{"id":"F2023L00476","name":"Statement of Principles concerning shingles and postherpetic neuralgia (Balance of Probabilities) (No. 28 of 2023)","slug":"statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441821,"registerId":"F2023L00476-fast-fetch-1775957018818","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning shingles and postherpetic neuralgia (Balance of Probabilities) (No. 28 of 2023)","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\nSHINGLES AND POSTHERPETIC NEURALGIA (Balance of Probabilities)\n\n(No. 28 of 2023)\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 24 April 2023.\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 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning shingles and postherpetic neuralgia (Balance of Probabilities) (No. 28 of 2023).\n\n2 Commencement\n\n This instrument commences on 23 May 2023.\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 herpes zoster No. 48 of 2015 (Federal Register of Legislation No. F2015L00254) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about shingles and postherpetic neuralgia and death from shingles and postherpetic neuralgia.\n\nMeaning of shingles and postherpetic neuralgia\n\n(2) For the purposes of this Statement of Principles, shingles and postherpetic neuralgia means a symptomatic reactivation of a dormant varicella-zoster virus infection, usually manifesting with neuritic pain and a vesicular eruption involving the skin or mucous membranes in a dermatomal pattern;\n\nNote 1: Shingles is also known as herpes zoster.\n\nNote 2: The dormant infection involves the peripheral nervous system ganglia. It can also involve the central nervous system, the eye and other organs.\n\n(3) While shingles and postherpetic neuralgia attracts ICD‑10‑AM code B02, in applying this Statement of Principles the meaning of shingles and postherpetic neuralgia is that given in subsection (2).\n\n(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from shingles and postherpetic neuralgia\n\n(5) For the purposes of this Statement of Principles, shingles and postherpetic neuralgia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's shingles and postherpetic neuralgia.\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 shingles and postherpetic neuralgia and death from shingles and postherpetic neuralgia 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, shingles and postherpetic neuralgia or death from shingles and postherpetic neuralgia is connected with the circumstances of a person's relevant service:\n\n(1) having chickenpox before the clinical onset of shingles or postherpetic neuralgia;\n\n(2) for vaccine strain shingles only, having live attenuated varicella vaccine before the clinical onset of shingles or postherpetic neuralgia;\n\nNote 1: Vaccine strain shingles is diagnosed by detecting the vaccine strain in the vesicular liquid.\n\nNote 2: This factor applies to live attenuated varicella zoster vaccines.\n\n(3) being prevented from accessing appropriate varicella-zoster vaccination in accordance with contemporary medical standards of the time, between 1 and 5 years before the clinical onset of shingles or postherpetic neuralgia;\n\n(4) being in an immunocompromised state as specified at the time of the clinical onset of shingles or postherpetic neuralgia;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 – Dictionary.\n\n(5) having trauma, including surgery, involving:\n\n(a) the dermatome affected by shingles or postherpetic neuralgia; or\n\n(b) the nerve supply to the dermatome affected by shingles or postherpetic neuralgia;\n\nwithin the 6 weeks before the clinical onset of shingles or postherpetic neuralgia;\n\nNote: Examples of trauma include blunt or penetrating trauma.\n\n(6) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of shingles or postherpetic neuralgia;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 – Dictionary\n\n(7) being in an immunocompromised state as specified at the time of the clinical worsening of shingles or postherpetic neuralgia;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 – Dictionary.\n\n(8) inability to obtain appropriate clinical management for shingles and postherpetic neuralgia.\n\n10 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 9(7) and 9(8) apply only to material contribution to, or aggravation of, shingles and postherpetic neuralgia where the person's shingles and postherpetic neuralgia 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 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 immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) having infection with human immunodeficiency virus;\n\n(b) taking an immunosuppressive drug which causes substantial suppression of immune responses;\n\n(c) having a haematological or solid organ malignancy;\n\n(d) having chronic renal failure; or\n\n(e) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure is defined in the Schedule -1 Dictionary.\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 shingles and postherpetic neuralgia—see subsection 7(2).\n\n specified list of autoimmune diseases means:\n\n(a) inflammatory bowel disease;\n\n(b) rheumatoid arthritis; or\n\n(c) systemic lupus erythematosus.\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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2015 Statement of Principles (section 4) and replaces it with updated definitions and a revised list of qualifying factors (sections 7 and 9, Schedule 1). It adds or clarifies items such as vaccine‑strain shingles, explicit immunocompromised criteria, specified autoimmune diseases, timing thresholds for vaccination access and trauma, and cross‑reference rules to other Statements (sections 9, Schedule 1, 11). The scope therefore changes by replacing the prior text and refining the medical and service‑connection criteria."},"complexity_factors":["Technical medical definitions and coding (shingles/PHN meaning vs ICD‑10‑AM reference) (see section 7(2)–(4))","Multiple alternative causal or contributory factors any one of which suffices (section 9)","Specific timing windows for factors (e.g. 1–5 years for prevented vaccination; 6 weeks for trauma) (section 9(3), 9(5))","Detailed, enumerated clinical states with subdefinitions (immunocompromised state, chronic renal failure) in Schedule 1","Interaction with other Statements of Principles when a factor refers to a separately covered disease (section 11)","Requirement that listed factors be related to the person’s relevant service (section 10)","Distinction between causation arising in service and material contribution or aggravation where condition pre‑existed (section 10(2))","Repeal and replacement of earlier instrument, requiring administrators to apply the new text from commencement (section 4, section 2)"],"plain_english_summary":"This Statement of Principles, made by the Repatriation Medical Authority, sets the medical and service‑related factors that must exist for shingles and postherpetic neuralgia to be treated as connected with a person’s military or veterans’ service for claims under the VEA or MRCA. It replaces the 2015 statement and lists specific clinical definitions, timing windows and circumstances (for example prior chickenpox, vaccine‑strain cases, immunocompromised states, trauma, and vaccination access) that decision‑makers use to decide entitlement."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces a 2015 instrument concerning the same condition (herpes zoster/shingles) without expanding beyond the traditional purpose of establishing medical causation factors for veterans' compensation claims. The inclusion of postherpetic neuralgia alongside shingles reflects standard medical understanding of the disease progression rather than scope creep."},"complexity_factors":["Moderate cross-referencing: 8 defined terms in Schedule 1 Dictionary, with some terms referencing other defined terms (e.g., 'immunocompromised state as specified' references 'chronic renal failure')","Conditional logic in factor application: Section 10(2) creates a limitation where factors 9(7) and 9(8) only apply to 'material contribution to, or aggravation of' pre-existing conditions, not initial onset","Nested definitions: 'immunocompromised state as specified' contains 5 sub-categories, one of which ('chronic renal failure') has its own 3-part definition","Specific temporal requirements: Factor 9(3) requires a 1-5 year window before clinical onset; Factor 9(5) requires a 6-week window before onset","Dual-pathway application: The instrument applies to two different Acts (VEA and MRCA) with slightly different service definitions","Medical-legal hybrid language: Requires understanding of clinical concepts (dermatomal patterns, ICD-10-AM codes, vaccine strain detection) alongside legal causation tests"],"plain_english_summary":"This instrument sets the medical criteria used to decide whether shingles (herpes zoster) or postherpetic neuralgia is compensable for Australian veterans and defence members under the VEA and MRCA, and guides the Repatriation Medical Authority’s assessments using the balance-of-probabilities test.\n\nIt requires proving at least one clinical link to service—for example prior chickenpox or vaccine-strain infection, immunosuppression, recent trauma/surgery to the area, lack of vaccine access or treatment, or certain autoimmune conditions—and confirms shingles-related deaths can include contributory terminal events."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2","history":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2/history","analysis":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2/analysis","conflicts":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2/important-cases","documents":"/api/acts/statement-of-principles-concerning-shingles-and-postherpetic-neuralgia-balance-of-probabilities-no-2/documents"}}