{"id":"F2017L00879","name":"Statement of Principles concerning sickle-cell disorder (Reasonable Hypothesis) (No. 40 of 2017)","slug":"statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439251,"registerId":"F2017L00879-fast-fetch-1775955347209","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 (Reasonable Hypothesis) (No. 40 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 (Reasonable Hypothesis)\n\n(No. 40 of 2017)\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 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 (Reasonable Hypothesis) (No. 40 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning sickle-cell disorder No. 43 of 2008 made under subsection 196B(2) of the VEA is revoked.\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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that sickle-cell disorder and death from sickle-cell disorder 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: relevant service is 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 sickle-cell disorder or death from sickle-cell disorder 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) having symptomatic asthma within the one year 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(7) 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(7) 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(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 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) 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 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\n \n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument replaces the earlier 2008 Statement (s4) but retains the same statutory application to claims under the VEA and MRCA (s5). It continues to define sickle‑cell disorder broadly (s7(2)) and sets factors for establishing a reasonable hypothesis of service connection (s9–s10). The revocation updates and restates criteria rather than expanding or narrowing the categories of persons or types of service covered."},"complexity_factors":["Technical medical definitions and diagnostic boundaries (s7(2)–(4); Schedule) — covers HbS genetics, disease vs trait, and death from a terminal event.","Causation standard is the statutory ‘reasonable hypothesis’ test implemented by enumerated factors rather than open-ended medical causation analysis (s9; s3 referencing subsection 196B(2) VEA).","Multiple time windows and exposure thresholds to prove a qualifying trigger (24 hours, 7 days, 30 days, 6 months, 1 year) (s9(1)–(6); Schedule).","Enumerated lists of stimuli with differing evidentiary weight and mechanisms (Specified List 1 vs Specified List 2) (Schedule).","Quantitative exposure measures defined in Schedule (eg. one pack-year = 7,300 cigarettes; 1,000 hours second‑hand smoke) that create documentary/forensic proof burdens for claimants (Schedule).","Requirement that the factor must be related to the person’s relevant service and that the disorder pre‑existed or was contracted before/during service (material contribution/aggravation only) (s10(1)–(2)).","Cross‑application to other Statements of Principles where a factor refers to another injury/disease (s11) introduces inter-instrument dependency and interpretive complexity.","Reference to external medical classification (ICD‑10‑AM) formalises coding but may require mapping between clinical records and the instrument (s7(3)–(4)).","Definitions of key outcome measures such as ‘clinical worsening’, ‘sickle‑cell crisis’ and ‘terminal event’ require specific medical evidence (Schedule).","Administrative steps: revocation of the 2008 instrument and application to specified claim types (s4–s5) create transitional/coverage questions for legacy claims."],"plain_english_summary":"This Statement of Principles (No. 40 of 2017) sets the medical rules used to decide whether sickle-cell disorder (including sickle-cell disease, trait and double heterozygotes) or death from it can be reasonably linked to a veteran’s relevant service for VEA or MRCA claims. It lists specific medical triggers, time-windows and measurable exposures (eg. altitude, dehydration, smoking, corticosteroid treatment) and requires the identified factor to be related to the person’s relevant service before a reasonable hypothesis of service connection is raised."},"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":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2008 version with updated medical criteria but does not expand beyond the traditional function of determining service-relatedness for genetic conditions that pre-existed service. The limitation in section 10(2) — applying only to aggravation of pre-existing conditions rather than new incidence — actually constrains the scope compared to typical injury provisions, which is appropriate given the genetic nature of sickle-cell disorder."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 Dictionary (15+ defined terms)","Nested conditional logic: factors in section 9 only apply to pre-existing conditions per section 10(2), creating a two-step test","Precise quantitative thresholds requiring calculation (pack-year calculations, 1,000 hours of second-hand smoke, 5-degree temperature drops)","Multiple temporal windows (24 hours, 7 days, 30 days, 6 months, 1 year) that must be matched to specific factors","Incorporation by reference of external classification systems (ICD-10-AM Ninth Edition)","Dual statutory framework requiring coordination between VEA and MRCA claims","Section 11 creates dynamic incorporation of other Statements of Principles, meaning content can change without amendment to this instrument"],"plain_english_summary":"This instrument issues an updated Statement of Principles for linking sickle‑cell disorder (including trait and variants) to Australian defence service for compensation claims. It replaces the 2008 version and sets the medical-legal test used under veterans’ compensation laws.\n\nIt affects veterans and current/former defence members with pre‑existing sickle‑cell who say service worsened their condition. The instrument identifies specific service‑related exposures (e.g., high altitude, dehydration, infection, surgery, tobacco, corticosteroids, limited care) that, if proven, create a reasonable hypothesis that service caused clinical worsening."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017","history":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017/history","analysis":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017/important-cases","documents":"/api/acts/statement-of-principles-concerning-sickle-cell-disorder-reasonable-hypothesis-no-40-of-2017/documents"}}