{"id":"F2019L00888","name":"Statement of Principles concerning strongyloidiasis (Reasonable Hypothesis) (No. 63 of 2019)","slug":"statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440149,"registerId":"F2019L00888-fast-fetch-1775955891772","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning strongyloidiasis (Reasonable Hypothesis) (No. 63 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 (Reasonable Hypothesis)\n\n(No. 63 of 2019)\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 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 (Reasonable Hypothesis) (No. 63 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning strongyloidiasis No. 88 of 2010 (Federal Register of Legislation No. F2010L02844) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that strongyloidiasis and death from strongyloidiasis 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 strongyloidiasis or death from strongyloidiasis with the circumstances of a person's relevant service:\n\n(1) being a prisoner of war before the clinical onset of strongyloidiasis;\n\n(2) 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(3) 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(4) 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(5) having alcohol use disorder at the time of the clinical worsening of strongyloidiasis;\n\n(6) 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(4) to 9(6) 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(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\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\nrelevant 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\nstrongyloidiasis—see subsection 7(2).\n\nterminal 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\nVEA 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 standard scope of Repatriation Medical Authority Statements of Principles. It replaces the 2010 version (No. 88 of 2010) with updated medical evidence and definitions, but does not expand beyond the traditional purpose of establishing causation factors for a specific disease in the veterans' compensation context. The structure and approach remain consistent with other SOPs under subsection 196B(2) of the VEA."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 (Dictionary) for defined terms","Conditional logic in section 10(2) restricting application of certain factors (9(4)-9(6)) to aggravation cases only","Nested definitions: 'immunocompromised state as specified' contains six sub-categories, with 'chronic renal failure' and 'immunosuppressive drug' requiring further definition","Incorporation by reference of external medical classification (ICD-10-AM Tenth Edition) with specific ISBN and effective date","Dual statutory framework application (VEA and MRCA) requiring understanding of six different service types listed in definitions","Section 11 creates dynamic referencing to other Statements of Principles that may change over time ('as in force from time to time')","Medical-legal hybrid language requiring understanding of both clinical concepts (autoinfective cycle, hyperinfection syndrome) and legal concepts (reasonable hypothesis, material contribution)"],"plain_english_summary":"This instrument sets the medical test for whether Australian veterans or defence members can get compensation for strongyloidiasis by requiring a reasonable medical hypothesis linking the infection to their service. Claimants must satisfy at least one specified risk factor and show that the factor is connected to their service; worsening during severe immunosuppression, alcohol disorder, or lack of treatment is treated as service-linked only if infection predated or began in service. It also covers deaths contributed to by the disease."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals and replaces the prior Statement of Principles No. 88 of 2010 (s4). It continues to apply to claims under the VEA and MRCA (s5) and sets out current definitions, enumerated trigger factors and interactions with other Statements (ss7–11, Schedule). The source text itself does not state how these provisions differ from the 2010 Statement; determining whether clinical or claim scope has been expanded or narrowed requires direct comparison with the repealed instrument."},"complexity_factors":["Use of the 'reasonable hypothesis' legal standard for causation (instrument heading and section 9)","Cross-references to primary legislation and claim pathways (applies to claims under VEA s120A and MRCA s338) (s5)","Formal repeal and replacement of a 2010 Statement (s4) requiring comparison to prior text to assess substantive change (s4)","Detailed medical definitions and clinical notes (definition of strongyloidiasis, ICD‑10‑AM reference, clinical notes) (s7)","Multiple, heterogeneous trigger factors combining epidemiological exposure and clinical states (prisoner of war, contact with larvae, infected organ transplant, immunocompromised state, alcohol disorder, inability to obtain appropriate management) (s9)","Technical medical concepts defined in the Schedule (eg. 'immunocompromised state', 'chronic renal failure', 'immunosuppressive drug') that require expert evidence to apply","Requirement that any listed factor be related to the person's relevant service, which raises factual and evidentiary questions (s10)","Interaction with other Statements of Principles where an identified factor is itself an injury/disease covered elsewhere (s11)","Potential administrative discretion in assessing vague or context‑dependent factors (for example, 'inability to obtain appropriate clinical management') (s9(6))"],"plain_english_summary":"This Statement of Principles sets out the medical criteria the Repatriation Medical Authority will use to decide whether strongyloidiasis (infection with Strongyloides stercoralis) or death from it can reasonably be connected to a person’s relevant military service. It defines the condition, who the rule applies to (claims under the VEA and MRCA) and lists the factual and medical triggers the Authority treats as sufficient to raise a reasonable hypothesis linking the disease to service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019","history":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-strongyloidiasis-reasonable-hypothesis-no-63-of-2019/documents"}}