{"id":"F2024L01336","name":"Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Balance of Probabilities) (No. 85 of 2024)","slug":"statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442619,"registerId":"F2024L01336-fast-fetch-1775957587818","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Balance of Probabilities) (No. 85 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\nTRIGEMINAL NEURALGIA OR TRIGEMINAL NEUROPATHY  (Balance of Probabilities)\n\n(No. 85 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 18 October 2024.\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Balance of Probabilities) (No.85 of 2024).\n\n1.                Commencement\n\n\n              This instrument commences on 19 November 2024.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning trigeminal neuropathy (No. 80 of 2015) (Federal Register of Legislation No. F2015L00912) and trigeminal neuralgia (No 78 of 2015) (Federal Register of Legislation No. F2015L00910) made under subsection 196B(3) of the VEA are repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about trigeminal neuralgia or trigeminal neuropathy and death from trigeminal neuralgia or trigeminal neuropathy.\n\n\nMeaning of trigeminal neuralgia or trigeminal neuropathy\n\n1.           For the purposes of this Statement of Principles:\n\n\ntrigeminal neuralgia:\n\n1.           means a clinical facial pain syndrome characterised by recurring paroxysmal attacks of severe, electric shock-like, shooting, stabbing or sharp pain lasting from a fraction of a second to 2 minutes, occurring in the distribution of one or more divisions of the trigeminal nerve, which are precipitated by innocuous stimuli to the affected side of the face; and\n2.            includes classical trigeminal neuralgia and secondary trigeminal neuralgia; and\n3.            excludes:\n  1.             dental or periodontal pain of local origin;\n  2.          facial presentations of primary headache disorders;\n  3.         glossopharyngeal neuralgia;\n  4.         postherpetic neuralgia;\n  5.           short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT); and\n  6.         trigeminal neuropathy.\n\n\nNote 1: The trigeminal (or fifth cranial) nerve arises from the lateral surface of the mid-pons and traverses the middle cranial fossa to Meckel’s cave, where the trigeminal ganglion splits into three divisions (ophthalmic, maxillary and mandibular). The trigeminal nerve includes sensory and motor nuclei in the brainstem.\n\nNote 2: The trigeminal nerve provides sensory innervation to the face, teeth, mouth and nasal cavity, and motor innervation to the facial muscles involved in mastication.\n\nNote 3: Trigeminal neuralgia is also known as tic douloureux.\n\ntrigeminal neuropathy:\n\n1.           means continuous or near-continuous facial pain, characterised as burning, squeezing, aching or like pins and needles, that occurs in the distribution of one or more branches of the trigeminal nerve, and/or symptoms or signs of impaired motor, sensory or autonomic functioning in the distribution of the trigeminal nerve; and\n\n\n1.            includes:\n  1.             neuropathy confined to the trigeminal nerve;\n  2.           neuropathy of the trigeminal nerve occurring simultaneously with other cranial nerve disorders; and\n  3.         trigeminal sensory neuropathy; and\n2.            excludes:\n  1.              persistent idiopathic facial pain; and\n  2.           trigeminal neuralgia (classical and secondary).\n\n\nNote 1: The trigeminal (or fifth cranial) nerve arises from the lateral surface of the mid-pons and traverses the middle cranial fossa to Meckel’s cave, where the trigeminal ganglion splits into three divisions (ophthalmic, maxillary and mandibular). The trigeminal nerve includes sensory and motor nuclei in the brainstem.\n\nNote 2: The trigeminal nerve provides sensory innervation to the face, teeth, mouth and nasal cavity, and motor innervation to the facial muscles involved in mastication.\n\n1.           While trigeminal neuralgia attracts ICD 10 AM code G50.0, in applying this Statement of Principles the meaning of trigeminal neuralgia is that given in subsection (2).\n2.           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\n\nDeath from trigeminal neuralgia or trigeminal neuropathy\n\n1.           For the purposes of this Statement of Principles, trigeminal neuralgia or trigeminal neuropathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's trigeminal neuralgia or trigeminal neuropathy.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that trigeminal neuralgia or trigeminal neuropathy and death from trigeminal neuralgia or trigeminal neuropathy 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, trigeminal neuralgia or trigeminal neuropathy or death from trigeminal neuralgia or trigeminal neuropathy is connected with the circumstances of a person's relevant service:\n\n1.           having maxillary, sphenoid or frontal sinus barotrauma involving the affected trigeminal nerve, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;\n2.           having one of the following traumatic injuries to the affected trigeminal nerve:\n  1.           mechanical injury caused by compression, crush, transection or stretching;\n  2.           chemical burn;\n  3.           thermal burn;\n\n\nwithin the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;\n\n1.           having an injury to the affected trigeminal nerve as a result of a dental or surgical procedure or injury to the cornea as a result of surgical or laser treatment, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;\n\n\n1.           undergoing one of the following procedures for the treatment of trigeminal neuralgia, involving the affected trigeminal nerve, within the 2 years before clinical onset or clinical worsening of trigeminal neuropathy:\n  1.           fractionated stereotactic radiotherapy;\n  2.           Gamma Knife radiosurgery;\n  3.           microvascular decompression;\n  4.           peripheral alcohol injection;\n  5.           percutaneous rhizotomy, including chemical (glycerol) rhizolysis, mechanical balloon compression and radiofrequency thermocoagulation;\n\n\n1.           undergoing a course of therapeutic radiation, where the affected trigeminal nerve was in the field of radiation, within the 6 months before clinical onset or clinical worsening of trigeminal neuropathy;\n2.           having osteoradionecrosis of the mandible at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n3.           having bisphosphonate-related osteonecrosis of the jaw at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n\n\n1.           having vascular compression of the trigeminal nerve close to its point of entry into the brainstem, by one of the following:\n  1.           tortuous or aberrant loop of arteries or veins;\n  2.           haemangioma;\n  3.           aneurysm;\n  4.           venous sinus thrombosis;\n  5.           arteriovenous malformation;\n\n\nat the time of clinical onset or clinical worsening of trigeminal neuralgia;\n\n1.           having a mass lesion which compresses, displaces or infiltrates the affected trigeminal nerve, at the time of clinical onset or clinical worsening;\n\n\nNote: Examples of a mass lesion that can compress, displace or infiltrate the trigeminal nerve include a benign or malignant neoplasm, haematoma, abscess, granuloma, amyloidoma, cyst or benign fibro-osseous lesion.\n\n1.       having cervical disc prolapse or cervical syringomyelia, involving the cervical spine at C4 or above, at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n\n\n1.       having one of the following inflammatory connective tissue diseases:\n  1.           mixed connective tissue disease;\n  2.           Sjögren syndrome;\n  3.           systemic lupus erythematosus;\n  4.           systemic sclerosis (scleroderma);\n\n\nat the time of clinical onset or clinical worsening;\n\n1.        having sarcoidosis at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n2.       having invasive bacterial or fungal paranasal sinusitis or viral meningoencephalitis, at the time of clinical onset or clinical worsening of trigeminal neuralgia;\n3.       having one of the following infections involving the affected trigeminal nerve, at the time of clinical onset or clinical worsening of trigeminal neuropathy:\n  1.           abscess;\n  2.           Lyme disease (Borrelia burgdorferi infection);\n  3.           brainstem meningitis or encephalitis;\n  4.           herpes simplex virus infection;\n  5.           invasive bacterial or fungal sinusitis;\n  6.            leprosy (Mycobacterium leprae infection);\n  7.           odontogenic infection;\n  8.           osteomyelitis;\n  9.             suppurative otitis media;\n4.       having acute herpes zoster involving the affected trigeminal nerve, within the 6 months before clinical onset or clinical worsening of trigeminal neuropathy;\n5.       having multiple sclerosis at the time of clinical onset or clinical worsening;\n6.       having Charcot–Marie–Tooth disease at the time of clinical onset or clinical worsening of trigeminal neuralgia;\n7.       having a cerebrovascular accident (stroke) involving the brainstem within the 30 days before clinical onset or clinical worsening;\n8.       inhaling, ingesting or having cutaneous contact with trichloroethylene on at least 30 occasions, within the 6 months before clinical onset or clinical worsening of trigeminal neuropathy;\n9.       having an episode of acute intoxication, from inhaling, ingesting or having cutaneous contact with trichloroethylene, within the 30 days before clinical onset or clinical worsening of trigeminal neuropathy;\n10.       inability to obtain appropriate clinical management for trigeminal neuralgia before clinical worsening of trigeminal neuralgia;\n11.       inability to obtain appropriate clinical management for trigeminal neuropathy before clinical worsening of trigeminal neuropathy.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, trigeminal neuralgia or trigeminal neuropathy where the person's trigeminal neuralgia or trigeminal neuropathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                             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                               trigeminal neuralgia or trigeminal neuropathy—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":5,"scope_assessment":{"changed":false,"description":"This instrument consolidates two existing 2015 Statements of Principles without expanding scope. It maintains the same fundamental purpose: establishing causal factors for veterans' compensation claims. The combination of neuralgia and neuropathy into one instrument reflects administrative efficiency rather than substantive expansion, as both conditions affect the same anatomical structure and were previously covered separately."},"complexity_factors":["22 distinct causal factors with varying timeframes (30 days to 2 years before onset/worsening)","Dual condition structure requiring careful differentiation between trigeminal neuralgia and trigeminal neuropathy with mutually exclusive definitions","Extensive medical terminology requiring 6 explanatory notes on neuroanatomy","Cross-referencing mechanism in section 11 linking to other Statements of Principles","Conditional logic distinguishing between 'clinical onset' and 'clinical worsening' with different applicability rules in section 10(2)","Specific exclusion lists for each condition (6 exclusions for neuralgia, 2 for neuropathy)","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN"],"plain_english_summary":"This instrument replaces two 2015 rules with a single legal test for trigeminal neuralgia and trigeminal neuropathy, clearly defining each condition and identifying service-related factors that can establish causation or aggravation. It governs claims by veterans and current/former defence members under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004.  \n\nIt matters because the listed factors determine whether, on the balance of probabilities, the government will accept a service connection and award compensation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument consolidates and replaces the separate 2015 Statements for trigeminal neuropathy and trigeminal neuralgia (s4), combines both conditions into a single Statement (s7), explicitly includes death from the conditions (Schedule 1 definition and s7 notes), and updates the list of service‑related linking factors with specific procedures, infections, systemic diseases, toxin exposures (notably trichloroethylene), and defined temporal windows for onset or worsening (s9). It also retains the requirement that any listed factor be related to the person's relevant service (s10) and defers to other Statements of Principles where applicable (s11)."},"complexity_factors":["Detailed medical definitions and exclusions for two closely related conditions (s7(2)).","Multiple temporal thresholds for causation or clinical worsening (e.g. 3 months, 6 months, 2 years, 30 days) embedded in factors (s9).","Wide range of causal mechanisms and clinical events (s9) including trauma, surgery, radiotherapy, infections, vascular lesions, systemic diseases and specific toxin exposures.","Separate treatment of clinical onset versus clinical worsening with a service‑relation requirement (s10).","Interplay with other Statements of Principles when factors reference other injuries/diseases (s11).","Inclusion of death from the condition and definition of terminal events (Schedule 1).","Repeal and consolidation of prior Statements, requiring cross‑referencing with replaced instruments (s4).","References to diagnostic coding (ICD‑10‑AM) and medical‑scientific evidence standard (s7(4); s8)."],"plain_english_summary":"This instrument defines trigeminal neuralgia and trigeminal neuropathy for veterans’ claims, sets medical and time‑based factors that, on the balance of probabilities, link those conditions (including death) to relevant service, and repeals earlier 2015 Statements. It applies to claims under the VEA and MRCA and lists specific causes, procedures, infections and exposures with temporal windows that must exist to establish service connection—criteria used to decide entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil","history":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil/history","analysis":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil/analysis","conflicts":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil/important-cases","documents":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-balance-of-probabil/documents"}}