{"id":"F2019L00948","name":"Statement of Principles concerning subarachnoid haemorrhage (Balance of Probabilities) (No. 68 of 2019)","slug":"statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440166,"registerId":"F2019L00948-fast-fetch-1775955902442","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning subarachnoid haemorrhage (Balance of Probabilities) (No. 68 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\nSUBARACHNOID HAEMORRHAGE (Balance of Probabilities)\n\n(No. 68 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 subarachnoid haemorrhage (Balance of Probabilities) (No. 68 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 subarachnoid haemorrhage No. 68 of 2010 (Federal Register of Legislation No. F2010L02307) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 subarachnoid haemorrhage and death from subarachnoid haemorrhage.\n\nMeaning of subarachnoid haemorrhage\n\n(2) For the purposes of this Statement of Principles, subarachnoid haemorrhage:\n\n(a) means bleeding into the intracranial subarachnoid space; and\n\n(b) excludes an extension of bleeding into the subarachnoid space from a cerebral tumour or from an intracerebral haemorrhage.\n\n(3) While subarachnoid haemorrhage attracts ICD‑10‑AM code I60 or S06.6, in applying this Statement of Principles the meaning of subarachnoid haemorrhage 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 subarachnoid haemorrhage\n\n(5) For the purposes of this Statement of Principles, subarachnoid haemorrhage, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's subarachnoid haemorrhage.\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 subarachnoid haemorrhage and death from subarachnoid haemorrhage 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, subarachnoid haemorrhage or death from subarachnoid haemorrhage is connected with the circumstances of a person's relevant service:\n\n(1) undertaking physical activity of at least six METs within the two hours before the clinical onset of subarachnoid haemorrhage;\n\nNote: MET is defined in the Schedule 1 - Dictionary. \n\n(2) having concussion or moderate to severe traumatic brain injury within the 30 days before the clinical onset of subarachnoid haemorrhage;\n\n(3) having hypertension at the time of the clinical onset of subarachnoid haemorrhage;\n\n(4) having pregnancy-induced hypertension at the time of the clinical onset of subarachnoid haemorrhage;\n\n(5) smoking at least one pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of subarachnoid haemorrhage, and where smoking has ceased, the clinical onset of subarachnoid haemorrhage has occurred within ten years of cessation;\n\nNote: pack-year of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(6) undergoing antithrombotic therapy within the two weeks before the clinical onset of subarachnoid haemorrhage;\n\nNote: antithrombotic therapy is defined in the Schedule 1 - Dictionary. \n\n(7) taking at least 700 milligrams of aspirin within a seven day period before the clinical onset of subarachnoid haemorrhage, and where the last dose of aspirin was taken no more than seven days before the clinical onset of subarachnoid haemorrhage;\n\n(8) having infective intracranial vasculitis at the time of the clinical onset of subarachnoid haemorrhage;\n\n(9) having an inflammatory vascular disease from the specified list of inflammatory vascular diseases affecting the cerebral vessels at the time of the clinical onset of subarachnoid haemorrhage;\n\nNote: specified list of inflammatory vascular diseases is defined in the Schedule 1 - Dictionary. \n\n(10) for males, consuming an average of at least 200 grams of alcohol per week for a continuous period of at least the six months before the clinical onset of subarachnoid haemorrhage;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(11) for females, consuming an average of at least 150 grams of alcohol per week for a continuous period of at least the six months before the clinical onset of subarachnoid haemorrhage;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n(12) using a drug from the specified list of drugs within the 72 hours before the clinical onset of subarachnoid haemorrhage;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary. \n\n(13) taking an oral contraceptive pill for a period of at least the three weeks before the clinical onset of subarachnoid haemorrhage;\n\n(14) having an acquired disorder resulting in impaired haemostasis at the time of the clinical onset of subarachnoid haemorrhage;\n\nNote: Examples of acquired disorders which have impaired haemostasis include, but are not limited to, thrombocytopaenia, cirrhosis of the liver and aplastic anaemia.\n\n(15) inability to obtain appropriate clinical management for subarachnoid haemorrhage.\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 factor set out in subsection 9(15) applies only to material contribution to, or aggravation of, subarachnoid haemorrhage where the person's subarachnoid haemorrhage 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 antithrombotic therapy means taking a drug for the treatment or prophylaxis of a thrombotic event, and includes antiplatelet drugs, anticoagulants and thrombolytic agents.\n\nNote: Examples of drugs used in antithrombotic therapy include, but are not limited to, aspirin, clopidogrel, tirofiban, warfarin, heparin, dabigatran, apixaban, rivaroxaban and alteplase.\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-year of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\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 specified list of drugs means:\n\n(a) amphetamine;\n\n(b) cocaine;\n\n(c) dextroamphetamine;\n\n(d) methamphetamine;\n\n(e) phenylpropanolamine; or\n\n(f) 3,4-methylenedioxymethamphetamine (ecstasy).\n\n specified list of inflammatory vascular diseases means:\n\n(a) allergic granulomatous angiitis;\n\n(b) Behcet disease;\n\n(c) giant cell arteritis;\n\n(d) granulomatosis with polyangiitis (Wegener granulomatosis);\n\n(e) polyarteritis nodosa;\n\n(f) rheumatoid arthritis;\n\n(g) Sjogren syndrome;\n\n(h) systemic lupus erythematosus; or\n\n(i) Takayasu arteritis.\n\n subarachnoid haemorrhage—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":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles No. 68 of 2010 (s4) and replaces it with updated criteria (s9) and definitions. It applies to claims under section 120B of the VEA or section 339 of the MRCA (s5), thereby modifying the operative Statement of Principles used to determine service connection for subarachnoid haemorrhage (s8)."},"complexity_factors":["Multiple technical medical criteria with specific numeric thresholds and time windows (e.g. exertion within 2 hours, concussion within 30 days, aspirin dosing within 7 days) (see s9(1)-(7)).","Gender‑specific and quantifiable risk thresholds for alcohol consumption (s9(10)-(11) and Schedule).","Use of defined clinical concepts and external classification systems (definition of subarachnoid haemorrhage, reference to ICD‑10‑AM) requiring medical interpretation (s7(2)-(4) and Schedule).","Detailed, technical definitions in the Dictionary—e.g. MET, pack‑year, antithrombotic therapy, specified drug lists—that shape legal application (Schedule 1).","Requirement that any listed factor must be related to the person's relevant service, placing a causal/connection evidential burden on claimants (s10(1) and s9).","A specific exception for inability to obtain appropriate clinical management that only applies where the condition existed before or during service (s9(15), s10(2)).","Cross‑instrument interaction: if a factor refers to another injury/disease covered by a different Statement of Principles, that other Statement applies (s11), adding cross‑referencing complexity.","Instrumental reliance on the Repatriation Medical Authority's assessment of ‘sound medical‑scientific evidence’ as the basis for the Statement (s8), which embeds expert judgment into legal criteria.","Administrative update mechanics: this instrument repeals the 2010 Statement and replaces it (s4), requiring practitioners and decision‑makers to track versioning.","Application limited to claims under specified statutory provisions (s5), meaning its effects are confined to the VEA/MRCA claims framework rather than general tort or clinical contexts."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority uses to decide whether a subarachnoid haemorrhage (or death from one) is connected to a veteran's or serving member's relevant service for claims under the VEA or MRCA. It lists specific medical, exposure and timing factors (and definitions) that, if established on the balance of probabilities and linked to service, support entitlement decisions. It matters because those criteria determine eligibility for service‑related benefits."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument under the Veterans' Entitlements Act framework. It updates the 2010 version but maintains the same fundamental scope: establishing causal connection factors for a specific medical condition. The 15 factors represent typical medical-scientific evidence for subarachnoid haemorrhage and do not represent scope creep beyond the original legislative purpose of determining service-related compensation eligibility."},"complexity_factors":["15 distinct factual factors requiring specific temporal relationships (e.g., 'within 2 hours', 'within 30 days', 'for at least 6 months')","7 defined terms in Schedule 1, including technical medical measurements (METs, pack-years) and cross-references to other legislation (VEA, MRCA)","Nested definitional complexity: 'pack-year' requires mathematical conversion between cigarettes, pipe tobacco, and weight-based equivalents","Gender-specific thresholds for alcohol consumption (200g vs 150g weekly)","Exclusion clause in section 7(2)(b) carving out tumours and intracerebral haemorrhages","Conditional application in section 10(2) restricting the 'inability to obtain appropriate clinical management' factor to pre-existing conditions only","Incorporation by reference of ICD-10-AM Tenth Edition with specific ISBN and effective date","Recursive definition structure: section 11 requires cross-referencing other Statements of Principles when factors refer to other diseases"],"plain_english_summary":"This instrument sets the medical rules for deciding whether a subarachnoid haemorrhage (a brain bleed) is connected to military service, replacing the 2010 rules. It lists 15 specific medical or lifestyle factors that must be proven on the balance of probabilities to link the bleed to service, and applies to veterans and current/former defence members claiming under the VEA or MRCA. If none apply, the condition is not service‑related, creating a high, determinative threshold for claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019","history":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-subarachnoid-haemorrhage-balance-of-probabilities-no-68-of-2019/documents"}}