that must be checked in claims (adds factual specificity).","Interaction clause that imports other Statements of Principles where factors refer to other diseases (section 11)."],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- Replaces the earlier Statement of Principles for Alzheimer‑type dementia and establishes a disease‑specific Statement of Principles for \"neurocognitive disorder with Lewy bodies\" (NCDLB). (See sections 3–4, 7.)\n- Defines NCDLB by reference to clinical diagnostic criteria derived from DSM‑5 (sets required clinical features and exclusions). (See section 7(2) and Schedule 1.)\n- Lists the minimum factual factors that must exist to raise a \"reasonable hypothesis\" that a person’s NCDLB (or death from it) is related to their military/relevant service for the purposes of claims under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA). (See sections 5, 9.)\n- Requires that any listed factor relied on must be related to the claimant’s relevant service. Some factors (treatment with certain medicines; inability to obtain care) can only be used to show material contribution or aggravation where the NCDLB existed before or during service (but did not arise out of service). (See section 10.)\n- Cross‑applies other Statements of Principles where a listed factor refers to a different injury or disease that already has its own Statement of Principles. (See section 11.)\n\n**Who is affected**\n\n- Veterans, former members of the Forces and certain peacekeeping personnel making claims for NCDLB (or death from NCDLB) under section 120A of the VEA or section 338 of the MRCA. (See section 5 and Schedule 1 definition of relevant service.)\n- Decision makers in the Department of Veterans’ Affairs (DVA) and medical assessors who apply the Statement of Principles when deciding whether a reasonable hypothesis exists linking NCDLB to service. (See sections 3, 8.)\n- Treating clinicians and record‑keepers, because claims will typically require medical records showing timing of diagnoses, medication use and clinical management history. (See sections 7, 9 and Schedule 1.)\n\n**Why it matters (the instrument’s stated purpose and practical effect)**\n\n- The Repatriation Medical Authority states there is sound medical‑scientific evidence that NCDLB can be related to relevant service; the Statement codifies the medical criteria and the factual factors that, if shown, raise a reasonable hypothesis of service‑connection. (See section 8 and section 7 for clinical criteria.)\n- Practically, the instrument sets the yardstick used to start a claims process: if a claimant can show at least one of the listed factors (for example, a history of major depressive disorder or posttraumatic stress disorder at least ten years before NCDLB onset, or specified medication use at the time of clinical worsening), and that the factor relates to relevant service, a reasonable hypothesis may be established and the claim proceeds to further adjudication. (See section 9 and section 10.)\n\n**Key provisions and how they work in practice**\n\n- Diagnostic definition: NCDLB must meet DSM‑5 derived criteria (major or mild neurocognitive disorder, insidious onset/gradual progression, and at least two listed features such as fluctuating cognition or visual hallucinations) and not be primarily due to other listed causes. This focuses adjudication on a specific clinical syndrome rather than only an ICD code. (See section 7(2)–(4) and Schedule 1.)\n- Minimum factors (any one suffices to raise a reasonable hypothesis):\n - major depressive disorder ≥10 years before NCDLB onset; or\n - posttraumatic stress disorder ≥10 years before onset; or\n - being treated with an antipsychotic at time of clinical worsening; or\n - being treated with a specified anticholinergic drug at time of clinical worsening; or\n - inability to obtain appropriate clinical management for NCDLB. (See section 9.)\n- Temporal/causal limits: medication‑related factors and inability to access care are only available as factors for material contribution/aggravation when NCDLB existed before or during (but did not arise out of) service. That is, these factors are primarily for assessing aggravation of pre‑existing disease, not new onset caused by service. (See section 10(2).)\n- Interaction with other Statements of Principles: where a factor refers to another injury/disease already covered by an SOP, the rules in that SOP apply. This avoids conflicting causation rules. (See section 11.)\n\n**Costs, incentives, trade‑offs and implementation risks**\n\n- Who bears costs: the immediate fiscal and administrative costs fall on the decision system (DVA/claims administrators) and the medical assessment process. Claimants bear the evidentiary cost of obtaining historical medical records and assessments. (See sections 5, 9.)\n- Evidence burden and compliance: the instrument requires clinical diagnosis timing and medication records (for example, proof of depressive disorder or PTSD ten or more years prior, or records of antipsychotic/anticholinergic use). That creates a tangible compliance burden for claimants and for clinicians asked to supply records. (See sections 9 and Schedule 1.)\n- Incentives for medical practice: listing specific medication classes (antipsychotics and certain anticholinergics) may influence prescribing choices or record‑keeping, because medication history is a listed factor. Clinicians might alter prescriptions or documentation to reduce potential future liability or to protect patient eligibility for claims. (See section 9(3)–(4) and Schedule 1 specified drug list.)\n- Scope of the \"inability to obtain appropriate clinical management\" factor: this factor can link lack of access to care during service to later disease aggravation. It therefore requires administrative fact‑finding about access to services, which can be complex and fact‑sensitive. That raises implementation risk and may increase contested factual inquiries. (See section 9(5) and section 10.)\n- Administrative discretion and medical judgment: the RMA sets the Statement of Principles, but application to individual claims requires medical and administrative judgment (for example, whether a psychiatric diagnosis existed ten years before onset, or whether a medicine was being taken “at the time of clinical worsening”). This preserves decision‑maker discretion and creates room for differing expert opinions. (See sections 8–10.)\n- Concentrated benefits vs diffuse costs: benefits (successful claims) are concentrated (to claimants who meet the factors); administrative and clinical assessment costs are borne more diffusely across the claims system. The instrument creates clearer pathways for certain claimants (e.g., those with long‑standing depression/PTSD) while potentially increasing assessment work for DVA.\n\n**Direct effects on private markets and individual choice**\n\n- Limited direct effect on private enterprise or markets. The main private‑sector effect is on clinicians and pharmacies because medical records and prescribing practices can affect claim outcomes, and some clinicians may change prescribing for patients who are current or future claimants. (See section 9 and Schedule 1.)\n- No direct regulation of business competition, prices or ownership. The instrument is a claims‑assessment tool used by the veterans’ compensation system.\n\n**Practical takeaway**\n\n- For claimants: establish one of the listed factors and show it relates to your relevant service. Obtain medical records documenting psychiatric diagnoses, medication prescriptions and any evidence about access to clinical care. (See sections 9–10.)\n- For clinicians and record‑keepers: accurate dating of diagnoses and clear records of prescriptions and care access will be material to future claims. (See Schedule 1 and section 9.)\n\n(Primary sources: Statement of Principles sections 3–11 and Schedule 1.)"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope as a disease-specific Statement of Principles under section 196B of the VEA. It precisely targets neurocognitive disorder with Lewy bodies and does not expand beyond the statutory purpose of establishing causal factors for veterans' compensation claims. The repeal of the 2010 Alzheimer-type dementia instrument appears to be a housekeeping measure rather than scope expansion."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 dictionary (8 defined terms)","Nested conditional logic in section 10(2) restricting application of certain factors to aggravation cases only","Medical diagnostic criteria in section 7(2) incorporate external standard (DSM-5) by reference with four sub-criteria and exclusion clauses","Dual statutory framework requiring navigation between VEA and MRCA definitions","Specific temporal requirements ('at least ten years before', 'at the time of') creating precise factual thresholds","Incorporation by reference of ICD-10-AM coding system with specific edition and ISBN"],"plain_english_summary":"This Statement of Principles sets the medical criteria for linking neurocognitive disorder with Lewy bodies to military service, affecting veterans, peacekeepers, and current or former defence members claiming under the VEA or MRCA. It defines the disease by DSM‑5 features and requires specified risk factors (including long‑prior major depression or PTSD, certain medications, and lack of treatment) to establish a service connection. The instrument determines acceptance of compensation claims and replaces a 2010 Alzheimer‑type dementia instrument."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no","history":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no/history","analysis":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no/analysis","conflicts":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no/important-cases","documents":"/api/acts/statement-of-principles-concerning-neurocognitive-disorder-with-lewy-bodies-reasonable-hypothesis-no/documents"}}