{"id":"F2020L01393","name":"Statement of Principles concerning spinal adhesive arachnoiditis (Balance of Probabilities) (No. 75 of 2020)","slug":"statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440648,"registerId":"F2020L01393-fast-fetch-1775956212615","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning spinal adhesive arachnoiditis (Balance of Probabilities) (No. 75 of 2020)","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\nSPINAL ADHESIVE ARACHNOIDITIS (Balance of Probabilities)\n\n(No. 75 of 2020)\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 October 2020\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 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 spinal adhesive arachnoiditis (Balance of Probabilities) (No. 75 of 2020).\n\n2 Commencement\n\n This instrument commences on 30 November 2020.\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 spinal adhesive arachnoiditis No. 117 of 2011 (Federal Register of Legislation No. F2011L01749) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 spinal adhesive arachnoiditis and death from spinal adhesive arachnoiditis.\n\nMeaning of spinal adhesive arachnoiditis\n\n(2) For the purposes of this Statement of Principles, spinal adhesive arachnoiditis:\n\n(a) means:\n\n(i) chronic inflammation of the arachnoid membrane of the spinal cord, with fibrosis and nerve root adhesions in the arachnoid and subarachnoid space that have been demonstrated by imaging or surgery; and\n\n(ii) neurological symptoms and signs that are consistent with the observed spinal pathology; and\n\n(b) includes arachnoiditis ossificans; and\n\n(c) excludes asymptomatic transient inflammation of the arachnoid membrane and arachnoid inflammation involving the brain and cranial nerves.\n\nDeath from spinal adhesive arachnoiditis\n\n(3) For the purposes of this Statement of Principles, spinal adhesive arachnoiditis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's spinal adhesive arachnoiditis.\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 spinal adhesive arachnoiditis and death from spinal adhesive arachnoiditis 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, spinal adhesive arachnoiditis or death from spinal adhesive arachnoiditis is connected with the circumstances of a person's relevant service:\n\n(1) having severe spinal trauma involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;\n\nNote: severe spinal trauma is defined in the Schedule 1 - Dictionary.\n\n(2) undergoing spinal surgery involving the affected site within the ten years before the clinical onset of spinal adhesive arachnoiditis;\n\nNote: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.\n\n(3) having a lumboperitoneal shunt at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;\n\n(4) having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical onset of spinal adhesive arachnoiditis;\n\n(5) having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical onset of spinal adhesive arachnoiditis;\n\nNote: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary. \n\n(6) having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical onset of spinal adhesive arachnoiditis;\n\n(7) having an in situ intrathecal drug delivery system at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;\n\n(8) having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical onset of spinal adhesive arachnoiditis;\n\n(9) having intrathecal injection of radioactive gold at the affected site before the clinical onset of spinal adhesive arachnoiditis;\n\n(10) having an infection from the specified list of infections before the clinical onset of spinal adhesive arachnoiditis;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(11) having a subarachnoid haemorrhage within the ten years before the clinical onset of spinal adhesive arachnoiditis;\n\n(12) having a spinal subdural haematoma at the affected site within the two years before the clinical onset of spinal adhesive arachnoiditis;\n\n(13) having severe spinal trauma involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;\n\nNote: severe spinal trauma is defined in the Schedule 1 - Dictionary.\n\n(14) undergoing spinal surgery involving the affected site within the ten years before the clinical worsening of spinal adhesive arachnoiditis;\n\nNote: Examples of spinal surgery include spinal fusion, laminectomy and discectomy.\n\n(15) having a lumboperitoneal shunt at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;\n\n(16) having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical worsening of spinal adhesive arachnoiditis;\n\n(17) having a myelogram involving an injection of water-soluble intrathecal radiological contrast agent from the specified list of radiological contrast agents within the ten years before the clinical worsening of spinal adhesive arachnoiditis;\n\nNote: specified list of radiological contrast agents is defined in the Schedule 1 - Dictionary. \n\n(18) having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical worsening of spinal adhesive arachnoiditis;\n\n(19) having an in situ intrathecal drug delivery system at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;\n\n(20) having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical worsening of spinal adhesive arachnoiditis;\n\n(21) having intrathecal injection of radioactive gold at the affected site before the clinical worsening of spinal adhesive arachnoiditis;\n\n(22) having an infection from the specified list of infections before the clinical worsening of spinal adhesive arachnoiditis;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(23) having a subarachnoid haemorrhage within the ten years before the clinical worsening of spinal adhesive arachnoiditis;\n\n(24) having a spinal subdural haematoma at the affected site within the two years before the clinical worsening of spinal adhesive arachnoiditis;\n\n(25) inability to obtain appropriate clinical management for spinal adhesive arachnoiditis.\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(13) to 9(25) apply only to material contribution to, or aggravation of, spinal adhesive arachnoiditis where the person's spinal adhesive arachnoiditis 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 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 severe spinal trauma means the application of significant external force, including a blunt, blast or penetrating force, that causes fracture or crush injury of the vertebral column, or other direct injury to the spinal cord or meninges that results in neurological dysfunction.\n\nNote: This definition excludes surgical and therapeutic procedures.\n\n specified list of infections means:\n\n(a) fungal or bacterial infection of the spinal cord;\n\n(b) fungal or bacterial meningitis;\n\n(c) neurosyphilis;\n\n(d) spinal toxoplasmosis;\n\n(e) spinal tuberculosis; or\n\n(f) vertebral osteomyelitis at the affected site.\n\n specified list of radiological contrast agents means:\n\n(a) dimeglumine iocarmate (Dimer-X);\n\n(b) meglumine iothalamate (Conray);\n\n(c) metrizamide (Amipaque); or\n\n(d) sodium iodomethanesulfonate/methiodal sodium (Abrodil).\n\n spinal adhesive arachnoiditis—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 is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the established structure of listing specific causal factors for a particular medical condition, consistent with the original legislative scheme for determining service-related disability compensation. The scope remains tightly focused on establishing medical causation for spinal adhesive arachnoiditis in the veteran compensation context."},"complexity_factors":["25 enumerated factors with specific temporal windows (ranging from 1 year to 10 years before clinical onset or worsening)","Dual application structure: factors 1-12 for initial onset, factors 13-24 for worsening of pre-existing conditions, plus factor 25 for clinical management failure","Cross-referencing to external legislation: Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004","Defined terms in Schedule 1 including technical medical terminology (intrathecal, myelogram, lumboperitoneal shunt) and specific drug/agent lists","Nested definitions: 'relevant service' excludes certain service types (operational service, hazardous service, British nuclear test defence service)","Section 11 creates dynamic incorporation of other Statements of Principles by reference ('as in force from time to time')","Medical specificity requirements: imaging or surgical demonstration of pathology plus consistent neurological symptoms"],"plain_english_summary":"This instrument sets the medical rules for deciding when spinal adhesive arachnoiditis is attributable to Australian defence service, replacing the 2011 version. It applies to veterans under the Veterans' Entitlements Act 1986 and current/former members under the Military Rehabilitation and Compensation Act 2004, using the \"balance of probabilities\" standard.\n\nIt lists 25 medical factors (trauma, surgery, certain procedures, infections, bleeding, and lack of care) that, if proven to be connected to service, can establish entitlement to compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument replaces the earlier Statement of Principles No. 117 of 2011 (s 4) and applies to claims under the VEA (s 5) and MRCA (s 5). It defines the clinical threshold for spinal adhesive arachnoiditis, enumerates multiple specific causative or aggravating factors with time limits (s 9), and includes death from the condition (s 7(3)). The text reproclaims scope and criteria but does not itself state whether the list of factors narrows or widens the previous instrument; determining substantive change requires comparison with the 2011 instrument (s 4)."},"complexity_factors":["Detailed clinical diagnosis requirement: condition must be demonstrated by imaging or surgery and have consistent neurological signs (s 7(2)(a)(i)-(ii)).","Large list of alternative causation/triggering factors with differing time limits (many items in s 9(1)–9(24)).","Non-medical/administrative factor: inability to obtain appropriate clinical management can satisfy causation (s 9(25)).","Interaction with definitions in the Schedule (e.g. ‘severe spinal trauma’, specified infections, specified contrast agents) creates cross‑referencing complexity (Schedule 1).","Different legal relationships to service: factors must be related to relevant service (s 10(1)); separate rules for material contribution/aggravation where condition pre‑existed service (s 10(2)).","Reference to other Statements of Principles means causation may depend on the terms of other instruments (s 11).","Standard of scientific basis: RMA’s view based on 'sound medical‑scientific evidence' shapes interpretive discretion (s 8).","Application limited to claims under specified statutory sections (s 5) and prior Statement is repealed (s 4), so claimants and decision‑makers must map transitional or replacement effects.","Exclusions and inclusions in the definition narrow scope (e.g. excludes asymptomatic transient inflammation and cranial arachnoiditis) (s 7(2)(c))."],"plain_english_summary":"This instrument sets the medical rules the Repatriation Medical Authority uses to decide whether spinal adhesive arachnoiditis (and death from it) is linked to a person’s military or defence service for claims under the VEA and MRCA. It defines the clinical diagnosis required and lists specific medical or procedural factors (for example, severe spinal trauma, spinal surgery, certain injections or infections) and time limits that, if present, can establish a service connection."},"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-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2","history":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2/history","analysis":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2/analysis","conflicts":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2/important-cases","documents":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-balance-of-probabilities-no-75-of-2/documents"}}