{"id":"F2024L00758","name":"Statement of Principles concerning tinea (Balance of Probabilities) (No. 56 of 2024)","slug":"statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442454,"registerId":"F2024L00758-fast-fetch-1775957455768","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning tinea (Balance of Probabilities) (No. 56 of 2024)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nTINEA  (Balance of Probabilities)\n\n(No. 56 of 2024)\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 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of      \n\nThe Repatriation Medical Authority\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 tinea (Balance of Probabilities) (No. 56 of 2024).\n\n2               Commencement\n\n              This instrument commences on 23 July 2024.\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 tinea No. 12 of 2015 (Federal Register of Legislation No. F2014L01816) made under subsection 196B(3) of the VEA is repealed.\n\n5               Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and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 tinea and death from tinea.\n\nMeaning of tinea\n\n(2)          For the purposes of this Statement of Principles, tinea:\n\n(a)          means a fungal infection of the skin, hair or nails caused by the dermatophytes Epidermophyton, Trichophyton, Microsporum, Arthroderma, Ctenomyces, Lophophyton, Nannizzia, Guarromyces or Paraphyton; and\n\n(b)          includes:\n\n(i)            tinea infection of the beard (tinea barbae), scalp (tinea capitis), body (tinea corporis), groin/perineal region (tinea cruris/inguinalis), hand (tinea manus/manuum), foot (tinea pedis), and nail (tinea unguium/onchomycosis);\n\n(ii)         tinea gladiatorum; and\n\n(iii)       Majocchi’s granuloma (granuloma trichophyticum); and\n\n(c)          excludes:\n\n(i)            tinea versicolour;\n\n(ii)         tinea flava;\n\n(iii)       tinea nigra;\n\n(iv)        tinea blanca;\n\n(v)          tinea amiantacea; and\n\n(vi)        fungal infection involving mucous membranes or a systemic fungal infection.\n\nNote 1: Tinea includes Id reactions which is an allergic rash occurring as a result of allergy to fungal antigens from a tinea at a distant site.\n\nNote 2: The SoP should be invoked separately in relation to each instance of tinea, in each separate location of the body, and in each instance separate in time.\n\nNote 3: Some examples of clinical worsening are where tinea has disseminated, become deeply invasive in the form of Majocchi’s granuloma, or has become refractory to first-line treatment.\n\n(3)          While tinea attracts ICD‑10‑AM code B35, in applying this Statement of Principles the meaning of tinea 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 tinea\n\n(5)          For the purposes of this Statement of Principles, tinea, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tinea.\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 tinea and death from tinea 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, tinea or death from tinea is connected with the circumstances of a person's relevant service:\n\n(1)          having unprotected physical contact with:\n\n(a)          a person infected with tinea;\n\n(b)          an animal infected with tinea;\n\n(c)          objects or surfaces contaminated with dermatophytes;\n\n(d)          using communal showering or bathing facilities, swimming pool facilities or locker rooms;\n\n(e)          soil contaminated with dermatophytes; or\n\n(f)           a site of tinea on the same body;\n\nbetween 2 days and 3 weeks before the clinical onset or clinical worsening;\n\nNote 1: Examples of unprotected physical contact with a person could include contact sports and unarmed physical combat.\n\nNote 2: Examples of animals that can be infected with tinea include mammals, reptiles, birds, fish, arthropods, and worms.\n\nNote 3: Examples of objects that can be contaminated include brushes, hats, razors, footwear, towels or clothing. Examples of surfaces that can be contaminated include communal showers, baths, pools, locker rooms, and laundry facilities.\n\n(2)          having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening;\n\nNote 1: Situations in which skin maceration can occur are prolonged use of occlusive footwear or clothing, heavy sweating, and prolonged exposure to water.\n\nNote 2: skin maceration is defined in the Schedule-1 dictionary.\n\n(3)          having diabetes mellitus at the time of clinical worsening;\n\n(4)          having a substantially lowered immune function at the time of clinical worsening due to:\n\n(a)          human immunodeficiency virus (HIV) infection;\n\n(b)          glucocorticoids other than inhaled glucocorticoids;\n\n(c)          solid organ transplant (excluding corneal transplant), stem cell or bone marrow transplantation;\n\n(5)          having topical glucocorticoid applied at the site of the tinea at the time of clinical worsening;\n\n(6)          having chronic renal failure at the time of clinical worsening of tinea unguium, as indicated by any of the following;\n\n(a)           a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n\n(b)           undergoing chronic dialysis for renal failure.\n\n(7)          taking risankizumab and guselkumab at the time of clinical worsening;\n\n(8)          having peripheral artery disease of the lower limb at the time of clinical worsening of tinea affecting the foot;\n\n(9)          having chronic venous insufficiency of the lower limb at the time of clinical worsening of tinea unguium of the toes;\n\n(10)      having varicose veins of the lower limb at the time of clinical worsening of tinea unguium of the toes;\n\n(11)      inability to obtain appropriate clinical management for tinea before clinical worsening.\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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, tinea where the person's tinea 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                             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                               skin maceration means softening of the skin by soaking in aqueous liquids or sweat.\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                               tinea—see subsection 7(2).\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement (section 4) and replaces it with an updated SoP that (a) specifies included dermatophyte genera and explicit clinical exclusions and Id reaction inclusion (section 7(2)); (b) defines death from tinea by contribution to listed terminal events (section 7(5) and Schedule 1); (c) lists granular factors including diabetes, quantified chronic renal failure criteria and dialysis, substantially lowered immune function categories, topical glucocorticoid use, and named biologics (sections 9(3)–9(9)); and (d) clarifies temporal windows and per‑site/per‑time invocation (section 9, section 7 Notes). The application remains to claims under section 120B of the VEA and section 339 of the MRCA (section 5)."},"complexity_factors":["Technical medical specificity: enumerated dermatophyte genera and multiple included/excluded clinical entities (section 7(2)–(3)).","Fixed causation window (2 days–3 weeks) for exposure before clinical onset or worsening, applied to several exposure routes (section 9(1) and Note 1–3).","Distinction between new onset and clinical worsening, and requirement that worsening relate to service when tinea pre‑existed or was contracted before/during service (section 10(2); Note 2 to section 7).","Cross‑reference to other Statements of Principles where a listed factor is itself another injury/disease, requiring layered application (section 11).","Objective thresholds alongside subjective elements: GFR <15 mL/min/1.73 m2 for ≥3 months and dialysis vs. subjective 'inability to obtain appropriate clinical management' (section 9(6) and 9(11)).","Inclusion of named pharmaceutical agents (risankizumab and guselkumab) as causal factors increases evidentiary tracing to specific treatments (section 9(7)).","Death linkage defined via contribution to a terminal event with an explicit list (section 7(5) and Schedule 1 definitions).","Operational interface with veterans’ claim law and repeal of the prior SoP, affecting procedural application to VEA/MRCA claims (sections 3–5, 4).","Multiple loci and temporal separations require separate invocation per site/time, complicating claim aggregation and proof (section 7 Note 2)."],"plain_english_summary":"Replaces the prior tinea Statement of Principles and sets the medical criteria used to decide, on the balance of probabilities, whether tinea (specified dermatophyte infections) or death from tinea is connected with a veteran’s relevant service under the VEA/MRCA. It defines included and excluded tinea types and lists exposure, medical and treatment-related factors (for example contact with infected people/animals, skin maceration, diabetes, immunosuppression, specified biologics, chronic renal failure) and a 2‑day to 3‑week exposure window. These factors determine entitlement and shape required clinical evidence."},"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 Repatriation Medical Authority Statement of Principles update, replacing the 2015 version. It maintains the same core purpose: establishing service connection criteria for a specific medical condition. The scope remains tightly focused on tinea and its relationship to veteran compensation claims, with no expansion into unrelated areas."},"complexity_factors":["Moderate cross-referencing: references two separate Acts (VEA and MRCA) and incorporates definitions from Schedule 1","Conditional logic with time windows: factors (1) and (2) require specific 2-day to 3-week temporal relationships","Nested definitions: 'tinea' defined with inclusions, exclusions, and notes; 'terminal event' has 5 sub-categories","Specific medical terminology: 9 dermatophyte genera named, ICD-10-AM code references with edition specificity","Factor interdependence: section 11 creates dynamic incorporation of other Statements of Principles by reference","Dual application structure: distinguishes between clinical onset (new infection) and clinical worsening (aggravation of pre-existing)"],"plain_english_summary":"This instrument updates the 2015 rules for deciding if tinea (fungal skin infections) is service-related and compensable for veterans and current/former defence members, using a \"balance of probabilities\" test. It lists 11 risk factors (including wet environments, contact with infected sources, certain medical conditions, and lack of treatment access) that, if proven, can link an infection to service. Each distinct infection requires its own claim; death is covered if tinea contributed."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024","history":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-tinea-balance-of-probabilities-no-56-of-2024/documents"}}