{"id":"F2024L01699","name":"Statement of Principles concerning polymyalgia rheumatica (Balance of Probabilities) (No. 6 of 2025)","slug":"statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442679,"registerId":"F2024L01699-fast-fetch-1775957631565","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning polymyalgia rheumatica (Balance of Probabilities) (No. 6 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\nPOLYMYALGIA RHEUMATICA  (Balance of Probabilities)\n\n(No. 6 of 2025)\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 17 December 2024.\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\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 polymyalgia rheumatica (Balance of Probabilities) (No. 6 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 28 January 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning polymyalgia rheumatica (Balance of Probabilities) (No. 20 of 2016) (Federal Register of Legislation No. F2016L00259) made under subsection 196B(3) of the VEA is repealed.\n\n1.                Application\n\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\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 polymyalgia rheumatica and death from polymyalgia rheumatica.\n\n\nMeaning of polymyalgia rheumatica\n\n1.           For the purposes of this Statement of Principles, polymyalgia rheumatica:\n  1.           means an inflammatory rheumatic disorder with the following characteristics:\n    1.             bilateral aching and stiffness involving the shoulder or proximal regions of the arms; or the hip or proximal regions of the thighs; or the neck or lower back;\n    2.          elevated acute phase reactants (erythrocyte sedimentation rate and/or C reactive protein) or systemic symptoms such as malaise, fatigue and a low-grade fever; and\n    3.        occurring in the absence of other diseases capable of causing the musculoskeletal system symptoms; and\n  2.           excludes polymyalgia rheumatica coexistent with giant cell arteritis. \n\n\nNote: In patients with polymyalgia rheumatica who can take corticosteroids, there is a rapid response to corticosteroid therapy.\n\n1.           While polymyalgia rheumatica attracts ICD‑10‑AM code M35.3, in applying this Statement of Principles the meaning of polymyalgia rheumatica is that given in subsection (2).\n2.           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\n\nDeath from polymyalgia rheumatica\n\n1.           For the purposes of this Statement of Principles, polymyalgia rheumatica, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's polymyalgia rheumatica.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that polymyalgia rheumatica and death from polymyalgia rheumatica 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, polymyalgia rheumatica or death from polymyalgia rheumatica is connected with the circumstances of a person's relevant service:\n\n1.           being treated with immune checkpoint inhibitors within the 1 year before clinical onset or clinical worsening;\n\n\nNote: Examples of immune checkpoint inhibitors include atezolizumab, avelumab, cemiplimab, durvalumab, ipilimumab, nivolumab, and pembrolizumab. \n\n1.           inability to obtain appropriate clinical management for polymyalgia rheumatica 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 aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, polymyalgia rheumatica where the person's polymyalgia rheumatica 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(3) 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                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               polymyalgia rheumatica—see subsection 7(2).\n\n                             relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n                             terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2016 predecessor. It remains tightly focused on establishing specific causal factors for one discrete medical condition (polymyalgia rheumatica) in the veterans' compensation context. The 2025 revision updates the medical evidence and replaces the previous instrument but does not expand the scope beyond its original purpose of determining service connection for this specific disease."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (MRCA, polymyalgia rheumatica, relevant service, terminal event, VEA)","Simple binary structure: two specific factors in section 9, both clearly stated","Minimal cross-referencing — only internal references to the Dictionary and related Acts","No nested exceptions or conditional logic beyond the basic 'at least one factor must exist' requirement","Straightforward medical definition in section 7 with clear inclusion/exclusion criteria"],"plain_english_summary":"This instrument sets medical criteria for when polymyalgia rheumatica is considered service-related for compensation claims by veterans and current/former defence members under the VEA and MRCA. It updates prior guidance and narrows how service connection is established.\n\nThe Repatriation Medical Authority finds a service link mainly where the condition follows immune checkpoint inhibitor cancer treatment within a year, or where lack of appropriate medical care allowed worsening. Cases concurrent with giant cell arteritis are excluded."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2016 Statement (s4) and replaces it with a Statement that: (a) defines polymyalgia rheumatica and excludes coexistent giant cell arteritis (s7(2)); (b) specifies two service‑related factors (immune checkpoint inhibitors within 1 year; inability to obtain appropriate clinical management) as the bases for connection (s9); and (c) clarifies death from the condition via terminal events (Schedule). These textual changes indicate a change in scope of qualifying causal factors and evidentiary focus."},"complexity_factors":["Specialised medical definition of polymyalgia rheumatica with clinical and laboratory criteria (s7(2)) increases evidentiary complexity for claimants and clinicians.","Explicit exclusion of polymyalgia rheumatica coexistent with giant cell arteritis requires differential diagnosis (s7(2)(4)).","Only two listed service‑related factors can establish connection: immune checkpoint inhibitor treatment within 1 year, and inability to obtain appropriate clinical management — both time‑sensitive and fact‑dependent (s9).","Nuanced relationship‑to‑service rules require the factor to be related to relevant service and limit clinical worsening rules to pre‑existing conditions (s10(1)‑(2)).","Cross‑references to other Statements of Principles mean entitlements may depend on interpretation of other instruments (s11).","Instrument applies only to VEA/MRCA claims, narrowing procedural scope but concentrating effects on claimants under those Acts (s5).","Replaces prior 2016 Statement, so precedent and expectations may shift (s4).","References to ICD‑10‑AM codes and a Schedule dictionary add technical coding and definitional complexity (s7(4)‑(5); Schedule).","Death definition includes a list of terminal events, requiring causal linkage between condition and listed terminal events for fatality claims (Schedule).","Practical compliance burdens: claimants must produce medical evidence of treatment timing, access to care, and clinical course; the Authority retains interpretive discretion about what constitutes 'inability to obtain appropriate clinical management' (s9; s10)."],"plain_english_summary":"This instrument sets the medical test for linking polymyalgia rheumatica to eligible veterans’ or members’ service for VEA and MRCA claims. It defines the clinical features of the condition, excludes cases co‑existing with giant cell arteritis, and lists the service‑related factors that can establish a connection.\n\nIt affects veterans and serving members making entitlement claims because entitlement decisions will rely on the specified clinical definition and two service‑related factors: recent immune‑checkpoint therapy or inability to obtain appropriate clinical management."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025","history":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-balance-of-probabilities-no-6-of-2025/documents"}}