{"id":"F2019L00636","name":"Statement of Principles concerning rheumatic heart disease (Balance of Probabilities) (No. 52 of 2019)","slug":"statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440053,"registerId":"F2019L00636-fast-fetch-1775955834957","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning rheumatic heart disease (Balance of Probabilities) (No. 52 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\nRHEUMATIC HEART DISEASE (Balance of Probabilities)\n\n(No. 52 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 26 April 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 rheumatic heart disease (Balance of Probabilities) (No. 52 of 2019).\n\n2 Commencement\n\n This instrument commences on 27 May 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 rheumatic heart disease No. 20 of 2011 (Federal Register of Legislation No. F2011L00492) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 rheumatic heart disease and death from rheumatic heart disease.\n\nMeaning of rheumatic heart disease\n\n(2) For the purposes of this Statement of Principles, rheumatic heart disease:\n\n(a) means a clinically or echocardiographically documented cardiac disease, commonly involving the mitral or aortic valve, that follows acute rheumatic fever; and\n\n(b) includes pathological stenosis or regurgitation in the presence of scarring, deformity or morphological change of at least one heart valve, chronic rheumatic myocarditis and chronic rheumatic pericarditis; and\n\n(c) excludes acute carditis of acute rheumatic fever.\n\nNote: Rheumatic heart disease can be diagnosed in the absence of previously documented acute rheumatic fever.\n\n(3) While rheumatic heart disease attracts ICD‑10‑AM code I05, I06, I07, I08 or I09, in applying this Statement of Principles the meaning of rheumatic heart 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 rheumatic heart disease\n\n(5) For the purposes of this Statement of Principles, rheumatic heart disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's rheumatic heart 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 rheumatic heart disease and death from rheumatic heart 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, rheumatic heart disease or death from rheumatic heart disease is connected with the circumstances of a person's relevant service:\n\n(1) having acute rheumatic fever at least three months before the clinical onset of rheumatic heart disease;\n\n(2) having a group A beta-haemolytic streptococcal infection of the pharynx at least three months before the clinical onset of rheumatic heart disease;\n\n(3) experiencing crowded living or working conditions at least three months before the clinical onset of rheumatic heart disease;\n\n(4) having acute rheumatic fever before the clinical worsening of rheumatic heart disease;\n\n(5) having a group A beta-haemolytic streptococcal infection of the pharynx before the clinical worsening of rheumatic heart disease;\n\n(6) experiencing crowded living or working conditions within the ten years before the clinical worsening of rheumatic heart disease;\n\n(7) being pregnant within the 30 days before the clinical worsening of rheumatic heart disease;\n\n(8) inability to obtain appropriate clinical management for rheumatic heart 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(4) to 9(8) apply only to material contribution to, or aggravation of, rheumatic heart disease where the person's rheumatic heart 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 MRCA means the Military Rehabilitation and Compensation Act 2004.\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 rheumatic heart disease—see subsection 7(2).\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The instrument repeals the 2011 Statement of Principles (s4) and replaces it with updated and clarified criteria: a specific medical definition and ICD coding reference (s7(2)–(4)), an explicit inclusion of death from terminal events (s7(5)), a new/rewritten list of causation and aggravation factors with timing rules (s9), and cross‑references to other Statements (s11). These changes alter the concrete criteria used to link rheumatic heart disease to relevant service for VEA/MRCA claims (s5)."},"complexity_factors":["Technical medical definition and ICD‑10‑AM cross‑reference for the condition (s7(2)–(4)).","Multiple temporal windows and distinct tests for causation versus aggravation (s9: ≥3 months; within 10 years; 30 days; s10(2)).","Evidentiary standard based on medical‑scientific judgment — 'more probable than not' (s8) which requires probabilistic assessment of medical evidence.","Interaction with other Statements of Principles when a factor refers to another injury/disease (s11), adding cross‑instrument dependence.","Requirement that any listed factor be related to 'relevant service' as defined in the Schedule (s10(1); Schedule—relevant service), creating a nexus test between service and factor.","Inclusion of death from a terminal event as within scope and a specific terminal‑event definition (s7(5); Schedule—terminal event).","Administrative and claimant evidence burden to demonstrate past acute rheumatic fever, documented streptococcal infection, crowded living/working conditions, pregnancy timing, or lack of access to appropriate clinical management (s9).","Repeal of the prior 2011 Statement (s4) and replacement with updated criteria may require re‑interpretation of earlier decisions or pending claims."],"plain_english_summary":"This instrument sets the medical criteria used to decide whether rheumatic heart disease (including death from it) is linked to a veteran's or serving member's relevant service for claims under the VEA and MRCA. It defines the condition, references ICD‑10‑AM codes, lists required causal or aggravating factors with timing rules, and applies the balance‑of‑probabilities standard to entitlement decisions."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope as a specific disease-determination tool under the Veterans' Entitlements Act. It replaces an earlier 2011 version (No. 20 of 2011) with updated medical evidence and ICD-10-AM coding references, but does not expand beyond its statutory purpose of establishing causation factors for rheumatic heart disease in veterans' compensation claims."},"complexity_factors":["Moderate cross-referencing: Links to two other Acts (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004) and incorporates external medical classification system (ICD-10-AM)","Dual temporal frameworks: Different time limits apply depending on whether claiming for initial onset (3 months) versus worsening (ranging from 30 days to 10 years)","Nested definitions: 'Terminal event' definition contains 5 sub-categories; 'relevant service' has 3 distinct service types across 2 different legislative schemes","Conditional logic in Section 10(2): Creates a carve-out for pre-existing conditions with specific temporal requirements ('before or during (but did not arise out of)')","Self-referential mechanism in Section 11: Allows factors to cascade into other Statements of Principles, creating potential interdependence with unknown external instruments","Medical terminology requiring specialist knowledge: References to 'group A beta-haemolytic streptococcal infection', 'echocardiographically documented', and specific ICD-10-AM codes"],"plain_english_summary":"This rulebook sets when Australian veterans and defence personnel (and their families for death claims) can get compensation for rheumatic heart disease by requiring proof, on the balance of probabilities, that service-related medical or situational factors caused or worsened the condition. \n\nIt matters because the test ties claims to specific service-linked triggers (e.g., untreated strep, crowded living, lack of care), focusing relief on cases where military conditions plausibly caused or aggravated a disease that disproportionately affects Indigenous and other high‑risk communities."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019","history":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-balance-of-probabilities-no-52-of-2019/documents"}}