{"id":"F2019L01102","name":"Statement of Principles concerning obstructive and reflux nephropathy (Balance of Probabilities) (No. 86 of 2019)","slug":"statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440208,"registerId":"F2019L01102-fast-fetch-1775955924022","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning obstructive and reflux nephropathy (Balance of Probabilities) (No. 86 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\nOBSTRUCTIVE AND REFLUX NEPHROPATHY (Balance of Probabilities)\n\n(No. 86 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 23 August 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 obstructive and reflux nephropathy (Balance of Probabilities) (No. 86 of 2019).\n\n2 Commencement\n\n This instrument commences on 23 September 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 obstructive and reflux nephropathy No. 32 of 2011 (Federal Register of Legislation No. F2011L00769) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 obstructive and reflux nephropathy and death from obstructive and reflux nephropathy.\n\nMeaning of obstructive and reflux nephropathy\n\n(2) For the purposes of this Statement of Principles, obstructive and reflux nephropathy:\n\n(a) means an acquired mechanical or functional impediment to normal urine flow, with urinary stasis and elevation in urinary tract pressure, causing:\n\n(i) clinical or biochemical evidence of impaired renal function or renal parenchymal damage; or\n\n(ii) calyceal deformity, or dilatation of the ureter (hydroureter) or renal pyelocalyceal system (hydronephrosis); and\n\n(b) includes renal scarring due to acquired vesicoureteric reflux; and\n\n(c) excludes acute, transient urinary retention not due to a fixed mechanical obstruction.\n\n(3) While obstructive and reflux nephropathy attracts ICD‑10‑AM code N13, in applying this Statement of Principles the meaning of obstructive and reflux nephropathy 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 obstructive and reflux nephropathy\n\n(5) For the purposes of this Statement of Principles, obstructive and reflux nephropathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's obstructive and reflux nephropathy.\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 obstructive and reflux nephropathy and death from obstructive and reflux nephropathy 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, obstructive and reflux nephropathy or death from obstructive and reflux nephropathy is connected with the circumstances of a person's relevant service:\n\n(1) having upper urinary tract obstruction, due to partial or complete blockage of the renal pelvicalyceal system, ureter or ureteropelvic junction on the affected side, before the clinical onset of obstructive and reflux nephropathy;\n\nNote: Examples of causes of upper urinary tract obstruction include, but are not limited to, renal stone disease, benign or malignant neoplasm, faecal impaction, and complications of an indwelling ureteric stent. \n\n(2) having lower urinary tract obstruction, due to partial or complete blockage of the bladder outlet or urethra, before the clinical onset of obstructive and reflux nephropathy;\n\nNote: Examples of causes of lower urinary tract obstruction include, but are not limited to, benign or malignant neoplasm of the prostate, bladder or urethra; benign prostatic hyperplasia; urethral sling; and urethral stricture or stenosis.\n\n(3) having a renal or ureteric transplant on the affected side, before the clinical onset of obstructive and reflux nephropathy;\n\n(4) having neurogenic bladder at the time of the clinical onset of obstructive and reflux nephropathy;\n\nNote: neurogenic bladder is defined in the Schedule 1 - Dictionary.\n\n(5) having upper urinary tract obstruction, due to partial or complete blockage of the renal pelvicalyceal system, ureter or ureteropelvic junction on the affected side, before the clinical worsening of obstructive and reflux nephropathy;\n\nNote: Examples of causes of upper urinary tract obstruction include, but are not limited to, renal stone disease, benign or malignant neoplasm, faecal impaction, and complications of an indwelling ureteric stent. \n\n(6) having lower urinary tract obstruction, due to partial or complete blockage of the bladder outlet or urethra, before the clinical worsening of obstructive and reflux nephropathy;\n\nNote: Examples of causes of lower urinary tract obstruction include, but are not limited to, benign or malignant neoplasm of the prostate, bladder or urethra; benign prostatic hyperplasia; urethral sling; and urethral stricture or stenosis.\n\n(7) having a renal or ureteric transplant on the affected side, before the clinical worsening of obstructive and reflux nephropathy;\n\n(8) having neurogenic bladder at the time of the clinical worsening of obstructive and reflux nephropathy;\n\nNote: neurogenic bladder is defined in the Schedule 1 - Dictionary.\n\n(9) inability to obtain appropriate clinical management for obstructive and reflux nephropathy.\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, obstructive and reflux nephropathy where the person's obstructive and reflux nephropathy 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 MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neurogenic bladder means flaccid, spastic or mixed bladder dysfunction caused by neurological damage affecting the bladder. \n\nNote: Examples of causes of neurogenic bladder include, but are not limited to, spinal cord injury, cerebrovascular accident, Parkinson's disease and diabetic autonomic neuropathy.\n\n obstructive and reflux nephropathy—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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles updating the 2011 version. It maintains the same scope: establishing medical criteria for linking obstructive and reflux nephropathy to military service. No expansion beyond the original purpose of determining service connection for this specific kidney condition."},"complexity_factors":["Moderate medical terminology requiring definitions (e.g., 'neurogenic bladder', 'hydronephrosis', 'pelvicalyceal system')","Parallel structure with near-identical factors repeated for 'clinical onset' vs 'clinical worsening' (factors 1-4 vs 5-8)","Cross-references to other Statements of Principles for related conditions (section 11)","Conditional application: factors 5-9 only apply to aggravation of pre-existing conditions, not new onset (section 10(2))","Specific exclusion in definition (acute transient retention not due to fixed obstruction)","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"This Statement of Principles from the Repatriation Medical Authority sets the medical test for when obstructive and reflux nephropathy (kidney damage from blocked or backward urine flow) is accepted as service-related for compensation. It defines the condition and replaces the 2011 rules.\n\nThe RMA requires at least one of nine specified clinical factors to be met, on the balance of probabilities, to link the condition to service. It applies to veterans and current/former ADF members under the VEA and MRCA."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2011 Statement (s4) and replaces it with updated definitions, factors and application rules (notably s7–s11). It applies to claims under section 120B of the VEA or section 339 of the MRCA (s5). The text confirms a replacement has occurred but does not state within this instrument whether the substantive criteria are broader or narrower than the repealed 2011 Statement."},"complexity_factors":["Medical definitions and diagnostic references (see s7(2) and ICD‑10‑AM cross‑reference in s7(3)–(4))","Enumerated factual factors that must be proven (nine principal factors in s9)","Two different causal roles: causation for onset versus material contribution/aggravation for pre‑existing disease (s10(2))","Application to death via contribution to a terminal event (s7(5))","Cross‑reference and interaction with other Statements of Principles where a factor refers to another disease (s11)","Legal standard of proof is balance of probabilities (stated in title and s8)","Replaces an earlier Statement (repeal in s4) requiring comparison with prior instrument if relevant","Scope limited to claims under specified statutory sections (s5) which requires procedural linkage to VEA/MRCA claims processes"],"plain_english_summary":"This instrument sets the medical rules the Repatriation Medical Authority uses to decide whether obstructive and reflux nephropathy (and deaths from it) are connected to a person’s relevant service for claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act. It defines the condition, lists specific clinical factors (e.g. upper/lower urinary‑tract obstruction, neurogenic bladder, transplants, or inability to obtain appropriate care) that must be present, and applies a balance‑of‑probabilities standard to link those factors to service."},"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-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86","history":"/api/acts/statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86/history","analysis":"/api/acts/statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86/analysis","conflicts":"/api/acts/statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86/important-cases","documents":"/api/acts/statement-of-principles-concerning-obstructive-and-reflux-nephropathy-balance-of-probabilities-no-86/documents"}}