{"id":"F2023L00892","name":"Statement of Principles concerning Paget disease of bone (Reasonable Hypothesis) (No. 62 of 2023)","slug":"statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441978,"registerId":"F2023L00892-fast-fetch-1775957127947","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 (Reasonable Hypothesis) (No. 62 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 (Reasonable Hypothesis)\n\n(No. 62 of 2023)\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 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 (Reasonable Hypothesis) (No. 62 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning Paget's disease of bone No. 49 of 2015 (Federal Register of Legislation No. F2015L00255) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that Paget disease of bone and death from Paget disease of bone 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 Paget disease of bone or death from Paget disease of bone 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 subsection 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(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 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) 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 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":true,"description":"The scope has narrowed significantly compared to typical Statements of Principles. Previous versions of this instrument (such as the 2015 No. 49 version being repealed) contained multiple connecting factors (typically 3-5 factors covering various exposures and clinical scenarios). This 2023 version reduces the connecting factors to just one — inability to obtain appropriate clinical management. This represents a substantial restriction in the pathways available for veterans to establish service connection for Paget disease under the reasonable hypothesis standard."},"complexity_factors":["Very short instrument (approximately 3 pages)","Only 7 defined terms in the Dictionary","Single operative factor in section 9 (previously multiple factors existed in earlier versions)","Minimal cross-referencing — only refers to parent Acts (VEA and MRCA) and one repealed instrument","Clear structure with numbered sections and plain headings","One conditional limitation in section 10(2) restricting the factor to aggravation cases only","No nested exceptions or complex logical operators"],"plain_english_summary":"This instrument sets the medical test for linking Paget disease of bone to military service so veterans and serving/former defence members can claim under the VEA or MRCA. It defines the disease, covers death from its complications, and adopts a single connecting factor: service-related inability to obtain proper medical treatment that worsened pre‑existing Paget disease (it does not cover service as the cause of new disease).\n\nIt replaces the 2015 version and narrows eligibility by listing only that one connecting factor."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement of Principles and substitutes a new Statement (section 4). Its operative change is to set a single, explicitly stated minimum factor — inability to obtain appropriate clinical management before clinical worsening — as the basis for raising a reasonable hypothesis (section 9(1)). The new text therefore replaces prior guidance and will change which cases meet the reasonable hypothesis test for claims under the VEA and MRCA (section 5)."},"complexity_factors":["Single operative causation factor: the instrument relies chiefly on 'inability to obtain appropriate clinical management' as the minimum factor (section 9(1)), concentrating interpretive importance on that phrase.","Definitions and medical framing: detailed medical definition of Paget disease of bone (section 7(2)) and an ICD‑10‑AM code reference (section 7(3)–(4)) require clinical interpretation.","Scope of application: applies to claims under the VEA and MRCA (section 5; Schedule definition of 'relevant service'), so it interacts with two statutory schemes.","Treatment of pre‑existing conditions: the factor in section 9(1) only applies to material contribution or aggravation where the disease was suffered or contracted before or during (but did not arise out of) relevant service (section 10(2)), adding a temporal/causation constraint.","Inclusion of death: death from Paget disease is covered where death was contributed to by the disease; 'terminal event' is defined in the Schedule (section 7(5); Schedule 'terminal event').","Interplay with other Statements of Principles: cross‑reference to other Statements may import their factors and complexity (section 11).","Repeal and replacement: repeals the 2015 Statement (section 4), creating transitional and precedent implications for past claims.","Administrative authority and timing: instrument made under subsection 196B(2) of the VEA and commences on a specific date (section 3; section 2), so decision‑makers and claimants must apply the new text from commencement."],"plain_english_summary":"This instrument replaces the previous Statement of Principles and sets the medical test for linking Paget disease of bone (including death where Paget disease contributed) to veterans’ service for claims under the VEA and the MRCA. It comes into force on 25 July 2023. Mechanically, a reasonable hypothesis of service connection requires at least one qualifying factor — principally an inability to obtain appropriate clinical management before clinical worsening — and the condition must be related to the person’s relevant service."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023","history":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-paget-disease-of-bone-reasonable-hypothesis-no-62-of-2023/documents"}}