{"id":"F2020L01391","name":"Statement of Principles concerning spinal adhesive arachnoiditis (Reasonable Hypothesis) (No. 74 of 2020)","slug":"statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440645,"registerId":"F2020L01391-fast-fetch-1775956212570","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 (Reasonable Hypothesis) (No. 74 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 (Reasonable Hypothesis)\n\n(No. 74 of 2020)\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 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 (Reasonable Hypothesis) (No. 74 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning spinal adhesive arachnoiditis No. 116 of 2011 (Federal Register of Legislation No. F2011L01748) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that spinal adhesive arachnoiditis and death from spinal adhesive arachnoiditis 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\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 spinal adhesive arachnoiditis or death from spinal adhesive arachnoiditis 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 an epidural blood patch within the three months before the clinical onset of spinal adhesive arachnoiditis;\n\n(5) having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical onset of spinal adhesive arachnoiditis;\n\n(6) 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(7) having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical onset of spinal adhesive arachnoiditis;\n\n(8) having intrathecal injection of methylprednisolone acetate (Depo-Medrol) within the two years before the clinical onset of spinal adhesive arachnoiditis;\n\n(9) 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(10) having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical onset of spinal adhesive arachnoiditis;\n\n(11) having intrathecal injection of radioactive gold at the affected site before the clinical onset of spinal adhesive arachnoiditis;\n\n(12) 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(13) having a subarachnoid haemorrhage within the ten years before the clinical onset of spinal adhesive arachnoiditis;\n\n(14) having a spinal subdural haematoma at the affected site within the two years before the clinical onset of spinal adhesive arachnoiditis;\n\n(15) having ankylosing spondylitis involving the affected site before the clinical onset of spinal adhesive arachnoiditis;\n\n(16) having an intervertebral disc prolapse causing spinal stenosis at the affected site at the time of the clinical onset of spinal adhesive arachnoiditis;\n\n(17) having sarcoidosis before the clinical onset of spinal adhesive arachnoiditis;\n\n(18) 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(19) 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(20) having a lumboperitoneal shunt at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;\n\n(21) having an epidural blood patch within the three months before the clinical worsening of spinal adhesive arachnoiditis;\n\n(22) having a myelogram involving an injection of oil-soluble intrathecal radiological contrast agent before the clinical worsening of spinal adhesive arachnoiditis;\n\n(23) 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(24) having an injection of Thorotrast (thorium dioxide suspension) into the subarachnoid space before the clinical worsening of spinal adhesive arachnoiditis;\n\n(25) 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(26) having intrathecal injection of methotrexate or cytosine arabinoside within the one year before the clinical worsening of spinal adhesive arachnoiditis;\n\n(27) having intrathecal injection of radioactive gold at the affected site before the clinical worsening of spinal adhesive arachnoiditis;\n\n(28) 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(29) having a subarachnoid haemorrhage within the ten years before the clinical worsening of spinal adhesive arachnoiditis;\n\n(30) having a spinal subdural haematoma at the affected site within the two years before the clinical worsening of spinal adhesive arachnoiditis;\n\n(31) having ankylosing spondylitis involving the affected site before the clinical worsening of spinal adhesive arachnoiditis;\n\n(32) having an intervertebral disc prolapse causing spinal stenosis at the affected site at the time of the clinical worsening of spinal adhesive arachnoiditis;\n\n(33) having sarcoidosis before the clinical worsening of spinal adhesive arachnoiditis;\n\n(34) 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(18) to 9(34) 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(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 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 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","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the same scope as its predecessor (No. 116 of 2011) and aligns with the standard template for Repatriation Medical Authority Statements of Principles. It updates the medical factors based on current evidence but does not expand beyond the original purpose of determining service connection for this specific condition. The structure — covering both onset and worsening with a reasonable hypothesis test — is consistent with other SOPs under the VEA and MRCA."},"complexity_factors":["34 distinct factors with varying time limits (ranging from 3 months to 10 years, or no time limit)","Dual structure covering both clinical onset (factors 1-17) and clinical worsening (factors 18-33)","7 defined terms in Schedule 1, including nested definitions (e.g., 'relevant service' has 6 sub-categories)","Cross-references to other Statements of Principles for conditions mentioned as factors (section 11)","Specific medical terminology requiring precise interpretation (e.g., 'intrathecal', 'subarachnoid', 'arachnoiditis ossificans')","Conditional application in section 10(2) — factors 18-34 only apply to pre-existing conditions aggravated by service, not new conditions arising during service","Exclusion clauses in the definition of spinal adhesive arachnoiditis (subsection 7(2)(c))"],"plain_english_summary":"Replaces the 2011 guidance and sets medical rules for deciding compensation for spinal adhesive arachnoiditis affecting Australian Defence Force members, veterans and their families. It lists 34 specific medical factors that can establish a \"reasonable hypothesis\" of a service connection and applies to claims under the VEA and MRCA.\n\nA claim needs at least one listed factor linked to service; the \"reasonable hypothesis\" standard is lower than proving causation, so plausible service links can secure pensions, treatment and death benefits."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles No. 116 of 2011 (see s4) and replaces the authoritative criteria for linking spinal adhesive arachnoiditis to service. It establishes the operative scope for claims under section 120A of the VEA and section 338 of the MRCA (see s5). The instrument text does not itemise differences from the repealed instrument; the effective scope is whatever is stated in this instrument."},"complexity_factors":["Technical medical definitions and diagnostic requirements (see s7(2)): clinical, imaging or surgical demonstration plus compatible neurological signs.","Many specific causal factors with varying look‑back periods (see s9(1)–(34)) — different time limits (3 months, 1, 2, 10 years) increase evidentiary complexity.","Interplay between causation, material contribution and aggravation rules (see s10) — different tests depending on whether condition arose before/during service.","Cross-references to other Statements of Principles where factors overlap (see s11) create dependency on external instruments.","Multiple statutory regimes and claim routes (applies to VEA and MRCA claims; see s5), requiring administrative alignment.","Several specialized defined lists in Schedule 1 (specified infections, contrast agents, definitions of severe spinal trauma, terminal event) require medical-technical interpretation.","Authority and threshold language: RMA determines factors and the standard is a ‘reasonable hypothesis’ (s3, s9), which is a legal-evidentiary concept applied to medical facts."],"plain_english_summary":"This instrument tells decision-makers what medical evidence is needed to treat spinal adhesive arachnoiditis (and death from it) as possibly caused by a person’s military service. It defines the condition, lists specific prior events, procedures, infections and time limits that can establish a “reasonable hypothesis” of service connection, and applies to claims under the VEA and MRCA."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020","history":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-spinal-adhesive-arachnoiditis-reasonable-hypothesis-no-74-of-2020/documents"}}