{"id":"F2023L01427","name":"Statement of Principles concerning pericarditis (Reasonable Hypothesis) (No. 90 of 2023)","slug":"statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442139,"registerId":"F2023L01427-fast-fetch-1775957229477","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pericarditis (Reasonable Hypothesis) (No. 90 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\nPERICARDITIS (Reasonable Hypothesis)\n\n(No. 90 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 25 October 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 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning pericarditis (Reasonable Hypothesis) (No. 90 of 2023).\n\n2 Commencement\n\n This instrument commences on 28 November 2023.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about pericarditis and death from pericarditis.\n\nMeaning of pericarditis\n\n(2) For the purposes of this Statement of Principles, pericarditis:\n\n(a) means an inflammation of the pericardium; and\n\n(b) includes:\n\n(i) acute pericarditis;\n\n(ii) chronic pericarditis;\n\n(iii) recurrent pericarditis; and\n\n(iv) constrictive pericarditis; and\n\n(c) excludes haemorrhage from pericardial injury not associated with pericardial inflammation.\n\n(3) While pericarditis attracts ICD‑10‑AM codes, I30, I31.0, I31.1, I01.0, and I09.2, in applying this Statement of Principles the meaning of pericarditis 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 pericarditis\n\n(5) For the purposes of this Statement of Principles, pericarditis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pericarditis.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that pericarditis and death from pericarditis 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\n8 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 pericarditis or death from pericarditis with the circumstances of a person's relevant service:\n\n(1) having open heart surgery within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(2) having a pacemaker, or defibrillator lead insertion within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(3) having a cardiac ablation procedure to treat cardiac dysrhythmia within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(4) having sclerosants such as talc, and tetracyclines directly introduced into the pericardial sac before the clinical onset or clinical worsening of pericarditis;\n\n(5) having penetrating or blunt trauma to the heart within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(6) having electrical injury affecting the heart within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(7) having a peptic ulcer that erodes the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\n(8) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(9) having a pericardial infection at the time of the clinical onset or clinical worsening of pericarditis;\n\n(10) having a systemic viral infection within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(11) having tuberculosis before the clinical onset or clinical worsening of pericarditis;\n\n(12) having an infection of the structures contiguous with the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: Infections reported to spread to the pericardium from anatomical sites contiguous with the pericardium include empyema, and amoebic liver abscess.\n\n(13) having myocarditis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(14) having acute rheumatic fever at the time of the clinical onset or clinical worsening of pericarditis;\n\n(15) having one of the following vasculitides:\n\n(a) Behcet's disease;\n\n(b) eosinophilic granulomatosis with polyangiitis (Churg Straus syndrome);\n\n(c) giant cell (temporal) arteritis;\n\n(d) granulomatosis with polyangiitis (Wegener's granulomatosis);\n\n(e) microscopic polyangiitis;\n\n(f) polyarteritis nodosa; or\n\n(g) Takayasu's arteritis;\n\nat the time of the clinical onset or clinical worsening of pericarditis;\n\n(16) having one of the following systemic inflammatory diseases:\n\n(a) Addison disease with type 2 autoimmune polyglandular syndrome;\n\n(b) ankylosing spondylitis and seronegative spondyloarthropathies;\n\n(c) dermatomyositis;\n\n(d) IgG4-related disease;\n\n(e) inflammatory bowel disease;\n\n(f) mixed connective tissue disease;\n\n(g) polymyositis;\n\n(h) rheumatoid arthritis;\n\n(i) scleroderma (progressive systemic sclerosis);\n\n(j) Sjögren's syndrome; or\n\n(k) systemic lupus erythematosus;\n\nat the time of the clinical onset or clinical worsening of pericarditis;\n\n(17) having a heart transplant, lung transplant, kidney transplant or haematopoietic cell transplant before the clinical onset or clinical worsening of pericarditis;\n\n(18) having a myocardial infarction within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(19) having a dissection of the ascending aorta at the time of the clinical onset or clinical worsening of pericarditis;\n\n(20) having a pulmonary infarction at the time of the clinical onset or clinical worsening of pericarditis;\n\n(21) having pancreatitis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(22) having a benign or malignant cancer involving the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\n(23) having a malignant neoplasm with a paraneoplastic pericarditis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(24) having sarcoidosis or amyloidosis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(25) having acute or chronic renal failure at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: Pericarditis can occur in patients who are undergoing haemodialysis or peritoneal dialysis. Chronic renal failure is equivalent to a stage 5 chronic kidney disease with a glomerular filtration rate <15 ml/min/1.73 m2.\n\n(26) having diabetic ketoacidosis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(27) taking a drug from the specified list at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: drug from the specified list is defined in the Schedule1- Dictionary.\n\n(28) taking a drug which is associated in the individual with the development of pericarditis during drug therapy; and either:\n\n(a) the improvement of pericarditis within one month of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of pericarditis on rechallenge with the same drug; and\n\nwhere taking the drug continued for at least the 7 days before the clinical onset of pericarditis;\n\n(29) having a COVID-19 vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(30) having smallpox vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(31) having asbestosis or asbestos related pleural plaques before the clinical onset or clinical worsening of pericarditis;\n\n(32) inhaling respirable asbestos fibres in an enclosed space at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 1,000 hours before the clinical onset of pericarditis; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of pericarditis;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres.\n\n(33) inhaling respirable asbestos fibres in an open environment at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 3,000 hours before the clinical onset of pericarditis; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of pericarditis;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres.\n\n(34) inability to obtain appropriate clinical management for pericarditis before the clinical worsening of pericarditis.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The clinical worsening aspects of factors apply only to material contribution to, or aggravation of, pericarditis where the person's pericarditis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n drug from the specified list means:\n\n(a) 5-fluorouracil;\n\n(b) amiodarone;\n\n(c) anthracyclines including doxorubicin, daunorubicin, idarubicin, epirubicin and mitoxantrone;\n\n(d) anticoagulants;\n\n(e) bromocriptine;\n\n(f) cabergoline;\n\n(g) clozapine;\n\n(h) cromolyn sodium;\n\n(i) cyclophosphamide;\n\n(j) cyclosporine;\n\n(k) cytarabine/cytosine arabinoside;\n\n(l) dantrolene;\n\n(m) GM-CSF/granulocyte macrophage colony stimulating factor;\n\n(n) hydantoins;\n\n(o) hydralazine;\n\n(p) immune checkpoint inhibitors including ipilimumab, nivolumab, pembrolizumab, atexolizumab, avelumab, dostarlimab, and durvalumab;\n\n(q) intravesicular BCG;\n\n(r) isoniazid;\n\n(s) mesalazine/mesalamine/5-aminosalicylic acid;\n\n(t) methyldopa;\n\n(u) methysergide;\n\n(v) minoxidil;\n\n(w) penicillins;\n\n(x) pergolide;\n\n(y) phenylbutazone;\n\n(z) phenytoin;\n\n(aa) practolol;\n\n(bb) procainamide;\n\n(cc) psicofuranine;\n\n(dd) reserpine;\n\n(ee) rifampicin;\n\n(ff) Streptokinase;\n\n(gg) streptomycin;\n\n(hh) sulfa drugs;\n\n(ii) thiazides;\n\n(jj) thrombolytic agents;\n\n(kk) tocainide;\n\n(ll) tryptophan;\n\n(mm) tumour necrosis alpha antagonists; or\n\n(nn) tyrosine kinase inhibitors.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pericarditis—see subsection 6(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 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":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles instrument of the kind regularly made under the Veterans' Entitlements Act. It follows the established template and scope for determining service-related medical conditions. The inclusion of COVID-19 vaccines (factor 29) reflects contemporary medical knowledge rather than scope creep, and the asbestos provisions mirror standard occupational exposure language used across similar instruments."},"complexity_factors":["34 distinct factual factors with varying timeframes (4 weeks, 20 years, or no time limit)","Multiple cross-references to other legislation (VEA, MRCA) and other Statements of Principles","Specific medical terminology requiring definitions (vasculitides, systemic inflammatory diseases, ICD-10-AM codes)","Conditional logic distinguishing between 'clinical onset' and 'clinical worsening' with different rules for each","Detailed exposure thresholds for asbestos (1,000 hours enclosed/3,000 hours open, plus 5-year latency period)","Complex drug-related factor (factor 28) requiring proof of causation through dechallenge/rechallenge","40-item defined term list for 'drug from the specified list' alone"],"plain_english_summary":"Establishes a medical test for when Australian veterans and defence members can claim pericarditis (or death from it) as service-related by listing 34 medical factors—such as recent cardiac procedures, trauma or infection, autoimmune disease, certain drugs/vaccines, asbestos exposure, radiation, or inadequate treatment. It applies under the VEA 1986 and MRCA 2004 to veterans and current/former defence personnel from operations, peacekeeping, hazardous or nuclear service.\n\nIf at least one listed factor links the condition to service, that creates a reasonable basis for pension, treatment, or compensation claims."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument defines its own scope: it applies to claims under section 120A of the VEA or section 338 of the MRCA and to pericarditis as defined in section 6. The text does not state or evidence any expansion or contraction of statutory application beyond those claims or of the medical condition beyond the definition provided."},"complexity_factors":["Long enumerated list of causative and contributory factors (33 discrete factor types in section 8), increasing factual complexity for claims assessors and claimants.","Multiple differing temporal thresholds for causation or aggravation (for example: 4 weeks for viral infection, cardiac ablation, myocardial infarction and vaccines; 20 years for surgery, trauma, radiation and transplants) (see section 8, paras 1–3, 8, 18, 29–30).","Dual causal concept: factors may establish either onset or clinical worsening and must be related to 'relevant service' (sections 8 and 9), creating interaction between medical history and service history.","Cross‑references to other Statements of Principles and statutory instruments (section 10), requiring assessors to reconcile multiple instruments and current versions.","Defined technical terms and external code references (pericarditis definition and ICD‑10‑AM codes in section 6(2)–(4); Schedule 1 definitions), requiring medical coding and interpretation.","List of specified drugs with varied mechanisms (Schedule 1) and an alternative drug-induced causation pathway requiring evidence of improvement on withdrawal or reproducibility on rechallenge (section 8(28)).","Application limited to statutory claim streams (section 4), so legal thresholds and administrative procedures of VEA/MRCA interact with medical findings.","Requirement that each listed factor be 'related to the relevant service' (section 9(1)) creates evidentiary and proof burdens linking medical events to service exposures."],"plain_english_summary":"This Statement of Principles prescribes the medical criteria used to decide whether pericarditis (or death from pericarditis) can be reasonably hypothesised to be connected to a person's military service. It lists specific causes, procedures, infections, drugs, exposures and time limits which, if present and related to relevant service, satisfy the statutory threshold for claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act. It affects veterans, current/former members and decision-makers assessing entitlement claims."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023","history":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-pericarditis-reasonable-hypothesis-no-90-of-2023/documents"}}