{"id":"F2022L00654","name":"Statement of Principles concerning seizure(Balance of Probabilities) (No. 38 of 2022)","slug":"statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441371,"registerId":"F2022L00654-fast-fetch-1775956681439","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning seizure(Balance of Probabilities) (No. 38 of 2022)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nSEIZURE (Balance of Probabilities)\n\n(No. 38 of 2022)\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 29 April 2022\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 Terence Campbell AM
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 Schedules\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\nSchedule 2 - Drugs\n\n1 Specified drugs\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning seizure(Balance of Probabilities) (No. 38 of 2022).\n\n2 Commencement\n\n This instrument commences on 30 May 2022.\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 epileptic seizure No. 78 of 2013 (Federal Register of Legislation No. F2013L01899) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Schedules\n\nAny item in a Schedule to this Instrument has effect according to its terms.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about seizure and death from seizure.\n\nMeaning of seizure\n\n(2) For the purposes of this Statement of Principles, seizure:\n\n(a) means an acute, nonrecurring episode of paroxysmal brain dysfunction due to sudden, abnormal, excessive neuronal discharge manifesting as seizure; and\n\n(b) includes status epilepticus; and\n\n(c) excludes:\n\n(i) movement disorders such as restless legs syndrome, periodic limb movement disorder, chorea and tics;\n\n(ii) muscle dystonia or spasms associated with tetanus, drugs or chemical poisons;\n\n(iii) psychogenic seizures;\n\n(iv) seizures occurring during electroconvulsive therapy; and\n\n(v) spontaneous movements occurring with syncope, vertigo or migraine.\n\nDeath from seizure\n\n(3) For the purposes of this Statement of Principles, seizure, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's seizure.\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 seizure and death from seizure 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, seizure or death from seizure is connected with the circumstances of a person's relevant service:\n\n(1) having a moderate to severe traumatic brain injury within the 10 years before the clinical onset of seizure;\n\n(2) having concussion within the 3 months before the clinical onset of seizure;\n\n(3) having an electrical injury of the brain before the clinical onset of seizure;\n\nNote: Electrical injury of the brain excludes transcranial magnetic stimulation and electroconvulsive therapy.\n\n(4) having a surgical procedure which involves a craniotomy or cranioplasty within the 10 years before the clinical onset of seizure;\n\n(5) having cardiac surgery or extracorporeal membrane oxygenation at the time of the clinical onset of seizure;\n\n(6) having brain radiotherapy to treat primary or secondary brain neoplasia or to treat brain arteriovenous malformation before the clinical onset of seizure;\n\n(7) having an hypoxic cerebral insult within the 30 days before the clinical onset of seizure;\n\nNote: hypoxic cerebral insult is defined in the Schedule 1 – Dictionary.\n\n(8) having a central nervous system vascular lesion from the specified list of central nervous system vascular lesions within the 10 years before the clinical onset of seizure;\n\nNote: specified list of central nervous system vascular lesions is defined in the Schedule 1 – Dictionary.\n\n(9) having autoimmune encephalitis at the time of the clinical onset of seizure;\n\nNote 1: Examples of diseases that can cause autoimmune encephalitis include granulomatosis with polyangiitis (Wegener granulomatosis), Hashimoto encephalopathy, multiple sclerosis, neuromyelitis optica, paraneoplastic neurological syndrome and systemic lupus erythematosus.\n\nNote 2: autoimmune encephalitis is defined in the Schedule 1 – Dictionary.\n\n(10) having an infection of the brain or meninges within the 6 months before the clinical onset of seizure;\n\n(11) having infection with human immunodeficiency virus at the time of the clinical onset of seizure;\n\n(12) having septicaemia at the time of clinical onset of seizure;\n\n(13) having an intracranial space-occupying lesion within the 10 years before the clinical onset of seizure;\n\nNote: intracranial space-occupying lesion is defined in the Schedule 1 – Dictionary.\n\n(14) having dementia as specified at the time of the clinical onset of seizure;\n\nNote: dementia as specified is defined in the Schedule 1 – Dictionary.\n\n(15) having a medical condition affecting the brain from the specified list of medical conditions at the time of the clinical onset of seizure;\n\nNote: specified list of medical conditions is defined in the Schedule 1 – Dictionary.\n\n(16) having alcohol intoxication, alcohol withdrawal or moderate to severe alcohol use disorder, at the time of the clinical onset of seizure;\n\nNote: alcohol intoxication, alcohol withdrawal and moderate to severe alcohol use disorder are defined in the Schedule 1 – Dictionary.\n\n(17) having malignant hypertension or hypertensive encephalopathy within the 4 weeks before the clinical onset of seizure;\n\nNote: malignant hypertension is defined in the Schedule 1 – Dictionary.\n\n(18) having eclampsia within the 4 weeks before the clinical onset of seizure;\n\nNote: eclampsia is defined in the Schedule 1 – Dictionary.\n\n(19) having acute liver failure at the time of the clinical onset of seizure;\n\n(20) having acute renal failure or chronic renal failure at the time of the clinical onset of seizure;\n\nNote: acute renal failure and chronic renal failure are defined in the Schedule 1 – Dictionary.\n\n(21) having an amniotic fluid embolism or fat embolism at the time of the clinical onset of seizure;\n\n(22) having hypoglycaemia at the time of the clinical onset of seizure;\n\nNote: hypoglycaemia is defined in the Schedule 1 – Dictionary.\n\n(23) having hyperglycaemia at the time of the clinical onset of seizure;\n\nNote: hyperglycaemia is defined in the Schedule 1 – Dictionary.\n\n(24) having diabetes mellitus at the time of the clinical onset of seizure;\n\n(25) having an electrolyte abnormality at the time of the clinical onset of seizure;\n\nNote: electrolyte abnormality is defined in the Schedule 1 – Dictionary.\n\n(26) having carbon monoxide poisoning within the 30 days before the clinical onset of seizure;\n\n(27) having sleep deprivation at the time of the clinical onset of seizure;\n\nNote: sleep deprivation is defined in the Schedule 1 – Dictionary.\n\n(28) having exertional heat stroke at the time of the clinical onset of seizure;\n\n(29) being dehydrated at the time of the clinical onset of seizure;\n\n(30) undergoing organ or tissue transplantation, excluding corneal transplant, within the 6 months before the clinical onset of seizure;\n\nNote: organ or tissue transplantation is defined in the Schedule 1 – Dictionary.\n\n(31) taking a drug specified in the Schedule 2 - Drugs of this Instrument, within the 24 hours before the clinical onset of seizure, and if multiple seizures occur, the first seizure occurred within 24 hours of taking the drug;\n\n(32) taking a drug which is associated in the individual with:\n\n(a) the development of a seizure within 24 hours of first taking the drug; and\n\n(b) the redevelopment of a seizure on rechallenge with the same drug;\n\n(33) being exposed to radiographic contrast media within the 24 hours before the clinical onset of seizure, and if multiple seizures occur, the first seizure occurred within 24 hours of exposure to the radiographic contrast media;\n\nNote: Examples of radiographic contrast media include meglumine carbamate, metrizamide and iohexol.\n\n(34) reducing the intake of, or withdrawing from, a chronically administered sedative drug within the 2 weeks before the clinical onset of seizure;\n\nNote: sedative drug is defined in the Schedule 1 – Dictionary.\n\n(35) being exposed to partial pressures of oxygen above 1.2 atmospheres absolute (120 kPa) from:\n\n(a) breathing oxygen enriched air during diving;\n\n(b) receiving hyperbaric oxygen therapy;\n\n(c) saturation diving; or\n\n(d) the use of closed or semi-closed rebreathing apparatus;\n\nwithin the 24 hours before the clinical onset of seizure;\n\n(36) being exposed to an abrupt reduction in the pressure of the air surrounding the person, resulting in the development of cerebral arterial gas embolism or decompression sickness, within the 24 hours before the clinical onset of seizure;\n\n(37) being poisoned with a metal from the specified list of metals, as demonstrated by clinical, haematological or biochemical evidence of such poisoning, at the time of the clinical onset of seizure;\n\nNote: specified list of metals is defined in the Schedule 1 – Dictionary.\n\n(38) inhaling, ingesting or having cutaneous contact with a neurotoxic substance, or a food or compound containing a neurotoxic substance, within the 24 hours before the clinical onset of seizure, and:\n\n(a) other signs and symptoms of poisoning are present; and\n\n(b) if multiple seizures occur, the first seizure occurred within 24 hours of exposure to the neurotoxic substance;\n\nNote: neurotoxic substance or a food or compound containing a neurotoxic substance and signs and symptoms of poisoning are defined in the Schedule 1 – Dictionary.\n\n(39) experiencing animal envenomation within the 24 hours before the clinical onset of seizure;\n\n(40) inability to obtain appropriate clinical management for seizure.\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 factor set out in subsection 9(40) applies only to material contribution to, or aggravation of, seizure where the person's seizure 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 acute renal failure means a kidney disorder characterised by rapid decline of glomerular filtration rate and retention of nitrogenous waste products.\n\n alcohol intoxication means recently consuming a quantity of alcohol such that the person exhibits the following behaviours and signs and symptoms:\n\n(a) clinically significant problematic behavioural or psychological changes (for example, inappropriate sexual or aggressive behaviour, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion;\n\n(b) one (or more) of the following signs or symptoms developing during, or shortly after, alcohol use:\n\n(i) slurred speech;\n\n(ii) incoordination;\n\n(iii) unsteady gait;\n\n(iv) nystagmus;\n\n(v) impairment in attention or memory; or\n\n(vi) stupor or coma; and\n\n(c) the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance.\n\n alcohol withdrawal means ceasing or reducing the intake of alcohol after a continuous period of at least 2 weeks of heavy alcohol use.\n\n autoimmune encephalitis means a diffuse brain injury due to autoimmune inflammation of the brain.\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n dementia as specified means one of the following forms of dementia:\n\n(a) Alzheimer dementia;\n\n(b) Creutzfeldt-Jakob disease with dementia;\n\n(c) dementia pugilistica;\n\n(d) frontotemporal dementia;\n\n(e) Huntington's chorea with dementia;\n\n(f) neurocognitive disorder with Lewy bodies;\n\n(g) Parkinson's disease with dementia;\n\n(h) vascular dementia; or\n\n(i) any other type of dementia.\n\n eclampsia means a condition occurring in pregnant or puerperal women, characterised by hypertension, coma, convulsions, oedema or proteinuria.\n\n electrolyte abnormality means:\n\n(a) hypercalcaemia;\n\n(b) hypocalcaemia;\n\n(c) hypomagnesaemia;\n\n(d) hyponatraemia; or\n\n(e) hypophosphataemia.\n\nNote: An example of a condition in which electrolyte abnormality occurs is tumour lysis syndrome.\n\n hyperglycaemia means a serum glucose concentration greater than 17 mmol/L.\n\n hypoglycaemia means a serum glucose concentration less than 3 mmol/L.\n\n hypoxic cerebral insult means an event which results in either a decreased rate of cerebral blood flow or decreased oxygen content of cerebral arterial blood for a sustained period.\n\n inhalants means a breathable chemical that produces psychoactive vapours and includes organic solvents, aerosols and some anaesthetics.\n\nNote: organic solvents is also defined in the Schedule 1 – Dictionary.\n\n intracranial space-occupying lesion means a pathological entity occupying volume within the cranial cavity, including intracranial aneurysm, neoplasm and abscess.\n\n iron overload means an accumulation of excess iron in tissues and organs which has been confirmed by elevated ferritin or transferrin saturation levels.\n\nNote: Causes include haemochromatosis and blood transfusions.\n\n malignant hypertension means a severe hypertensive state characterised by papilloedema of the ocular fundus, retinal haemorrhage and exudates, cardiac decompensation and declining renal function.\n\n moderate to severe alcohol use disorder means a psychiatric disorder characterised by a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 4 of the following criteria, occurring within a 12-month period:\n\n(a) alcohol is often taken in larger amounts or over a longer period than was intended;\n\n(b) there is a persistent desire or unsuccessful efforts to cut down or control alcohol use;\n\n(c) a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects;\n\n(d) craving, or a strong desire or urge to use alcohol;\n\n(e) recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home;\n\n(f) continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol;\n\n(g) important social, occupational, or recreational activities are given up or reduced because of alcohol use;\n\n(h) recurrent alcohol use in situations in which it is physically hazardous;\n\n(i) alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol; or\n\n(j) tolerance, defined by either:\n\n(i) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or\n\n(ii) a markedly diminished effect with continued use of the same amount of alcohol.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neurotoxic substance or a food or compound containing a neurotoxic substance means:\n\n(a) abrin (Abrus precatorius);\n\n(b) anatoxin;\n\n(c) camphor;\n\n(d) chemical weapon agents sarin, soman and VX gas;\n\n(e) colloidal silver;\n\n(f) cyanide;\n\n(g) cyclotrimethylenetrinitramine (RDX or C4 explosive);\n\n(h) domoic acid;\n\n(i) ethylene glycol;\n\n(j) eucalyptus oil;\n\n(k) Illicium henryi or Illicium anisatum;\n\n(l) methyl bromide;\n\n(m) N,N-diethyl-m-toluamide (DEET);\n\n(n) organochlorine insecticides;\n\n(o) organophosphates;\n\n(p) picrotoxin (Anamirta cocculus);\n\n(q) sodium azide;\n\n(r) star fruit (Averrhoa carambola);\n\n(s) strychnine (Strychnos nux-vomica);\n\n(t) tetramine; or\n\n(u) any other epileptogenic neurotoxic compound.\n\n organ or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\n organic solvents means:\n\n(a) aliphatic hydrocarbon solvents; or\n\n(b) aromatic hydrocarbon solvents; or\n\n(c) chlorinated organic solvents; or\n\n(d) oxygenated organic solvents.\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 sedative drug means a psychoactive agent used therapeutically to suppress central nervous system activity, including barbiturates, benzodiazepines, anticonvulsants, sedatives and hypnotics.\n\n seizure—see subsection 7(2).\n\n signs and symptoms of poisoning means one of the following signs and symptoms which are not attributable to seizure:\n\n(a) behavioural impairments including loss of motor control and loss of consciousness;\n\n(b) blurred vision and eye irritation;\n\n(c) central nervous system excitation and depression including agitation, lethargy and perceptual disturbances;\n\n(d) cough, acute lung injury and respiratory depression or failure;\n\n(e) dermatitis and skin irritation;\n\n(f) ear, nose and throat irritation and hypersalivation;\n\n(g) gastrointestinal symptoms including nausea, diarrhoea and vomiting; or\n\n(h) neurocognitive deficits including stupor, confusion and memory deficits.\n\n sleep deprivation means having not slept within the 36 hours after the end of the last period of 4 hours or more of uninterrupted sleep, or having less than 4 hours sleep for 3 consecutive 24-hour periods.\n\n specified list of central nervous system vascular lesions means:\n\n(a) cerebral venous thrombosis;\n\n(b) cerebrovascular accident;\n\n(c) subarachnoid haemorrhage; or\n\n(d) subdural haematoma.\n\nspecified list of medical conditions means:\n\n(a) cerebral hyperperfusion syndrome;\n\n(b) cerebral vasoconstriction syndrome;\n\n(c) Creutzfeldt-Jakob disease;\n\n(d) Huntington's chorea;\n\n(e) iron overload;\n\n(f) Parkinson's disease and secondary parkinsonism;\n\n(g) posterior reversible encephalopathy syndrome;\n\n(h) sarcoidosis; or\n\n(i) sickle-cell disease.\n\nNote: iron overload is also defined in the Schedule 1 – Dictionary.\n\n specified list of metals means:\n\n(a) lead;\n\n(b) nickel; or\n\n(c) tungsten.\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\n\nSchedule 2 - Drugs \n\nNote: See Section 6, Subsection 9(31)\n\n1 Specified drugs\n\n \n\n| amantadine | 2. aminophylline | 3. amphetamine and its derivatives, including methylenedioxy-methamphetamine (MDMA) |\n| --- | --- | --- |\n| 4. amphotericin B | 5. antibiotics excluding antimycobacterial agents | 6. anticholinesterase drugs used to treat Alzheimer disease and myasthenia gravis |\n| 7. antidepressants | 8. antineoplastic agents excluding etoposide, carboplatin and oxaliplatin | 9. antipsychotics |\n| 10. apalutamide | 11. atovaquone with proguanil | 12. atropine |\n| 13. baclofen | 14. benztropine | 15. bupropion |\n| 16. chloroquine | 17. cinacalet | 18. cocaine |\n| 19. cycloserine | 20. danazol | 21. dantrolene |\n| 22. desmopressin | 23. diaxoxide | 24. digoxin |\n| 25. disulfiram | 26. efavirenz | 27. enzalutamide |\n| 28. ephedrine | 29. esmolol | 30. fampridine |\n| 31. fentanyl | 32. flucytosine | 33. foscarnet |\n| 34. gamma hydroxybutyrate (GHB) | 35. general anaesthetics excluding ketamine | 36. guanine analogue antiviral agents including acyclovir, ganciclovir and valganciclovir |\n| 37. heroin | 38. immunomodulatory agents | 39. inhalants |\n| 40. isoniazid | 41. ivermectin | 42. kratom (Mitragyna speciosa) |\n| 43. lidocaine | 44. lithium | 45. mannitol |\n| 46. mefloquine | 47. memantine | 48. methylphenidate |\n| 49. mexiletine | 50. non-topical local anaesthetics | 51. ondansetron |\n| 52. opioid analgesics | 53. perhexiline | 54. phencyclidine |\n| 55. phentermine | 56. phenylpropanolamine | 57. pizotifen |\n| 58. pranziquantel | 59. pyrimethamine | 60. ranolazine |\n| 61. rasburicase | 62. salicylate in overdose | 63. sedating antihistamines |\n| 64. synthetic cannabinoids | 65. theophylline | 66. tranexamic acid |\n| 67. trihexyphenidyl | | |\n\n\nNote: inhalants is also defined in the Schedule 1 – Dictionary.\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":6,"scope_assessment":{"changed":true,"description":"The original 2013 instrument was narrowly titled 'Statement of Principles concerning epileptic seizure' and focused specifically on epilepsy. This 2022 version expands the scope significantly to cover all 'seizure' broadly defined, including status epilepticus and death from seizure, while explicitly excluding non-epileptic seizure mimics. The factor list grew from the original 2013 set to 40 factors, incorporating modern medical understanding including autoimmune encephalitis, specific diving-related injuries, expanded neurotoxic substance lists (including chemical weapons and explosives like RDX), and a comprehensive drug schedule. The temporal windows have been refined with more precise medical evidence, and the definition now explicitly covers terminal events contributed to by seizure."},"complexity_factors":["40 distinct causal factors with varying temporal windows (ranging from 24 hours to 10 years)","27 defined terms in Schedule 1 Dictionary, many with nested definitions and cross-references","67 specified drugs in Schedule 2 requiring cross-referencing","Multiple exclusion clauses within the definition of 'seizure' itself (subsection 7(2)(c))","Complex interaction with other Statements of Principles via section 11 (incorporation by reference)","Dual legislative framework application (VEA and MRCA) with different service definitions","Specific medical thresholds requiring clinical measurement (e.g., serum glucose >17 mmol/L for hyperglycaemia, GFR <15 mL/min for chronic renal failure)","Conditional logic for drug-related seizures requiring both temporal proximity AND rechallenge confirmation (factor 32)","Nested definitions (e.g., 'organic solvents' defined within 'inhalants', 'iron overload' referenced in multiple places)","Special rule for factor 40 (clinical management) limiting it to aggravation cases only, not initial causation"],"plain_english_summary":"The Repatriation Medical Authority updates how seizures (including epilepsy) are linked to Australian military service for compensation: a new statement lists 40 medical factors that, if related to service, can support claims under the Veterans' Entitlements Act and Military Rehabilitation and Compensation Act. It affects current and former ADF members, veterans and their families making seizure- or seizure‑death claims, broadening causes covered and reflecting updated medical evidence."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument replaces the RMA’s 2013 Statement of Principles for ‘epileptic seizure’ and broadens and re‑frames the subject as ‘seizure’ and ‘death from seizure’ (sections 3 and 4). Compared with the earlier title focusing on ‘epileptic seizure’, the 2022 instrument: expands the range of accepted causative factors (extensive lists of metabolic, toxicological, surgical, radiotherapy, infectious and other causes in section 9 and Schedules), explicitly includes death contributed to by seizure (section 7(3)), updates and extends timing windows for many factors, and provides a large, explicit drug list (Schedule 2). Those changes materially broaden the catalogue of circumstances that can support a service connection finding, and therefore represent a substantive enlargement of scope beyond a narrow ‘epileptic’ focus. (This assessment is based on the instrument’s text which repeals the 2013 instrument and replaces it with a broader, more detailed Statement.)"},"complexity_factors":["Large number of listed causative factors (40+ numbered items in section 9) with differing timing windows","Extensive definitional Schedule (Schedule 1) containing many medical and technical terms to be interpreted","Long, explicit list of specified drugs (Schedule 2) with ~67 entries","Cross‑references to other Statements of Principles (section 11) and to VEA/MRCA definitions, creating inter‑instrument dependencies","Several conditional or exception rules (e.g. exclusions in seizure definition 7(2)(c), note exclusions to electrical injury, limitation on factor 9(40) in section 10(2))","Mixed evidentiary timing rules (24 hours, 30 days, 6 months, 10 years, etc.) requiring precise temporal proof","Specialist interpretation required for many items (e.g. ‘moderate to severe’ TBI, ‘autoimmune encephalitis’, ‘hypoxic cerebral insult’)","Overlap of metabolic, toxicological and traumatic causes requiring multidisciplinary evidence (imaging, toxicology, surgery notes, critical care records)"],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- Replaces the earlier 2013 Repatriation Medical Authority (RMA) Statement of Principles on epileptic seizure with a new Statement of Principles titled “seizure (Balance of Probabilities)” (No. 38 of 2022) (see sections 3 and 4). It comes into force on 30 May 2022 (section 2).\n- Sets out the medical definition of “seizure” and explicitly includes death that is contributed to by a seizure (section 7).\n- Lists the specific medical, toxicological and situational factors which, if present and related to a person’s relevant service, are sufficient to conclude on the balance of probabilities that the seizure (or death from seizure) is connected with that service (section 9). At least one listed factor must be present (section 9 heading and first paragraph).\n- Requires that any factor relied on must be related to the person’s relevant service as defined in the instrument (section 10). One specific factor (lack of appropriate clinical management) is restricted in how it may be used (section 10(2)).\n- Cross‑refers to other Statements of Principles where a listed factor refers to an injury/disease already covered by another Statement (section 11).\n- Includes detailed definitions for medical terms and precisely lists drugs and toxicants that count as qualifying exposures (Schedules 1 and 2).\n\n**Who this affects**\n\n- Veterans and current or former members of the Australian Defence Force who lodge claims under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) and who assert that a seizure (or death from seizure) is connected to their relevant service (section 5; Schedule 1 definitions of VEA/MRCA/relevant service).\n- Clinical practitioners and medico‑legal assessors who must provide or review evidence of the listed factors and their timing relative to seizure onset.\n- The Department/administrative decision‑makers who determine entitlement under the VEA or MRCA using this Statement as the causation benchmark.\n\n**Why it matters (official rationale and practical effect)**\n\n- The RMA states it is satisfied, on available medical‑scientific evidence, that seizure and death from seizure can be related to relevant service (section 8). Translating that view into administrative practice, this Statement gives a concrete list of conditions and exposures which, when established and linked to relevant service, satisfy the causation test on the balance of probabilities (section 9). In short: presence of a listed factor (and a link to service) equals a presumptive connection for claims assessment purposes.\n\n**Practical mechanics and evidentiary rules**\n\n- Timing windows vary by factor. Examples: traumatic brain injury within 10 years before seizure onset (9(1)); concussion within 3 months (9(2)); infections of brain/meninges within 6 months (9(10)); many toxic exposures or drug takes have a 24‑hour window (9(31), 9(33), 9(38), 9(39)); some metabolic causes apply at the time of clinical onset (e.g. hypoglycaemia 9(22), electrolyte abnormality 9(25)). These timing rules are integral to whether a listed factor “exists” for the benefit of a claimant.\n- The Schedules define medical terms (Schedule 1) and provide an express list of specified drugs/neurotoxicants (Schedule 2). Several items are explicitly excluded from qualifying exposures (for example, transcranial magnetic stimulation and electroconvulsive therapy are excluded from “electrical injury of the brain”; section 9(3) note).\n- If a listed factor itself refers to another SOP, that other SOP governs how that factor is applied (section 11).\n\n**Costs, incentives, trade‑offs and implementation issues (testing the RMA’s claim against practical effects)**\n\n- Who pays and who decides: administrative liabilities (payment of entitlements, treatment or rehabilitation) remain with the Department under the VEA/MRCA; decision‑makers use this Statement as the medical causation standard (sections 3, 5). The Statement does not itself allocate money, but materially changes the presumptive medical link used in entitlement decisions.\n- Concentrated benefits vs diffuse costs: the primary beneficiaries are claimants whose seizures coincide with any of the listed factors and who can show the factor was related to service; the fiscal cost of successful claims is borne by the Government (noted implication from the instrument’s application to VEA/MRCA claims). The instrument centralises benefit for claimants meeting the list; costs are dispersed across the veteran compensation system.\n- Compliance burden: claimants and medical practitioners must provide specific clinical evidence (timing, documented diagnosis, toxicology or operative records, etc.) to establish a listed factor and link to service. The variable timing windows and detailed definitions (Schedules 1 & 2) increase evidentiary complexity for both claimants and decision‑makers (see section 9 and Schedules).\n- Implementation risk and bureaucratic discretion: many factors require specialist interpretation (e.g. what constitutes “moderate to severe traumatic brain injury”, “autoimmune encephalitis”, or clinical proof of metal poisoning). Discretion will lie with medical assessors to interpret these definitions against often incomplete clinical records, which may lead to inconsistent outcomes or more reviews/appeals (see Schedule 1 definitions and notes to section 9).\n- Interaction with other SOPs: section 11 makes some causative factors subject to other Statements of Principles, creating cross‑reference risks where two SOPs overlap. That increases administrative complexity and may create gaps or duplications in evidence requirements.\n- Effects on private behaviour and providers: treating clinicians and hospitals may be asked to supply detailed medico‑legal documentation (surgical notes, radiotherapy records, toxicology) to support claims. There is an incentive for claimants to obtain contemporaneous documentation demonstrating timing and exposure within the specified windows. This could shift some costs onto private clinics and treating doctors in terms of record‑keeping and report preparation.\n- Potential for substitution effects and unintended consequences: listing many non‑structural causes (e.g. metabolic disturbances, drugs, alcohol withdrawal, sleep deprivation) could expand the pool of events treated as service‑related where those exposures occurred in service. Conversely, many exclusions and timing constraints will preclude linkage in other cases. The practical outcome will depend on how strictly the definitions and timing windows are applied in claims assessment (section 9 and Schedules).\n\n**Key procedural points worth noting**\n\n- At least one listed factor must be established (section 9). The factor must be related to the person’s relevant service (section 10).\n- Factor 9(40) (inability to obtain appropriate clinical management) is limited to contributing to or aggravating a seizure only where the seizure was suffered or contracted before or during service but did not arise out of service (section 10(2)).\n- The instrument expressly includes death caused by terminal events that were contributed to by seizure; the definition of “terminal event” is in Schedule 1.\n\n**Sections to watch when preparing or evaluating a claim**\n\n- Section 7 (definition and scope of “seizure”);\n- Section 9 (the list of causative factors and their timing);\n- Section 10 (relationship to relevant service and the limitation on factor 9(40));\n- Section 11 and the Schedules (definitions and lists of drugs/toxicants).\n\n"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022","history":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-seizure-balance-of-probabilities-no-38-of-2022/documents"}}