{"id":"F2019L00944","name":"Statement of Principles concerning renal stone disease (Balance of Probabilities) (No. 70 of 2019)","slug":"statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440164,"registerId":"F2019L00944-fast-fetch-1775955900284","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning renal stone disease (Balance of Probabilities) (No. 70 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nRENAL STONE DISEASE (Balance of Probabilities)\n\n(No. 70 of 2019)\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 21 June 2019\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\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\n1 Name\n\nThis is the Statement of Principles concerning renal stone disease (Balance of Probabilities) (No. 70 of 2019).\n\n2 Commencement\n\n This instrument commences on 22 July 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning renal stone disease No. 66 of 2010 (Federal Register of Legislation No. F2010L02305) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 stone disease and death from renal stone disease.\n\nMeaning of renal stone disease\n\n(2) For the purposes of this Statement of Principles, renal stone disease:\n\n(a) means the presence of one or more calculi in the kidney (nephrolithiasis) or ureter (ureterolithiasis), which result from crystallisation of mineral salts in the urine; and\n\n(b) excludes nephrocalcinosis (renal parenchymal calcification) and primary calculus of the lower urinary tract (urinary bladder or urethra).\n\nNote: Renal stones are typically composed of calcium salts (calcium oxalate or calcium phosphate), uric acid, cystine or struvite (magnesium, ammonium and phosphate).\n\n(3) While renal stone disease attracts ICD‑10‑AM code N20, in applying this Statement of Principles the meaning of renal stone 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 stone disease\n\n(5) For the purposes of this Statement of Principles, renal stone disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's renal stone disease.\n\nNote: 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 stone disease and death from renal stone disease 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\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 stone disease or death from renal stone disease is connected with the circumstances of a person's relevant service:\n\n(1) having primary hyperparathyroidism within the ten years before the clinical onset of renal stone disease;\n\n(2) having post-surgical hypoparathyroidism at the time of the clinical onset of renal stone disease;\n\n(3) having a malignant neoplasm, other than non-metastatic non-melanotic malignant neoplasm of the skin, at the time of the clinical onset of renal stone disease;\n\n(4) having a haematological disease from the specified list of haematological diseases at the time of the clinical onset of renal stone disease;\n\nNote: specified list of haematological diseases is defined in the Schedule 1 - Dictionary.\n\n(5) having gout or hyperuricaemia at the time of the clinical onset of renal stone disease;\n\nNote: hyperuricaemia is defined in the Schedule 1 - Dictionary.\n\n(6) having tumour lysis syndrome at the time of the clinical onset of renal stone disease;\n\nNote: tumour lysis syndrome is defined in the Schedule 1 - Dictionary.\n\n(7) having diarrhoea on more days than not, for a continuous period of at least four weeks, within the three months before the clinical onset of renal stone disease;\n\n(8) having hypokalaemia for a continuous period of at least the four weeks before the clinical onset of renal stone disease;\n\n(9) having distal renal tubular acidosis at the time of the clinical onset of renal stone disease;\n\nNote: distal renal tubular acidosis is defined in the Schedule 1 - Dictionary.\n\n(10) having a urinary tract infection with urease-producing bacteria within the five years before the clinical onset of renal stone disease;\n\nNote: urease-producing bacteria is defined in the Schedule 1 - Dictionary.\n\n(11) having an acquired narrowing or obstruction of the ureter, ureteropelvic junction or renal calyx, on the affected side, at the time of the clinical onset of renal stone disease;\n\n(12) having a gastrointestinal disease from the specified list of gastrointestinal diseases at the time of the clinical onset of renal stone disease;\n\nNote: specified list of gastrointestinal diseases is defined in the Schedule 1 - Dictionary.\n\n(13) having undergone:\n\n(a) a malabsorptive bariatric procedure; or\n\n(b) ileal resection or ileal bypass surgery; or\n\n(c) Roux-en-Y gastric bypass surgery;\n\nwithin the five years before the clinical onset of renal stone disease;\n\nNote: malabsorptive bariatric procedure is defined in the Schedule 1 - Dictionary.\n\n(14) having a systemic disease from the specified list of systemic diseases at the time of the clinical onset of renal stone disease;\n\nNote: specified list of systemic diseases is defined in the Schedule 1 - Dictionary.\n\n(15) being treated with a drug or a drug from a class of drugs from the specified list of drugs, within the six weeks before the clinical onset of renal stone disease;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(16) having a urinary diversion procedure before the clinical onset of renal stone disease;\n\nNote: urinary diversion procedure is defined in the Schedule 1 - Dictionary.\n\n(17) having neurogenic bladder at the time of the clinical onset of renal stone disease;\n\nNote: neurogenic bladder is defined in the Schedule 1 - Dictionary.\n\n(18) having paraplegia or quadriplegia at the time of the clinical onset of renal stone disease;\n\n(19) being immobile for a continuous period of at least four weeks within the three months before the clinical onset of renal stone disease;\n\nNote: being immobile is defined in the Schedule 1 - Dictionary.\n\n(20) having inadequate fluid intake, for a continuous period of at least four weeks, within the three months before the clinical onset of renal stone disease;\n\nNote: inadequate fluid intake is defined in the Schedule 1 - Dictionary.\n\n(21) being overweight or obese for at least the five years before the clinical onset of renal stone disease;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(22) having anorexia nervosa at the time of the clinical onset of renal stone disease;\n\n(23) having a renal transplant before the clinical onset of renal stone disease;\n\n(24) experiencing spaceflight for a continuous period of at least seven days within the 30 days before the clinical onset of renal stone disease;\n\n(25) inability to obtain appropriate clinical management for renal stone 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 factor set out in subsection 9(25) applies only to material contribution to, or aggravation of, renal stone disease where the person's renal stone 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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n being immobile means having gross diminution or near complete absence of movement of the body, such as could occur as a result of paralysis, lower limb fracture or being bed-bound.\n\n being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n distal renal tubular acidosis means an acquired syndrome of hyperchloraemic metabolic acidosis due to distal tubular dysfunction, characterised by hypokalaemia, alkaline urine, low urine citrate excretion, hypercalciuria, and often bone disease.\n\n hyperuricaemia means a serum uric acid level of at least 6.8 mg/dL (404 micromoles/litre).\n\n inadequate fluid intake means fluid intake:\n\n(a) that is insufficient to maintain an average daily urine volume of at least 750 millilitres; or\n\n(b) that results in urine which is consistently darker than a pale yellow colour, and there is no biochemical or medical reason for such colouration other than inadequate hydration.\n\nNote: Urine that is darker than a pale yellow colour corresponds to grades 4 to 8 on a standard dehydration urine colour chart.\n\n malabsorptive bariatric procedure means a surgical weight-loss technique which alters the structure of the digestive tract, allowing food to bypass portions of the small intestine. Examples of such procedures include, but are not limited to, distal or total gastrectomy, biliopancreatic diversion and duodenal switch. Purely restrictive bariatric procedures, such as laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy, are not considered malabsorptive bariatric procedures.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neurogenic bladder means flaccid, spastic or mixed bladder dysfunction caused by neurological damage affecting the bladder.\n\nNote: Examples of causes of neurogenic bladder include, but are not limited to, spinal cord injury, cerebrovascular accident, Parkinson's disease and diabetic autonomic neuropathy.\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 renal stone disease—see subsection 7(2).\n\n specified list of drugs means:\n\n(a) aluminium derivatives;\n\n(b) aminopenicillins;\n\n(c) ammonium chloride;\n\n(d) carbonic anhydrase inhibitors;\n\n(e) ceftriaxone;\n\n(f) efavirenz;\n\n(g) ephedrine;\n\n(h) guaifenesin; \n\n(i) nitrofurantoin;\n\n(j) orlistat;\n\n(k) phenazopyridine;\n\n(l) phosphoric acid;\n\n(m) protease inhibitors;\n\n(n) quinolones;\n\n(o) silicate-containing antacids;\n\n(p) sulphasalazine; \n\n(q) sulphonamides;\n\n(r) systemic glucocorticoids; \n\n(s) topiramate;\n\n(t) triamterene;\n\n(u) uricosuric drugs; or\n\n(v) urinary alkalinisation agents.\n\nNote 1: Aluminium derivatives include, but are not limited to, aluminium hydroxide antacids and aluminium magnesium potassium urate.\n\nNote 2: Urinary alkalinisation agents are carbonate- or bicarbonate-containing drugs. Examples include, but are not limited to, sodium bicarbonate and potassium citrate.\n\n specified list of gastrointestinal diseases means:\n\n(a) biliary cirrhosis;\n\n(b) blind loop syndrome;\n\n(c) chronic pancreatitis;\n\n(d) coeliac sprue; or\n\n(e) inflammatory bowel disease.\n\n specified list of haematological diseases means:\n\n(a) haemolytic anaemia;\n\n(b) haematological malignancy;\n\n(c) lymphoproliferative disease;\n\n(d) myeloproliferative disease;\n\n(e) sickle-cell disease; or\n\n(f) thalassaemia.\n\n specified list of systemic diseases means:\n\n(a) Cushing syndrome; \n\n(b) diabetes mellitus;\n\n(c) sarcoidosis; or\n\n(d) Sjogren syndrome.\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 tumour lysis syndrome means a group of metabolic and electrolyte abnormalities that occurs in patients with a malignant neoplasm, usually after the initiation of cytotoxic treatment, but also spontaneously. It is characterised by excessive cell lysis resulting in hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia.\n\n urease-producing bacteria means any bacteria which possess the enzyme urease that degrades urea to ammonia and carbon dioxide, and includes, but is not limited to, Proteus spp., Haemophilus spp., Klebsiella spp., Ureaplasma urealyticum and Serratia ureilytica.\n\n urinary diversion procedure means a surgical procedure in which the ureter is transposed from its usual position. Examples include, but are not limited to, ureterosigmoidostomy and ileal conduit diversion.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument repeals and replaces the 2010 Statement but, on its face, applies to the same classes of claims (claims under section 120B of the VEA and section 339 of the MRCA) and defines factors for attributing renal stone disease to relevant service. The instrument does not state an explicit expansion or contraction of scope compared with the prior instrument."},"complexity_factors":["Large set of medical and biochemical conditions and procedures (25 listed factors) that require clinical evidence.","Multiple technical definitions with numeric thresholds (e.g. BMI ≥25; serum uric acid ≥6.8 mg/dL; urine volume ≥750 mL).","Temporal qualification for many factors (e.g. within 5 years, within 3 months, continuous periods of 4 weeks).","Cross-reference to other statutory instruments and medical classifications (VEA, MRCA, ICD‑10‑AM, other Statements of Principles).","Interplay between causation standards: factor must both exist and be related to relevant service (requires factual connection proof).","A discretionary element where a factor itself refers to an injury/disease covered by another Statement — that other instrument governs the application.","Broadly worded factors that may be evidentially difficult to prove (e.g. \"inability to obtain appropriate clinical management\").","Mixture of objective measures (lab values, procedures) and subjective clinical states (e.g. \"being immobile\", urine colour assessment)."],"plain_english_summary":"This Statement of Principles sets out when renal stone disease (including death contributed to by it) is, on the balance of probabilities, attributable to a veteran's or Defence member's relevant service for claims under the VEA and MRCA. It lists specific medical conditions, procedures, drugs, exposures and measurable thresholds that—if present and linked to service—establish the required connection and replaces the 2010 statement."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement of an earlier Statement of Principles (No. 66 of 2010). The scope remains consistent with the original intent: establishing medical criteria for linking renal stone disease to military service. While the specific factors have been updated based on current medical evidence (including the notable addition of spaceflight as a factor), the fundamental purpose and scope—determining service connection for this specific condition—has not expanded beyond its original purpose."},"complexity_factors":["25 distinct causal factors with varying timeframes (ranging from 6 weeks to 5+ years before clinical onset)","Multiple defined terms in Schedule 1 (approximately 15-20 specific definitions including medical conditions, drug classes, and measurement standards)","Cross-references to other Statements of Principles for conditions mentioned in the factors (section 11)","Specific technical definitions requiring medical knowledge (e.g., 'distal renal tubular acidosis', 'tumour lysis syndrome')","Nested definitions (e.g., 'being overweight or obese' refers to BMI, which is separately defined)","Multiple specified lists that must be consulted (drugs, gastrointestinal diseases, haematological diseases, systemic diseases)","Conditional logic in section 9(25) and section 10(2) limiting application to aggravation cases where disease pre-existed service","Reference to external classification systems (ICD-10-AM Tenth Edition) for coding purposes"],"plain_english_summary":"The Repatriation Medical Authority sets a 25-factor medical checklist for deciding compensation for renal stone disease or death in veterans and current/former defence members under the VEA and MRCA. If a veteran has kidney stones and at least one listed factor applies and is connected to their service, causation is established on the balance of probabilities, easing the claimant’s burden. This replaces the 2010 statement with updated medical evidence; the key limit is the factor must be service-related."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019","history":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-renal-stone-disease-balance-of-probabilities-no-70-of-2019/documents"}}