{"id":"F2025L00976","name":"Statement of Principles concerning occipital neuralgia (Balance of Probabilities) (No. 74 of 2025)","slug":"statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442935,"registerId":"F2025L00976-fast-fetch-1775957848839","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning occipital neuralgia (Balance of Probabilities) (No. 74 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nOCCIPITAL NEURALGIA  (Balance of Probabilities)\n\n(No. 74 of 2025)\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 22 August 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning occipital neuralgia (Balance of Probabilities) (No. 74 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 22 September 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about occipital neuralgia and death from occipital neuralgia.\n\n\nMeaning of occipital neuralgia\n\n1.           For the purposes of this Statement of Principles, occipital neuralgia:\n  1.           means unilateral or bilateral paroxysmal attacks of severe pain, of shooting, stabbing or sharp quality, in the posterior part of the scalp lasting from a few seconds to minutes, in the distribution of the greater, lesser and/or third occipital nerves; and\n  2.           the pain is associated with dysaesthesia (an unpleasant sensation) and/or allodynia (pain) apparent during innocuous stimulation of the scalp and/or hair (e.g. brushing hair); and\n  3.           there is tenderness over the affected nerve branches and/or trigger points at the emergence of the greater occipital nerve or in the distribution of the second cervical nerve; and\n  4.           excludes:\n    1.             cervicogenic headache;\n    2.          cluster headache;\n    3.        migraine;\n    4.         tension-type headache; and\n    5.           trigeminal neuralgia.\n\n\nNote 1: Occipital nerve entrapment is an example of a condition that may be included in occipital neuralgia.\n\nNote 2: The pain of occipital neuralgia is eased temporarily by local anaesthetic block of the affected occipital nerve(s).\n\n1.           While occipital neuralgia attracts ICD‑10‑AM code M54.81, in applying this Statement of Principles the meaning of occipital neuralgia is that given in subsection (2).\n2.           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\n\nDeath from occipital neuralgia\n\n1.           For the purposes of this Statement of Principles, occipital neuralgia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's occipital neuralgia.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that occipital neuralgia and death from occipital neuralgia 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, occipital neuralgia or death from occipital neuralgia is connected with the circumstances of a person's relevant service:\n\n1.           having concussion or moderate to severe traumatic brain injury within the 3 months before clinical onset or clinical worsening;\n2.           having trauma to the neck or back of the head within the 3 months before clinical onset or clinical worsening;\n\n\nNote 1: trauma to the neck or back of the head is defined in the Schedule 1 – Dictionary.\n\nNote 2: Examples of trauma to the neck or back of the head include fracture of the occipital bone, fracture, subluxation, dislocation or instability of the cervical spine, whiplash injury, strain of the cervical ligaments or sprain of the cervical muscles. Examples of circumstances where this trauma may occur include motor vehicle accidents, a fall from height, playing sports, or gunshot wound.\n\n1.           having surgery involving the upper neck or base of skull within the 6 months before clinical onset or clinical worsening;\n\n\nNote: Examples of types of surgery involving the upper neck or base of skull include occipital-cervical fusion, fusion of the first or second cervical vertebra (also known as atlantoaxial fusion), insertion of screw into first or second cervical vertebrae, or craniotomy.\n\n1.           having cervical spondylosis involving the upper cervical spine before clinical onset or clinical worsening;\n\n\nNote: Upper cervical refers to cervical levels C1, C2 or C3.\n\n1.           having a mass lesion which compresses, displaces or infiltrates the affected upper cervical spinal cord, upper cervical spinal nerves, or occipital nerve, at the time of clinical onset or clinical worsening;\n\n\nNote 1: Examples of a mass lesion include excessive callus formation, cyst, benign or malignant neoplasm, cavernoma (cavernous angioma), dural arteriovenous fistula or abscess. \n\nNote 2: Upper cervical refers to cervical levels C1, C2 or C3.\n\n1.           having acute herpes zoster involving the affected occipital nerve, within the 6 months before clinical onset or clinical worsening;\n2.           having one of the following diseases involving the upper cervical spinal cord at the time of clinical onset or clinical worsening:\n  1.           Behcet syndrome;\n  2.           infarction;\n  3.           multiple sclerosis and clinically isolated syndrome;\n  4.           myelitis; or\n  5.           neuromyelitis optica.\n\n\nNote: Upper cervical refers to cervical levels C1, C2 or C3.\n\n1.           having rheumatoid arthritis of the upper cervical spine at the time of clinical onset or clinical worsening;\n\n\nNote: Upper cervical refers to cervical levels C1, C2 or C3.\n\n1.           inability to obtain appropriate clinical management for occipital neuralgia before clinical worsening.\n\n\n1.                Relationship to service\n  1.           The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n  2.           The clinical worsening aspect of factors set out in subsection 8 applies only to material contribution to, or aggravation of, occipital neuralgia where the person's occipital neuralgia was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 8 applies in relation to a person; and\n2.           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\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 5\n\n1               Definitions\n\nIn this instrument:\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             occipital neuralgia—see subsection 6(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 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                             trauma to the neck or back of the head means traction, stretching, compression or penetrating injury to the neck or back of the head.\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 Repatriation Medical Authority Statement of Principles, which follows the established template for determining service connection of medical conditions. The scope remains tightly focused on establishing the causal link between occipital neuralgia and military service, consistent with the original purpose of the Veterans' Entitlements Act framework."},"complexity_factors":["Multiple defined terms in Schedule 1 (MRCA, VEA, relevant service, terminal event, trauma to the neck or back of the head)","Cross-references between sections (e.g., section 8 factors reference definitions in Schedule 1)","Nested definitions within the occipital neuralgia definition (subsection 6(2) has 4 sub-paragraphs with exclusions)","Temporal conditions attached to factors (3-month and 6-month windows for various triggers)","Anatomical specificity requiring medical knowledge (references to cervical levels C1, C2, C3, specific nerves)","Conditional logic in section 9 regarding clinical worsening only applying to pre-existing conditions","Incorporation by reference to other Statements of Principles in section 10","Dual legislative framework application (VEA and MRCA with different service definitions)"],"plain_english_summary":"This instrument sets the medical criteria used by the Department of Veterans' Affairs and tribunals to decide compensation claims for occipital neuralgia—severe nerve pain at the back of the head—affecting veterans and Defence Force members. It identifies service‑connected causes (e.g. recent head/neck trauma, relevant surgery, cervical degeneration or compression, shingles, certain diseases, or lack of treatment) and applies the \"balance of probabilities\" test to determine if service caused or worsened the condition."},"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 expressly applies to claims under section 120B of the VEA and section 339 of the MRCA and defines occipital neuralgia and qualifying service‑related factors. The text does not indicate any alteration of those statutory claim categories or an expansion/contraction of claimant classes relative to the statutory framework; no earlier instrument or baseline is supplied in the text to show a change in scope."},"complexity_factors":["Specialised clinical definition with medical exclusions and reference to ICD-10-AM (diagnostic complexity)","Multiple distinct causal factors with different temporal windows (3 months, 6 months) increasing factual inquiry","Requirement to establish either clinical onset or clinical worsening and its temporal relation to service (causation vs aggravation complexity)","Cross-reference to other Statements of Principles for factors that overlap other injuries/diseases (inter-instrument linkage)","Defined statutory evidentiary standard: balance of probabilities (legal rather than scientific certainty)","Dictionary definitions (terminal event, trauma to neck/back of head, relevant service) that affect scope and interpretation","Potential need for specialised medical evidence (neurosurgical records, imaging, herpes zoster diagnosis, rheumatologic/neurologic assessments)"],"plain_english_summary":"This Statement of Principles, made by the Repatriation Medical Authority under subsection 196B(3) of the VEA, defines occipital neuralgia for veterans' compensation claims and sets the evidentiary test (balance of probabilities) used to link it to relevant service under the VEA and the MRCA.\n\nIt gives a clinical definition (including death from occipital neuralgia), and lists specific service‑related factors and time limits (recent concussion or neck trauma, certain neck/skull surgery, cervical disease, mass lesions, herpes zoster, listed neurological or inflammatory diseases, or inability to obtain appropriate care) that, if present, can connect the condition to service and inform entitlement decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025","history":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-occipital-neuralgia-balance-of-probabilities-no-74-of-2025/documents"}}