{"id":"F2025L01627","name":"Statement of Principles concerning smallpox (Reasonable Hypothesis) (No. 5 of 2026)","slug":"statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443106,"registerId":"F2025L01627-fast-fetch-1775958027947","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning smallpox (Reasonable Hypothesis) (No. 5 of 2026)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nSMALLPOX  (Reasonable Hypothesis)\n\n(No. 5 of 2026)\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   19 December 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning smallpox (Reasonable Hypothesis) (No. 5 of 2026).\n\n1.                Commencement\n\n\n              This instrument commences on 19 January 2026.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning smallpox (Reasonable Hypothesis) (No. 89 of 2016) (Federal Register of Legislation No. F2016L01669) made under subsection 196B(2) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about smallpox and death from smallpox.\n\n\nMeaning of smallpox\n\n1.           For the purposes of this Statement of Principles, smallpox:\n  1.           means a clinical illness caused by infection with the variola virus, a member of the Orthopoxvirus genus, which has been confirmed by laboratory testing; and\n  2.           includes smallpox caused by infection with variola major or variola minor strains.\n\n\nNote: The most common clinical presentation of smallpox may include an acute onset of fever, prostration, headache, body aches and a vesicular or pustular rash, known as the ordinary form of smallpox caused by variola major virus.\n\n1.           While smallpox attracts ICD‑10‑AM code B03, in applying this Statement of Principles the meaning of smallpox is that given in subsection (2).\n2.           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\n\nDeath from smallpox\n\n1.           For the purposes of this Statement of Principles, smallpox, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's smallpox.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that smallpox and death from smallpox 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\n1.                Factors that must exist\n\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 smallpox or death from smallpox with the circumstances of a person's relevant service:\n\n1.           being exposed to the variola virus by:\n  1.           having close contact with a person who has smallpox; or\n  1.           having direct contact with body fluids or tissue from a person infected with the variola virus; or\n  2.           having direct contact with a laboratory strain of the variola virus; or\n  3.           handling clothing, bedding, or objects contaminated with the variola virus; or\n  4.           having skin penetration by an instrument contaminated with the variola virus; or\n  5.            inhaling droplet nuclei or aerosols of the variola virus.   \n\n\nwhere variola virus exposure occurs within the 4 weeks immediately preceding clinical onset;\n\n1.           inability to access the appropriate smallpox vaccination in accordance with contemporary medical standards of the time, within the 2 years immediately preceding clinical onset;\n2.           being pregnant within the 6 weeks immediately preceding clinical onset of haemorrhagic type smallpox or death from smallpox;\n\n\nNote: haemorrhagic type smallpox typically involves a more severe clinical course, haemorrhage into skin lesions, multiorgan failure and is usually fatal.\n\n1.           having a substantially compromised immune system at the time of clinical worsening due to any of the following:\n  1.           chronic renal failure as indicated by:\n    1.             a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n    2.          undergoing chronic dialysis for renal failure;\n  1.           haematological or solid organ malignancy;\n  2.           infection with human immunodeficiency virus;\n  3.           severe malnutrition (protein-calorie malnutrition associated with a Body Mass Index (BMI) of less than or equal to 18.5 kg/m2);\n\n\nNote: Body Mass Index (BMI) is calculated as W/H2 where:\n\n          (a) W is the person's weight in kilograms; and\n\n          (b) H is the person's height in metres.\n\n1.           solid organ, stem cell or bone marrow transplantation;\n2.            taking one of the following immunosuppressive medications:\n  1.             corticosteroids other than inhaled or topical corticosteroids;\n  2.          drugs used to prevent transplant rejection;\n  3.        tumour necrosis factor-α inhibitors;\n  4.         chemotherapeutic agents used for the treatment of cancer;\n\n\n1.           inability to obtain appropriate clinical management for smallpox before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspect of factors set out in section 9 apply only to material contribution to, or aggravation of, smallpox where the person's smallpox was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                                MRCA means the Military Rehabilitation and Compensation Act 2004.\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 defined in the Schedule 1 - Dictionary.\n\n                               smallpox—see subsection 7(2).\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":{"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 a 2016 version (No. 89 of 2016) with updated numbering (No. 5 of 2026) but follows the standard template for determining service-relatedness of specific diseases under the veterans' compensation scheme. The scope remains tightly focused on establishing medical-scientific connections between smallpox and military service for compensation purposes."},"complexity_factors":["Moderate cross-referencing between the VEA (Veterans' Entitlements Act 1986) and MRCA (Military Rehabilitation and Compensation Act 2004)","7 defined terms in Schedule 1, plus inline definitions for 'smallpox' and 'death from smallpox' in section 7","Nested sub-paragraphs in section 9 (factors) with multiple levels of indentation (9(a)(i)-(v), 9(d)(a)-(f))","Technical medical terminology requiring explanation (ICD-10-AM codes, glomerular filtration rates, BMI calculations, specific drug classes)","Temporal conditions attached to factors (4 weeks, 2 years, 6 weeks, 3 months timeframes)","Conditional logic in section 10 distinguishing between 'clinical onset' and 'clinical worsening' scenarios","Incorporation by reference of other Statements of Principles (section 11)"],"plain_english_summary":"This rulebook determines when Australian veterans or defence personnel (and their families if death occurred) can get compensation for contracting smallpox in connection with service. It applies a lower \"reasonable hypothesis\" test: if at least one listed risk factor linked to service is shown, the disease is treated as service-related. Key risk factors include recent exposure, lack of vaccination, pregnancy, immunosuppression, or inadequate treatment. It eases proof for historical or bioterrorism-related claims."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument continues to address smallpox and death from smallpox for claims under the VEA and MRCA (see Kind of injury s7 and Application s5). Although it repeals the 2016 statement (see Repeal s4) and updates or specifies particular medical, temporal and immunosuppression criteria (see Factors s9 and Schedule 1), it does not broaden the class of injuries covered beyond smallpox/death from smallpox. Changes are procedural and evidentiary (updated factors and thresholds) rather than an expansion of substantive scope."},"complexity_factors":["Cross-references to multiple statutes and claim pathways (VEA s.196B(2); application to claims under VEA s.120A and MRCA s.338) — requires legal alignment across regimes (see Authority s3 and Application s5).","Interplay with prior instrument: repeal of the 2016 Statement of Principles means claimants and decision-makers must track changes between instruments (see Repeal s4).","Medical and temporal thresholds are technical and specific (lab confirmation requirement; exposure within 4 weeks; vaccination access within 2 years; pregnancy within 6 weeks) — precise timing affects causation assessments (see Meaning of smallpox s7(2); Factors s9).","Detailed clinical definitions and cut-offs (e.g. GFR <15 mL/min/1.73 m2 for ≥3 months; BMI ≤18.5 kg/m2; definitions of terminal events) introduce medical evidence burdens and quantifiable standards (see Factors s9 and Schedule 1).","Multiple alternative exposure pathways listed (direct contact, lab strain, contaminated objects, needle penetration, inhalation) expand evidentiary routes but require specific factual proof (see Factors s9.1).","Dependency on contemporaneous medical standards for vaccination access creates an evidentiary and interpretive task for decision-makers (see Factors s9.2).","Cross-application with other Statements of Principles where a listed factor refers to a condition covered elsewhere means decision-makers must consult and harmonise multiple instruments (see Factors referring to another Statement s11).","Requirement that any listed factor be related to the person's relevant service adds a causation threshold that is legal as well as medical, shifting part of the burden onto claim evidence linking factor to service (see Relationship to service s10)."],"plain_english_summary":"This Statement of Principles (commencing 19 January 2026) sets the medical criteria the Repatriation Medical Authority uses to decide whether smallpox or death from smallpox can be reasonably connected to a person’s relevant service under the VEA or MRCA. It lists specific exposure, vaccination-access, pregnancy, immune‑compromise and clinical‑management factors that, if tied to service, can justify a claim for entitlements related to smallpox."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026","history":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026/history","analysis":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026/analysis","conflicts":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026/important-cases","documents":"/api/acts/statement-of-principles-concerning-smallpox-reasonable-hypothesis-no-5-of-2026/documents"}}