{"id":"F2020L01095","name":"Statement of Principles concerning renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020)","slug":"statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":113514,"registerId":"commonwealth-F2020L01095-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020)\n\nmade under subsection 196B(3) 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 renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020) 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 renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\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 renal artery atherosclerotic disease and death from renal artery atherosclerotic disease.\n\nMeaning of renal artery atherosclerotic disease\n\n(2) For the purposes of this Statement of Principles, renal artery atherosclerotic disease means atherosclerosis of the renal arteries which causes a partial or complete occlusion of a renal artery and either:\n\n(a) warrants medical treatment; or\n\n(b) results in at least one of the following clinical manifestations:\n\n(i) moderate to severe hypertension;\n\n(ii) poorly controlled hypertension;\n\n(iii) persistent renal impairment;\n\n(iv) acute pulmonary oedema; or\n\n(v) chronic heart failure.\n\n(3) While renal artery atherosclerotic disease attracts ICD‑10‑AM code I70.1, in applying this Statement of Principles the meaning of renal artery atherosclerotic disease 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 renal artery atherosclerotic disease\n\n(5) For the purposes of this Statement of Principles, renal artery atherosclerotic disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's renal artery atherosclerotic disease.\n\n> Note: 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 renal artery atherosclerotic disease and death from renal artery atherosclerotic disease can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, renal artery atherosclerotic disease or death from renal artery atherosclerotic disease is connected with the circumstances of a person's relevant service:\n\n(1) having hypertension for a period of at least ten years before the clinical onset of renal artery atherosclerotic disease;\n\n(2) having diabetes mellitus before the clinical onset of renal artery atherosclerotic disease;\n\n(3) having dyslipidaemia before the clinical onset of renal artery atherosclerotic disease;\n\n> Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(4) where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical onset of renal artery atherosclerotic disease;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(5) where smoking has permanently ceased before the clinical onset of renal artery atherosclerotic disease:\n\n(a) having smoked at least five pack-years of tobacco products; or\n\n(b) having smoked at least one pack-year but less than five pack-years of tobacco products, and the clinical onset of renal artery atherosclerotic disease has occurred within 20 years of smoking cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(6) where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical onset of renal artery atherosclerotic disease;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(7) where exposure to second-hand smoke has permanently ceased before the clinical onset of renal artery atherosclerotic disease:\n\n(a) being exposed to second-hand smoke for at least 5,000 hours; or\n\n(b) being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical onset of renal artery atherosclerotic disease has occurred within five years of the last exposure to second-hand smoke;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(8) having hyperhomocysteinaemia before the clinical onset of renal artery atherosclerotic disease;\n\n(9) undergoing a course of therapeutic radiation for cancer, where the renal artery was in the field of radiation, before the clinical onset of renal artery atherosclerotic disease;\n\n(10) having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the renal artery before the clinical onset of renal artery atherosclerotic disease;\n\n> Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n(11) having hypertension for a period of at least ten years before the clinical worsening of renal artery atherosclerotic disease;\n\n(12) having diabetes mellitus before the clinical worsening of renal artery atherosclerotic disease;\n\n(13) having dyslipidaemia before the clinical worsening of renal artery atherosclerotic disease;\n\n> Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.\n\n(14) where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical worsening of renal artery atherosclerotic disease;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(15) where smoking has permanently ceased before the clinical worsening of renal artery atherosclerotic disease:\n\n(a) having smoked at least five pack-years of tobacco products; or\n\n(b) having smoked at least one pack-year but less than five pack-years of tobacco products, and the clinical worsening of renal artery atherosclerotic disease has occurred within 20 years of smoking cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(16) where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical worsening of renal artery atherosclerotic disease;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(17) where exposure to second-hand smoke has permanently ceased before the clinical worsening of renal artery atherosclerotic disease:\n\n(a) being exposed to second-hand smoke for at least 5,000 hours; or\n\n(b) being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical worsening of renal artery atherosclerotic disease has occurred within five years of the last exposure to second-hand smoke;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(18) having hyperhomocysteinaemia before the clinical worsening of renal artery atherosclerotic disease;\n\n(19) undergoing a course of therapeutic radiation for cancer, where the renal artery was in the field of radiation, before the clinical worsening of renal artery atherosclerotic disease;\n\n(20) having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the renal artery before the clinical worsening of renal artery atherosclerotic disease;\n\n> Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n(21) being treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker, within the three months before the clinical worsening of renal artery atherosclerotic disease;\n\n(22) inability to obtain appropriate clinical management for renal artery atherosclerotic disease.\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(11) to 9(22) apply only to material contribution to, or aggravation of, renal artery atherosclerotic disease where the person's renal artery atherosclerotic disease 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nbeing exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\ncumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.\n\n> Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.\n\n> Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.\n\ndyslipidaemia means persistently abnormal blood lipid levels, diagnosed by a medical practitioner and evidenced by:\n\n(a) a serum high density lipoprotein cholesterol level less than 1.0 mmol/L; or\n\n(b) a serum low density lipoprotein level greater than 4.0 mmol/L; or\n\n(c) a serum triglyceride level greater than 2.0 mmol/L; or\n\n(d) a total serum cholesterol level greater than 5.5 mmol/L; or\n\n(e) the regular administration of drug therapy to normalise blood lipid levels.\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\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nrenal artery atherosclerotic disease—see subsection 7(2).\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\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 renal artery atherosclerotic disease (Balance of Probabilities) (No. 57 of 2020)           | 31 August 2020F2020L01095 | 28 September 2020 |                                                 |\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(4) note.....                      | rs No. 94 of 2022 |\n| Subsection 9(5) note.....                      | rs No. 94 of 2022 |\n| Subsection 9(14) note...                       | rs No. 94 of 2022 |\n| Subsection 9(15) note...                       | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","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":"Amendments updated the definition and calculation of 'one pack‑year' and related notes affecting subsections that use pack‑year thresholds (see Schedule 1 definition of one pack‑year and endnotes/Amendment history). This refines how smoking exposure is measured for the factors in ss 9(4)–(5) and 9(14)–(15), which can change which claimants meet smoking‑related thresholds and how evidence is calculated."},"complexity_factors":["Technical medical criteria and definitions (clinical manifestations and ICD‑10‑AM cross‑reference) (see s 7(2)–(4)).","Multiple conditional branches and timing distinctions (factors before clinical onset versus before clinical worsening) (see ss 9(1), 9(11)–(22)).","Quantified exposure thresholds that require retrospective calculation or reconstruction (pack‑years, hours of second‑hand smoke, cumulative equivalent radiation dose) (see ss 9(4)–(7), 9(14)–(17), 9(10), Schedule 1).","Detailed, technical definitions in the dictionary (one pack‑year, cumulative equivalent dose, dyslipidaemia), which affect how evidence is assessed (Schedule 1).","Interaction with other Statements of Principles where a factor refers to another injury/disease (see s 11), adding cross‑instrument dependency.","Administrative and evidentiary burden on claimants and medical assessors to establish duration, timing and magnitude of exposures (see ss 9 and 10)."],"plain_english_summary":"This Statement of Principles sets the medical definition and the specific exposure and clinical criteria used to decide if renal artery atherosclerotic disease (and death from it) is connected to a veteran’s relevant service for compensation purposes. It lists required risk factors (for example long‑term hypertension, diabetes, dyslipidaemia, specified smoking and second‑hand smoke thresholds, radiation dose) and timing rules. It matters because it fixes the evidentiary thresholds that claimants, medical assessors and decision‑makers must apply when determining entitlement to benefits."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument remains tightly focused on its original purpose: establishing the medical factors for linking renal artery atherosclerotic disease to military service. The 2022 amendment (No. 94 of 2022) was a technical update that refined the definition of 'one pack-year' in the Dictionary to clarify calculation methods, but did not expand the scope beyond the original intent of providing clear evidentiary standards for this specific condition."},"complexity_factors":["22 distinct factors with parallel structure (factors 1-10 for clinical onset, factors 11-20 for clinical worsening, plus 2 additional aggravation factors)","Nested conditional logic in smoking-related factors (factors 4-5, 14-15) with alternative thresholds based on whether smoking has 'permanently ceased'","Nested conditional logic in second-hand smoke factors (factors 6-7, 16-17) with alternative hour thresholds and time limits since cessation","7 defined terms in Schedule 1 Dictionary, including technical medical definitions (dyslipidaemia with 5 alternative diagnostic criteria, cumulative equivalent dose with reference to external ARPANSA methodology)","Cross-reference to external technical standard (ICD-10-AM Tenth Edition) for disease classification","Cross-reference to separate Statements of Principles for related conditions (section 11)","Specific quantitative thresholds throughout (10 years, 1 pack-year, 5 pack-years, 20 years, 1,000 hours, 5,000 hours, 5 years, 1.0 sievert, 3 months)","Dual application framework covering both the Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004"],"plain_english_summary":"This Statement of Principles sets the medical tests used to decide whether renal artery atherosclerotic disease is connected to Australian military service. It guides veterans and current/former defence members on what medical evidence can establish a service link, and directs DVA decision‑makers how to apply that evidence. By translating clinical risk factors into legal criteria, it standardises and speeds compensation decisions and reduces the need for case‑by‑case medical inquiries."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-","history":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-/history","analysis":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-/important-cases","documents":"/api/acts/statement-of-principles-concerning-renal-artery-atherosclerotic-disease-balance-of-probabilities-no-/documents"}}