{"id":"F2025L00725","name":"Statement of Principles concerning sarcoidosis (Balance of Probabilities) (No. 61 of 2025)","slug":"statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442864,"registerId":"F2025L00725-fast-fetch-1775957792376","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sarcoidosis (Balance of Probabilities) (No. 61 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nSARCOIDOSIS  (Balance of Probabilities)\n\n(No. 61 of 2025)\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 20 June 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning sarcoidosis (Balance of Probabilities) (No. 61 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 21 July 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning sarcoidosis (Balance of Probabilities) (No. 60 of 2016) (Federal Register of Legislation No. F2016L01143) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about sarcoidosis and death from sarcoidosis.\n\n\nMeaning of sarcoidosis\n\n1.           For the purposes of this Statement of Principles, sarcoidosis means a chronic, multisystem disorder characterised in affected organs by an accumulation of T lymphocytes and mononuclear phagocytes, non-caseating epithelioid granulomas, and derangement of the normal tissue architecture.\n2.           While sarcoidosis attracts ICD‑10‑AM code D86 in applying this Statement of Principles the meaning of sarcoidosis is that given in subsection (2).\n3.           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\n\nDeath from sarcoidosis\n\n1.           For the purposes of this Statement of Principles, sarcoidosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sarcoidosis.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that sarcoidosis and death from sarcoidosis 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, sarcoidosis or death from sarcoidosis is connected with the circumstances of a person's relevant service:\n\n1.           taking one of the following medications within the 5 years before clinical onset or clinical worsening;\n  1.           BRAF/MEK inhibitors;\n  2.           immune checkpoint inhibitors;\n  3.           interferons.\n\n\nNote 1: BRAF/MEK inhibitor drugs include dabrafenib, lorlatinib, trametinib, and vemurafenib.\n\nNote 2: Immune checkpoint inhibitor drugs include ipilimumab, nivolumab, and pembrolizumab.\n\nNote 3: Interferon drugs include interferon alpha, interferon beta, peginterferon alpha, and peginterferon beta.\n\n1.           having received an organ or tissue transplant, other than a corneal transplant, from a donor with sarcoidosis within the 2 years before clinical onset;\n2.           inability to obtain appropriate clinical management for sarcoidosis before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, sarcoidosis where the person's sarcoidosis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                               sarcoidosis—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":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2016 version (No. 60 of 2016) with updated medical factors (particularly the addition of modern immunotherapy drugs like checkpoint inhibitors and BRAF/MEK inhibitors), but does not expand beyond the established purpose of determining service connection for sarcoidosis under veterans' compensation legislation."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (MRCA, relevant service, sarcoidosis, terminal event, VEA)","Simple conditional structure: one of three factors must exist (section 9)","Minimal cross-referencing — only refers to the parent Acts (VEA and MRCA) and one repealed instrument","Clear, linear organisation with numbered sections matching standard Repatriation Medical Authority format","Medical terminology is explained in plain English (e.g., definition of sarcoidosis in section 7(2))","No nested exceptions or complex temporal calculations beyond straightforward 'within X years' timeframes"],"plain_english_summary":"This rulebook sets how decision-makers decide if sarcoidosis in Australian veterans or defence members is connected to service, using a \"balance of probabilities\" test so affected personnel (and families of those who die) can access pensions and treatment.  \n\nIt says a service link can be found if service exposed the person to certain drugs, to an organ/tissue transplant from a donor with sarcoidosis, or prevented timely treatment — but only where sarcoidosis existed before or during service and was worsened by that service."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2016 Statement (s 4) and replaces it with a Statement that specifies particular qualifying factors and timeframes (s 9). Because the new text narrows qualifying pathways to listed drug exposures, transplant from an affected donor, or inability to obtain appropriate clinical management, the set of service‑connected sarcoidosis claims that will meet the balance‑of‑probabilities test is altered. Determination of effect on individual claims requires comparing the new factors (s 9) with the prior instrument's content."},"complexity_factors":["Medical definition and ICD reference: uses a clinical definition of sarcoidosis and cross‑references ICD‑10‑AM (s 7(1)–(3)), requiring technical medical interpretation.","Temporal linkage windows: prescribes fixed exposure periods (drug use within 5 years; transplant within 2 years) that must be applied to individual case histories (s 9(1)–(2)).","Limited, discrete set of qualifying factors: only three categories are listed (drug exposure, transplant, lack of appropriate management), reducing interpretive breadth but concentrating significance on those factors (s 9).","Clinical worsening nuance: material contribution/aggravation rules apply differently where sarcoidosis pre‑existed service, adding a causal threshold for aggravation claims (s 10(2)).","Cross‑instrument interaction: factors that refer to other Statements of Principles invoke other instruments and their current terms, creating dependency on external statements (s 11).","Statutory application scope: ties to claims under specific VEA/MRCA sections, so legal applicability depends on claim type and service classification (s 5, Schedule 1 definitions)."],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the medical criteria the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether sarcoidosis (including death from it) is connected to a person’s relevant service. It applies to claims under section 120B of the Veterans’ Entitlements Act 1986 and section 339 of the Military Rehabilitation and Compensation Act 2004.\n\nIt defines sarcoidosis clinically and requires at least one qualifying factor — recently used immunomodulatory drugs (within 5 years), organ/tissue transplant from a donor with sarcoidosis (within 2 years), or inability to obtain appropriate clinical management before worsening — to establish a service connection."},"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-sarcoidosis-balance-of-probabilities-no-61-of-2025","history":"/api/acts/statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-sarcoidosis-balance-of-probabilities-no-61-of-2025/documents"}}