{"id":"F2024L01698","name":"Statement of Principles concerning polymyalgia rheumatica (Reasonable Hypothesis) (No. 5 of 2025)","slug":"statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442681,"registerId":"F2024L01698-fast-fetch-1775957631601","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning polymyalgia rheumatica (Reasonable Hypothesis) (No. 5 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  (Reasonable Hypothesis)\n\n(No. 5 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    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   \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 (Reasonable Hypothesis) (No. 5 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning polymyalgia rheumatica (Reasonable Hypothesis) (No. 19 of 2016) (Federal Register of Legislation No. F2016L00249) 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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that polymyalgia rheumatica and death from polymyalgia rheumatica 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 polymyalgia rheumatica or death from polymyalgia rheumatica 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.           having a COVID-19 vaccine within the 4 weeks before clinical onset or clinical worsening;\n2.           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(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                                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)          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":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2016 Statement (section 4) and replaces it with updated definitions and a revised set of causal factors (section 9). New named factors include immune checkpoint inhibitor treatment within 1 year (section 9.1), COVID‑19 vaccination within 4 weeks (section 9.2), and inability to obtain appropriate clinical management before worsening (section 9.3). It also clarifies the PMR definition and excludes PMR coexistent with giant cell arteritis (section 7(2)). These changes modify which exposures and circumstances can raise a reasonable hypothesis linking PMR to relevant service for claims under the VEA or MRCA (see section 5)."},"complexity_factors":["Medical specificity: provides a clinical definition of PMR (symptom pattern, elevated inflammatory markers, exclusion of other causes) which requires medical evidence for claims (see section 7(2)).","Time‑limited exposure windows: causal factors include specific timing requirements (immune checkpoint inhibitors within 1 year; COVID‑19 vaccine within 4 weeks) that create evidentiary thresholds (see section 9.1–9.2).","Interplay with other Statements of Principles: factors that reference other diseases invoke those Statements’ terms, creating cross‑instrument dependence (see section 11).","Legal coverage scope: applies to claims under both the VEA and MRCA, so administrative pathways and decision rules differ by claimant class (see section 5).","Exclusion and limitation rules: excludes PMR coexistent with giant cell arteritis, and limits the application of \"clinical worsening\" to specified service timing, constraining when aggravation claims apply (see section 7(2) and section 10(2)).","Repeal/replacement effect: repeals a prior Statement, requiring practitioners and decision‑makers to switch to the new text for post‑commencement claims (see section 4 and commencement at section 2).","Administrative proof burden: establishing the required factor(s) and their relation to relevant service imposes evidentiary and medical-record demands on claimants (see sections 9 and 10)."],"plain_english_summary":"This instrument updates how polymyalgia rheumatica (PMR) and death from PMR are treated for veterans’ and defence-related entitlement claims. It replaces the earlier Statement of Principles, defines PMR medically, and lists specific factors that can raise a \"reasonable hypothesis\" linking PMR to a person’s relevant service (for example, recent immune checkpoint inhibitor treatment, recent COVID‑19 vaccination, or lack of appropriate clinical management). It matters because these rules determine when service or service‑related events can form the basis of an entitlement claim."},"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":"The legislation maintains its original narrow purpose: establishing specific medical criteria for linking polymyalgia rheumatica to military service. The 2025 update adds modern causal factors (COVID-19 vaccines, immune checkpoint inhibitors) that reflect recent medical developments, but does not expand beyond the established framework of determining service-related liability for this specific condition."},"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 structure: definitions, three specific causal factors, and relationship-to-service rules","Minimal cross-referencing — primarily internal references to the Dictionary and the two parent Acts (VEA and MRCA)","No nested exceptions or conditional logic beyond the basic 'at least one factor must exist' requirement","Clear delineation between 'clinical onset' (new condition) and 'clinical worsening' (aggravation of pre-existing condition)"],"plain_english_summary":"This instrument sets when Australian veterans and defence members can claim compensation for polymyalgia rheumatica (PMR), replacing the 2016 rules and applying to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It affects current and former ADF members, veterans, peacekeepers and families claiming death benefits.\n\nIt ties accepted service-related PMR to three specific links (immune‑checkpoint inhibitor treatment within 1 year, COVID‑19 vaccination within 4 weeks, or lack of proper treatment), excludes PMR with giant cell arteritis, and so determines entitlement to pensions and compensation."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025","history":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-polymyalgia-rheumatica-reasonable-hypothesis-no-5-of-2025/documents"}}