{"id":"F2023L00894","name":"Statement of Principles concerning Paget disease of bone (Balance of Probabilities) (No. 63 of 2023)","slug":"statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441983,"registerId":"F2023L00894-fast-fetch-1775957130073","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Paget disease of bone (Balance of Probabilities) (No. 63 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nPAGET DISEASE OF BONE (Balance of Probabilities)\n\n(No. 63 of 2023)\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 June 2023.\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 Terence Campbell AM
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 Paget disease of bone (Balance of Probabilities) (No. 63 of 2023).\n\n2 Commencement\n\n This instrument commences on 25 July 2023.\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 Paget's disease of bone No. 50 of 2015 (Federal Register of Legislation No. F2015L00256) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Paget disease of bone and death from Paget disease of bone.\n\nMeaning of Paget disease of bone\n\n(2) For the purposes of this Statement of Principles, Paget disease of bone means a focal disease of bone at single or multiple sites, with repeated episodes of accelerated bone resorption followed by disorganised new bone formation, resulting in bone of impaired integrity and structure.\n\nNote: Clinical manifestations typically include bone pain, bone enlargement, deformity or bowing of bones but may be asymptomatic. Bones commonly involved include the skull, spine, pelvis, and long bones of the lower extremity. Paget disease of bone is also known as osteitis deformans.\n\n(3) While Paget disease of bone attracts ICD‑10‑AM code M88, in applying this Statement of Principles the meaning of Paget disease of bone 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 Paget disease of bone\n\n(5) For the purposes of this Statement of Principles, Paget disease of bone, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Paget disease of bone.\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 Paget disease of bone and death from Paget disease of bone 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, Paget disease of bone or death from Paget disease of bone is connected with the circumstances of a person's relevant service:\n\n(1) inability to obtain appropriate clinical management for Paget disease of bone before the clinical worsening of Paget disease of bone.\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 factor set out in subsections 9(1) applies only to material contribution to, or aggravation of, Paget disease of bone where the person's Paget disease of bone 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 paget disease of bone—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":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2015 predecessor. It continues to address only Paget disease of bone with a single aggravation factor. There is no evidence of scope creep; the instrument remains tightly focused on its original purpose of determining service connection for this specific bone disorder."},"complexity_factors":["Very short instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (MRCA, paget disease of bone, relevant service, terminal event, VEA)","Single causal factor in section 9 (inability to obtain appropriate clinical management)","Limited conditional logic: section 10(2) contains one nested condition limiting the factor to aggravation of pre-existing disease","No cross-references to other legislation beyond the standard VEA/MRCA definitions","Straightforward structure: standard SOP format with no unusual procedural provisions"],"plain_english_summary":"This instrument, effective 25 July 2023, sets the rules for Paget disease of bone claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004, replacing the 2015 rules. It affects current and former ADF members and the Repatriation Medical Authority. To succeed, claimants must show on the balance of probabilities that service worsened pre‑existing Paget disease due to an inability to obtain proper medical treatment — a very narrow pathway to compensation."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the 2015 Statement and issues a replacement (s4). It frames Paget disease of bone, limits application to specified VEA/MRCA claim types (s5, s7), and sets a single required factor for service connection (s9). The instrument does not itself state a comparison of substantive differences with the prior instrument, only that the prior Statement is repealed (s4)."},"complexity_factors":["Single, narrowly framed required factor: 'inability to obtain appropriate clinical management' must exist (s9(1)) — simplifies causal inquiry but demands evidentiary proof of access to care.","Legal evidentiary standard: connection assessed on the balance of probabilities and RMA's view of medical‑scientific evidence (s8).","Defined medical meaning and cross‑reference to ICD‑10‑AM code M88, while using its own textual definition (s7(2)–(4)) — requires clinical interpretation.","Application limited to claims under specified provisions of the VEA and MRCA (s5) — constrains who is affected.","Relationship nuance: factor applies only when disease pre‑existed or occurred during service and is a material contribution or aggravation, not where disease arose out of service (s10(2)).","Interaction with other Statements of Principles: factors referring to other covered injuries/diseases invoke those other Statements as they stand (s11) — introduces cross‑instrument dependency.","Administrative change: repeals the 2015 Statement (s4), so practitioners must rely on this instrument for current claims (s4)."],"plain_english_summary":"This instrument replaces a prior statement and sets the medical test the Repatriation Medical Authority will use to decide whether Paget disease of bone (defined in the instrument) is connected to a veteran’s or member’s service for claims under the VEA or MRCA (s4, s5, s7). It requires the balance‑of‑probabilities standard and at least one specified factor — chiefly, inability to obtain appropriate clinical management before clinical worsening — linked to the person’s relevant service (s8–s10)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023","history":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-balance-of-probabilities-no-63-of-2023/documents"}}