{"id":"F2019L01348","name":"Statement of Principles concerning subdural haematoma (Balance of Probabilities) (No. 101 of 2019)","slug":"statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440272,"registerId":"F2019L01348-fast-fetch-1775955960475","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning subdural haematoma (Balance of Probabilities) (No. 101 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\nSUBDURAL HAEMATOMA (Balance of Probabilities)\n\n(No. 101 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 18 October 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:
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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 subdural haematoma (Balance of Probabilities) (No. 101 of 2019).\n\n2 Commencement\n\n This instrument commences on 18 November 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 subdural haematoma No. 34 of 2011 (Federal Register of Legislation No. F2011L00786) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 subdural haematoma and death from subdural haematoma.\n\nMeaning of subdural haematoma\n\n(2) For the purposes of this Statement of Principles, subdural haematoma:\n\n(a) means bleeding into the space between the dura mater and the arachnoid mater in the skull or spinal cord; and\n\n(b) includes acute and chronic forms of subdural haematoma; and\n\n(c) excludes bleeding from a neoplasm and an extension of bleeding into the subdural space from subarachnoid haemorrhage or from an intracerebral haemorrhage.\n\n(3) While subdural haematoma attracts ICD‑10‑AM code S06.5 or I62.0, in applying this Statement of Principles the meaning of subdural haematoma 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 subdural haematoma\n\n(5) For the purposes of this Statement of Principles, subdural haematoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's subdural haematoma.\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 subdural haematoma and death from subdural haematoma 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, subdural haematoma or death from subdural haematoma is connected with the circumstances of a person's relevant service:\n\n(1) for intracranial subdural haematoma only:\n\n(a) experiencing head trauma within the two months before the clinical onset of subdural haematoma;\n\nNote: head trauma is defined in the Schedule 1 - Dictionary. \n\n(b) having intracranial neurosurgery or penetrating cranial trauma within the two weeks before the clinical onset of subdural haematoma;\n\n(c) having active epilepsy at the time of the clinical onset of subdural haematoma;\n\nNote: active epilepsy is defined in the Schedule 1 - Dictionary. \n\n(d) having an epileptic seizure within the two months before the clinical onset of subdural haematoma;\n\n(e) having a specified form of dementia at the time of the clinical onset of subdural haematoma; or\n\nNote: specified form of dementia is defined in the Schedule 1 - Dictionary. \n\n(f) having alcohol use disorder at the time of the clinical onset of subdural haematoma;\n\n(2) undergoing a cerebrospinal procedure within the two months before the clinical onset of subdural haematoma;\n\nNote: cerebrospinal procedure is defined in the Schedule 1 - Dictionary. \n\n(3) for spinal subdural haematoma only, experiencing trauma to the spinal region within the two weeks before the clinical onset of subdural haematoma;\n\nNote: trauma to the spinal region is defined in the Schedule 1 - Dictionary. \n\n(4) undergoing antithrombotic therapy within the two weeks before the clinical onset of subdural haematoma;\n\nNote: antithrombotic therapy is defined in the Schedule 1 - Dictionary. \n\n(5) taking at least 700 milligrams of aspirin within a seven day period before the clinical onset of subdural haematoma, and where the last dose of aspirin was taken no more than seven days before the clinical onset of subdural haematoma;\n\n(6) having an acquired disorder resulting in impaired haemostasis at the time of the clinical onset of subdural haematoma;\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(7) undergoing haemodialysis within the one week before the clinical onset of subdural haematoma;\n\n(8) having a cerebrospinal fluid shunt at the time of the clinical onset of subdural haematoma;\n\n(9) inability to obtain appropriate clinical management for subdural haematoma.\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(9) applies only to material contribution to, or aggravation of, subdural haematoma where the person's subdural haematoma 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\nactive epilepsy means having at least one seizure per year.\n\nantithrombotic 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\ncerebrospinal procedure means:\n\n(a) cerebrospinal fluid drainage from the spine;\n\n(b) endoscopic third ventriculostomy;\n\n(c) lumbar puncture;\n\n(d) myelography;\n\n(e) spinal anaesthesia; or\n\n(f) spinal analgesia.\n\nhead trauma means trauma to the head resulting from external forces, including blunt trauma, acceleration or deceleration forces, or blast force.\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\nspecified form of dementia means:\n\n(a) dementia pugilistica;\n\n(b) major neurocognitive disorder due to Alzheimer disease;\n\n(c) major neurocognitive disorder due to frontotemporal degeneration;\n\n(d) major neurocognitive disorder with Lewy bodies;\n\n(e) major neurocognitive disorder due to traumatic brain injury; or\n\n(f) vascular dementia.\n\n subdural haematoma—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\ntrauma to the spinal region means injury to the vertebral column, spinal cord or spinal meninges as a result of external force including blunt trauma, acceleration or deceleration forces, blast force, penetrating trauma or surgery.\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 is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2011 predecessor and other similar instruments — establishing causal factors for a specific medical condition in veterans' compensation claims. No significant scope creep is evident; it follows the established template for Repatriation Medical Authority determinations."},"complexity_factors":["Multiple conditional timeframes (ranging from 1 week to 2 months depending on the factor)","Specific dosage threshold for aspirin (700mg within 7 days)","Differential treatment of intracranial vs spinal subdural haematoma (factors 1 and 3)","12 defined terms in Schedule 1, including nested definitions (e.g., 'specified form of dementia' lists 6 specific conditions)","Cross-reference to external classification system (ICD-10-AM Tenth Edition)","Conditional application of factor 9 (inability to obtain clinical management) limited to pre-existing conditions","Incorporation by reference of other Statements of Principles (section 11)"],"plain_english_summary":"This instrument replaces the 2011 guidance and sets the medical test for linking subdural haematoma to military service for claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. It uses the balance‑of‑probabilities standard and requires at least one specified medical factor (e.g., recent head trauma, surgery, seizure, dementia type, anticoagulant use) that is connected to the person’s service.\n\nIt matters because it determines whether the government accepts liability and pays compensation for a veteran’s potentially disabling or fatal brain bleed."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement No. 34 of 2011 (s4) and replaces it with updated definitions and a revised list of qualifying factors (s9; Schedule 1). Notable scope adjustments in the text include explicit exclusions for bleeding from neoplasm and extensions from subarachnoid or intracerebral haemorrhage (s7(2)(c)), added or clarified procedures and exposures (cerebrospinal procedures, cerebrospinal fluid shunt, haemodialysis, specified aspirin dosing) (s9; Schedule 1), and reaffirmed application to claims under section 120B of the VEA and section 339 of the MRCA (s5)."},"complexity_factors":["Technical medical criteria and terminology (subdural haematoma types, acute vs chronic, terminal event) requiring clinical evidence (Schedule 1; s7(2), s7(5))","Multiple discrete temporal thresholds linking events to onset (e.g. two months, two weeks, one week, seven days) which create fine evidentiary timing issues (s9)","List of diverse causative or contributory factors spanning trauma, procedures, drugs and disorders (s9(1)–(9))","Quantitative dosing criterion for aspirin (≥700 mg within 7 days) introducing precise pharmacological proof requirements (s9(5))","Cross‑references to other Statements of Principles where overlapping injuries/diseases are involved (s11)","Interaction with two statutory schemes (VEA and MRCA) and application to both injury and death, expanding administrative scope (s5; s7(5))","Replaces an earlier Statement, so claimants and clinicians must map differences between instruments (s4)","Discretion and causation standard: application of 'balance of probabilities' by RMA requires evaluative judgment of clinical evidence (s8)"],"plain_english_summary":"This instrument tells decision‑makers how to decide, on the balance of probabilities, whether a subdural haematoma (or death from it) is connected with a veteran’s relevant service for claims under the VEA and MRCA. It sets specific medical criteria, time windows and defined terms (for example head or spinal trauma, neurosurgery, antithrombotic therapy, specified dementias, aspirin exposure and cerebrospinal procedures) that must be present to establish service connection."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019","history":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-subdural-haematoma-balance-of-probabilities-no-101-of-2019/documents"}}