{"id":"F2025L01289","name":"Statement of Principles concerning Parkinson disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 87 of 2025)","slug":"statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443012,"registerId":"F2025L01289-fast-fetch-1775957928274","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Parkinson disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 87 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\nPARKINSON DISEASE AND SECONDARY PARKINSONISM  (Reasonable Hypothesis)\n\n(No. 87 of 2025)\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    24 October 2025\n\n \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   \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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning Parkinson disease and Secondary Parkinsonism (Reasonable Hypothesis) (No. 87 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 24 November 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning Parkinson’s disease and secondary parkinsonism (Reasonable Hypothesis) (No. 55 of 2016) (Federal Register of Legislation No. F2016L00560) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\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 Parkinson disease and Secondary Parkinsonism and death from Parkinson disease and Secondary Parkinsonism.\n\n\nMeaning of Parkinson disease and Secondary Parkinsonism\n\n1.             For the purposes of this Statement of Principles:\n\n\nParkinson disease means a neurodegenerative disease involving the progressive failure of dopaminergic transmission in the nigrostriatal system of the basal ganglia, which:\n\n1.    is characterised clinically by:\n  1.             the presence of bradykinesia, muscular rigidity, a resting tremor and/or postural instability;\n  2.          symptoms which may gradually progress;\n  3.        a sustained response to therapy with levodopa; and/or\n  4.         non-motor symptoms including sleep, mood and autonomic disturbances; and/or\n\n\n1.             is characterised pathologically by the degeneration of dopaminergic neurons in the substantia nigra pars compacta and the presence of alpha-synuclein-associated Lewy bodies or Lewy neurite intracellular inclusions at widespread locations in the central and peripheral nervous system; and\n2.             excludes:\n  1.             Secondary Parkinsonism;\n  2.          Parkinsonism in other primary neurodegenerative diseases such as Creutzfeldt-Jacob disease, Huntington disease, motor neurone disease, Wilson disease; and\n  3.        Parkinson Plus diseases including neurocognitive disorder with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, frontotemporal dementia and corticobasal degeneration.\n\n\nSecondary Parkinsonism means an acquired movement disorder caused by exogenous factors that interfere with dopaminergic transmission in the nigrostriatal system of the basal ganglia, which:\n\n1.           is characterised clinically by the presence of bradykinesia, muscular rigidity, a resting tremor and/or postural instability; and\n\n\n1.             excludes:\n  1.             Parkinson disease;\n  2.          dementia pugilistica;\n  3.        non-parkinsonian tremors such as benign essential tremor;\n  4.         Parkinsonism in primary neurodegenerative diseases such as Creutzfeldt-Jacob disease, Huntington disease, motor neurone disease, Wilson disease;\n  5.           Parkinson Plus diseases including neurocognitive disorder with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, frontotemporal dementia and corticobasal degeneration; and\n  6.         psychogenic parkinsonism.\n\n\nDeath from Parkinson disease and Secondary Parkinsonism\n\n1.           For the purposes of this Statement of Principles, Parkinson disease or Secondary Parkinsonism, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Parkinson disease or Secondary Parkinsonism.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that Parkinson disease or Secondary Parkinsonism and death from Parkinson disease or Secondary Parkinsonism 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\n1.                Factors that must exist\n\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 Parkinson disease or Secondary Parkinsonism or death from Parkinson disease or Secondary Parkinsonism with the circumstances of a person's relevant service:\n\nParkinson disease\n\n1.           having moderate to severe traumatic brain injury at least 15 years before clinical onset of Parkinson disease;\n2.           having moderate to severe traumatic brain injury within the 1 year before clinical worsening of Parkinson disease;\n3.           having concussion at least 15 years before clinical onset of Parkinson disease;\n4.           having concussion within the 1 year before clinical worsening of Parkinson disease;\n5.           inhaling, ingesting or having cutaneous contact with trichloroethylene for a cumulative period of at least 2,000 hours, at least 20 years before clinical onset of Parkinson disease;\n6.           inhaling, ingesting or having cutaneous contact with trichloroethylene for a cumulative period of at least 2,000 hours, within the 20 years before clinical worsening of Parkinson disease;\n7.           inhaling, ingesting or having cutaneous contact with one of the following pesticides, for a cumulative period of at least 1,000 hours, at least 5 years before clinical onset of Parkinson disease:\n  1.             dithiocarbamate-based fungicide;\n  2.             organochlorine insecticide;\n  3.             organophosphorus ester;\n  4.             paraquat;\n  5.             phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) (components of Agent Orange); or\n  6.              rotenone.\n\n\nNote: exposure to phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) can also occur apart from Agent Orange\n\n1.           inhaling, ingesting or having cutaneous contact with one of the following pesticides, for a cumulative period of at least 1,000 hours, within the 10 years before clinical worsening of Parkinson:\n  1.             dithiocarbamate-based fungicide;\n  2.             organochlorine insecticide;\n  3.             organophosphorus ester;\n  4.             paraquat;\n  5.             phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) (components of Agent Orange); or\n  6.              rotenone.\n\n\nNote: exposure to phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) can also occur apart from Agent Orange\n\n1.           inability to undertake any physical activity greater than 3 METs for at least 10 years within the 20 years before clinical onset of Parkinson disease;\n\n\nNote: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening\n\n1.       inability to undertake any physical activity greater than 3 METs for at least the 5 years before clinical worsening of Parkinson disease;\n\n\nNote: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening\n\n1.       consuming an average of at least 1 litre of cow’s milk per day for at least the 15 years before clinical onset of Parkinson disease;\n2.       consuming an average of at least 1 litre of cow’s milk per day for at least the 5 years before clinical worsening of Parkinson disease;\n3.       having one of the following clinically significant disorders of mental health at least 15 years before clinical onset of Parkinson disease:\n  1.             anxiety disorder;\n  2.             bipolar disorder; \n  3.             depressive disorder; or\n  4.             posttraumatic stress disorder.\n\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 – Dictionary.\n\n1.       having one of the following clinically significant disorders of mental health for at least the 5 years before clinical worsening of Parkinson disease:\n  1.             anxiety disorder;\n  2.             bipolar disorder; \n  3.             depressive disorder; or\n  4.             posttraumatic stress disorder.\n\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 – Dictionary.\n\n1.       in a person with a history of a regular smoking habit, having not smoked for at least the 5 years before clinical onset of Parkinson disease;\n\n\nNote: regular smoking habit is defined in the Schedule 1 - Dictionary.\n\n1.       in a person with a history of a regular smoking habit, having not smoked within the 10 years before clinical worsening of Parkinson disease;\n\n\nNote: regular smoking habit is defined in the Schedule 1 – Dictionary.\n\n1.       having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the 3 months before clinical worsening of Parkinson disease;\n\n\nNote: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 – Dictionary.\n\n1.       having an intracranial space occupying lesion within the 3 months before clinical worsening of Parkinson disease;\n\n\nNote: Examples of intracranial space occupying lesion include meningioma, glioma, lymphoma of the central nervous system, metastatic lesions, arachnoid cysts, abscess and subdural haematoma.\n\n1.       having hydrocephalus, or draining of hydrocephalus, within the 3 months before clinical worsening of Parkinson disease;\n\n\nNote: hydrocephalus is defined in the Schedule 1 - Dictionary.\n\n1.       having a cerebrovascular accident, excluding transient ischaemic attack, within the 3 months before clinical worsening of Parkinson disease;\n2.       having one of the following diseases of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, at the time of clinical worsening of Parkinson disease:\n  1.             cerebral small vessel disease (Binswanger disease);\n  2.             cerebral amyloid angiopathy;\n  3.             cerebral arteriolosclerosis;\n  4.             cerebral venous thrombosis;\n  5.             hippocampal sclerosis of vascular origin (seen in temporal lobe epilepsy, hypoxic/ischaemic brain injury);\n  6.              inflammatory or immunologically mediated vasculitis;\n  7.             intravascular lymphomatosis (a type of non-Hodgkin lymphoma);\n  8.             laminar cortical necrosis; or\n  9.               Moyamoya disease or syndrome.\n\n\nNote 1: cerebral arteriolosclerosis is defined in the Schedule - 1 Dictionary.\n\nNote 2: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 – Dictionary.\n\n1.       having a subarachnoid haemorrhage within the 3 months before clinical worsening of Parkinson disease;\n2.       having an acquired cerebrovascular malformation or dural arteriovenous fistula at the time of clinical worsening of Parkinson disease;\n3.       having an hypoxic cerebral insult within the 2 years before clinical worsening of Parkinson disease;\n\n\nNote: hypoxic cerebral insult is defined in the Schedule 1 - Dictionary.\n\n1.       having influenza within the 3 months before clinical worsening of Parkinson disease;\n2.       having encephalitis within the 3 months before clinical worsening of Parkinson disease;\n3.       having infection with human immunodeficiency virus before clinical worsening of Parkinson disease;\n4.       having neurosyphilis at the time of clinical worsening of Parkinson disease;\n\n\nNote: neurosyphilis is defined in the Schedule 1 - Dictionary.\n\n1.       having neurocysticercosis at the time of clinical worsening of Parkinson disease;\n\n\nNote: Neurocysticercosis is caused by central nervous system infection with the pork tapeworm Tenia solium.\n\n1.       inhaling carbon disulphide vapour in an enclosed space, or having cutaneous contact with carbon disulphide, for a cumulative period of at least 500 hours, within the 10 years before clinical worsening of Parkinson disease;\n2.       inhaling or ingesting methanol or ethylene glycol, and having clinical, haematological or biochemical evidence of methanol or ethylene glycol intoxication, within the 3 months before clinical worsening of Parkinson disease;\n3.       being exposed to manganese for a cumulative period of at least 250 hours, within the 10 years before clinical worsening of Parkinson disease;\n\n\nNote: being exposed to manganese is defined in the Schedule 1 - Dictionary.\n\n1.       having clinical or biochemical evidence of manganese intoxication while receiving total parenteral nutrition or maintenance haemodialysis, at the time of clinical worsening of Parkinson disease;\n\n\nNote: total parenteral nutrition is defined in the Schedule 1 - Dictionary.\n\n1.       inhaling, ingesting or having cutaneous contact with cyanide, and having clinical, haematological or biochemical evidence of cyanide intoxication, within the 3 months before clinical worsening of Parkinson disease;\n2.       having an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 3 months before clinical worsening of Parkinson disease;\n3.       using one or more of the following drugs within the 3 months before clinical worsening of Parkinson disease:\n  1.             3,4-methylenedioxymethamphetamine (Ecstasy or MDMA);\n  2.             khat (Catha edulis);\n  3.             methamphetamine; or\n  4.             methcathinone (ephedrone).\n4.       taking any of the medications from the specified list of medications for at least 1 week within the 3 months before clinical worsening of Parkinson disease;\n\n\nNote: specified list of medications is defined in the Schedule 1 – Dictionary.\n\n1.       taking a medication which is associated with:\n  1.             the clinical worsening of Parkinson disease during medication therapy; and\n  2.             the cessation of clinical worsening within 3 months of discontinuing medication therapy; and\n\n\nwhere treatment with the drug continued for at least the 3 days before clinical worsening;\n\n1.       having one of the following disorders of calcium metabolism at the time of clinical worsening of Parkinson disease:\n  1.             Fahr syndrome;\n  2.             hyperparathyroidism;\n  3.             hypoparathyroidism; or\n  4.             pseudohyperparathyroidism.\n\n\nNote: Fahr syndrome involves pathological calcification of the basal ganglia (beyond the globus pallidus), typically presents with neuropsychiatric symptoms, and causes include hypoparathyroidism, pseudohypoparathyroidism, cranial radiotherapy, post-infection.\n\n1.       having cirrhosis of the liver at the time of clinical worsening of Parkinson disease;\n2.       having chronic renal failure at the time of clinical worsening of Parkinson disease as indicated by:\n  1.             a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n  2.             undergoing chronic dialysis for renal failure.\n3.       having one of the following autoimmune diseases at the time of clinical worsening of Parkinson disease:\n  1.             antiphospholipid syndrome;\n  2.             Behçet disease;\n  3.             nonvasculitic autoimmune inflammatory meningoencephalitis;\n  4.             Sjogren syndrome; or\n  5.             systemic lupus erythematosus.\n4.       having a paraneoplastic encephalomyelitis at the time of clinical worsening of Parkinson disease;\n5.       taking a beta-blocker medication for a cumulative period of at least 6 months, at least 5 years before clinical onset of Parkinson disease; \n6.       taking a beta-blocker medication for a cumulative period of at least 6 months, within the 5 years before clinical worsening of Parkinson disease; \n7.       having diabetes mellitus at least 5 years before clinical onset of Parkinson disease;\n8.       having diabetes mellitus within the 5 years before clinical worsening of Parkinson disease;\n9.       inability to obtain appropriate clinical management for Parkinson disease before clinical worsening;\n\n\nSecondary Parkinsonism\n\n1.       having moderate to severe traumatic brain injury within the 1 year before clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       having concussion within the 1 year before clinical onset or clinical worsening of Secondary Parkinsonism;\n3.       inhaling, ingesting or having cutaneous contact with trichloroethylene for a cumulative period of at least 2,000 hours, within the 20 years before clinical onset or clinical worsening of Secondary Parkinsonism;\n4.       inhaling, ingesting or having cutaneous contact with one of the following pesticides, for a cumulative period of at least 1,000 hours, within the 10 years before clinical worsening of Secondary Parkinsonism:\n  1.             dithiocarbamate-based fungicide;\n  2.             organochlorine insecticide;\n  3.             organophosphorus ester;\n  4.             paraquat;\n  5.             phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) (components of Agent Orange); or\n  6.              rotenone.\n\n\nNote: exposure to phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) can also occur apart from Agent Orange\n\n1.       inability to undertake any physical activity greater than 3 METs for at least the 5 years before clinical worsening of Secondary Parkinsonism;\n\n\nNote: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening\n\n1.       consuming an average of at least 1 litre of cow’s milk per day for at least the 5 years before clinical worsening of Secondary Parkinsonism;\n2.       having one of the following clinically significant disorders of mental health for at least the 5 years before clinical worsening of Secondary Parkinsonism:\n  1.             anxiety disorder;\n  2.             bipolar disorder; \n  3.             depressive disorder; or\n  4.             posttraumatic stress disorder.\n\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 – Dictionary.\n\n1.       in a person with a history of a regular smoking habit, having not smoked within the 10 years before clinical worsening of Secondary Parkinsonism;\n\n\nNote: regular smoking habit is defined in the Schedule 1 – Dictionary.\n\n1.       having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 – Dictionary.\n\n1.       having an intracranial space occupying lesion within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: Examples of intracranial space occupying lesion include meningioma, glioma, lymphoma of the central nervous system, metastatic lesions, arachnoid cysts, abscess and subdural haematoma.\n\n1.       having hydrocephalus, or draining of hydrocephalus, within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: hydrocephalus is defined in the Schedule 1 - Dictionary.\n\n1.       having a cerebrovascular accident, excluding transient ischaemic attack, within the 5 years before clinical onset of Secondary Parkinsonism;\n2.       having a cerebrovascular accident, excluding transient ischaemic attack, within the 3 months before clinical worsening of Secondary Parkinsonism;\n3.       having one of the following diseases of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, at the time of clinical onset or clinical worsening of Secondary Parkinsonism:\n  1.             cerebral small vessel disease (Binswanger disease);\n  2.             cerebral amyloid angiopathy;\n  3.             cerebral arteriolosclerosis;\n  4.             cerebral venous thrombosis;\n  5.             hippocampal sclerosis of vascular origin (seen in temporal lobe epilepsy, hypoxic/ischaemic brain injury);\n  6.              inflammatory or immunologically mediated vasculitis;\n  7.             intravascular lymphomatosis (a type of non-Hodgkin lymphoma);\n  8.             laminar cortical necrosis; or\n  9.               Moyamoya disease or syndrome.\n\n\nNote 1: cerebral arteriolosclerosis is defined in the Schedule - 1 Dictionary.\n\nNote 2: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 – Dictionary.\n\n1.       having a subarachnoid haemorrhage within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       having an acquired cerebrovascular malformation or dural arteriovenous fistula at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n3.       having an hypoxic cerebral insult within the 2 years before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: hypoxic cerebral insult is defined in the Schedule 1 - Dictionary.\n\n1.       having influenza within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       having encephalitis within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n3.       having infection with human immunodeficiency virus before clinical onset or clinical worsening of Secondary Parkinsonism;\n4.       having neurosyphilis at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: neurosyphilis is defined in the Schedule 1 - Dictionary.\n\n1.       having neurocysticercosis at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: Neurocysticercosis is caused by central nervous system infection with the pork tapeworm Tenia solium.\n\n1.       inhaling carbon disulphide vapour in an enclosed space, or having cutaneous contact with carbon disulphide, for a cumulative period of at least 500 hours, within the 10 years before clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       inhaling or ingesting methanol or ethylene glycol, and having clinical, haematological or biochemical evidence of methanol or ethylene glycol intoxication, within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n3.       being exposed to manganese for a cumulative period of at least 250 hours, within the 10 years before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: being exposed to manganese is defined in the Schedule 1 - Dictionary.\n\n1.       having clinical or biochemical evidence of manganese intoxication while receiving total parenteral nutrition or maintenance haemodialysis, at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: total parenteral nutrition is defined in the Schedule 1 - Dictionary.\n\n1.       inhaling, ingesting or having cutaneous contact with cyanide, and having clinical, haematological or biochemical evidence of cyanide intoxication, within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       having an injection containing 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n3.       using one or more of the following drugs within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism:\n  1.             3,4-methylenedioxymethamphetamine (Ecstasy or MDMA);\n  2.             khat (Catha edulis);\n  3.             methamphetamine; or\n  4.             methcathinone (ephedrone).\n4.       taking any of the medications from the specified list of medications for at least 1 week within the 3 months before clinical onset or clinical worsening of Secondary Parkinsonism;\n\n\nNote: specified list of medications is defined in the Schedule 1 – Dictionary.\n\n1.       taking a medication which is associated with:\n  1.             the development of Secondary Parkinsonism during medication therapy; and\n  2.             the cessation of Secondary Parkinsonism within 12 months of discontinuing medication therapy; and\n\n\nwhere treatment with the drug continued for at least the 7 days before clinical onset;\n\n1.       taking a medication which is associated with:\n  1.             the clinical worsening of Secondary Parkinsonism during medication therapy; and\n  2.             the cessation of clinical worsening within 3 months of discontinuing medication therapy; and\n\n\nwhere treatment with the drug continued for at least the 3 days before clinical worsening;\n\n1.       having one of the following disorders of calcium metabolism at the time of clinical onset or clinical worsening of Secondary Parkinsonism:\n  1.             Fahr syndrome;\n  2.             hyperparathyroidism;\n  3.             hypoparathyroidism; or\n  4.             pseudohyperparathyroidism.\n\n\nNote: Fahr syndrome involves pathological calcification of the basal ganglia (beyond the globus pallidus), typically presents with neuropsychiatric symptoms, and causes include hypoparathyroidism, pseudohypoparathyroidism, cranial radiotherapy, post-infection.\n\n1.       having cirrhosis of the liver at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n2.       having chronic renal failure at the time of clinical onset or clinical worsening of Secondary Parkinsonism as indicated by:\n  1.             a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n  2.             undergoing chronic dialysis for renal failure.\n3.       having one of the following autoimmune diseases at the time of clinical onset or clinical worsening of Secondary Parkinsonism:\n  1.             antiphospholipid syndrome;\n  2.             Behçet disease;\n  3.             nonvasculitic autoimmune inflammatory meningoencephalitis;\n  4.             Sjogren syndrome; or\n  5.             systemic lupus erythematosus.\n4.       having a paraneoplastic encephalomyelitis at the time of clinical onset or clinical worsening of Secondary Parkinsonism;\n5.       taking a beta-blocker medication for a cumulative period of at least 6 months, within the 5 years before clinical worsening of Secondary Parkinsonism; \n6.       having diabetes mellitus within the 5 years before clinical worsening of Secondary Parkinsonism;\n7.       inability to obtain appropriate clinical management for Secondary Parkinsonism before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, Parkinson disease or Secondary Parkinsonism where the person's Parkinson disease or Secondary Parkinsonism 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 9 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(2) 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 6\n\n1               Definitions\n\nIn this instrument:\n\n                               acute cholinergic poisoning means symptoms and signs due to the inhibition of acetylcholinesterase enzyme activity which occur within the 24 hours following exposure. These symptoms and signs are acute paralysis, overwhelming bronchial secretions, bradycardia, gastrointestinal distress, miosis, lacrimation or diarrhoea.\n\n                               being exposed to manganese means:\n\n(a)           working in the mining or smelting of ores containing manganese; or\n\n(b)           welding with rods containing manganese; or\n\n(c)           inhaling dust containing manganese.\n\n                               cerebral arteriolosclerosis means thickening of the walls of small arteries or arterioles of the brain, due to cell proliferation or hyaline deposition.\n\n                               clinically significant disorder of mental health means a disorder of mental health which is of sufficient severity to warrant ongoing management.\n\nNote: To warrant ongoing management does not require that any actual management was received or given for the condition.\n\n                               hydrocephalus means a condition characterised by dilation of the cerebral ventricles and accompanied by accumulation of excess cerebrospinal fluid within the skull. This definition includes obstructive and non-obstructive hydrocephalus, idiopathic normal pressure hydrocephalus or traumatic hydrocephalus.\n\n                               hypoxic cerebral insult means an event which results in either a decreased rate of cerebral blood flow or decreased oxygen content of cerebral arterial blood for a sustained period. Circumstances where hypoxic cerebral insult occur include carbon monoxide poisoning, cardiac arrest and high-altitude mountain ascent.\n\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               neuroimaging (magnetic resonance imaging or computed tomography) findings means an image of an interior of a body obtained by medical techniques, that is usually obtained at a date after clinical onset of the disease.\n\n                               neurosyphilis means infection of the central nervous system with Treponema pallidum.\n\n                               one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\nNote 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\nNote 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\n                               organophosphorus ester means an agent used to inhibit acetylcholinesterase, and includes the organophosphate pesticides chlorpyrifos, dichlorvos, O-ethyl-O-(4-nitrophenyl)phenylthiophosphonate (EPN), leptophos, methamidophos, mipafox (diisopropyl phosphorofluoridate), omethoate, parathion, TOCP (tri-ortho-cresyl phosphate), trichlorfon and trichlornat.\n\n                               Parkinson disease and Secondary Parkinsonism—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 defined in the Schedule 1 - Dictionary.\n\n                               regular smoking habit means having smoked at least 5 pack-years of tobacco products, within a continuous 5 year period.\n\nNote: one pack-year is also defined in the Schedule 1 – Dictionary.\n\n                               specified list of medications means:\n\n(a)          5-fluorouracil;\n\n(b)          alpha-methyldopa;\n\n(c)          amiodarone;\n\n(d)          amlodipine;\n\n(e)          amoxapine;\n\n(f)           amphotericin B;\n\n(g)          antipsychotic drug (including typical and atypical agents);\n\n(h)          aprindine;\n\n(i)            bethanechol (intraspinal or intracranial);\n\n(j)            bupropion;\n\n(k)          buspirone;\n\n(l)            butyrophenones (e.g. haloperidol, droperidol);\n\n(m)        captopril;\n\n(n)          cephaloridine;\n\n(o)          chloroquine;\n\n(p)          cimetidine;\n\n(q)          cinnarizine;\n\n(r)           clopamide-pindolol combination;\n\n(s)           cyclophosphamide;\n\n(t)            cyclosporine;\n\n(u)          cytosine arabinoside;\n\n(v)          diltiazem;\n\n(w)        disulfiram;\n\n(x)          domperidone;\n\n(y)          donepezil;\n\n(z)          doxorubicin;\n\n(aa)       droperidol;\n\n(bb)      etoposide;\n\n(cc)       flunarizine;\n\n(dd)      flurbiprofen;\n\n(ee)       gabapentin;\n\n(ff)        indeloxazine;\n\n(gg)      interferon-alpha;\n\n(hh)      lithium;\n\n(ii)         lorazepam;\n\n(jj)         mandipine;\n\n(kk)      methotrexate;\n\n(ll)         metoclopramide;\n\n(mm) metopimazine;\n\n(nn)      mexiletine;\n\n(oo)      molindone;\n\n(pp)      naproxen;\n\n(qq)      nifedipine;\n\n(rr)        pentoxifylline;\n\n(ss)        pethidine;\n\n(tt)         phenelzine;\n\n(uu)      phenothiazines (e.g. phenothiazine, prochlorperazine or promethazine);\n\n(vv)      phenylamine;\n\n(ww)  phenytoin;\n\n(xx)      pimozide;\n\n(yy)      pregabalin;\n\n(zz)       procaine;\n\n(aaa)   prokinetics/propulsive agents (including alizapride, cisapride, clebopride, itopride);\n\n(bbb)  propiverine;\n\n(ccc)   pyridostigmine; \n\n(ddd)  reserpine;\n\n(eee)   selective serotonin reuptake inhibitor;\n\n(fff)      sodium valproate (valproic acid);\n\n(ggg)  tacrine;\n\n(hhh)  tacrolimus;\n\n(iii)       tetrabenazine;\n\n(jjj)       thiethylperazine;\n\n(kkk)  thioxanthenes;\n\n(lll)       tiapride;\n\n(mmm)trimetazidine;\n\n(nnn)  veralipride;\n\n(ooo)  verapamil; or\n\n(ppp)  vincristine plus Adriamycin.\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                               total parenteral nutrition means continuous intravenous drip feeding with no feeding via mouth or gut.\n\n                               VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles (No. 55 of 2016) and replaces it with a new, detailed Statement that specifies many named exposures, drugs, medical conditions and quantitative thresholds and distinct timing rules for onset versus clinical worsening (section 4; section 9; Schedule 1). The repeal and the added/clarified thresholds mean the legal criteria governing which service‑related Parkinson disease or Secondary Parkinsonism claims meet a 'reasonable hypothesis' have been changed."},"complexity_factors":["Layered causation tests: separate requirements for 'clinical onset' and 'clinical worsening' with different time windows and thresholds (section 9).","Large number of discrete factors and exposures listed (traumatic brain injury, specific solvents, many pesticides, drugs, infections, metabolic disorders, organ failures, etc.), each with bespoke timing or cumulative‑exposure rules (section 9; Schedule 1).","Quantitative evidence needs: cumulative exposure hours, METs for physical activity, pack‑years for smoking, laboratory/clinical evidence of intoxication or organ failure, and neuroimaging findings are expressly required or referenced (section 9; Schedule 1).","Many defined technical terms and measurement rules located in Schedule 1, creating cross‑reference burdens for evidence and interpretation (Schedule 1; section 6).","Interplay with other Statements of Principles: where a listed factor refers to another Statement that instrument’s terms apply, producing inter‑instrument dependencies (section 11).","Application limited to statutory claim streams under the VEA s120A and MRCA s338 — procedural and entitlement consequences hinge on that boundary (section 5).","Decision framing and discretion: the Repatriation Medical Authority sets the factors and their thresholds (Authority; opening text), but claim assessment requires administrative fact‑finding about exposures, dates and medical evidence.","Evidence timing precision: many factors require proximate timing (e.g. within 3 months, within 10 or 20 years), increasing evidentiary and medical‑opinion burdens on claimants (section 9).","Exclusions and diagnostic distinctions between Parkinson disease and Secondary Parkinsonism impose clinical diagnostic complexity (section 7(2)).","Repeal of the 2016 instrument and replacement with this text alters the legal baseline and may require reassessment of prior claims under the new criteria (section 4)."],"plain_english_summary":"This instrument replaces the previous Repatriation Medical Authority Statement of Principles for Parkinson disease and Secondary Parkinsonism and sets the specific medical findings, exposures and time thresholds that, if established, raise a ‘reasonable hypothesis’ connecting those conditions (or death from them) to a person’s relevant military service. It applies to claims under the VEA and MRCA and therefore determines which veterans or serving members may have service‑related entitlement claims accepted (the Authority says it rests on medical‑scientific evidence; section 8)."},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2016 version (No. 55 of 2016) with updated medical evidence but does not expand beyond the traditional purpose of establishing service-related factors for veterans' compensation claims. The structure—covering both onset and worsening factors for primary and secondary conditions—follows the standard RMA template."},"complexity_factors":["Extensive defined terms: 18 specific definitions in Schedule 1, including technical medical terms like 'acute cholinergic poisoning', 'cerebral arteriolosclerosis', and 'one pack-year' with mathematical calculation notes.","Dual condition structure: Separate but overlapping factor lists for Parkinson disease (45+ factors) and Secondary Parkinsonism (35+ factors), with different timeframes and thresholds.","Complex temporal requirements: Multiple cascading time windows (e.g., 'at least 15 years before clinical onset' vs 'within 1 year before clinical worsening') that vary by factor and condition type.","Cumulative exposure calculations: Requires precise hour-counting for chemical exposures (2,000 hours for trichloroethylene, 1,000 hours for pesticides, 500 hours for carbon disulphide, 250 hours for manganese).","Nested exclusions and inclusions: Detailed pathological and clinical definitions in section 7 with multiple layers of exclusions (e.g., Parkinson disease explicitly excludes Secondary Parkinsonism and 'Parkinson Plus' diseases).","Cross-referencing architecture: Section 11 creates dynamic links to other Statements of Principles, meaning this instrument interacts with an entire corpus of RMA determinations.","Dual onset/worsening framework: Factors are split between causing the disease initially ('clinical onset') and making it worse later ('clinical worsening'), with different applicability rules in section 10.","Technical medical specificity: Requires understanding of METs (metabolic equivalents), specific drug classes (dithiocarbamate-based fungicides, organophosphorus esters), and neuroimaging findings."],"plain_english_summary":"This instrument tells how the Repatriation Medical Authority decides if Parkinson disease or secondary parkinsonism is linked to military service so veterans and current/former defence members can claim benefits. It applies a \"reasonable hypothesis\" test — a lower threshold than usual causation — relying on plausible service-related factors (e.g., head injury, chemical exposures, certain meds or medical/lifestyle risks) to establish a connection. It updates 2016 guidance and matters because it determines access to pensions, treatment and other entitlements."},"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-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi","history":"/api/acts/statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi/history","analysis":"/api/acts/statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi/analysis","conflicts":"/api/acts/statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi/important-cases","documents":"/api/acts/statement-of-principles-concerning-parkinson-disease-and-secondary-parkinsonism-reasonable-hypothesi/documents"}}