{"id":"F2019L00635","name":"Statement of Principles concerning rheumatic heart disease (Reasonable Hypothesis) (No. 51 of 2019)","slug":"statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440052,"registerId":"F2019L00635-fast-fetch-1775955834958","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 (Reasonable Hypothesis) (No. 51 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 (Reasonable Hypothesis)\n\n(No. 51 of 2019)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 51 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning rheumatic heart disease No. 19 of 2011 (Federal Register of Legislation No. F2011L00493) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that rheumatic heart disease and death from rheumatic heart disease 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\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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting rheumatic heart disease or death from rheumatic heart disease 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 skin or 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 skin or 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(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\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) 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\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_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 instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2011 version (No. 19 of 2011) with updated medical criteria but does not expand beyond the established framework of determining service-relatedness for veterans' compensation purposes. The structure and purpose remain consistent with the original legislative intent under subsection 196B(2) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary)","Conditional logic in section 10(2) restricting factors 4-8 to pre-existing conditions only","Nested definitions: 'relevant service' has 6 sub-categories spanning two different Acts","Temporal requirements with varying windows (3 months, 10 years, 30 days) that must be precisely tracked","Incorporation by reference to ICD-10-AM medical coding system (external document)","Circular definition note in Schedule 1 where 'MRCA' and 'VEA' definitions refer back to themselves","Section 11 creates dynamic incorporation of other Statements of Principles 'as in force from time to time'"],"plain_english_summary":"This Statement of Principles sets the medical test for awarding veterans’ and defence members’ compensation for rheumatic heart disease. It lists eight risk factors; if a claimant has at least one factor connected to their service, a “reasonable hypothesis” exists that the condition is service-related.\n\nFactors 4–8 only apply where the disease pre‑existed and was worsened by service. The instrument replaces the 2011 version, recognises crowding in military settings as a key risk, and lowers the burden of proof for affected veterans."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier 2011 Statement (section 4) and replaces it. It applies to claims under VEA s120A and MRCA s338 (section 5). The text does not itself state whether coverage is broader or narrower than the repealed instrument; it provides updated definitions, listed factors and timing rules that now govern reasonable-hypothesis linking for entitlement decisions."},"complexity_factors":["Technical medical definitions and diagnostic references (subsection 7(2); ICD-10-AM reference in 7(3)-(4))","Multiple temporal thresholds and conditions (e.g. \"at least three months\", \"within ten years\", \"within 30 days\") in section 9","Distinction between onset, worsening, material contribution and aggravation (sections 9 and 10(2))","Cross-references to other legislation and Statements of Principles (Authority in section 3; application in section 5; interaction in section 11)","Replaces a prior Statement (repeal in section 4) which may affect continuity of precedent","Includes death via contributory terminal events (definition of terminal event in Schedule 1)"],"plain_english_summary":"This Statement of Principles sets out the medical criteria used to decide whether rheumatic heart disease (and death from it) can be reasonably linked to a person's military or peacekeeping service. It lists the clinical definition of the disease, specific factors and timing rules that can raise a \"reasonable hypothesis\" connecting the disease to service, and who can apply (claims under the VEA s120A or MRCA s338). It matters because it defines the threshold medical links used in veterans' entitlement decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019","history":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-rheumatic-heart-disease-reasonable-hypothesis-no-51-of-2019/documents"}}