{"id":"F2025L00157","name":"Statement of Principles concerning pterygium (Balance of Probabilities) (No. 34 of 2025)","slug":"statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442742,"registerId":"F2025L00157-fast-fetch-1775957690365","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pterygium (Balance of Probabilities) (No. 34 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\nPTERYGIUM  (Balance of Probabilities)\n\n(No. 34 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 18 February 2025.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\n \n\n   \n\n\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 pterygium (Balance of Probabilities) (No. 34 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 25 March 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 pterygium No. 117 of 2015 (Federal Register of Legislation No. F2015L01674) made under subsection 196B(3) of the VEA is repealed.\n\n1.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 pterygium and death from pterygium.\n\n\nMeaning of pterygium\n\n1.           For the purposes of this Statement of Principles, pterygium:\n  1.           means a triangular or wedge-shaped expanse of fibrovascular tissue which grows horizontally in the interpalpebral fissure, extending from the conjunctiva to the cornea, being immovably united to the cornea at its apex, firmly attached to the sclera throughout its middle portion, and merged with the conjunctiva at its base; and\n  2.           excludes:\n    1.             pseudo-pterygium;\n    2.          pinguecula;\n    3.        pterygium of the nails;\n    4.         pterygium colli;\n    5.           antecubital pterygium; and\n    6.         popliteal pterygium.\n2.           While pterygium attracts ICD‑10‑AM code H11.0, in applying this Statement of Principles the meaning of pterygium is that given in subsection (2).\n3.           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 pterygium\n\n1.           For the purposes of this Statement of Principles, pterygium, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pterygium.\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 pterygium and death from pterygium 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, pterygium or death from pterygium is connected with the circumstances of a person's relevant service:\n\n1.           having sunlight exposure to the eye which is not protected by clothing, ultraviolet-blocking sunglasses, or other physical barrier, for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset;\n\n\nNote: latitude equivalent hours is defined in the Schedule 1 - Dictionary.\n\n1.           inability to obtain appropriate clinical management for pterygium 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 factor set out in subsection 9(2) applies only to material contribution to, or aggravation of, pterygium where the person's pterygium 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                               latitude equivalent hours means hours of exposure multiplied by the appropriate latitude weighting factor as follows:\n\n(a)          For tropical latitudes (23.5° South to 23.5° North) multiply by 1.0;\n\n(b)          For subtropical latitudes (23.6° - 35°) multiply by 0.75;\n\n(c)          For warm temperate latitudes (35.1° - 45°) multiply by 0.5;\n\n(d)          For cool temperate latitudes (45.1° - 65°) multiply by 0.25.\n\nNote 1: sunlight exposure is calculated as the sum of sunlight exposure in each separate latitude, accounting for the different sunlight intensity in each latitude (weighting factor).\n\nNote 2: Sum of sunlight exposure = (sunlight hours spent in tropical latitude x tropical latitude weighting factor) + (sunlight hours spent in subtropical latitude x subtropical latitude weighting factor) + (sunlight hours spent in warm temperate latitude x warm temperate latitude weighting factor) + (sunlight hours spent in cool temperate latitude x cool temperate latitude weighting factor)\n\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n              pterygium—see subsection 7(2).\n\nrelevant service means:\n\n1.           eligible war service (other than operational service) under the VEA;\n\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 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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals Statement No. 117 of 2015 and replaces it with an updated Statement that codifies a quantitative sunlight‑exposure threshold (4,500 latitude‑equivalent hours), an explicit latitude weighting system for exposure calculations, clarified clinical definitions and exclusions, and continued application to claims under specified VEA and MRCA provisions (see sections 2, 4, 5, 7(2), 9(1) and Schedule 1)."},"complexity_factors":["Quantitative exposure threshold (4,500 latitude‑equivalent hours) as a binary criterion for causation (section 9(1))","Latitude equivalent hours metric requires weighted summation across latitudes, adding calculation and evidentiary complexity (Schedule 1 definitions)","Detailed clinical definition and enumerated exclusions for 'pterygium' narrow the medical concept used in decisions (section 7(2))","Requirement that the qualifying factor be related to the person's relevant service introduces temporal and causal linkage assessments (section 10(1)–(2))","Provision for contribution to death requires assessment of terminal events and proximate causation (Death from pterygium; Schedule 1 terminal event definition)","Interaction rule where factors refer to injuries/diseases covered by other Statements of Principles may require cross-referencing and applying other instruments (section 11)","Application limited to specific claim pathways under the VEA and MRCA constrains scope but requires claim administrators to map cases to the correct statutory scheme (section 5)","Repeal of the prior Statement creates a transitional/administrative change for existing claim assessments (section 4)"],"plain_english_summary":"This instrument (commencing 25 March 2025) replaces the earlier Statement of Principles and sets the medical criteria for deciding whether pterygium, or death contributed by it, is connected to a veteran's or member's service under the VEA or MRCA. A claim is accepted only if at least one listed factor applies: cumulative unprotected sunlight exposure totalling at least 4,500 latitude‑equivalent hours, or inability to obtain appropriate clinical management, and that factor must be related to the person's relevant service."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow scope as a specific medical determination for a single condition (pterygium) under the Repatriation Medical Authority's framework. It replaces the 2015 version without expanding into new areas of compensation or additional conditions."},"complexity_factors":["Specialised medical definition of pterygium with 6 specific exclusions requiring anatomical knowledge","Mathematical calculation requirement for 'latitude equivalent hours' with 4-tier weighting system based on geographic coordinates","Cross-references to two separate Acts (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004)","Conditional logic in section 10(2) restricting the 'inability to obtain clinical management' factor to pre-existing conditions only","Incorporation by reference to ICD-10-AM Tenth Edition (external medical classification system)","Nested definitions requiring navigation between main text and Schedule 1 Dictionary"],"plain_english_summary":"This instrument (effective 25 March 2025) sets when Australian Defence Force members and veterans can claim compensation for pterygium under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act, replacing the 2015 rules. It covers claims for the condition itself and death from it.\n\nTo be service-related, claimants must show on the balance of probabilities either very high unprotected sun exposure (4,500 latitude-equivalent hours) or inability to obtain medical care for a pre-existing or service-era condition."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025","history":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-pterygium-balance-of-probabilities-no-34-of-2025/documents"}}