{"id":"F2021L00609","name":"Statement of Principles concerning transverse myelitis (Reasonable Hypothesis) (No. 71 of 2021)","slug":"statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440855,"registerId":"F2021L00609-fast-fetch-1775956333513","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning transverse myelitis (Reasonable Hypothesis) (No. 71 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 (Reasonable Hypothesis)\n\n(No. 71 of 2021)\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 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 (Reasonable Hypothesis) (No. 71 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(2) of the Veterans' Entitlements Act 1986.\n\n4 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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that transverse myelitis and death from transverse myelitis 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\n8 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 transverse myelitis or death from transverse myelitis 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) taking heroin within the 7 days before the clinical onset of transverse myelitis;\n\n(8) receiving oral polio vaccine within the 2 months before the clinical onset of transverse myelitis;\n\n(9) having a bone marrow or stem cell transplant before the clinical onset of transverse myelitis;\n\n(10) 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(10) 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(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 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) 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 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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard, discrete Statement of Principles instrument of the kind regularly made by the Repatriation Medical Authority. It addresses a single condition (transverse myelitis) under the 'reasonable hypothesis' stream, consistent with the Authority's established function under section 196B(2) of the VEA. No scope creep is evident."},"complexity_factors":["Moderate cross-referencing between two major compensation schemes (VEA and MRCA)","10 distinct factors with varying time windows (2 months, 7 days, 'at time of', 'before')","Nested definitions: 'specified list of drugs' refers to 'biologic agents' which has its own technical definition plus examples","Exclusion list in section 6(2)(b) with 10 specific alternative diagnoses that must be ruled out","Conditional logic in section 9(2) restricting factor 8(10) to aggravation claims only","Incorporation by reference to ICD-10-AM Tenth Edition with specific ISBN","Self-referential structure where section 10 incorporates other Statements of Principles dynamically ('as in force from time to time')"],"plain_english_summary":"This instrument sets when Australian veterans and current/former defence members can claim compensation for transverse myelitis by applying a lower \"reasonable hypothesis\" test and a rebuttable presumption linking the condition to service. It identifies ten service‑related risk factors (infections, immune conditions, certain drugs/vaccines, healthcare access issues, etc.) that, if connected to operational, peacekeeping, hazardous or warlike service, allow claims without proving the exact medical mechanism.\n\nIt matters because transverse myelitis often has no clear cause; the rule recognises service exposures that civilians rarely face."},"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"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument defines and limits the scope to transverse myelitis (and death contributed by it) for claims under the VEA (section 120A) and MRCA (section 338). It sets evidentiary factors and exclusions rather than expanding statutory entitlements. The text does not indicate a change from any prior legislative intent; it establishes the criteria used to assess whether service connection can be reasonably hypothesised."},"complexity_factors":["Medical definitional detail with express exclusions (subsection 6(2))","Closed list of factual factors and precise timing windows (section 8: 2 months, 7 days, etc.)","Interaction with other Statements of Principles where factors reference other diseases (section 10)","Requirement that listed factors be related to relevant service — causal nexus assessment (section 9)","Clinical evidence standards implicit (diagnosis by imaging or CSF, notes in 6(2) and diagnostic references)","Cross-references to VEA and MRCA claim frameworks (sections 3–5, Schedule definitions)","Defined technical terms (biologic agent, specified list of drugs, terminal event) that require clinical interpretation","Potential administrative discretion in applying 'inability to obtain appropriate clinical management' (8(10))","Limited normative complexity but moderate evidentiary burden on claimants and medical practitioners"],"plain_english_summary":"This instrument sets the medical rules the Repatriation Medical Authority uses to decide whether transverse myelitis (including death partly caused by it) can be reasonably linked to a person’s military, peacekeeping or other relevant service. It applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act and so affects veterans and service members seeking service-related entitlements.\n\nThe instrument defines transverse myelitis, lists excluded causes, and specifies a closed list of clinical factors and timing windows (recent infections, certain drugs or vaccines, transplants, autoimmune disease, lack of appropriate care) that claimants and clinicians must demonstrate to meet the reasonable‑hypothesis threshold."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021","history":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-transverse-myelitis-reasonable-hypothesis-no-71-of-2021/documents"}}