{"id":"F2021L00608","name":"Statement of Principles concerning transverse myelitis (Balance of Probabilities) (No. 72 of 2021)","slug":"statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440854,"registerId":"F2021L00608-fast-fetch-1775956333493","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning transverse myelitis (Balance of Probabilities) (No. 72 of 2021)","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\nTRANSVERSE MYELITIS (Balance of Probabilities)\n\n(No. 72 of 2021)\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 May 2021\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 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 transverse myelitis (Balance of Probabilities) (No. 72 of 2021).\n\n2 Commencement\n\n This instrument commences on 21 June 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about transverse myelitis and death from transverse myelitis.\n\nMeaning of transverse myelitis\n\n(2) For the purposes of this Statement of Principles, transverse myelitis:\n\n(a) means an acute or subacute immune-mediated, inflammatory disorder of the spinal cord producing symptoms and signs of impaired motor, sensory or autonomic functioning; and\n\n(b) excludes myelitis or myelopathy of the spinal cord due to:\n\n(i) acute disseminated encephalomyelitis;\n\n(ii) atopic myelitis;\n\n(iii) intrathecal chemotherapy;\n\n(iv) multiple sclerosis;\n\n(v) neuromyelitis optica syndrome;\n\n(vi) radiation;\n\n(vii) spinal cord compression;\n\n(viii) trauma;\n\n(ix) tumour invasion; and\n\n(x) vascular, metabolic or degenerative pathologies.\n\nNote 1: Transverse myelitis typically presents with symptoms or signs developing over hours to days. Impaired autonomic functioning may present as bowel or bladder dysfunction. There is usually bilateral sensory alteration with a defined upper sensory level.\n\nNote 2: The diagnosis of transverse myelitis can be confirmed by finding evidence of spinal cord inflammation on neuroimaging or by analysis of cerebrospinal fluid.\n\n(3) While transverse myelitis attracts ICD‑10‑AM code G37.3, in applying this Statement of Principles the meaning of transverse myelitis 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 transverse myelitis\n\n(5) For the purposes of this Statement of Principles, transverse myelitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's transverse myelitis.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n7 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 transverse myelitis and death from transverse myelitis 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\n8 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, transverse myelitis or death from transverse myelitis is connected with the circumstances of a person's relevant service:\n\n(1) having a symptomatic gastrointestinal infection or respiratory tract infection within the 2 months before the clinical onset of transverse myelitis;\n\n(2) having an infection with a viral, bacterial, fungal or parasitic organism within the 2 months before the clinical onset of transverse myelitis;\n\n(3) having a systemic autoimmune disease at the time of the clinical onset of transverse myelitis;\n\n(4) having sarcoidosis at the time of the clinical onset of transverse myelitis;\n\n(5) having a malignant neoplasm, other than non-melanotic malignant neoplasm of the skin, at the time of the clinical onset of transverse myelitis;\n\nNote: Transverse myelitis may be part of a paraneoplastic syndrome and the malignant neoplasm may be present but not yet diagnosed at the time of the clinical onset of transverse myelitis.\n\n(6) taking a drug from the specified list of drugs within the 2 months before the clinical onset of transverse myelitis;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(7) receiving oral polio vaccine within the 2 months before the clinical onset of transverse myelitis;\n\n(8) having a bone marrow or stem cell transplant before the clinical onset of transverse myelitis;\n\n(9) inability to obtain appropriate clinical management for transverse myelitis.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factor set out in subsection 8(9) applies only to material contribution to, or aggravation of, transverse myelitis where the person's transverse myelitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n biologic agent means a therapeutic product which is derived from living organisms or which contains components of living organisms.\n\nNote: Examples of biologic agents that have been associated with transverse myelitis include tyrosine kinase inhibitors, immune checkpoint inhibitors and dinutuximab.\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 specified list of drugs means:\n\n(a) biologic agents for the treatment of cancer; or\n\n(b) tumour necrosis factor-α inhibitors.\n\nNote: biologic agent is also defined in the Schedule 1 - Dictionary.\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 transverse myelitis—see subsection 6(2).\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument narrows and clarifies the coverage mechanics by defining transverse myelitis specifically and listing excluded causes (subsection 6(2)), by prescribing a closed set of contributory factors and time limits that must be present to establish a service connection (section 8, two‑month windows in several items), and by including death contributed to by transverse myelitis (subsection 6(5)). It therefore changes how entitlement is mechanically established compared with an undefined or broader notion of the condition."},"complexity_factors":["Technical medical definition and exclusions for transverse myelitis (subsection 6(2)): requires clinical and investigational criteria and excludes multiple specific causes.","Temporal windows for causation (two-month exposure/onset rule) in several factors (section 8(1)–(2), (6), (7)).","Factor-based threshold: entitlement depends on at least one listed factor being present and related to relevant service (section 8 and section 9(1)).","Interaction with other Statements of Principles where a referenced factor is itself covered elsewhere (section 10) creates cross-references and possible overlap.","Defined lists and technical terms in the Schedule (e.g. 'specified list of drugs', 'biologic agent', 'terminal event') require interpretation of medical products and events.","Inclusion of death as ‘death from transverse myelitis’ with proximate‑cause treatment (subsection 6(5) and Schedule terminal event definition).","Special rule limiting section 8(9) (inability to obtain appropriate clinical management) to material contribution/aggravation where TM pre‑existed or was contracted before/during service (section 9(2)).","Evidentiary posture declared by the Authority (balance of probabilities) but relying on 'sound medical‑scientific evidence' to establish probable links (section 7) — this imposes a medical‑evidence burden on claimants."],"plain_english_summary":"Made by the Repatriation Medical Authority, this Statement sets the medical test for linking transverse myelitis (and death from it) to a veteran's or service‑member's relevant service. A connection requires evidence of at least one listed factor near clinical onset — for example, recent infection (within 2 months), systemic autoimmune disease, sarcoidosis, malignancy, certain cancer biologics or TNF‑α inhibitors, oral polio vaccine, prior transplant, or inadequate clinical management — and that the factor is related to the person's relevant service. It defines transverse myelitis and excludes other causes."},"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 instrument appears tightly scoped to its original purpose. It addresses a single medical condition (transverse myelitis) with a specific diagnostic definition, applies to defined claimant populations under two specific Acts, and establishes a discrete set of causal factors. There is no evidence of scope creep beyond the original intent of creating a compensation determination framework for this particular spinal cord condition."},"complexity_factors":["Moderate cross-referencing between the main body and Schedule 1 (Dictionary)","Nested definitions: 'specified list of drugs' depends on 'biologic agent', which itself requires further definition","10 specific exclusions in the definition of transverse myelitis (subsection 6(2))","Conditional logic in section 8 requiring at least one of nine factors to be satisfied","Special limitation in section 9(2) regarding the 'inability to obtain appropriate clinical management' factor","Incorporation by reference of external classification system (ICD-10-AM Tenth Edition)","Reference to other Statements of Principles in section 10, creating interdependence with instruments not contained in this document"],"plain_english_summary":"This Statement of Principles sets the medical test for when transverse myelitis—a rapid, immune-mediated inflammation of the spinal cord (excluding causes like MS, trauma, tumour, radiation)—can be accepted as related to Australian Defence service for claims under the VEA or MRCA. \n\nA claim succeeds on the balance of probabilities if at least one of nine specified service-related factors (e.g., recent infections, certain immune‑modulating treatments, transplant or vaccine exposure, or lack of adequate care) is shown to be connected to onset."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021","history":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-transverse-myelitis-balance-of-probabilities-no-72-of-2021/documents"}}