{"id":"F2025L00724","name":"Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 60 of 2025)","slug":"statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442863,"registerId":"F2025L00724-fast-fetch-1775957792367","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 60 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  (Reasonable Hypothesis)\n\n(No. 60 of 2025)\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    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   \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 (Reasonable Hypothesis) (No. 60 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning sarcoidosis (Reasonable Hypothesis) (No. 59 of 2016) (Federal Register of Legislation No. F2016L01144) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that sarcoidosis and death from sarcoidosis 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\n1.                Factors that must exist\n\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 sarcoidosis or death from sarcoidosis 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.           being treated for human immunodeficiency virus infection with antiretroviral drugs within the 2 years before clinical onset or clinical worsening;\n2.           having received an organ or tissue transplant, other than a corneal transplant, from a donor with sarcoidosis within the 2 years before clinical onset;\n3.           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(2) 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)          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 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":{"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":"The legislation maintains its original, narrow purpose: establishing the medical criteria for linking sarcoidosis to military service. It is a direct replacement of the 2016 version with updated medical factors (notably the addition of modern immunotherapy drugs like checkpoint inhibitors), but does not expand beyond its intended function as a determinative instrument for veterans' compensation claims."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) with a single medical condition as its subject","Only 6 defined terms in the Dictionary, with straightforward definitions","Clear, numbered structure with logical flow (Name → Commencement → Application → Definitions → Factors → Relationship to service)","Limited cross-referencing — primarily internal references to the Dictionary and two principal Acts (VEA and MRCA)","Conditional logic is present but not deeply nested: section 9 lists alternative factors (disjunctive 'at least one of'), and section 10 adds service-connection requirements","Medical terminology is used but immediately explained in plain English (e.g., specific drug classes with examples in notes)","No exceptions to exceptions or complex temporal layering beyond simple 'within X years before' timeframes"],"plain_english_summary":"This RMA Statement of Principles updates the medical evidence linking sarcoidosis to military service and sets the criteria for when veterans, peacekeepers, and current or former defence members can plausibly claim compensation under the Veterans' Entitlements Act and MRCA. \n\nIt explains the \"reasonable hypothesis\" test and identifies service-related exposures and events (including certain immunotherapies, antiretrovirals, transplants from affected donors, or inadequate care) that can establish a service connection — determining access to pensions and treatment."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning sarcoidosis (No. 59 of 2016) (s 4) and replaces it with the 2025 Statement, specifying particular causative factors, exposure time-windows and application rules (s 7–11). Because the earlier instrument’s text is not provided here, the direction of change (narrower or broader coverage) cannot be determined from this instrument alone; the 2025 version clearly revises the factual triggers and cross-application rules that govern claims under the VEA and MRCA."},"complexity_factors":["Statutory evidentiary threshold: use of the “reasonable hypothesis” test (see section 9 introductory text).","Precise medical definition of sarcoidosis tied to pathology features and ICD‑10‑AM code D86 (s 7(1)–(3)).","Time-bound exposure windows for causative factors: 5-year window for listed medications; 2-year windows for antiretroviral treatment and donor-transplant exposure (s 9(1)–(3)).","Enumerated medical exposures and treatments specified by class rather than exhaustive drug lists, requiring interpretation of drug classes (s 9(1) and Notes 1–3).","Requirement that any listed factor be related to the person’s relevant service (s 10(1)), creating a two-step factual inquiry (factor exists + relation to service).","Limitation on clinical worsening: applies only where sarcoidosis pre-existed service (s 10(2)), requiring historical clinical evidence.","Cross-reference to other Statements of Principles where a listed factor is itself covered elsewhere (s 11), creating dependency on other instruments.","Repeal of the prior Statement (No. 59 of 2016) and commencement rules (s 4, s 2) — legal transition considerations for ongoing claims.","Reliance on defined terms in Schedule 1 (eg. relevant service, terminal event, MRCA, VEA), requiring cross-checking of definitions for scope determinations."],"plain_english_summary":"This Statement of Principles sets the medical factors that, if present and connected to a person’s relevant service, raise a “reasonable hypothesis” that sarcoidosis or death from sarcoidosis is related to service under the VEA or MRCA. It applies to veterans and serving members making claims and lists specific drug exposures, transplant history, HIV treatment windows and failure to obtain appropriate management as the triggering circumstances that matter for compensation decision-making."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025","history":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-sarcoidosis-reasonable-hypothesis-no-60-of-2025/documents"}}