{"id":"F2024L00757","name":"Statement of Principles concerning tinea (Reasonable Hypothesis) (No. 55 of 2024)","slug":"statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442452,"registerId":"F2024L00757-fast-fetch-1775957453624","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning tinea (Reasonable Hypothesis) (No. 55 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  (Reasonable Hypothesis)\n\n(No. 55 of 2024)\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 2024.\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   \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 (Reasonable Hypothesis) (No. 55 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(2) of the Veterans' Entitlements Act 1986.\n\n4               Repeal\n\nThe Statement of Principles concerning tinea No. 11 of 2015 (Federal Register of Legislation No. F2014L01814) made under subsection 196B(2)  of the VEA is repealed.\n\n5               Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that tinea and death from tinea 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 tinea or death from tinea 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)      having shaved the skin at the affected site within 3 weeks of clinical worsening;\n\n(12)      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(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\n                               MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                               relevant 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 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_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 periodic update of a Repatriation Medical Authority Statement of Principles. It replaces the 2015 version (No. 11 of 2015) with the same fundamental purpose: establishing the causal connection between tinea and military service. The scope remains tightly focused on this specific medical condition and its relationship to veterans' compensation entitlements. While medical knowledge has evolved (evidenced by new factors like specific biologic drugs and refined immunosuppression criteria), the legislative scope has not expanded beyond its original intent."},"complexity_factors":["Moderate cross-referencing between the main body and Schedule 1 dictionary (6 defined terms)","Nested definitions requiring careful parsing (e.g., 'tinea' defined in s 7(2) but referenced throughout)","Conditional timing requirements throughout section 9 (the 'between 2 days and 3 weeks' window applies to some but not all factors)","Specific exclusions in the definition of tinea (6 explicit exclusions in s 7(2)(c))","Dual legislative framework application (VEA and MRCA) requiring understanding of two separate Acts","Clinical specificity in factors (e.g., GFR thresholds for renal failure, specific drug names like risankizumab and guselkumab)","Distinction between 'clinical onset' and 'clinical worsening' with different factors applying to each"],"plain_english_summary":"This Statement of Principles tells when tinea (fungal skin, hair or nail infections) can be accepted as caused or aggravated by military service for veterans’ compensation. It replaces the 2015 SoP, narrows covered/uncovered presentations, and sets out 12 risk factors that can link tinea to service.\n\nTo succeed, a claimant must show at least one listed factor was service‑related and that exposure occurred within about 2 days to 3 weeks before symptoms began or worsened."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"The instrument repeals the earlier tinea Statement of Principles and replaces it with a new text that defines tinea inclusions/exclusions, adds a set of specified exposure, clinical and treatment-related factors and explicitly includes death contributed to by tinea (s4, s7, s9). The instrument continues to apply to claims under the VEA and MRCA (s5) but, as the prior instrument is repealed, this instrument is now the operative statement of the scope and factors to be applied."},"complexity_factors":["Technical medical definitions and included/excluded subtypes of tinea, creating bright-line content questions (s7(2)).","Multiple, discrete exposure and clinical risk factors with specific timing windows (e.g. 2 days–3 weeks) that claimants must establish (s9(1), s9(2)).","Incorporation of comorbid conditions, immunosuppression and specific treatments as causal or aggravating factors (s9(3)–(9), s9(11)).","Explicit treatment-related and access-to-care factors (topical glucocorticoids, inability to obtain appropriate management) that shift burden to show service link (s9(5), s9(12)).","Inclusion of death from a terminal event contributed to by tinea, requiring causal linkage to terminal events listed in the Dictionary (s7(5); Sch 1 terminal event).","Requirement that any factor be related to ‘relevant service’ and rules on aggravation vs material contribution, adding evidentiary and temporal complexity (s10(1)–(2); Sch 1 relevant service).","Cross-application with other Statements of Principles where factors overlap, requiring cross-referencing and potential inter-instrument interpretation (s11).","Administrative change via repeal of the prior SoP, meaning claimants and decision-makers must apply the new text (s4, s5).","Legal evidentiary standard referenced ('reasonable hypothesis') which requires synthesis of medical and service records to meet (title; s9)."],"plain_english_summary":"This instrument replaces the earlier tinea Statement of Principles and sets the medical criteria used to link tinea (specified dermatophyte infections of skin, hair or nails) — and deaths contributed to by tinea — to a person’s relevant service for claims under the VEA and MRCA. It matters because it lists the exact exposures, medical conditions, treatments and timing windows claimants must show to raise a reasonable hypothesis that their tinea was related to service (see ss7–9)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024","history":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-tinea-reasonable-hypothesis-no-55-of-2024/documents"}}