{"id":"F2022L00651","name":"Statement of Principles concerning seizure (Reasonable Hypothesis) (No. 37 of 2022)","slug":"statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441363,"registerId":"F2022L00651-fast-fetch-1775956678889","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning seizure (Reasonable Hypothesis) (No. 37 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 (Reasonable Hypothesis)\n\n(No. 37 of 2022)\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 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 (Reasonable Hypothesis) (No. 37 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning epileptic seizure No. 77 of 2013 (Federal Register of Legislation No. F2013L01897) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that seizure and death from seizure 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 seizure or death from seizure with the circumstances of a person's relevant service:\n\n(1) having a moderate to severe traumatic brain injury within the 20 years before the clinical onset of seizure;\n\n(2) having concussion within the 6 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 20 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 2 months 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 20 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 1 year 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 20 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 1 year 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(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 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) 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 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":"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":6,"scope_assessment":{"changed":true,"description":"The original 2013 instrument was titled 'Statement of Principles concerning epileptic seizure' — this 2022 version expands scope significantly. It broadens from 'epileptic seizure' to 'seizure' generally, explicitly includes 'death from seizure' and terminal events, adds 40 detailed causal factors (many more than typical earlier instruments), and incorporates modern medical understanding including autoimmune encephalitis, diving-related conditions, and extensive pharmaceutical triggers. The expansion reflects evolving medical science and a more generous approach to recognising service-related causes of seizure disorders."},"complexity_factors":["40 distinct causal factors with varying timeframes (ranging from 24 hours to 20 years before clinical onset)","Extensive defined terms in Schedule 1 — approximately 25+ specialised medical and legal definitions including 'hypoxic cerebral insult', 'autoimmune encephalitis', 'moderate to severe alcohol use disorder' with 10 specific diagnostic criteria","Cross-referencing structure — factors in section 9 refer to definitions in Schedule 1, and some definitions cross-reference other definitions (e.g., 'inhalants' defined in Schedule 1 and referenced in Schedule 2)","Nested conditional logic in several factors — e.g., factor 38 requires both exposure to neurotoxin AND other signs of poisoning AND temporal relationship to first seizure","Specific list structures — 4 specified central nervous system vascular lesions, 9 specified medical conditions, 3 specified metals, 9 forms of dementia, 5 electrolyte abnormalities","Schedule 2 contains 67 specified drugs with specific inclusion/exclusion language (e.g., 'antibiotics excluding antimycobacterial agents', 'general anaesthetics excluding ketamine')","Dual legislative framework application — must operate under both VEA and MRCA with slightly different service definitions","Section 11 creates dynamic incorporation by reference — if a factor refers to another disease with its own Statement of Principles, that entire instrument is imported by reference","Factor 40 has a limited application clause restricting it to aggravation cases only (subsection 10(2))","Medical-scientific evidentiary basis requirement in section 8 creates a threshold that must be met for factors to be valid"],"plain_english_summary":"This Statement of Principles sets the medical rules the Repatriation Medical Authority and DVA use to decide if a veteran’s seizure is service-related for claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It lists 40 factors that, if present, create a “reasonable hypothesis” linking seizures to service (a lower evidentiary standard).\n\nIt matters because it determines veterans’ access to pensions, treatment and compensation; psychogenic seizures and some movement disorders are excluded."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument broadens and updates the earlier 2013 Statement for 'epileptic seizure' by replacing it with a more detailed \"seizure (Reasonable Hypothesis)\" SOP. Changes in scope include: (a) renaming to cover seizure and death from seizure (not limited to 'epileptic' forms) and explicit inclusion/exclusion clauses (section 7); (b) an expanded and more granular list of qualifying factors (section 9) including modern exposures (e.g. specified neurotoxins, hyperbaric/oxygen‑toxicity exposures, a long Schedule 2 of drugs); (c) detailed timing windows (from 24 hours to 20 years) that allow both acute and long‑latency service links; and (d) an added provision allowing \"inability to obtain appropriate clinical management\" to be considered in limited circumstances (section 10(2)). Together these changes increase the instrument’s substantive reach and the range of evidence that can support a reasonable hypothesis compared with the earlier 2013 instrument."},"complexity_factors":["Large number of discrete, conditional factors in section 9 (39 listed factors with varied time windows)","Multiple specific temporal thresholds (24 hours, 2 weeks, 4 weeks, 2 months, 6 months, 1 year, 20 years, etc.) across factors","Extensive defined terms in Schedule 1 controlling many factors (dozens of medical definitions and lists)","Schedule 2 drug list of ~67 specified drugs and broad drug classes to be assessed against a 24‑hour rule","Cross‑references to other Statements of Principles (section 11) creating interdependence between instruments","Exceptions and exclusions within definitions (e.g. exclusion of ECT, psychogenic seizures) that require careful application","A special rule for factor 9(40) (inability to obtain appropriate clinical management) limiting when it can apply (section 10(2))","Mixture of acute exposure criteria and long‑latency structural causes increases evidentiary variety and assessment complexity","Medical judgement required on severity thresholds (e.g. 'moderate to severe' TBI) and on linking factor to 'relevant service'","Potential need for diverse types of evidence (surgical, radiotherapy, toxicology, hyperbaric/diving logs, infectious disease testing, psychiatric records)"],"plain_english_summary":"**What this instrument is and who it affects (mechanics)\n\n- This is a \"Statement of Principles\" (SOP) made by the Repatriation Medical Authority under the Veterans' Entitlements Act. It sets the medical criteria that decision‑makers must use when deciding whether a person's seizure (or death from seizure) can be reasonably hypothesised to be related to their relevant military service (see sections 3, 7 and 9).\n\n- It replaces the earlier 2013 SOP for \"epileptic seizure\" (section 4) and commenced on 30 May 2022 (section 2). It applies to claims under the VEA and the Military Rehabilitation and Compensation Act (section 5).\n\n- The SOP defines \"seizure\" and \"death from seizure\" and lists what is included and expressly excluded (section 7(2)–(3)). Important exclusions include psychogenic seizures and seizures caused by electroconvulsive therapy (ECT).\n\n- The practical legal test this instrument establishes is: at least one listed factor must be present to raise a \"reasonable hypothesis\" that the person’s seizure is related to relevant service (section 9). The listed factors are concrete medical events, exposures or conditions (for example: moderate to severe traumatic brain injury within 20 years; concussion within 6 months; brain surgery; brain radiotherapy; infections; metabolic disturbances such as hypoglycaemia; alcohol intoxication or withdrawal; taking certain drugs within 24 hours; exposure to neurotoxic substances or specified metals; diving/hyperbaric oxygen exposures; sleep deprivation; inability to obtain appropriate clinical management, etc.). Each factor has temporal limits where relevant (section 9 and Schedule 1 definitions).\n\n- Section 10 requires that the factor(s) relied on must be related to the person's \"relevant service\" (as defined in Schedule 1) and explains a limited special rule for the factor about inability to obtain appropriate clinical management.\n\n- Section 11 says that if a listed factor refers to an injury or disease that already has its own SOP, the factors in that other SOP apply in accordance with its terms.\n\nWhy the Authority says it was done (official rationale)\n\n- The Authority states it made the SOP because it considers there is sound medical‑scientific evidence that seizure (and death from seizure) can be related to service (section 8). That is the stated evidentiary basis for producing these objective criteria.\n\nHow this matters in practice (effects, who decides, who pays, and likely behaviour changes)\n\n- Who decides: Decision makers in the Department administering the VEA/MRCA (and review bodies) use this SOP as the medical threshold for forming a \"reasonable hypothesis\" that links seizure to service. The SOP does not itself pay benefits but sets the medical test used in entitlement/compensation decisions (sections 5, 9).\n\n- Who pays if the link is accepted: entitlements or compensation under the VEA or MRCA are funded/paid under those Acts (this instrument operates within those schemes).\n\n- What claimants must show: medical evidence documenting a listed factor and the temporal relationship to the clinical onset of seizure (for example surgical records, imaging, toxicology, hospital notes, treatment records) and that the factor is connected to their relevant service (section 10).\n\n- Behavioural effects and practical consequences: claimants and their clinicians will focus on documenting the presence, timing and service‑connection of the listed factors. Decision makers will rely on the SOP to accept or reject a plausible service link without needing a full causal proof. Some factors require acute proof (e.g. drug exposure within 24 hours), others allow long latency (e.g. traumatic brain injury within 20 years), which affects evidence gathering and record retention.\n\nCosts, incentives and administrative trade‑offs (testing the Authority's purpose claim)\n\n- Administrative cost and compliance burden: the SOP’s many specific factors, varying time windows and defined medical terms increase evidentiary and assessment work for claimants and the Department (see section 9 and Schedules 1–2). Specialist records (neurosurgery, radiotherapy, toxicology, diving records) will often be required.\n\n- Concentrated benefits vs diffuse costs: benefits concentrate on claimants who can document the listed factors (for example documented TBI, brain surgery, radiotherapy, or specific toxic exposures). Costs (administrative, possible additional payments under the VEA/MRCA) are borne by the compensation schemes and ultimately public funds.\n\n- Incentives and substitution: because one listed factor is sufficient to raise the reasonable hypothesis, claimants may prioritise establishing whichever qualifying factor is most easily documented; conversely, seizures clearly explained by excluded causes (e.g. psychogenic seizures) remain outside this SOP.\n\n- Implementation risk: disputes are likely over (a) whether a medical event meets the SOP definitions (e.g. severity of TBI), (b) the correct timing window (24 hours, 2 weeks, 6 months, 20 years etc.), and (c) whether the factor is actually related to the person’s relevant service (section 10). Cross‑references to other SOPs (section 11) add complexity where overlapping conditions exist.\n\nKey operational features and trade‑offs to note (by section)\n\n- Section 9 (Factors): sets the \"one factor\" threshold and lists many discrete, sometimes time‑limited factors. The range runs from very proximate causes (drugs, toxins within 24 hours) to long‑latency structural brain injury (TBI, surgery, radiotherapy within 20 years).\n\n- Schedule 2 (Drugs): contains a long list of specified drugs (many classes and individual agents). If a listed drug was taken within 24 hours of first seizure, that alone can raise the reasonable hypothesis (section 9(31)).\n\n- Schedule 1 (Definitions): contains many defined medical terms that control the application of the factors (for instance \"hypoxic cerebral insult\", \"sleep deprivation\", \"malignant hypertension\").\n\n- Section 11 (Cross‑references): directs decision makers to apply any other applicable SOP if a factor refers to a condition already covered elsewhere.\n\nNet mechanical effect\n\n- The instrument provides a structured, objective list of medical events and exposures that, if shown and related to relevant service, will support a reasonable hypothesis that seizure is service‑related. It standardises the medical threshold used in VEA/MRCA claims and replaces the prior 2013 SOP for epileptic seizure.\n\n(References: see sections 3, 4, 5, 7–11, Schedule 1 and Schedule 2.)"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022","history":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-seizure-reasonable-hypothesis-no-37-of-2022/documents"}}