{"id":"F2021L00213","name":"Statement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021)","slug":"statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":101322,"registerId":"commonwealth-F2021L00213-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021) that shows the text of the law as amended and in force on 19 September 2022.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1 Name\n\nThis is the Statement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021).\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\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 pulmonary thromboembolism and death from pulmonary thromboembolism.\n\nMeaning of pulmonary thromboembolism\n\n(2) For the purposes of this Statement of Principles, pulmonary thromboembolism means obstruction of the pulmonary artery or one of its branches by a mass of clotted blood.\n\n(3) While pulmonary thromboembolism attracts ICD‑10‑AM code I26, in applying this Statement of Principles the meaning of pulmonary thromboembolism is that given in subsection (2).\n\n(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from pulmonary thromboembolism\n\n(5) For the purposes of this Statement of Principles, pulmonary thromboembolism, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pulmonary thromboembolism.\n\n> Note: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that pulmonary thromboembolism and death from pulmonary thromboembolism 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\n> Note: 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting pulmonary thromboembolism or death from pulmonary thromboembolism with the circumstances of a person's relevant service:\n\n(1) having a deep vein thrombosis within the six months before the clinical onset of pulmonary thromboembolism;\n\n(2) having superficial vein thrombosis within the twelve months before the clinical onset of pulmonary thromboembolism;\n\n(3) having acute myocardial infarction within the six months before the clinical onset of pulmonary thromboembolism;\n\n(4) having heart failure or a thrombus within the right atrium or right ventricle at the time of the clinical onset of pulmonary thromboembolism;\n\n(5) having a malignant neoplasm at the time of the clinical onset of pulmonary thromboembolism;\n\n(6) having an aneurysm of a vein in the deep venous system at the time of the clinical onset of pulmonary thromboembolism;\n\n(7) being overweight or obese at the time of the clinical onset of pulmonary thromboembolism;\n\n> Note: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(8) having chronic obstructive pulmonary disease at the time of the clinical onset of pulmonary thromboembolism;\n\n(9) having sleep apnoea at the time of the clinical onset of pulmonary thromboembolism;\n\n(10) being pregnant within the three months before the clinical onset of pulmonary thromboembolism;\n\n(11) having cytomegalovirus infection of new onset within the 30 days before the clinical onset of pulmonary thromboembolism;\n\n(12) having infection with human immunodeficiency virus or hepatitis C virus at the time of the clinical onset of pulmonary thromboembolism;\n\n(13) having active tuberculosis disease within the 30 days before the clinical onset of pulmonary thromboembolism;\n\n> Note: active tuberculosis disease is defined in the Schedule 1 - Dictionary.\n\n(14) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the three months before the clinical onset of pulmonary thromboembolism;\n\n> Note: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).\n\n(15) having an autoimmune disease at the time of the clinical onset of pulmonary thromboembolism;\n\n> Note: Examples of autoimmune diseases that may cause pulmonary thromboembolism include rheumatoid arthritis, polymyositis and Sjögren syndrome.\n\n(16) having diabetes mellitus at the time of the clinical onset of pulmonary thromboembolism;\n\n(17) having a hypercoagulable state as specified at the time of the clinical onset of pulmonary thromboembolism;\n\n> Note: hypercoagulable state as specified is defined in the Schedule 1 - Dictionary.\n\n(18) having a kidney disease from the specified list of kidney diseases at the time of the clinical onset of pulmonary thromboembolism;\n\n> Note: specified list of kidney diseases is defined in the Schedule 1 - Dictionary.\n\n(19) having implantation of an intravenous device for a continuous period of at least 24 hours within the six months before the clinical onset of pulmonary thromboembolism;\n\n> Note: Examples of implanted devices include a central venous catheter, an indwelling cardiac pacemaker and defibrillator leads.\n\n(20) having surgery requiring a general, spinal or epidural anaesthetic within the six months before the clinical onset of pulmonary thromboembolism;\n\n(21) having an injury or illness as specified within the six months before the clinical onset of pulmonary thromboembolism;\n\n> Note: injury or illness as specified is defined in the Schedule 1 - Dictionary.\n\n(22) having restricted mobility for a continuous period of at least four hours within the eight weeks before the clinical onset of pulmonary thromboembolism;\n\n> Note: Examples of situations in which restricted mobility can occur include travel by road, rail or air and physical restraint.\n\n(23) having a neurological disease that causes loss or impairment of motor function of a limb within the three months before the clinical onset of pulmonary thromboembolism;\n\n> Note: Examples of neurological diseases that cause loss or impairment of motor function of a limb include cerebrovascular accident, multiple sclerosis and motor neurone disease.\n\n(24) having a clinically significant disorder of mental health as specified at the time of the clinical onset of pulmonary thromboembolism;\n\n> Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 \\- Dictionary.\n\n(25) taking a drug from the specified list of drugs within the three months before the clinical onset of pulmonary thromboembolism;\n\n> Note: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(26) taking combined estrogen-progestogen contraception or taking menopausal hormone therapy as an oral estrogen, or a non-oral estrogen combined with a progestogen, for a continuous period of at least four weeks, within the three months before the clinical onset of pulmonary thromboembolism;\n\n> Note: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.\n\n(27) having smoked tobacco products:\n\n(a) in an amount of at least one pack-year before the clinical onset of pulmonary thromboembolism; or\n\n(b) in an amount of at least 10 cigarettes per day, or the equivalent thereof in other tobacco products, for a period of at least three months before the clinical onset of pulmonary thromboembolism; and\n\nif smoking has ceased before the clinical onset of pulmonary thromboembolism, then that onset occurred within six months of cessation;\n\n> Note: cigarettes per day, or the equivalent thereof in other tobacco products and one pack-year are defined in the Schedule 1 - Dictionary.\n\n(28) being at an altitude of at least 3,000 metres for a continuous period of at least five days within the three months before the clinical onset of pulmonary thromboembolism;\n\n(29) inability to obtain appropriate clinical management for pulmonary thromboembolism.\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 factor set out in subsection 9(29) applies only to material contribution to, or aggravation of, pulmonary thromboembolism where the person's pulmonary thromboembolism 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(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nabnormality of kidney structure or function means:\n\n(a) having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or\n\n(b) having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or\n\n(c) having had a kidney transplant.\n\nactive tuberculosis disease means an illness in which tuberculosis bacteria are multiplying and inducing an inflammatory response.\n\nacute kidney injury means:\n\n(a) having an increase in serum creatinine of at least 26.5 mol/L within a period of 48 hours; or\n\n(b) having an increase in serum creatinine of at least 1.5 times baseline levels, which has occurred within the previous seven days; or\n\n(c) having a urine volume of less than 0.5 mL/kg/h for six hours.\n\nbeing overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\nchronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.\n\n> Note: abnormality of kidney structure or function is also defined in the Schedule 1 - Dictionary.\n\ncigarettes per day, or the equivalent thereof in other tobacco products means either:\n\n(a) cigarettes, pipe tobacco or cigars, alone or in any combination, where one tailor-made cigarette approximates one gram of tobacco; or\n\n(b) one gram of cigar, pipe or other smoking tobacco.\n\nclinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management:\n\n(a) depressive disorder;\n\n(b) posttraumatic stress disorder; or\n\n(c) schizophrenia.\n\n> Note 1: Management of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.\n\n> Note 2: To warrant ongoing management does not require that any actual management was received or given for the condition.\n\nhypercoagulable state as specified means:\n\n(a) antiphospholipid antibody syndrome;\n\n(b) cirrhosis of the liver;\n\n(c) Cushing syndrome;\n\n(d) disseminated intravascular coagulation;\n\n(e) heparin-induced thrombocytopaenia;\n\n(f) hyperhomocysteinaemia;\n\n(g) hyperthyroidism and thyrotoxicosis;\n\n(h) hypothyroidism;\n\n(i) inability to access anticoagulant treatment for an existing coagulation disorder;\n\n(j) paroxysmal nocturnal haemoglobinuria;\n\n(k) thrombocytosis; or\n\n(l) venom-induced thrombosis.\n\ninjury or illness as specified means:\n\n(a) a limb, pelvic, rib or spinal fracture;\n\n(b) a moderate to severe traumatic brain injury;\n\n(c) a physical injury or illness requiring mechanical ventilation support or admission to an intensive care unit;\n\n(d) a spinal cord injury;\n\n(e) a tear, rupture or avulsion of a muscle, tendon or ligament in the lower limb;\n\n(f) a traumatic upper or lower limb amputation;\n\n(g) an injury requiring immobilisation of an upper or lower limb in a plaster cast or similar restraining or bracing device; or\n\n(h) any other injury or illness that causes significantly reduced mobility.\n\n> Note: traumatic upper or lower limb amputation is also defined in the Schedule 1 - Dictionary.\n\nmenopausal hormone therapy means administration of estrogen preparations often in combination with a progestogen to offset a hormone deficiency following surgically induced or naturally occurring menopause.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\npulmonary thromboembolism—see subsection 7(2).\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nspecified list of drugs means:\n\n(a) anti-psychotic drugs;\n\n(b) chemotherapy for a malignant disease;\n\n(c) erythropoiesis-stimulating agents (including erythropoietin and darbepoietin);\n\n(d) intravenous thrombin or fibrin sealant;\n\n(e) lenalidomide;\n\n(f) selective estrogen receptor modulators (including tamoxifen); or\n\n(g) thalidomide.\n\nspecified list of kidney diseases means:\n\n(a) acute kidney injury;\n\n(b) chronic kidney disease; or\n\n(c) nephrotic syndrome.\n\n> Note: acute kidney injury and chronic kidney disease are also defined in the Schedule 1 - Dictionary.\n\nterminal 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\ntraumatic upper or lower limb amputation means loss of an upper or lower limb as a result of an accidental injury, including blast injury.\n\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                          | Registration              | Commencement      | Application, saving and transitional provisions |\n| ----------------------------------------------------------------------------------------------------------------------------- | ------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning pulmonary thromboembolism (Reasonable Hypothesis) (No. 37 of 2021)                         | 9 March 2021F2021L00213   | 5 April 2021      |                                                 |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128 | 19 September 2022 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                             | How affected      |\n| ---------------------------------------------- | ----------------- |\n| Section 2……………….                               | rep LA s 48D      |\n| Section 4……………….                               | rep LA s 48C      |\n| Subsection 9(27) note...                       | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This legislation maintains its original scope as a specific medical-determination instrument for pulmonary thromboembolism under the Veterans' Entitlements Act. The 2022 amendment was minor—simply updating the definition of 'one pack-year' for smoking calculations to provide clearer guidance. The instrument remains focused on its original purpose: establishing the medical factors for reasonable hypothesis claims regarding blood clots in the lungs."},"complexity_factors":["29 distinct medical factors in section 9, each with specific timeframes (ranging from 30 days to 12 months before onset)","Detailed definitions section (Schedule 1) with 17 defined terms including mathematical formulas (BMI calculation) and precise medical thresholds","Cross-references to other Statements of Principles (section 11) and external classification systems (ICD-10-AM)","Nested definitions where defined terms rely on other defined terms (e.g., 'chronic kidney disease' refers to 'abnormality of kidney structure or function')","Specific quantitative thresholds throughout (e.g., '3,000 metres for at least five days', '24 hours' for IV devices, 'four hours' for restricted mobility)","Conditional logic in factor 9(27) regarding smoking cessation timing","Dual legislative framework application (VEA and MRCA) requiring understanding of both Acts"],"plain_english_summary":"This Statement of Principles sets the medical criteria for deciding whether pulmonary thromboembolism (or death from it) can be linked to military service for veterans, peacekeepers, and current/former Defence members claiming under the VEA or MRCA.  \n\nIt lists 29 medical risk factors—if at least one is present and connected to service, decision-makers can form a \"reasonable hypothesis\" of service causation, guiding evidence and claim outcomes."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"No substantive expansion of policy scope is evident in this version. The instrument remains an SOP that sets medical circumstances which can raise a reasonable hypothesis connecting pulmonary thromboembolism to relevant service. The only notable change recorded in the amendment history is a technical clarification of the definition and calculation of \"one pack‑year\" and a minor note amendment to subsection 9(27) (Veterans' Entitlements (Statements of Principles—definition of \"one pack‑year\") Amendment Determination 2022 (No. 94 of 2022)). That change refines measurement and evidentiary detail rather than broadening the kinds of conditions covered or the RMA’s substantive criteria."},"complexity_factors":["29 discrete causal factors listed in section 9 with differing time windows and conditions","Approximately 25 defined terms in Schedule 1 (BMI, pack‑year, hypercoagulable state list, specified drugs, specified kidney diseases, relevant service categories, etc.)","Nested lists inside definitions (eg hypercoagulable state contains 12 subitems a–l)","Cross-reference to other Statements of Principles where a factor refers to another injury/disease (section 11)","Temporal qualifications and exceptions (eg smoking cessation within six months, time windows of 30 days, 3 months, 6 months, 12 months)","A separate rule (10(2)) limiting the application of factor 9(29) to material contribution or aggravation where PTE pre‑existed service","Reference to an external classification (ICD‑10‑AM code I26) but with an internal definitional override (7(3)–(4))","Recent amendment(s) clarifying metric conversion for one pack‑year (amendment No. 94 of 2022) increases technical specificity"],"plain_english_summary":"**What this instrument does, mechanically**\n\n- Creates a Statement of Principles (SOP) that the Repatriation Medical Authority (RMA) has determined for pulmonary thromboembolism (PTE) and death from PTE under the Veterans' Entitlements Act framework (see sections 1, 3, 5 and 7).  \n- Sets a legal definition of pulmonary thromboembolism for claims purposes (obstruction of the pulmonary artery or a branch by a clot) and confirms that the SOP’s definition, not the ICD code alone, governs the instrument (7(2)–(4)).  \n- Specifies that a “reasonable hypothesis” linking PTE (or death from it) to a person’s relevant service is raised only if at least one of the factors listed in section 9 is present, subject to timing and other qualifications in that section. In short: one listed factor (with its required timing) → a reasonable hypothesis may exist (section 9).  \n- Requires that any such factor be related to the person’s relevant service (section 10(1)). Where the factor is inability to obtain appropriate clinical management, that factor applies only to material contribution or aggravation when the PTE pre‑existed or was contracted before/during service (10(2)).  \n- Provides a dictionary of defined terms (Schedule 1) for time windows, clinical thresholds (eg BMI), specified diseases, specified drugs and other technical terms used in the list of factors.\n\n**Who is affected**\n\n- Veterans, members of Peacekeeping Forces and members of the Australian Defence Forces claiming compensation or benefits under the VEA or MRCA when pulmonary thromboembolism or death from it is asserted to be connected to their service (application provisions, section 5; relevant service defined in the Schedule).  \n- Decision-makers within the Department of Veterans’ Affairs and medical advisers who assess claims, because the SOP is the medical framework used to decide whether a reasonable hypothesis exists (sections 8–11).  \n- Treating clinicians and claimants: evidence must be produced that a listed factor existed in the time windows set out (section 9; Schedule 1 definitions such as BMI, pack‑year, and disease definitions).\n\n**Key substantive rules in plain language**\n\n- The SOP covers both current PTE and death where PTE materially contributed to the terminal event (7(1), 7(5)).  \n- At least one of 29 enumerated factors must be present and related to service to raise the reasonable hypothesis. Factors include prior deep vein thrombosis, recent surgery or anaesthesia, active cancer, obesity (BMI ≥ 25), certain infections (including recent SARS‑CoV‑2 infection), specified drugs (eg chemotherapy, some antipsychotics, tamoxifen), recent immobilisation, pregnancy, and more (section 9). Each factor carries its own timing window (for example, DVT within 6 months before PTE onset, superficial vein thrombosis within 12 months, SARS‑CoV‑2 within 3 months) — see section 9.  \n- Where a factor references another injury or disease that already has an SOP, the other SOP’s rules apply for that element (section 11).  \n- The RMA states it relied on “sound medical‑scientific evidence” for linking PTE to service (section 8); the SOP therefore represents the RMA’s evidentiary threshold for claims processing, not a clinical treatment guideline.\n\n**Why this matters (claimed purpose, then practical implications and trade-offs)**\n\n- The stated purpose: the RMA claims sound medical‑scientific evidence supports that PTE can be related to service, so it sets out the medical circumstances that can raise a reasonable hypothesis (section 8).  \n\nPractical implications, costs, incentives and trade‑offs (mechanical effects):\n\n- Who pays and who decides: financial exposure (pension/entitlement outcomes) is borne by the compensation system (the public fund administering VEA/MRCA entitlements) if a claim succeeds. The SOP guides DVA decision-makers and medical advisers in deciding whether a claimant has met the “reasonable hypothesis” threshold (sections 5, 8–11).  \n- Evidence and compliance burden: claimants must produce medical evidence of the listed factor(s) and the required time relationship to PTE onset (section 9; Schedule 1 definitions). That raises practical costs for claimants to obtain records, specialist reports, imaging or laboratory evidence.  \n- Incentives for behaviour: the SOP makes it useful for claimants to emphasise and document any listed factor (eg prior DVT, recent surgery, BMI, recent SARS‑CoV‑2). Clinicians and lawyers may focus submissions on evidencing these factors and their timing.  \n- Bureaucratic discretion and cross‑reference risk: the instrument delegates medical standard-setting to the RMA (section 3 and section 8). Section 11 routes some factual elements to other SOPs where they exist, which concentrates decision authority in the RMA’s SOP network and can create inter‑SOP complexity for adjudicators.  \n- Implementation risk and evidentiary ambiguity: some factors are straightforward to document (eg surgery under anaesthetic within 6 months), while others are harder to prove (eg inability to obtain appropriate clinical management — section 9(29), governed by 10(2) when pre‑existing). Temporal windows and clinical thresholds (eg BMI ≥ 25, definitions of infection windows) require precise documentation, or claims may fail on timing rather than on causation.  \n- Distribution of benefits and costs: benefits (successful claims) are concentrated to claimants who can both show a listed factor and connect it to relevant service; costs (administration and payouts) are dispersed across the compensation system. The instrument does not itself create new therapeutic obligations on private providers — it changes entitlement assessment mechanics.\n\n**Concrete examples of how the SOP will be applied**\n\n- If a veteran presents with PTE and records show a deep vein thrombosis within the previous six months, a reasonable hypothesis connecting the PTE to service may be raised if that DVT is related to service (9(1), 10(1)).  \n- If the claimant had PTE before service and later could not access anticoagulant follow‑up during service, the factor “inability to obtain appropriate clinical management” could support a claim of material contribution or aggravation, but only under the narrow rule in 10(2) and subject to proof of timing and material effect.  \n\n**What to watch operationally**\n\n- The need for specific clinical evidence matching the defined terms and time windows (see Schedule 1 definitions — BMI, pack‑year, hypercoagulable states, specified drugs, specified kidney diseases).  \n- How decision-makers treat overlapping conditions governed by other SOPs (section 11).  \n- The practical difficulty of proving circumstances listed in the SOP that are not routinely recorded (eg exact days at high altitude, or precise cigarette-equivalents for non-cigarette tobacco use)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021","history":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-pulmonary-thromboembolism-reasonable-hypothesis-no-37-of-2021/documents"}}