{"id":"F2023L00941","name":"Statement of Principles concerning peripheral neuropathy (Balance of Probabilities) (No. 73 of 2023)","slug":"statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441995,"registerId":"F2023L00941-fast-fetch-1775957135402","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning peripheral neuropathy (Balance of Probabilities) (No. 73 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\nPERIPHERAL NEUROPATHY (Balance of Probabilities)\n\n(No. 73 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:
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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 peripheral neuropathy (Balance of Probabilities) (No. 73 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 peripheral neuropathy No. 75 of 2014 (Federal Register of Legislation No. F2014L01137) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 peripheral neuropathy and death from peripheral neuropathy.\n\nMeaning of peripheral neuropathy\n\n(2) For the purposes of this Statement of Principles, peripheral neuropathy:\n\n(a) means a non-traumatic pathology of the peripheral nerves that supply the upper or lower limbs, and producing:\n\n(i) symptoms; and\n\n(ii) signs or electrodiagnostic evidence (electromyography or nerve conduction studies);\n\nof impaired motor, sensory or autonomic functioning; and\n\n(b) includes mononeuritis multiplex; and \n\n(c) excludes:\n\n(i) autoimmune nodopathies associated with autoantibodies against nodal and paranodal proteins;\n\n(ii) chronic immune sensory polyradiculopathy and chronic immune sensory and motor polyradiculopathy;\n\n(iii) chronic inflammatory demyelinating polyneuropathy and its variants;\n\n(iv) complex regional pain syndrome;\n\n(v) Guillain-Barre syndrome;\n\n(vi) hereditary neuropathies;\n\n(vii) isolated mononeuropathies of the upper or lower limbs including carpal tunnel syndrome, meralgia paraesthetica, Morton metatarsalgia, tarsal tunnel syndrome, and ulnar neuropathy at the elbow;\n\n(viii) motor neurone disease (amyotrophic lateral sclerosis);\n\n(ix) multifocal motor neuropathy;\n\n(x) neuralgic amyotrophy;\n\n(xi) neurogenic thoracic outlet syndrome; and\n\n(xii) peripheral manifestations of brain or spinal cord pathology including cerebrovascular accident, traumatic brain injury, cerebral tumours, multiple sclerosis, myelopathy, myelitis or cauda equina syndrome.\n\nNote 1: Peripheral nerves include motor, sensory and autonomic nerves extending from the nerve roots to the sensors or actuators.\n\nNote 2: Symptoms of peripheral neuropathy include tingling, numbness, pain, weakness and sweating dysfunction.\n\nNote 3: non-traumatic is defined in the Schedule 1 – Dictionary.\n\nDeath from peripheral neuropathy\n\n(3) For the purposes of this Statement of Principles, peripheral neuropathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's peripheral neuropathy.\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 peripheral neuropathy and death from peripheral neuropathy 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, peripheral neuropathy or death from peripheral neuropathy is connected with the circumstances of a person's relevant service:\n\n(1) having amyloidosis at the time of the clinical onset of peripheral neuropathy;\n\nNote: amyloidosis is defined in the Schedule 1 - Dictionary.\n\n(2) having chronic liver disease at the time of the clinical onset of peripheral neuropathy;\n\n(3) having chronic renal failure at the time of the clinical onset of peripheral neuropathy;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(4) having sarcoidosis at the time of the clinical onset of peripheral neuropathy;\n\n(5) having an endocrine disease from the specified list of endocrine diseases at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of endocrine diseases is defined in the Schedule 1 - Dictionary.\n\n(6) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.\n\n(7) having a systemic vasculitis from the specified list of forms of systemic vasculitis at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of forms of systemic vasculitis is defined in the Schedule 1 - Dictionary.\n\n(8) having an infection from the specified list of infections at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(9) having a haematological or lymphoproliferative disorder from the specified list of haematological or lymphoproliferative disorders at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of haematological or lymphoproliferative disorders is defined in the Schedule 1 - Dictionary.\n\n(10) having a malignant neoplasm, other than non-melanotic malignant neoplasm of the skin, at the time of the clinical onset of peripheral neuropathy;\n\n(11) having a neurological paraneoplastic syndrome at the time of the clinical onset of peripheral neuropathy;\n\n(12) having a critical illness within the 30 days before the clinical onset of peripheral neuropathy;\n\nNote: critical illness is defined in the Schedule 1 - Dictionary.\n\n(13) having severe alcohol use disorder at the time of the clinical onset of peripheral neuropathy;\n\nNote: severe alcohol use disorder is defined in the Schedule 1 - Dictionary.\n\n(14) consuming at least 300 kilograms of alcohol within the 10 years before the clinical onset of peripheral neuropathy;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(15) inhaling, ingesting or having cutaneous contact with a chemical from the specified list of chemicals (short term exposure);\n\n(a) on at least 30 occasions within a continuous period of 6 months before the clinical onset of peripheral neuropathy; and\n\n(b) where exposure has ceased before the clinical onset of peripheral neuropathy, then that onset occurred within 3 months of cessation;\n\nNote: specified list of chemicals (short term exposure) is defined in the Schedule 1 - Dictionary.\n\n(16) inhaling, ingesting or having cutaneous contact with a chemical from the specified list of chemicals (long term exposure):\n\n(a) on more days than not for at least 1 year before the clinical onset of peripheral neuropathy; and\n\n(b) where exposure has ceased before the clinical onset of peripheral neuropathy, then that onset occurred within 3 months of cessation;\n\nNote: specified list of chemicals (long term exposure) is defined in the Schedule 1 - Dictionary.\n\n(17) having a severe substance use disorder involving inhalation of a substance from the specified list of substances at the time of the clinical onset of peripheral neuropathy;\n\nNote: severe substance use disorder and specified list of substances are defined in the Schedule 1 - Dictionary.\n\n(18) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) within the 30 days before the clinical onset of peripheral neuropathy;\n\nNote: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.\n\n(19) having an episode of acute cholinergic poisoning from exposure to an organophosphorus compound or a carbamate insecticide within the 2 months before the clinical onset of peripheral neuropathy;\n\nNote: acute cholinergic poisoning and organophosphorus compound are defined in the Schedule 1 - Dictionary.\n\n(20) being poisoned with an agent from the specified list of agents, as demonstrated by clinical, haematological or biochemical evidence, within the 30 days before the clinical onset of peripheral neuropathy;\n\nNote: specified list of agents is defined in the Schedule 1 - Dictionary.\n\n(21) having a nutritional deficiency as specified at the time of the clinical onset of peripheral neuropathy;\n\nNote: nutritional deficiency as specified is defined in the Schedule 1 - Dictionary.\n\n(22) having hypophosphataemia while undergoing total parenteral nutrition at the time of the clinical onset of peripheral neuropathy;\n\n(23) taking a drug from the specified list of drugs that cannot be ceased or substituted, at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of drugs that cannot be ceased or substituted is defined in the Schedule 1 - Dictionary.\n\n(24) taking a drug that cannot be ceased or substituted and which is associated in the individual with the clinical onset of peripheral neuropathy during drug therapy and either:\n\n(a) the improvement of peripheral neuropathy within 3 months of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of peripheral neuropathy on rechallenge with the same drug or another drug from the same class of drugs; and\n\nwhere the drug was being taken at the time of the clinical onset of peripheral neuropathy;\n\n(25) taking a drug from the specified list of drugs at the time of the clinical onset of peripheral neuropathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(26) taking a drug which is associated in the individual with the clinical onset of peripheral neuropathy during drug therapy and either:\n\n(a) the improvement of peripheral neuropathy within 3 months of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of peripheral neuropathy on rechallenge with the same drug or another drug from the same class of drugs; and\n\nwhere the drug was being taken at the time of the clinical onset of peripheral neuropathy;\n\n(27) being treated with cisplatin within the 6 months before the clinical onset of peripheral neuropathy;\n\n(28) having bariatric surgery within the 5 years before the clinical onset of peripheral neuropathy;\n\nNote: bariatric surgery is defined in the Schedule 1 - Dictionary.\n\n(29) having vitamin B6 (pyridoxine) hypervitaminosis at the time of the clinical onset of peripheral neuropathy;\n\nNote: vitamin B6 (pyridoxine) hypervitaminosis is defined in the Schedule 1 - Dictionary.\n\n(30) undergoing stem cell or bone marrow transplantation before the clinical onset of peripheral neuropathy;\n\n(31) having acute carbon monoxide poisoning, with a carboxyhaemoglobin level of over 20 percent, within the 30 days before the clinical onset of peripheral neuropathy;\n\n(32) having amyloidosis at the time of the clinical worsening of peripheral neuropathy;\n\nNote: amyloidosis is defined in the Schedule 1 - Dictionary.\n\n(33) having chronic liver disease at the time of the clinical worsening of peripheral neuropathy;\n\n(34) having chronic renal failure at the time of the clinical worsening of peripheral neuropathy;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(35) having sarcoidosis at the time of the clinical worsening of peripheral neuropathy;\n\n(36) having an endocrine disease from the specified list of endocrine diseases at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of endocrine diseases is defined in the Schedule 1 - Dictionary.\n\n(37) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.\n\n(38) having a systemic vasculitis from the specified list of forms of systemic vasculitis at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of forms of systemic vasculitis is defined in the Schedule 1 - Dictionary.\n\n(39) having a haematological or lymphoproliferative disorder from the specified list of haematological or lymphoproliferative disorders at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of haematological or lymphoproliferative disorders is defined in the Schedule 1 - Dictionary.\n\n(40) having a malignant neoplasm, other than non-melanotic malignant neoplasm of the skin, at the time of the clinical worsening of peripheral neuropathy;\n\n(41) having a neurological paraneoplastic syndrome at the time of the clinical worsening of peripheral neuropathy;\n\n(42) having a critical illness within the 30 days before the clinical worsening of peripheral neuropathy;\n\nNote: critical illness is defined in the Schedule 1 - Dictionary.\n\n(43) having severe alcohol use disorder at the time of the clinical worsening of peripheral neuropathy;\n\nNote: severe alcohol use disorder is defined in the Schedule 1 - Dictionary.\n\n(44) consuming at least 300 kilograms of alcohol within the 10 years before the clinical worsening of peripheral neuropathy;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(45) inhaling, ingesting or having cutaneous contact with a chemical from the specified list of chemicals (short term exposure);\n\n(a) on at least 30 occasions within a continuous period of 6 months before the clinical worsening of peripheral neuropathy; and\n\n(b) where exposure has ceased before the clinical worsening of peripheral neuropathy, then that worsening occurred within 3 months of cessation;\n\nNote: specified list of chemicals (short term exposure) is defined in the Schedule 1 - Dictionary.\n\n(46) inhaling, ingesting or having cutaneous contact with a chemical from the specified list of chemicals (long term exposure):\n\n(a) on more days than not for at least 1 year before the clinical worsening of peripheral neuropathy; and\n\n(b) where exposure has ceased before the clinical worsening of peripheral neuropathy, then that worsening occurred within 3 months of cessation;\n\nNote: specified list of chemicals (long term exposure) is defined in the Schedule 1 - Dictionary.\n\n(47) having a severe substance use disorder involving inhalation of a substance from the specified list of substances at the time of the clinical worsening of peripheral neuropathy;\n\nNote: severe substance use disorder and specified list of substances are defined in the Schedule 1 - Dictionary.\n\n(48) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) within the 30 days before the clinical worsening of peripheral neuropathy;\n\nNote: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.\n\n(49) having an episode of acute cholinergic poisoning from exposure to an organophosphorus compound or a carbamate insecticide within the 2 months before the clinical worsening of peripheral neuropathy;\n\nNote: acute cholinergic poisoning and organophosphorus compound are defined in the Schedule 1 - Dictionary.\n\n(50) being poisoned with an agent from the specified list of agents, as demonstrated by clinical, haematological or biochemical evidence, within the 30 days before the clinical worsening of peripheral neuropathy;\n\nNote: specified list of agents is defined in the Schedule 1 - Dictionary.\n\n(51) having a nutritional deficiency as specified at the time of the clinical worsening of peripheral neuropathy;\n\nNote: nutritional deficiency as specified is defined in the Schedule 1 - Dictionary.\n\n(52) having hypophosphataemia while undergoing total parenteral nutrition at the time of the clinical worsening of peripheral neuropathy;\n\n(53) taking a drug from the specified list of drugs that cannot be ceased or substituted, at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of drugs that cannot be ceased or substituted is defined in the Schedule 1 - Dictionary.\n\n(54) taking a drug that cannot be ceased or substituted and which is associated in the individual with the clinical worsening of peripheral neuropathy during drug therapy and either:\n\n(a) the improvement of peripheral neuropathy within 3 months of discontinuing or tapering drug therapy; or\n\n(b) the clinical worsening of peripheral neuropathy on rechallenge with the same drug or another drug from the same class of drugs; and\n\nwhere the drug was being taken at the time of the clinical worsening of peripheral neuropathy;\n\n(55) taking a drug from the specified list of drugs at the time of the clinical worsening of peripheral neuropathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(56) taking a drug which is associated in the individual with the clinical worsening of peripheral neuropathy during drug therapy and either:\n\n(a) the improvement of peripheral neuropathy within 3 months of discontinuing or tapering drug therapy; or\n\n(b) the clinical worsening of peripheral neuropathy on rechallenge with the same drug or another drug from the same class of drugs; and\n\nwhere the drug was being taken at the time of the clinical worsening of peripheral neuropathy;\n\n(57) being treated with cisplatin within the 6 months before the clinical worsening of peripheral neuropathy;\n\n(58) having bariatric surgery within the 5 years before the clinical worsening of peripheral neuropathy;\n\nNote: bariatric surgery is defined in the Schedule 1 – Dictionary.\n\n(59) having vitamin B6 (pyridoxine) hypervitaminosis at the time of the clinical worsening of peripheral neuropathy;\n\nNote: vitamin B6 (pyridoxine) hypervitaminosis is defined in the Schedule 1 – Dictionary.\n\n(60) undergoing stem cell or bone marrow transplantation before the clinical worsening of peripheral neuropathy;\n\n(61) having acute carbon monoxide poisoning, with a carboxyhaemoglobin level of over 20 percent, within the 30 days before the clinical worsening of peripheral neuropathy;\n\n(62) inability to obtain appropriate clinical management for peripheral neuropathy before the clinical worsening of peripheral neuropathy.\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(32) to 9(62) apply only to material contribution to, or aggravation of, peripheral neuropathy where the person's peripheral neuropathy 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 acromegaly means a chronic disease of adults resulting from hypersecretion of growth hormone after closure of the epiphyses.\n\n acute cholinergic poisoning means symptoms and signs due to the inhibition of acetylcholinesterase enzyme activity which occur within 24 hours following exposure. These symptoms and signs include bradycardia, miosis, lacrimation, salivation, bronchorrhea, bronchospasm, urination, emesis and diarrhoea.\n\n amyloidosis means the accumulation of insoluble fibrillar proteins in organs or tissues of the body such that vital function is compromised.\n\nNote: Diseases that can be associated with amyloidosis include myeloma and chronic inflammatory diseases or chronic infectious diseases, such as inflammatory bowel disease, rheumatoid arthritis and tuberculosis.\n\n bariatric surgery means weight reduction surgical procedures including gastrojejunostomy, gastric stapling, vertical banded gastroplasty and gastrectomy with Roux-en-Y anastomosis.\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n critical illness means septicaemia, acute respiratory distress syndrome, acute renal tubular necrosis, disseminated intravascular coagulation, multiple organ failure, or a clinical condition requiring mechanical ventilation support, excluding ventilation during surgery.\n\n DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.\n\n inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means:\n\n(a) decanting or spraying;\n\n(b) cleaning or maintaining equipment used to apply;\n\n(c) being sprayed with;\n\n(d) handling or sawing timber treated with;\n\n(e) being in an environment shrouded in dust from timber treated with; or\n\n(f) using cutting oils contaminated with;\n\n one of the following chemicals:\n\n(a) 2,4,5-trichlorophenoxyacetic acid;\n\n(b) 2,4,5-trichlorophenoxypropionic acid;\n\n(c) 2,4,5-trichlorophenol;\n\n(d) 2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;\n\n(e) o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;\n\n(f) pentachlorophenol;\n\n(g) 2,3,4,6-tetrachlorophenol;\n\n(h) 2,4,6-trichlorophenol;\n\n(i) 1,3,5-trichloro-2-(4-nitrophenoxy)benzene;\n\n(j) 2,4-dichloro-1-(4-nitrophenoxy)benzene; or\n\n(k) 2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n non-traumatic means a disease mechanism not being damage due to blunt trauma, penetrating trauma, compression trauma, traction, thermal trauma, electrical trauma, ionising radiation, the effect of a space occupying lesion, or entrapment of a nerve or nerve root.\n\n nutritional deficiency as specified means having clinical or biochemical evidence of a deficiency of one of the following:\n\n(a) copper;\n\n(b) vitamin B1 (thiamine);\n\n(c) vitamin B6 (pyridoxine);\n\n(d) vitamin B12 (cobalamin); or\n\n(e) vitamin E.\n\n organophosphorus compound means an agent used to inhibit acetylcholinesterase, and includes Novichok nerve agents and the organophosphate pesticides chlorpyrifos, dichlorvos, diisopropyl phosphofluoridate, EPN (ethyl p-nitrophenyl theonobenzenephosphonate), ethyl parathion, fenthion, isopenphos, leptophos, malathion, merphos, methamidophos, mevinphos, mipafox (diisopropyl phosphorofluoridate), omethoate, parathion, phosphamidon/mevinphos, phenyl saligenin phosphate, trichlorfon, trichlornat and TOCP (tri-ortho-cresyl phosphate).\n\n peripheral neuropathy—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 severe alcohol use disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5-TR):\n\n A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 6 of the following, occurring within a 12-month period:\n\n1. Alcohol is often taken in larger amounts or over a longer period than was intended.\n2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.\n3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.\n4. Craving, or a strong desire or urge to use alcohol.\n5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home.\n6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.\n7. Important social, occupational or recreational activities are given up or reduced because of alcohol use.\n8. Recurrent alcohol use in situations in which it is physically hazardous.\n9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.\n10. Tolerance, as defined by either of the following:\n\n\n(i) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or\n\n(ii) a markedly diminished effect with continued use of the same amount of alcohol.\n\nK. Withdrawal, as manifested by either of the following:\n\n(i) the characteristic withdrawal syndrome for alcohol; or\n\n(ii) alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.\n\n The definition of severe alcohol use disorder excludes acute alcohol intoxication in the absence of alcohol use disorder.\n\nNote: DSM-5-TR is also defined in the Schedule 1 – Dictionary.\n\n severe substance use disorder means a disorder of mental health characterised by a problematic pattern of use of a substance leading to clinically significant impairment or distress, as manifested by at least 6 of the following criteria (derived from DSM-5-TR), occurring within a 12-month period:\n\n \n\n1. The substance is often taken in larger amounts or over a longer period than was intended.\n2. There is a persistent desire or unsuccessful efforts to cut down or control substance use.\n3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.\n4. Craving, or a strong desire or urge to use the substance.\n5. Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home.\n6. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.\n7. Important social, occupational or recreational activities are given up or reduced because of substance use.\n8. Recurrent substance use in situations in which it is physically hazardous.\n9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.\n10. Tolerance, as defined by either of the following:\n\n\n(i) a need for markedly increased amounts of the substance to achieve intoxication or desired effect; or\n\n(ii) a markedly diminished effect with continued use of the same amount of the substance.\n\nNote: DSM-5-TR is also defined in the Schedule 1 - Dictionary.\n\n specified list of agents means:\n\n(a) a polychlorinated biphenyl;\n\n(b) brevetoxin;\n\n(c) ciguatera toxin;\n\n(d) cobalt;\n\n(e) colloidal silver;\n\n(f) diethylene glycol;\n\n(g) dimethylamine borane;\n\n(h) fruit of the Buckthorn shrub (Karwinskia humboldtiana);\n\n(i) inorganic arsenic;\n\n(j) inorganic lead;\n\n(k) mercury;\n\n(l) methyl bromide;\n\n(m) N-3-pyridyl methyl-N’-p-nitrophenyl urea (Vacor);\n\n(n) saxitoxin;\n\n(o) tetrodotoxin;\n\n(p) thallium salts;\n\n(q) trichloropropane; or\n\n(r) tri-ortho-cresyl phosphate.\n\n specified list of autoimmune diseases means:\n\n(a) antiphospholipid syndrome;\n\n(b) coeliac disease;\n\n(c) inflammatory bowel disease;\n\n(d) mixed connective tissue disease;\n\n(e) rheumatoid arthritis;\n\n(f) Sjögren syndrome;\n\n(g) systemic lupus erythematosus; or\n\n(h) systemic sclerosis (scleroderma).\n\n specified list of chemicals (long term exposure) means:\n\n(a) acrylamide monomer at an oral dose rate of >0.001 mg/kg/day;\n\n(b) allyl chloride;\n\n(c) 1-bromopropane at an inhaled concentration of >0.02 ppm;\n\n(d) carbon disulphide at an inhaled concentration of >0.3 ppm;\n\n(e) ethylene oxide at an inhaled concentration of >1 ppm;\n\n(f) methyl bromide at an inhaled concentration of >0.02 ppm;\n\n(g) methyl n-butyl ketone (MNBK) at an inhaled concentration of >0.6 ppm; or\n\n(h) n-hexane at an inhaled concentration of >0.6 ppm.\n\n specified list of chemicals (short term exposure) means:\n\n(a) acrylamide monomer at an oral dose rate of >0.01 mg/kg/day;\n\n(b) 1-bromopropane at an inhaled concentration of >1 ppm or an oral dose rate of >0.001 mg/kg/day;\n\n(c) carbon disulphide at an inhaled concentration of >0.3 ppm;\n\n(d) dimethylaminopropionitrile;\n\n(e) ethylene oxide at an inhaled concentration of >5 ppm;\n\n(f) methyl bromide at an inhaled concentration of >0.02 ppm;\n\n(g) methyl n-butyl ketone (MNBK) at an inhaled concentration of >0.6 ppm; or\n\n(h) n-hexane at an inhaled concentration of >0.6 ppm.\n\n specified list of drugs means\n\n(a) amiodarone;\n\n(b) arsenic trioxide;\n\n(c) atezolizumab;\n\n(d) bortezomib;\n\n(e) brentuximab vedotin;\n\n(f) carfilzomib;\n\n(g) cycloserine;\n\n(h) dichloroacetate;\n\n(i) disulfiram;\n\n(j) fludarabine;\n\n(k) fluoroquinolone antibiotics, excluding topical formulations;\n\n(l) ipilimumab;\n\n(m) isoniazid;\n\n(n) itraconazole;\n\n(o) linezolid;\n\n(p) methotrexate;\n\n(q) metronidazole;\n\n(r) misonidazole;\n\n(s) nitrofurantoin;\n\n(t) pemetrexed;\n\n(u) platinum compounds;\n\n(v) pomalidomide;\n\n(w) statins;\n\n(x) taxanes;\n\n(y) thalidomide;\n\n(z) trastuzumab;\n\n(aa) trastuzumab emtansine;\n\n(bb) vigabatrin;\n\n(cc) vinca alkaloids; or\n\n(dd) zalcitabine (ddC).\n\n specified list of drugs that cannot be ceased or substituted means:\n\n(a) 5-fluorouracil;\n\n(b) acitretin;\n\n(c) altretamine;\n\n(d) auranofin;\n\n(e) aurothioglucose;\n\n(f) benznidazole;\n\n(g) brigatinib;\n\n(h) chloramphenicol; \n\n(i) chloroquine;\n\n(j) chlorprothixene;\n\n(k) colchicine;\n\n(l) crizotinib;\n\n(m) cytosine arabinoside;\n\n(n) dapsone;\n\n(o) daptomycin;\n\n(p) didanosine (ddI); \n\n(q) encorafenib;\n\n(r) entrectinib;\n\n(s) eribulin mesylate;\n\n(t) etanercept;\n\n(u) ethambutol;\n\n(v) etoposide;\n\n(w) etravirine;\n\n(x) gemcitabine;\n\n(y) glutethimide;\n\n(z) griseofulvin;\n\n(aa) hexamethylmelamine;\n\n(bb) hydralazine;\n\n(cc) hydroxychloroquine;\n\n(dd) infliximab;\n\n(ee) interferon alpha;\n\n(ff) ixabepilone;\n\n(gg) leflunomide;\n\n(hh) lenolidamide;\n\n(ii) levodopa;\n\n(jj) lithium;\n\n(kk) lorlatinib;\n\n(ll) mefloquine;\n\n(mm) nitrous oxide with prolonged use over 24 hours;\n\n(nn) nifurtimox;\n\n(oo) peginterferon alpha-2a;\n\n(pp) perhexiline maleate;\n\n(qq) phenytoin;\n\n(rr) podophyllin;\n\n(ss) ponatinib;\n\n(tt) procarbazine; \n\n(uu) sorafenib;\n\n(vv) stavudine (d4T); \n\n(ww) sulphasalazine;\n\n(xx) suramin;\n\n(yy) telbivudine;\n\n(zz) teniposide;\n\n(aaa) teriflunomide;\n\n(bbb) tioguanine; or\n\n(ccc) voriconazole.\n\n specified list of endocrine diseases means:\n\n(a) acromegaly;\n\n(b) diabetes mellitus;\n\n(c) hyperthyroidism, including goitre and Graves disease that has resulted in hyperthyroidism;\n\n(d) hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism; or\n\n(e) thyrotoxicosis.\n\nNote: acromegaly is also defined in the Schedule 1 – Dictionary.\n\n specified list of forms of systemic vasculitis means:\n\n(a) Behçet disease;\n\n(b) eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome);\n\n(c) giant cell (temporal) arteritis;\n\n(d) granulomatosis with polyangiitis (Wegener granulomatosis);\n\n(e) Henoch-Schonlein purpura (IgA vasculitis);\n\n(f) microscopic polyangiitis;\n\n(g) mixed cryoglobulinaemia; or\n\n(h) polyarteritis nodosa.\n\n specified list of haematological or lymphoproliferative disorders means:\n\n(a) acute lymphoblastic leukaemia/lymphoblastic lymphoma;\n\n(b) acute myeloid leukaemia;\n\n(c) mature B-cell lymphoid leukaemia and small lymphocytic lymphoma;\n\n(d) chronic myeloid leukaemia;\n\n(e) Hodgkin lymphoma;\n\n(f) hypereosinophilic syndrome;\n\n(g) monoclonal gammopathy;\n\n(h) myeloma;\n\n(i) non-Hodgkin lymphoma;\n\n(j) polycythaemia vera; or\n\n(k) Waldenström macroglobulinaemia.\n\n specified list of infections means:\n\n(a) Borrelia burgdorferi (Lyme disease);\n\n(b) Clostridium botulinum (botulism);\n\n(c) Corynebacterium diphtheriae (diphtheria);\n\n(d) cytomegalovirus;\n\n(e) hepatitis B virus;\n\n(f) hepatitis C virus;\n\n(g) human immunodeficiency virus;\n\n(h) Mycobacterium leprae (leprosy); or\n\n(i) Treponema pallidum (tertiary syphilis).\n\n specified list of substances means:\n\n(a) methyl n-butyl ketone (MNBK);\n\n(b) n-hexane;\n\n(c) nitrous oxide; or\n\n(d) petrol.\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 vitamin B6 (pyridoxine) hypervitaminosis means:\n\n(a) having taken least 100 milligrams of vitamin B6 per day for a continuous period of at least 12 months; or\n\n(b) having clinical or biochemical evidence of vitamin B6 hypervitaminosis.\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":false,"description":"This instrument replaces the 2014 Statement of Principles for peripheral neuropathy but remains within the original statutory purpose: to set the clinical and exposure factors that, if present and service‑related, establish a connection between peripheral neuropathy and relevant service for VEA/MRCA claims (see sections 3–5 and 7–9). The principal change is an update and expansion of definitional detail, enumerated lists, numeric thresholds and temporal windows (Schedule 1 and section 9). These changes add granularity and evidentiary specificity but do not extend the SoP beyond its original scope of defining how peripheral neuropathy is related to service for entitlement purposes."},"complexity_factors":["Long, enumerated factor list in section 9 with at least 62 separately numbered items covering onset and worsening scenarios","Extensive Schedule 1 with many defined terms and multiple long \"specified lists\" (drugs, drugs that cannot be ceased/substituted, chemicals short/long exposure, agents, infections, haematological disorders, endocrine diseases, forms of vasculitis, substances)","Multiple numeric thresholds and temporal windows (e.g. 30 occasions within 6 months; exposure ceased → onset within 3 months; 30 days; 2 months; 6 months; 1 year; 5 years; 300 kg alcohol in 10 years; GFR <15 mL/min/1.73m2; carboxyhaemoglobin >20%)","Nested conditional rules and exceptions (e.g. subsections 9(32)–9(62) apply only to aggravation of pre‑existing neuropathy and require the factor to be service‑related per section 10(2))","Cross‑references to other Statements of Principles (section 11) and to external diagnostic standards (DSM‑5‑TR) increase interpretive dependencies","Technical medical and toxicological content requiring specialist interpretation (electrodiagnostic evidence, specific poisonings, chemotherapy windows, nutritional deficiencies)","Multiple pathways to establish individual-level association (e.g. improvement within 3 months of stopping a drug or reproducible worsening on rechallenge) add evidentiary complexity","Mixture of categorical inclusions and many specific exclusions (section 7(2)(c)) necessitate careful case classification"],"plain_english_summary":"**What this instrument does (mechanics first)**\n\n- This is a Statement of Principles (SoP) issued by the Repatriation Medical Authority under subsection 196B(3) of the Veterans' Entitlements Act 1986. It replaces the earlier peripheral neuropathy SoP from 2014 (see section 4) and commenced on 25 July 2023 (section 2).\n- It applies to claims for service‑related injury or disease under the VEA and the Military Rehabilitation and Compensation Act (MRCA) (section 5).\n- The instrument defines what counts as \"peripheral neuropathy\" for the purpose of veteran and military compensation claims (section 7). That definition requires non‑traumatic disease of peripheral nerves supplying limbs with both symptoms (e.g. numbness, tingling, weakness) and signs or electrodiagnostic evidence (electromyography or nerve conduction studies) (section 7(2)). The instrument also lists specific exclusions (section 7(2)(c)).\n- The Authority states that, on the medical evidence available, it is \"more probable than not\" that peripheral neuropathy can be related to relevant service (section 8). That is the legal standard used here (balance of probabilities).\n- Section 9 sets out the causal / contributory \"factors that must exist\" before peripheral neuropathy (or death from it) can be accepted as connected with service. At least one of the enumerated factors must be present. The list includes diagnosed medical conditions (amyloidosis, chronic liver disease, chronic renal failure, sarcoidosis, listed endocrine or autoimmune disorders, forms of systemic vasculitis), infections and haematological disorders, malignancy or paraneoplastic syndromes, critical illness, specified substance‑use disorders and quantified alcohol use, specific toxic or chemical exposures (with short‑ and long‑term exposure definitions), episodes of specific poisonings (organophosphate/cholinergic), certain drugs or drug classes (including drugs that \"cannot be ceased or substituted\"), recent chemotherapy agent (cisplatin), bariatric surgery within 5 years, vitamin B6 toxicity, stem cell/bone marrow transplantation, acute carbon monoxide poisoning over a defined threshold, and inability to obtain appropriate clinical management (see sections 9(1)–9(62)). Many of the listed items apply both to causes at clinical onset and to events that materially contribute to a clinical worsening of pre‑existing peripheral neuropathy (distinct subsections 9(1)–9(31) and 9(32)–9(62)).\n- Section 10 requires that any listed factor relied upon must itself be \"related to the relevant service\". Subsections 9(32)–9(62) are limited to material contribution or aggravation where the neuropathy existed before or during (but did not arise out of) service (section 10(2)).\n- Section 11 says that, if a listed factor refers to a disease covered by another SoP, the rules in that other SoP apply (cross‑reference mechanism).\n- Schedule 1 contains detailed definitions and long enumerated lists (e.g. lists of drugs, chemicals, infections, haematological disorders, exposure thresholds, diagnostic thresholds such as GFR < 15 mL/min/1.73m2 for chronic renal failure, alcohol amounts, timeframe windows like 30 days/2 months/3 months/6 months/1 year/5 years, and DSM‑5‑TR‑derived definitions for severe substance or alcohol use disorder).\n\n**Official rationale (as stated in the instrument)**\n- The Repatriation Medical Authority records that, on the sound medical‑scientific evidence available, it is more probable than not that peripheral neuropathy and death from peripheral neuropathy can be related to relevant service (section 8). The SoP operationalises that view by listing the clinical, exposure and diagnostic factors that, if present and service‑related, establish a connection on the balance of probabilities.\n\n**What this means in practice (who pays, who decides, what changes behaviour)**\n- Who pays / benefits: Determination affects entitlement to veterans' and defence compensation and related benefits under the VEA and MRCA. If a claimant satisfies the SoP criteria and the factor is related to service, the Department of Veterans' Affairs (DVA) or other decision‑maker may accept the claim and provide entitlements (see section 5 and the enabling provision in section 3).\n- Who decides: The Repatriation Medical Authority issues the SoP; DVA (and relevant decision makers under MRCA/VEA) apply it to individual claims. Clinical evidence and diagnostic testing supplied by treating clinicians and specialists will be decisive in practice (see requirement for symptoms plus signs or electrodiagnostic evidence in section 7(2)).\n- Behavioural and administrative effects: The SoP changes what evidence claimants and clinicians need to show to establish service connection. It will increase demand for specific clinical tests, documented exposure histories, and clear temporal links between service and the listed factor. Claimants whose conditions or exposures match the enumerated factors will have a clearer path to accepted causation; claimants without those factors will face a higher evidentiary hurdle.\n\n**Implementation, compliance and operational consequences**\n- Evidence & measurement burden: The instrument imposes many specific evidentiary requirements and thresholds (e.g. exposure frequencies, time windows, measured carboxyhaemoglobin >20% for CO poisoning, GFR thresholds for chronic renal failure, 300 kg alcohol in 10 years as a quantitative cut‑off) that claimants and clinicians must document (Schedule 1; sections 7–9). That increases the diagnostic and record‑keeping burden on clinicians and the administrative workload for decision makers.\n- Timing and causation rules: Multiple temporal windows (30 days, 2 months, 3 months, 6 months, 1 year, 5 years) and exposure frequency rules add conditional complexity to many claims (see the short‑ and long‑term chemical exposure rules in sections 9(15), 9(16) and Schedule 1).\n- Medical interpretation risk: Several criteria require specialist interpretation (for example, establishing that a drug \"is associated in the individual with the clinical onset\" by improvement within 3 months of stopping the drug or by rechallenge). These will produce borderline cases and may increase appeals.\n- Bureaucratic discretion and cross‑references: The SoP expressly defers to other SoPs where a listed factor is itself covered elsewhere (section 11). That can shift decision logic between instruments and add complexity to adjudication.\n- Effects on private parties: The instrument does not regulate private businesses directly, but it can increase the need for employers, treating clinicians, and occupational health services to retain detailed exposure and medical records if a worker later claims veteran entitlements. It may also influence clinical practice in documentation for at‑risk patients (e.g. recording cumulative exposures, alcohol history, specific test results).\n\n**Costs, incentives, trade‑offs and plausible unintended effects**\n- Concentrated benefits, diffuse costs: The SoP concentrates benefits on claimants whose conditions or exposures match the enumerated factors (section 9). The administrative cost of assessing more detailed claims, and the demand on specialist diagnostic services, will be borne by government (DVA) and by clinicians preparing evidence.\n- Opportunity costs: DVA resources spent processing and medically assessing peripheral neuropathy claims are not available for other casework. Specialist services (EMG/nerve conduction studies, toxicology tests) may face increased demand.\n- Substitution and evidentiary framing: Claimants and treating clinicians may prioritise diagnoses, tests and exposure documentation that align with lists and thresholds in the SoP. That could change how histories are taken and what tests are ordered.\n- Implementation risk: The number of enumerated factors and precise thresholds can produce borderline cases requiring adjudication or review, increasing appeals and legal/medical contestation.\n\n**Section pointers**\n- Application to claims: section 5. Definition of peripheral neuropathy and exclusions: section 7. Basis/standard of causation: section 8. List of required factors: section 9 (and subsections). Relationship to service and limits on aggravation material: section 10. Cross‑reference to other SoPs: section 11. Definitions and thresholds: Schedule 1.\n\n(Analyst's note: the instrument is primarily an evidentiary / case‑definition tool. It operationalises the RMA's view that peripheral neuropathy can be linked to service by listing discrete, mostly medical or exposure‑based factors and precise time and dose thresholds. That approach lowers uncertainty for cases fitting the lists but raises documentation and adjudication complexity for borderline presentations.)"},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles that operates within its established statutory framework. It updates medical evidence from the 2014 version but does not expand beyond the traditional purpose of establishing service connection for specific conditions under veterans' compensation legislation."},"complexity_factors":["62 separate factors in section 9, many with nested sub-conditions (e.g., chemical exposure requiring specific frequency, duration AND timing relative to symptom onset)","Extensive defined terms in Schedule 1 — approximately 25+ defined terms, many themselves containing multiple sub-definitions (e.g., 'severe alcohol use disorder' incorporates 11 diagnostic criteria from DSM-5-TR)","Multiple cross-referenced lists: 8 'specified lists' containing dozens of specific chemicals, drugs, diseases and substances with precise technical thresholds (e.g., 'n-hexane at an inhaled concentration of >0.6 ppm')","Temporal complexity: Different factors require different look-back periods (30 days, 2 months, 6 months, 5 years, 10 years) with specific cessation windows","Dual structure: Factors 1-31 cover 'clinical onset', factors 32-62 cover 'clinical worsening', with factor 62 (inability to obtain appropriate clinical management) applying only to worsening","Section 11 creates dynamic incorporation by reference — other Statements of Principles apply if a factor refers to a disease covered by another instrument, creating interlocking statutory web","Exclusion clauses in section 7(2)(c) list 12 specific excluded conditions that must be distinguished from covered peripheral neuropathy"],"plain_english_summary":"This instrument sets the medical rules for when Australian veterans and defence members can claim peripheral neuropathy as service-related, replacing the 2014 version and narrowing what counts (and what is excluded). It lists 62 medical factors—like certain diseases, chemical exposures, medications, substance use, infections and surgeries—that, if proven at the condition’s onset or worsening, establish service connection on the balance of probabilities.\n\nIt matters because meeting at least one listed factor is the gateway to compensation under the VEA and MRCA."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023","history":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-peripheral-neuropathy-balance-of-probabilities-no-73-of-2023/documents"}}