{"id":"F2017L01057","name":"Statement of Principles concerning rheumatoid arthritis (Balance of Probabilities) (No. 51 of 2017)","slug":"statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439302,"registerId":"F2017L01057-fast-fetch-1775955381181","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning rheumatoid arthritis (Balance of Probabilities) (No. 51 of 2017)","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\nRHEUMATOID ARTHRITIS (Balance of Probabilities)\n\n(No. 51 of 2017)\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 18 August 2017\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 Revocation\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 rheumatoid arthritis (Balance of Probabilities) (No. 51 of 2017).\n\n2 Commencement\n\n This instrument commences on 18 September 2017.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning rheumatoid arthritis No. 69 of 2008 made under subsection 196B(3) of the VEA is revoked.\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 rheumatoid arthritis and death from rheumatoid arthritis.\n\nMeaning of rheumatoid arthritis\n\n(2) For the purposes of this Statement of Principles, rheumatoid arthritis means:\n\n(a) a symmetric, inflammatory, peripheral polyarthritis persisting for a continuous period of at least six weeks, characterised by inflammatory synovitis; and\n\n(b) excludes juvenile rheumatoid arthritis and non-rheumatoid conditions that may have similar clinical features, such as psoriatic arthritis, acute viral polyarthritis, systemic lupus erythematosus and polyarticular gout.\n\nNote: Rheumatoid arthritis usually involves peripheral joints, including cartilage damage and bone erosions and changes in joint integrity as manifestations of established disease. In addition, extra-articular manifestations are common.\n\n(3) While rheumatoid arthritis attracts ICD‑10‑AM code M05 or M06, in applying this Statement of Principles the meaning of rheumatoid arthritis 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.\n\nDeath from rheumatoid arthritis\n\n(5) For the purposes of this Statement of Principles, rheumatoid arthritis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's rheumatoid arthritis.\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 rheumatoid arthritis and death from rheumatoid arthritis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is 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, rheumatoid arthritis or death from rheumatoid arthritis is connected with the circumstances of a person's relevant service:\n\n(1) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of rheumatoid arthritis, and where smoking has ceased, the clinical onset of rheumatoid arthritis has occurred within ten years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(2) inhaling respirable crystalline silica dust, at the time material containing crystalline silica was being:\n\n(a) produced;\n\n(b) excavated;\n\n(c) drilled, cut or ground; or\n\n(d) used in construction, manufacturing, cleaning or blasting;\n\nfor a cumulative period of at least 5 000 hours within the ten years before the clinical onset of rheumatoid arthritis;\n\n(3) being treated with a drug from the specified list of drugs within the eight weeks before the clinical onset of rheumatoid arthritis;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(4) having periodontitis for at least the three months before the clinical onset of rheumatoid arthritis;\n\n(5) being obese for at least five years within the ten years before the clinical onset of rheumatoid arthritis;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(6) smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of rheumatoid arthritis, and where smoking has ceased, the clinical worsening of rheumatoid arthritis has occurred within two years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(7) inhaling respirable crystalline silica dust, at the time material containing crystalline silica was being:\n\n(a) produced;\n\n(b) excavated;\n\n(c) drilled, cut or ground; or\n\n(d) used in construction, manufacturing, cleaning or blasting;\n\nfor a cumulative period of at least 5 000 hours within the ten years before the clinical worsening of rheumatoid arthritis;\n\n(8) being treated with a drug from the specified list of drugs within the eight weeks before the clinical worsening of rheumatoid arthritis;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(9) suddenly discontinuing treatment with a disease modifying antirheumatic drug after undergoing continuous disease modifying antirheumatic drug treatment for at least six months, within the six months before the clinical worsening of rheumatoid arthritis;\n\nNote: disease modifying antirheumatic drug is defined in the Schedule 1 - Dictionary. \n\n(10) having periodontitis for at least the three months before the clinical worsening of rheumatoid arthritis;\n\n(11) being obese for at least five years within the ten years before the clinical worsening of rheumatoid arthritis;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(12) inability to obtain appropriate clinical management for rheumatoid arthritis.\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(6) to 9(12) apply only to material contribution to, or aggravation of, rheumatoid arthritis where the person's rheumatoid arthritis 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\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\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 disease modifying antirheumatic drug means a pharmacological agent which reduces or eradicates synovial inflammation, including methotrexate, prednisone, hydroxychloroquine, sulfasalazine, leflunomide, cyclosporine, abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, tocilizumab and rituximab.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\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 rheumatoid arthritis—see subsection 7(2).\n\n specified list of drugs means:\n\n(a) granulocyte-macrophage colony-stimulating factors (GM-CSF); or\n\n(b) interferon-α.\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","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It follows the standard template and structure used for determining service connection of diseases under the VEA and MRCA. The 2017 revision updates the medical evidence base (particularly regarding smoking, silica, obesity and periodontitis as risk factors) but does not expand beyond the original purpose of providing determinative medical criteria for veterans' compensation claims."},"complexity_factors":["Multiple defined terms (12 definitions in Schedule 1) requiring cross-reference","Precise quantitative thresholds (5,000 hours silica exposure, 5 pack-years smoking, BMI ≥30, specific time windows)","Dual structure covering both 'clinical onset' (factors 1-5) and 'clinical worsening' (factors 6-12)","Nested conditional logic in section 10(2) limiting certain factors to aggravation cases only","Cross-reference mechanism in section 11 linking to other Statements of Principles","Technical medical terminology requiring specialist knowledge (ICD-10-AM codes, disease modifying antirheumatic drugs, specific drug classes)"],"plain_english_summary":"This Statement of Principles sets the medical rules for when rheumatoid arthritis in Australian Defence Force members and veterans is accepted as service-related for compensation under the VEA and MRCA, replacing the 2008 version. It lists 12 specified risk factors — e.g. smoking, silica exposure, obesity, periodontitis, certain drugs, interrupted treatment or lack of care — and accepts the condition on the balance of probabilities if at least one factor is linked to relevant service."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly revokes the previous Statement of Principles (Rheumatoid arthritis No. 69 of 2008) and replaces it (section 4). Compared with the instrument it revoked, the 2017 SOP broadens and updates the set of qualifying factors by adding or explicitly listing items such as periodontitis (section 9(4),(10)), obesity with a defined BMI threshold and duration (section 9(5),(11) and Schedule 1), sudden discontinuation of DMARDs as a proximate aggravating factor (section 9(9)), inability to obtain appropriate clinical management (section 9(12)), and an explicit, quantified silica exposure threshold (section 9(2),(7)). It also specifies a short list of \"specified drugs\" (GM‑CSF and interferon‑α) and formalises multiple precise timing windows for onset and worsening. These additions broaden the circumstances in which RA or its worsening can be linked to relevant service, increasing the range of claimants who may meet the SOP criteria and creating more types of factual proof that decision‑makers must evaluate."},"complexity_factors":["Single disease focus with a short list of discrete qualifying factors (section 9) — reduces conceptual breadth","Multiple time windows and conditional timing rules (e.g. onset vs worsening; 10‑year, 5‑year, 8‑week and 6‑month windows) — adds temporal complexity","Defined quantitative thresholds that require measurement (5,000 cumulative hours of silica exposure; 5+ pack‑years; BMI >= 30 for 5 years) — evidentiary complexity","Cross‑references to other SOPs and to the VEA/MRCA (section 11 and sections 3–5) — requires checking other instruments","Schedule 1 contains several operational definitions (pack‑years, BMI, DMARD list, specified drugs, terminal events) — interpretive complexity from definitions","Revocation of prior instrument requires comparison when tracking legislative history (section 4)","Conditional application of a subset of factors (9(6)–9(12)) only to aggravation/material contribution cases (section 10(2)) — nested conditional logic"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- This is a Statement of Principles (SOP) issued by the Repatriation Medical Authority (RMA) that sets out the medical factors that, on the balance of probabilities, can link rheumatoid arthritis (RA) or death from RA to a person's \"relevant service\" under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA). (See sections 3, 5 and 7.)\n\n- It defines what the instrument means by \"rheumatoid arthritis\" (a symmetric inflammatory peripheral polyarthritis with inflammatory synovitis, persisting at least six weeks) and what is excluded (for example juvenile RA and several non‑rheumatoid conditions). (See subsection 7(2).)\n\n- The SOP lists specific *factors* (substance exposures, medical conditions, treatments and behaviours) that must be present before a decision‑maker can say, on the balance of probabilities, that a person’s RA or death from RA is connected with their relevant service. At least one of the factors in section 9 must be established. Examples include: a specified smoking history (pack‑years), long enough inhalation exposure to respirable crystalline silica during certain activities, periodontitis, obesity for defined durations, recent treatment with specified drugs (GM‑CSF or interferon‑α), and sudden discontinuation of disease‑modifying antirheumatic drugs (DMARDs). (See section 9 and Schedule 1 definitions.)\n\n- Timing and causation rules: many factors require the exposure or condition to be within a particular time window before the clinical onset or clinical worsening of RA (for example, silica exposure within the ten years before onset; smoking within ten years of cessation for onset, or within two years of cessation for worsening). (See paragraphs in section 9.)\n\n- Relationship to service: any factor relied on must be related to the person's relevant service (section 10). The SOP also clarifies that certain factors (those in subsections 9(6)–9(12)) only apply when the person’s RA existed before or during, but did not arise out of, the relevant service — i.e. these factors can show material contribution or aggravation of pre‑existing RA. (See section 10(2).)\n\n- Interaction with other SOPs: if a listed factor refers to an injury or disease already covered by another SOP, that other SOP’s factors apply according to its terms. (See section 11.)\n\n- Practical outcome: decision‑makers (typically the Department/claims administrators using this SOP) will use these defined factors and definitions when deciding compensation or entitlements claims for veterans or serving members. The RMA revoked the earlier RA SOP and replaced it with this instrument. (See section 4.)\n\nWhy this matters (purpose claims and testing them)\n\n- The RMA states that, on the available medical and scientific evidence, it is more probable than not that RA and death from RA can be related to relevant service (section 8). The SOP operationalises that view by listing concrete exposures and clinical circumstances that, if proved, satisfy the causation test.\n\n- Who pays and who decides: the government (through the Departments that administer the VEA and MRCA) pays entitlements or compensation where decision‑makers apply these SOP criteria and find service connection. The RMA sets the medical criteria; claims officers apply them to individual cases. (See sections 3, 5 and 8.)\n\n- Who benefits and who bears the cost: benefits are concentrated (veterans or members who can establish the listed factors). Costs are borne by the government (taxpayers) through veterans’ compensation/health entitlements and potentially by employers or insurers indirectly if occupational exposure histories are implicated in claims.\n\nTesting the SOP against implementation trade‑offs and risks\n\n- Evidentiary and administrative burden: several criteria require measurable histories (e.g. \"at least 5,000 hours\" of silica exposure, pack‑years of smoking, BMI of 30+ for five years, documented periodontitis for three months). These quantitative thresholds create a clear standard but shift the burden to claimants to produce records or credible histories, and to decision‑makers to assess occupational exposure hours and medical records. (See section 9 and Schedule 1.)\n\n- Bureaucratic discretion and cross‑references: the SOP reduces open‑ended medical judgment by setting thresholds, but decision‑makers must still evaluate whether a claimant’s documented exposures are \"related to\" relevant service (section 10) and reconcile overlaps with other SOPs (section 11), which leaves room for case‑by‑case interpretation.\n\n- Effects on private actors and markets: the SOP may increase claims arising from workplaces with silica exposure, potentially raising employer attention to exposure controls and occupational health monitoring. The specified list of drugs and DMARD discontinuation criteria could influence how claimants frame medical histories, but the SOP does not regulate prescribing or private clinical practice directly. (See Schedule 1 definitions.)\n\n- Substitution and unintended consequences: because the SOP fixes particular qualifying factors and time windows, claimants who cannot meet those thresholds might pursue other legal or medical pathways. There is a risk of disputes over measurement (e.g. reconstructing historical silica exposure or smoking amounts) and over the link between documented exposures and \"relevant service.\"\n\nSummary of key legal hooks and locations in the instrument\n\n- Definition and scope of RA: subsection 7(2).\n- List of qualifying factors and timing windows: section 9 (and Schedule 1 for defined terms such as \"pack‑years\", \"being obese\", and specified drugs).\n- Service relationship and aggravation rules: section 10.\n- Interaction with other SOPs: section 11.\n\nOverall, this SOP translates medical findings about risk factors for RA into specific, measurable criteria that claims decision‑makers must apply when assessing service connection for RA or death from RA. It concentrates benefits on claimants who can document the listed factors and transfers evidentiary and administrative tasks to claimants and decision‑makers.**"},"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-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017","history":"/api/acts/statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017/history","analysis":"/api/acts/statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017/analysis","conflicts":"/api/acts/statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017/important-cases","documents":"/api/acts/statement-of-principles-concerning-rheumatoid-arthritis-balance-of-probabilities-no-51-of-2017/documents"}}