{"id":"F2017L00881","name":"Statement of Principles concerning sickle-cell disorder (Balance of Probabilities) (No. 41 of 2017)","slug":"statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439250,"registerId":"F2017L00881-fast-fetch-1775955347184","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sickle-cell disorder (Balance of Probabilities) (No. 41 of 2017)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nSICKLE-CELL DISORDER (Balance of Probabilities)\n\n(No. 41 of 2017)\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 30 June 2017\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 Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Revocation\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 sickle-cell disorder (Balance of Probabilities) (No. 41 of 2017).\n\n2 Commencement\n\n This instrument commences on 31 July 2017.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning sickle-cell disorder No. 44 of 2008 made under subsection 196B(3) of the VEA is revoked.\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 sickle-cell disorder and death from sickle-cell disorder.\n\nMeaning of sickle-cell disorder\n\n(2) For the purposes of this Statement of Principles, sickle-cell disorder means:\n\n(a) a genetic disorder leading to the production of haemoglobin S (HbS), a defective form of haemoglobin; and\n\nincludes:\n\n(b) sickle-cell disease, in which there are two copies of the HbS gene (HbSS); and\n\n(c) sickle-cell trait, in which there is one copy of the HbS gene and one normal gene (HbSA); and\n\n(d) double heterozygous sickling disorders, in which there is one copy of the HbS gene plus one copy of another β-globin gene variant.\n\nNote 1: Sickle-cell disorder may involve symptomatic episodes in which red blood cells become deformed, leading to vaso-occlusive, anaemic or infectious events.\n\nNote 2: The diagnosis can also be made in asymptomatic individuals by genetic testing.\n\n(3) While sickle-cell disorder attracts ICD‑10‑AM code D57, in applying this Statement of Principles the meaning of sickle-cell disorder 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.\n\nDeath from sickle-cell disorder\n\n(5) For the purposes of this Statement of Principles, sickle-cell disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sickle-cell disorder.\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 sickle-cell disorder and death from sickle-cell disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is 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, sickle-cell disorder or death from sickle-cell disorder is connected with the circumstances of a person's relevant service:\n\n(1) experiencing a stimulus from Specified List 1 of stimuli within the 24 hours before the clinical worsening of sickle-cell disorder;\n\nNote: Specified List 1 of stimuli and clinical worsening of sickle-cell disorder are defined in the Schedule 1 - Dictionary. \n\n(2) experiencing a stimulus from Specified List 2 of stimuli within the seven days before the clinical worsening of sickle-cell disorder;\n\nNote: Specified List 2 of stimuli and clinical worsening of sickle-cell disorder are defined in the Schedule 1 - Dictionary. \n\n(3) smoking at least one pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of sickle-cell disorder, and where smoking has ceased, the clinical worsening of sickle-cell disorder has occurred within six months of cessation;\n\nNote: pack-year of cigarettes, or the equivalent thereof in other tobacco products and clinical worsening of sickle-cell disorder are defined in the Schedule 1 - Dictionary.\n\n(4) being exposed to second-hand smoke for at least 1 000 hours before the clinical worsening of sickle-cell disorder, and where the last exposure to second-hand smoke occurred within the six months before the clinical worsening of sickle-cell disorder;\n\nNote: being exposed to second-hand smoke and clinical worsening of sickle-cell disorder are defined in the Schedule 1 - Dictionary. \n\n(5) being treated with corticosteroids, other than inhaled or topical corticosteroids, within the 30 days before the clinical worsening of sickle-cell disorder;\n\nNote: clinical worsening of sickle-cell disorder is defined in the Schedule 1 - Dictionary. \n\n(6) inability to obtain appropriate clinical management for sickle-cell disorder.\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(1) to 9(6) apply only to material contribution to, or aggravation of, sickle-cell disorder where the person's sickle-cell disorder 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 a change in ambient temperature means a decrease in the mean daily temperature from one day to the next day of at least 5 degrees Celsius.\n\n being exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by a person who is smoking.\n\n clinical worsening of sickle-cell disorder means permanent worsening of sickle-cell disorder as evidenced by:\n\n(a) a sickle-cell crisis or series of crises resulting in end-organ damage or death; or\n\n(b) an increase in the requirement for management of the manifestations or complications of sickle-cell disorder.\n\nNote: sickle-cell crisis is also defined in the Schedule 1 - Dictionary.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-year of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\n\n puerperal period means the 42 days following a birth.\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 sickle-cell crisis means a vaso-occlusive, anaemic or infectious complication of sickle-cell disorder requiring hospitalisation or management by a medical practitioner.\n\n sickle-cell disorder—see subsection 7(2).\n\n Specified List 1 of stimuli means:\n\n(a) altitudes above 1 500 metres, including flying;\n\n(b) dehydration;\n\n(c) sleep apnoea or other causes of hypoxia; or \n\n(d) strenuous exercise.\n\n Specified List 2 of stimuli means:\n\n(a) a change in ambient temperature which results in skin cooling;\n\n(b) fever;\n\n(c) granulocyte colony-stimulating factors;\n\n(d) immersion in cold water;\n\n(e) infection;\n\n(f) iodinated radiological contrast agents;\n\n(g) pregnancy or puerperal period;\n\n(h) scuba diving; or\n\n(i) surgery.\n\nNote: a change in ambient temperature and puerperal period are also defined in the Schedule 1 - Dictionary.\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":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2008 predecessor and other similar instruments, applying established RMA methodology to a specific medical condition. No scope creep is evident; it performs the statutory function intended by subsection 196B(3) of the VEA."},"complexity_factors":["Moderate cross-referencing between main provisions and Schedule 1 dictionary (15+ defined terms)","Nested conditional logic in section 9 with multiple time-bound triggers (24 hours, 7 days, 30 days, 6 months)","Dual legislative framework application (VEA and MRCA with different service definitions)","Technical medical terminology requiring precise definitions (ICD-10-AM codes, heterozygous disorders, pack-year calculations)","Specific quantitative thresholds (1,500 metres altitude, 5°C temperature change, 1,000 hours second-hand smoke, 7.3kg tobacco weight equivalent)","Exception handling in section 10 limiting application to pre-existing conditions aggravated by service rather than new onset","Incorporation by reference to external classification systems (ICD-10-AM Ninth Edition)"],"plain_english_summary":"This instrument sets the medical rules for when sickle‑cell disorder (including trait and variants) or death from it can be attributed to Australian defence service for compensation, replacing the 2008 rules and using the balance‑of‑probabilities test. It affects veterans and ADF members claiming under the VEA 1986 or MRCA 2004 whose pre‑existing or service‑present condition clinically worsened due to service factors, determining eligibility for pensions and other benefits."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This 2017 Statement replaced the 2008 Statement and expands and clarifies the scope and evidential rules compared with a simple pre‑existing/agonising framework. Notable scope changes include: explicitly including sickle‑cell trait (HbSA) and double heterozygous variants, listing a wider range of specific physiological and iatrogenic stimuli (e.g. G‑CSF, iodinated contrast, pregnancy, scuba diving), and introducing lifestyle/exposure items (smoking pack‑years and quantified second‑hand smoke exposure). It also sets specific temporal windows for each factor (24 hours, 7 days, 30 days, 6 months) and adds the operationally open category \"inability to obtain appropriate clinical management.\" These additions broaden the pathways by which sickle‑cell disorder worsenings can be linked to service (more listed triggers) while simultaneously narrowing each pathway by attaching precise timing and evidence rules. The change is therefore a substantive refinement and partial expansion of the original instrument’s operational scope."},"complexity_factors":["Multiple defined medical terms in Schedule 1 (e.g. clinical worsening, sickle‑cell crisis, terminal event, pack‑year) — about 15 distinct definitions","Two tiered lists of stimuli with different time windows (Specified List 1: 24‑hour window; Specified List 2: 7‑day window)","Several explicit temporal thresholds/limits (24 hours, 7 days, 30 days, 6 months, 1,000 hours) that require precise factual proof","Cross‑reference to other Statements of Principles where a listed factor concerns another disease (section 11) — adds inter‑instrument dependency","Interaction between diagnosis categories (disease, trait, double heterozygotes) and ICD‑10‑AM coding note (section 7(3) and (4))","Application limited to pre‑existing or pre‑service conditions aggravated by service (section 10) — conditional scope","Revocation of previous Statement (2008) — requires comparison where precedent or case law may rely on earlier wording","Subjective or evidentially heavy factors such as \"inability to obtain appropriate clinical management\" that create discretionary assessment work for adjudicators","Specific quantitative exposures (pack‑year calculation, 1,000 hours second‑hand smoke) with technical measurement rules that may require expert evidence","References to external medical practices/agents (e.g. G‑CSF, iodinated contrast agents, systemic corticosteroids) linking clinical treatment decisions to compensation outcomes"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- This is a Repatriation Medical Authority (RMA) \"Statement of Principles\" that sets out the medical factors that, on the balance of probabilities, can link sickle‑cell disorder (including death from it) to a person’s relevant military service for the purposes of veterans’ compensation law.\n\n- It replaces an earlier 2008 Statement of Principles and applies to claims under specified parts of the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA).\n\n- The instrument defines \"sickle‑cell disorder\" broadly to include sickle‑cell disease (two HbS genes), sickle‑cell trait (one HbS gene), and double heterozygous sickling disorders (HbS plus another β‑globin variant). It also treats death from a terminal event that was contributed to by sickle‑cell disorder as part of the condition.\n\n- The RMA states that, on the available medical evidence, it is \"more probable than not\" that sickle‑cell disorder and death from it may be related to relevant service (this is the RMA's stated basis for the Statement).\n\n- To establish a connection with service on the balance of probabilities, at least one of the listed \"factors that must exist\" must be present and must be related to the person's relevant service. The factors are time‑limited exposures or events that must precede a documented clinical worsening of the disorder.\n\n**Who is affected\n\n- Primary affected persons: veterans or serving members who have sickle‑cell disorder (including trait and double heterozygotes) and who make claims under the VEA or MRCA provisions cited.\n\n- Decision makers: DVA and MRCA claims assessors, who will apply this Statement when deciding causation/aggravation questions for claims.\n\n- Clinicians: doctors may be asked to provide medical evidence that links a claimant’s clinical worsening to one of the listed factors within the specified time windows.\n\n**Key factors that can establish a link to service (summary of section 9 and Schedule definitions)\n\nAt least one of the following must be shown (and related to relevant service) before a clinical worsening can be treated as materially contributed to or aggravated by service:\n\n- Exposure to a Specified List 1 stimulus within 24 hours before clinical worsening (List 1: altitude above 1,500 m (including flying), dehydration, sleep apnoea/hypoxia, or strenuous exercise).\n\n- Exposure to a Specified List 2 stimulus within seven days before clinical worsening (List 2: skin‑cooling temperature change, fever, granulocyte colony‑stimulating factor [G‑CSF], immersion in cold water, infection, iodinated contrast agents, pregnancy/puerperal period, scuba diving, or surgery).\n\n- Smoking history of at least one pack‑year (or equivalent) before the clinical worsening; if smoking stopped, the worsening must occur within six months of cessation.\n\n- Exposure to second‑hand smoke for at least 1,000 hours before clinical worsening, with the last exposure within six months before the worsening.\n\n- Treatment with systemic corticosteroids (not inhaled/topical) within 30 days before the clinical worsening.\n\n- Inability to obtain appropriate clinical management for sickle‑cell disorder.\n\nOther operative points\n\n- The factors only operate where the sickle‑cell disorder existed before or during (but did not arise out of) the person’s relevant service — i.e., the Statement addresses material contribution or aggravation of a pre‑existing condition, not new conditions that arose out of service.\n\n- If a listed factor refers to another disease that has its own Statement of Principles, that other Statement (as in force) applies for that factor.\n\n**Official rationale and testing it against practical effects\n\n- Official claim: the RMA says medical evidence supports that these stimuli/events can materially contribute to or worsen sickle‑cell disorder (see section 8).\n\n- Who pays: financial outcomes flow through the DVA/MRCA compensation systems — ultimately the Australian Government funds accepted claims and any associated treatment/entitlements.\n\n- Who decides: the RMA supplies the medical criteria; DVA and MRCA decision‑makers apply these criteria to individual claims. Clinical evidence and service records will be used to establish whether a listed factor occurred and whether it related to the person’s relevant service.\n\n- Behavioural and provider effects tied to the instrument’s mechanics:\n - Clinicians may need to document temporal links between an exposure/treatment and a clinical worsening (e.g. record corticosteroid use, travel to high altitude, or infection dates) to support claims.\n - The inclusion of smoking and second‑hand smoke as factors means personal habits and workplace/off‑duty exposures are evidentially relevant to claims.\n - The corticosteroid item could influence prescribing decisions for patients with sickle‑cell disorder if clinicians perceive treatment may affect entitlement outcomes or medico‑legal risk.\n - \"Inability to obtain appropriate clinical management\" is a fairly open phrase and may increase administrative burden on decision‑makers to evaluate whether service circumstances prevented appropriate care.\n\n- Costs and trade‑offs: specifying discrete, time‑limited triggers (24 hours, 7 days, 30 days, 6 months) reduces some uncertainty for claim assessment but shifts evidential cost to claimants to prove timing and exposure (service logs, medical records, witness statements). The government bears the fiscal cost of accepted claims; claimants bear the evidentiary cost of assembling proof.\n\n- Implementation risk and discretion: assessing \"related to service\" and \"inability to obtain appropriate clinical management\" requires factual judgments about what happened during service, creating some scope for differing decisions and appeals. Cross‑reference to other Statements adds layers of medical cross‑checking.\n\n- Effects on private enterprise and competition: the instrument does not impose direct regulatory obligations on private business in the way a statute does. Indirect effects may arise where employers or healthcare providers are asked to produce records or where clinical practice changes (for instance, prescribing systemic corticosteroids) to manage risks for affected patients.\n\n**What changes for claimants and decision makers\n\n- Claimants: must show a qualifying factor occurred within the specified timeframe and that it is related to relevant service. Genetic testing or clinical evidence may be required to establish diagnosis and clinical worsening.\n\n- Decision makers: will use the Statement to accept or reject causation/aggravation elements of claims. The Statement narrows the set of medical events that can, by RMA view, link sickle‑cell disorder to service, but it also enlarges the evidential pathways by listing multiple specific stimuli and non‑clinical factors (e.g. inability to obtain care).\n\n**Concrete uncertainties and administrative burdens\n\n- Proving exposures like \"1,000 hours of second‑hand smoke\" or the exact timing of a respiratory infection relative to a crisis may be difficult, increasing evidentiary disputes.\n\n- The Statement requires linking the factor to relevant service — this can be straightforward where exposure clearly occurred during service, but in many cases it will require service records or contemporaneous medical notes.\n\n**Source citations (where to look in the instrument)\n\n- Definitions and lists: Schedule 1 (Dictionary).\n- Factors required: section 9 (and cross‑references to Schedule 1 for definitions).\n- Relationship to service and limits (pre‑existing/aggravation only): section 10.\n- Basis for the Statement: section 8.\n\nOverall, this Statement defines specific, time‑limited medical and exposure factors that, if proven and shown to be related to a person’s relevant service, allow decision‑makers to treat clinical worsenings of sickle‑cell disorder (and death contributed to by it) as connected to service for veterans’ entitlements purposes."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017","history":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017/history","analysis":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017/important-cases","documents":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-balance-of-probabilities-no-41-of-2017/documents"}}