{"id":"F2021L00481","name":"Statement of Principles concerning open-angle glaucoma (Reasonable Hypothesis) (No. 49 of 2021)","slug":"statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440820,"registerId":"F2021L00481-fast-fetch-1775956316147","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning open-angle glaucoma (Reasonable Hypothesis) (No. 49 of 2021)","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\nOPEN-ANGLE GLAUCOMA (Reasonable Hypothesis)\n\n(No. 49 of 2021)\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 23 April 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:
|\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 open-angle glaucoma (Reasonable Hypothesis) (No. 49 of 2021).\n\n2 Commencement\n\n This instrument commences on 24 May 2021.\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 open-angle glaucoma No. 27 of 2012 (Federal Register of Legislation No. F2012L00457) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 open-angle glaucoma and death from open-angle glaucoma.\n\nMeaning of open-angle glaucoma\n\n(2) For the purposes of this Statement of Principles, open-angle glaucoma:\n\n(a) means an acquired, progressive optic neuropathy involving characteristic optic disc abnormalities and associated visual field defects, occurring in the presence of an open iridocorneal angle and usually associated with raised intraocular pressure; and\n\n(b) includes normal tension glaucoma; and\n\n(c) excludes congenital, infantile or development glaucomas.\n\nNote 1: Open-angle glaucoma may be primary, or secondary to another eye disorder.\n\nNote 2: Open-angle glaucoma may be asymptomatic until the optic nerve damage is severe.\n\n(3) While open-angle glaucoma attracts ICD‑10‑AM code H40.1, in applying this Statement of Principles the meaning of open-angle glaucoma 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 open-angle glaucoma\n\n(5) For the purposes of this Statement of Principles, open-angle glaucoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's open-angle glaucoma.\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 open-angle glaucoma and death from open-angle glaucoma 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 open-angle glaucoma or death from open-angle glaucoma with the circumstances of a person's relevant service:\n\n(1) having glucocorticoid therapy as specified, before the clinical onset of open-angle glaucoma, and where the glucocorticoid therapy as specified has ceased, the last dose of the therapy was received within the three months before the clinical onset of open-angle glaucoma;\n\nNote: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.\n\n(2) having uveitis, scleritis or episcleritis at the time of the clinical onset of open-angle glaucoma;\n\nNote: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.\n\n(3) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-neoplastic lesion;\n\nof the affected eye at the time of the clinical onset of open-angle glaucoma;\n\nNote 1: Examples of a benign or malignant neoplasm include lymphoma, trabecular meshwork melanoma, choroidal metastasis and retinoblastoma.\n\nNote 2: Examples of a non-neoplastic lesion include cyst, ocular haemorrhage (including ghost cells), leakage of lens protein or lens particles and vascular malformation or thrombosis.\n\n(4) having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical onset of open-angle glaucoma;\n\nNote: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.\n\n(5) having trauma to the affected eye before the clinical onset of open-angle glaucoma;\n\nNote: trauma is defined in the Schedule 1 - Dictionary.\n\n(6) having sympathetic ophthalmia at the time of the clinical onset of open-angle glaucoma;\n\nNote: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.\n\n(7) having intraocular surgery to the affected eye before the clinical onset of open-angle glaucoma;\n\n(8) undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical onset of open-angle glaucoma;\n\n(9) having a disease from the specified list of endocrine diseases within the 12 months before the clinical onset of open-angle glaucoma;\n\nNote: specified list of endocrine diseases is defined in the Schedule 1 - Dictionary.\n\n(10) having hypertension before the clinical onset of open-angle glaucoma;\n\n(11) having dyslipidaemia before the clinical onset of open-angle glaucoma;\n\nNote: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(12) having glucocorticoid therapy as specified, before the clinical worsening of open-angle glaucoma, and where the glucocorticoid therapy as specified has ceased, the last dose of the therapy was received within the three months before the clinical worsening of open-angle glaucoma;\n\nNote: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.\n\n(13) having uveitis, scleritis or episcleritis at the time of the clinical worsening of open-angle glaucoma;\n\nNote: uveitis, scleritis and episcleritis are defined in the Schedule 1 - Dictionary.\n\n(14) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) a non-neoplastic lesion;\n\nof the affected eye at the time of the clinical worsening of open-angle glaucoma;\n\nNote 1: Examples of a benign or malignant neoplasm include lymphoma, trabecular meshwork melanoma, choroidal metastasis and retinoblastoma.\n\nNote 2: Examples of a non-neoplastic lesion include cyst, ocular haemorrhage (including ghost cells), leakage of lens protein or lens particles and vascular malformation or thrombosis.\n\n(15) having growth of new blood vessels (neovascularisation) of the iridocorneal angle due to a condition or procedure involving the affected eye from the specified list of conditions or procedures, before the clinical worsening of open-angle glaucoma;\n\nNote: specified list of conditions or procedures is defined in the Schedule 1 - Dictionary.\n\n(16) having trauma to the affected eye before the clinical worsening of open-angle glaucoma;\n\nNote: trauma is defined in the Schedule 1 - Dictionary.\n\n(17) having sympathetic ophthalmia at the time of the clinical worsening of open-angle glaucoma;\n\nNote: sympathetic ophthalmia is defined in the Schedule 1 - Dictionary.\n\n(18) having intraocular surgery to the affected eye before the clinical worsening of open-angle glaucoma;\n\n(19) undergoing a course of therapeutic radiation for cancer, where the affected eye was in the field of radiation, before the clinical worsening of open-angle glaucoma;\n\n(20) having a disease from the specified list of endocrine diseases within the 12 months before the clinical worsening of open-angle glaucoma;\n\nNote: specified list of endocrine diseases is defined in the Schedule 1 - Dictionary.\n\n(21) having hypertension before the clinical worsening of open-angle glaucoma;\n\n(22) having dyslipidaemia before the clinical worsening of open-angle glaucoma;\n\nNote: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(23) inability to obtain appropriate clinical management for open-angle glaucoma.\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(12) to 9(23) apply only to material contribution to, or aggravation of, open-angle glaucoma where the person's open-angle glaucoma 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 dyslipidaemia means persistently abnormal blood lipid levels, diagnosed by a medical practitioner and evidenced by:\n\n(a) a serum high density lipoprotein cholesterol level less than 1.0 mmol/L; or\n\n(b) a serum low density lipoprotein level greater than 4.0 mmol/L; or\n\n(c) a serum triglyceride level greater than or equal to 2.0 mmol/L; or\n\n(d) a total serum cholesterol level greater than 5.5 mmol/L; or\n\n(e) the regular administration of drug therapy to normalise blood lipid levels.\n\n episcleritis means acute or chronic inflammation of the superficial, episcleral layer of the eye ball.\n\n equivalent glucocorticoid therapy means a glucocorticoid in the following table, at the doses specified in the table, or a therapeutically equivalent dose of another glucocorticoid:\n\n \n\n| Glucocorticoid | Minimum cumulative
dose (milligrams)
| Minimum average
rate (milligrams/day) |\n| --- | --- | --- |\n| betamethasone | 60 | 2 |\n| cortisone | 1,875 | 62.5 |\n| dexamethasone | 50 | 1.67 |\n| methylprednisolone | 300 | 10 |\n| paramethasone | 150 | 5 |\n| prednisone | 375 | 12.5 |\n| prednisolone | 375 | 12.5 |\n| triamcinolone | 300 | 10 |\n\n\n equivalent inhaled glucocorticoid means:\n\n(a) 8,000 micrograms of triamcinolone;\n\n(b) 1,600 micrograms of budesonide;\n\n(c) 1,000 micrograms of fluticasone; or\n\n(d) a therapeutically equivalent dose of another inhaled glucocorticoid.\n\n glucocorticoid therapy as specified means:\n\n(a) taking:\n\n(i) hydrocortisone orally, by injection, or per rectum:\n\n1. to a cumulative dose of at least 1,500 milligrams; and\n2. at a minimum dose rate averaging 50 milligrams per day; or\n\n\n(ii) equivalent glucocorticoid therapy orally, by injection, or per rectum; or\n\n(b) inhaling at least 1,600 micrograms of beclomethasone, or equivalent inhaled glucocorticoid, daily for at least four weeks; or\n\n(c) using a topical ocular glucocorticoid to the affected eye daily for at least two weeks; or\n\n(d) using an intranasal glucocorticoid at above the maximum therapeutic dosage level daily for at least four weeks; or\n\n(e) having an intraocular or periocular glucocorticoid injection to the affected eye; or\n\n(f) applying a topical glucocorticoid to the face daily for at least four weeks; or\n\n(g) applying a high or very high potency topical glucocorticoid to at least 20% of total skin surface area, daily, for at least four weeks.\n\nNote: equivalent glucocorticoid therapy, equivalent inhaled glucocorticoid and high or very high potency topical glucocorticoid are also defined in the Schedule 1 - Dictionary.\n\n high or very high potency topical glucocorticoid means:\n\n(a) betamethasone dipropionate 0.05%;\n\n(b) betamethasone valerate 0.1%;\n\n(c) clobetasol proprionate 0.05%;\n\n(d) diflucortolone valerate 0.1%;\n\n(e) fluocinolone acetonide 0.025%; or\n\n(f) another topical glucocorticoid of equivalent potency.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n open-angle glaucoma—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 scleritis means acute or chronic inflammation that affects the white outer coating of the eye ball.\n\n specified list of conditions or procedures means:\n\n(a) carotid endarterectomy;\n\n(b) diabetic retinopathy;\n\n(c) intraocular surgery;\n\n(d) intraocular tumour;\n\n(e) carotid artery disease;\n\n(f) radiotherapy;\n\n(g) retinal detachment;\n\n(h) retinal vascular occlusion;\n\n(i) retinal vasculitis; or\n\n(j) another acquired condition causing posterior segment ischaemia.\n\n specified list of endocrine diseases means:\n\n(a) Cushing syndrome;\n\n(b) diabetes mellitus;\n\n(c) eye disease associated with Graves' disease; and\n\n(d) hypothyroidism.\n\n sympathetic ophthalmia means the presence of uveitis in both eyes following:\n\n(a) intraocular surgery to one eye; or\n\n(b) trauma to one eye.\n\nNote: trauma is 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 trauma means:\n\n(a) blunt or penetrating physical injury; or\n\n(b) chemical, thermal or radiation injury;\n\n that results in intraocular inflammation, intraocular bleeding or other intraocular tissue disruption.\n\n uveitis means acute or chronic inflammation of the vascular middle coat of the eye ball, comprising the iris, ciliary body and choroid. This definition includes choroidal effusion.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument updates and replaces the 2012 Statement of Principles (section 4) by restating the condition, refining definitions (notably precise glucocorticoid dose thresholds and equivalent inhaled/topical regimens in Schedule 1), and clarifying the distinction between factors that cause onset and those that materially contribute to or aggravate pre‑existing disease (subsection 10(2)). It also explicitly includes death contributed to by open‑angle glaucoma (subsection 7(5)) and adds an inability‑to‑obtain‑management factor (section 9(23)). These are refinements and clarifications to the original regulatory purpose (establishing medical factors for the reasonable‑hypothesis test) rather than a substantial extension of scope beyond the Statement’s original objective."},"complexity_factors":["23 discrete causal factors in section 9 (9(1)–9(23)) with separate treatment of onset and worsening/aggravation","Extensive Schedule 1 dictionary containing many defined terms and numeric thresholds (e.g. steroid dose table) — at least 15 defined terms/entries","Temporal conditions and limits (e.g. 3‑month last dose rule for ceased glucocorticoid therapy; 12‑month window for specified endocrine diseases)","Cross‑references to other instruments and Acts (VEA, MRCA, other Statements of Principles) (sections 5, 11)","Conditional application rules (subsection 10(2) limits some factors to aggravation of pre‑existing disease)","Multiple modalities of exposure (systemic, inhaled, topical, intraocular steroids) with equivalence rules and dose conversion table in Schedule 1","Inclusion of both clinical onset and clinical worsening with mirrored factor lists increases branching logic","Repeal and replacement of prior 2012 Statement adds a change‑tracking element (section 4)"],"plain_english_summary":"**What this instrument does (mechanics)**\n\n- This is a Statement of Principles about open‑angle glaucoma and death from open‑angle glaucoma for the purposes of veterans’ compensation law. It sets out the medical facts and specific factors that, if present, are sufficient to raise a “reasonable hypothesis” that a person’s glaucoma is related to their relevant service (see section 9). \n\n- It replaces an earlier 2012 Statement of Principles for the same condition (section 4). It applies to claims under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) (section 5). \n\n- The instrument defines “open‑angle glaucoma” for this purpose (subsection 7(2)) and expressly includes deaths that were contributed to by the condition (subsection 7(5)). It also notes that the usual ICD‑10‑AM code (H40.1) is not decisive — the statutory definition in subsection 7(2) controls (subsection 7(3)).\n\n**Who it affects**\n\n- Primary effect: veterans, ex‑service personnel and members of the Forces (including peacekeeping or warlike/non‑warlike service as defined) who make a claim for compensation or treatment where open‑angle glaucoma is alleged to be connected to their service (Schedule 1: definition of relevant service). \n\n- Secondary effect: medical practitioners, claims assessors and the Department administering veterans’ entitlements, who must collect and assess clinical evidence against the listed factors.\n\n**How the law decides a service connection (key substantive rules)**\n\n- The Statement lists 23 discrete factors; at least one of these must exist before a reasonable hypothesis of service‑connection for onset or death can be raised (section 9). Examples include: \n - specified patterns of systemic, inhaled, topical or local glucocorticoid (steroid) therapy prior to clinical onset (with a 3‑month limit if therapy has ceased) (section 9(1); Schedule 1: definitions of glucocorticoid therapy and dose table); \n - inflammatory eye conditions at onset (uveitis, scleritis, episcleritis) (sections 9(2), 9(13); Schedule 1 definitions); \n - neoplasm or other lesions of the affected eye (sections 9(3), 9(14)); \n - neovascularisation of the iridocorneal angle arising from a specified list of conditions or procedures (sections 9(4), 9(15); Schedule 1 lists the conditions/procedures); \n - eye trauma, intraocular surgery, intraocular/periocular steroid injections, therapeutic radiotherapy to the eye, certain endocrine diseases within 12 months, hypertension or dyslipidaemia (various items in section 9 and Schedule 1). \n - inability to obtain appropriate clinical management for open‑angle glaucoma (section 9(23)).\n\n- The Statement distinguishes two scenarios: factors that can support a link to the clinical onset of glaucoma (section 9(1)–9(11)) and factors that can support material contribution to, or aggravation of, glaucoma that pre‑existed service (section 9(12)–9(22)). Subsection 10(2) makes that distinction explicit: the latter group applies only where glaucoma was suffered or contracted before or during (but did not arise out of) relevant service.\n\n- If a factor in this Statement refers to an injury or disease covered by another Statement of Principles, the rules in that other Statement apply (section 11).\n\n**Official rationale and how to read it**\n\n- The Repatriation Medical Authority states it is satisfied there is sound medical‑scientific evidence that open‑angle glaucoma can be related to relevant service (section 8). That is the explanatory basis for listing the specific factors in section 9. \n\n**Costs, incentives and implementation considerations**\n\n- Who pays and who decides: decision makers in the veterans’ entitlements system (and ultimately the Department) decide claims based on whether a reasonable hypothesis is raised by the factors. Financial and treatment obligations flow from successful claims, so taxpayers/entitlement funds bear cost when service‑connection is accepted. (See sections 5, 8–11.)\n\n- Evidence and compliance burden: the Statement requires specific clinical and treatment history to demonstrate qualifying factors (for example, drug names, dosing, timing of last dose within three months, evidence of intraocular surgery, radiation fields, or diagnoses of endocrine disease within 12 months). This raises evidentiary burdens on claimants and record‑keeping requirements for treating clinicians (section 9; Schedule 1 definitions, including the steroid dose table).\n\n- Concentrated benefits and who is advantaged: the factors are specific and precise (for example, defined steroid dose thresholds). Claimants with documented, qualifying exposures (steroid therapy, surgery, trauma, etc.) are advantaged in meeting the reasonable‑hypothesis test; those without documentation may face difficulty.\n\n- Broadening elements and potential for wider claims: the inclusion of inability to obtain appropriate clinical management (section 9(23)) can allow claims where lack of access to care is alleged to have caused or worsened glaucoma — this shifts focus in some cases from discrete exposures to systems‑level access issues, which may be harder to assess.\n\n- Implementation risk and discretion: assessing the presence, timing and relationship of listed factors requires clinical judgement and administrative interpretation (for example, determining whether a steroid exposure meets the cumulative/daily thresholds in Schedule 1). Cross‑references to other Statements raise additional questions where overlapping conditions exist (section 11).\n\n- Effects on private actors: the Statement does not directly regulate private businesses, but it increases the value of accurate medical records and prescriptions. Clinicians and hospitals will be asked to supply detailed evidence for claims; there may be modest administrative costs to them.\n\n**Bottom line**\n\n- Mechanically, this document is a rulebook that lists the medical circumstances under which a veteran’s glaucoma (or a death contributed to by glaucoma) can reasonably be hypothesised to be connected with service. It specifies dose thresholds, timing windows and particular eye conditions or procedures that, if present and related to relevant service, satisfy the statutory gate‑test for a service link. (See sections 7–11 and Schedule 1.)"},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical-determination instrument for a specific eye condition. While it updates the 2012 version with new medical evidence (particularly expanded glucocorticoid definitions and refined endocrine disease criteria), it does not expand beyond its core function of establishing service connection factors for open-angle glaucoma compensation claims."},"complexity_factors":["Multiple nested definitions: 15+ defined terms in Schedule 1, with several definitions containing their own sub-definitions (e.g., 'glucocorticoid therapy as specified' refers to 'equivalent glucocorticoid therapy' and 'equivalent inhaled glucocorticoid', which themselves contain tables and further specifications)","Precise quantitative thresholds: Multiple factors require specific numerical cut-offs (e.g., serum cholesterol >5.5 mmol/L, cumulative steroid doses of 1,500mg hydrocortisone, 1,600 micrograms beclomethasone for 4 weeks, 20% skin surface area coverage)","Temporal requirements: Several factors include strict time limits (e.g., 'within 3 months' of stopping steroids, 'within 12 months' for endocrine diseases, 'at least 4 weeks' for topical applications)","Dual application structure: The 23 factors are essentially duplicated—factors 1-11 for 'clinical onset' and factors 12-22 for 'clinical worsening', with factor 23 applying to both, creating parallel but slightly different pathways","Cross-referencing between instruments: Section 11 requires readers to consult other Statements of Principles if a factor refers to a separate injury or disease, creating interdependence with the broader legislative scheme","Medical-legal hybrid language: Combines clinical terminology (neovascularisation, iridocorneal angle, trabecular meshwork) with legal concepts (terminal event, reasonable hypothesis, material contribution)"],"plain_english_summary":"This instrument sets the medical rules for when Australian Defence Force members and veterans can claim compensation for open‑angle glaucoma. It replaces the 2012 guidance and lists 23 medical factors that, if present and linked to service, create a \"reasonable hypothesis\" that service caused or worsened the condition.\n\nThat lower evidentiary standard makes it easier for ADF members, veterans and peacekeepers under the VEA or MRCA to obtain benefits without proving causation on the balance of probabilities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021","history":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-open-angle-glaucoma-reasonable-hypothesis-no-49-of-2021/documents"}}