{"id":"F2019L00889","name":"Statement of Principles concerning strongyloidiasis (Balance of Probabilities) (No. 64 of 2019)","slug":"statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440147,"registerId":"F2019L00889-fast-fetch-1775955891742","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning strongyloidiasis (Balance of Probabilities) (No. 64 of 2019)","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\nSTRONGYLOIDIASIS (Balance of Probabilities)\n\n(No. 64 of 2019)\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 21 June 2019\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 strongyloidiasis (Balance of Probabilities) (No. 64 of 2019).\n\n2 Commencement\n\n This instrument commences on 22 July 2019.\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 strongyloidiasis No. 89 of 2010 (Federal Register of Legislation No. F2010L02845) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 strongyloidiasis and death from strongyloidiasis.\n\nMeaning of strongyloidiasis\n\n(2) For the purposes of this Statement of Principles, strongyloidiasis means an infection with the parasitic roundworm Strongyloides stercoralis.\n\nNote 1: Strongyloides stercoralis can replicate indefinitely inside the body (autoinfective cycle) without any further contact with contaminated soil, causing a lifelong infection if left untreated.\n\nNote 2: Following infection, in otherwise healthy people, there may be no symptoms, or symptoms and signs may arise at variable times, even up to several decades later. Symptoms may include, but are not limited to, skin lesions, dry cough, breathing difficulties, diarrhoea, abdominal pain, nausea and vomiting. People with immunosuppression can develop sudden and severe illnesses, known as strongyloidiasis hyperinfection syndrome and disseminated strongyloidiasis.\n\n(3) While strongyloidiasis attracts ICD‑10‑AM code B78, in applying this Statement of Principles the meaning of strongyloidiasis 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from strongyloidiasis\n\n(5) For the purposes of this Statement of Principles, strongyloidiasis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's strongyloidiasis.\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 strongyloidiasis and death from strongyloidiasis 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, strongyloidiasis or death from strongyloidiasis is connected with the circumstances of a person's relevant service:\n\n(1) having cutaneous or mucosal contact with Strongyloides stercoralis roundworm larvae before the clinical onset of strongyloidiasis;\n\nNote 1: Contact with Strongyloides stercoralis is most likely to occur from ingestion of, or skin contact with, moist soil, sediment or mud contaminated with human or animal faeces, most frequently in warm and damp conditions, where facilities for the hygienic disposal of human waste are minimal.\n\nNote 2: Examples of activities involving contact with contaminated moist soil, sediment or mud contaminated with human or animal faeces include, but are not limited to, walking barefoot, farming, mining and tunnelling.\n\n(2) having a solid organ transplant, where the organ is infected with Strongyloides stercoralis, within the one year before the clinical onset of strongyloidiasis;\n\n(3) being in an immunocompromised state as specified at the time of the clinical worsening of strongyloidiasis;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 – Dictionary.\n\n(4) having alcohol use disorder at the time of the clinical worsening of strongyloidiasis;\n\n(5) inability to obtain appropriate clinical management for strongyloidiasis.\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(3) to 9(5) apply only to material contribution to, or aggravation of, strongyloidiasis where the person's strongyloidiasis 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\nchronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\nimmunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) being treated with an immunosuppressive drug;\n\n(b) having a haematological or solid organ malignancy;\n\n(c) having chronic renal failure;\n\n(d) having infection with human immunodeficiency virus;\n\n(e) having severe malnutrition; or\n\n(f) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.\n\nimmunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\nNote: Examples of an immunosuppressive drug include, but are not limited to:\n\n(a) chemotherapeutic agents used for the treatment of cancer;\n\n(b) corticosteroids, other than inhaled or topical corticosteroids;\n\n(c) drugs used to prevent transplant rejection; and\n\n(d) tumour necrosis factor-α inhibitors.\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 strongyloidiasis—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":{"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 2010 version concerning the same disease (strongyloidiasis) without expanding into new areas. The structure follows the standard template: defining the condition, listing causal/worsening factors, and specifying service connection requirements. No mission creep is evident."},"complexity_factors":["Moderate cross-referencing between main provisions and Schedule 1 definitions (8 defined terms)","Conditional logic distinguishing between 'clinical onset' (factors 9(1)-9(2)) and 'clinical worsening' (factors 9(3)-9(5))","Nested definitions: 'immunocompromised state as specified' contains 6 sub-categories, with 'chronic renal failure' and 'immunosuppressive drug' requiring their own definitions","Section 11 creates dynamic incorporation of other Statements of Principles by reference ('as in force from time to time')","Dual statutory framework application (VEA and MRCA) with different service definitions requiring reconciliation","Note hierarchy: some notes provide examples, others provide essential definitional context without being formally defined terms"],"plain_english_summary":"This instrument sets the medical criteria for when current and former Australian Defence Force members can claim compensation for strongyloidiasis (or death from it) under veterans’ law. It specifies the types of service-related exposure or conditions that can establish causation or aggravation of infection—notably contaminated soil exposure or infected-organ transplant can establish causation, while immune suppression, alcohol use disorder, or failure of treatment can only support aggravation of a pre-existing infection. It updates the 2010 guidance."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles for strongyloidiasis (s4) and replaces it with updated criteria (s7–s11). It explicitly includes death contributed to by strongyloidiasis (s7(5)), specifies required causal factors such as infected solid organ transplant within one year (s9(2)), immunocompromised states and their examples (s9(3); Schedule 1), alcohol use disorder (s9(4)) and inability to obtain appropriate clinical management (s9(5)). These changes alter the operational scope of factors used to link the disease to relevant service."},"complexity_factors":["Medical and technical definitions that determine eligibility (e.g. strongyloidiasis meaning, terminal event) (s7(2),(5); Schedule 1).","Detailed clinical thresholds and categories (e.g. chronic renal failure GFR threshold, list of immunocompromised conditions) (Schedule 1).","Multiple alternative causal factors that can each establish connection to service (s9), requiring different kinds of evidence (exposure history, transplant records, clinical management details).","Timing and causation rules restricting some factors to material contribution or aggravation where disease existed before or during service (s10(2)).","Cross‑references to other Statements of Principles when a factor pertains to another injury/disease (s11), adding inter-instrument dependency.","Administrative scope and application limited to specified claim regimes (VEA/MRCA) (s3,s5).","Repeal and substitution of a prior instrument (s4), which may affect precedent and claim framing."],"plain_english_summary":"Replaces the earlier Statement of Principles and sets the tests the Repatriation Medical Authority will use to decide, on the balance of probabilities, when strongyloidiasis (infection with Strongyloides stercoralis) — and deaths contributed to by it — are connected to a veteran's relevant service for VEA/MRCA claims. It lists required causal factors (e.g. cutaneous/mucosal contact with larvae, infected organ transplant, immunocompromised state, alcohol use disorder, or inability to obtain appropriate clinical management) and defines the medical terms used."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019","history":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-strongyloidiasis-balance-of-probabilities-no-64-of-2019/documents"}}