{"id":"F2024L01335","name":"Statement of Principles concerning trigeminal neuralgia or trigeminal neuropathy (Reasonable Hypothesis) (No. 84 of 2024)","slug":"statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442621,"registerId":"F2024L01335-fast-fetch-1775957587852","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 (Reasonable Hypothesis) (No. 84 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  (Reasonable Hypothesis)\n\n(No. 84 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                                                            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\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 (Reasonable Hypothesis) (No. 84 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(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statements of Principles concerning trigeminal neuropathy (No. 79 of 2015) (Federal Register of Legislation No. F2015L00911) and trigeminal neuralgia No. (77 of 2015) (Federal Register of Legislation No. F2015L00909)  made under subsection 196B(2) of the VEA are repealed.\n\n1.                Application\n\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\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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that trigeminal neuralgia or trigeminal neuropathy  and death from trigeminal neuralgia or trigeminal neuropathy  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\n1.                Factors that must exist\n\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 trigeminal neuralgia or trigeminal neuropathy  or death from trigeminal neuralgia or trigeminal neuropathy  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;\n2.           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;\n3.           undergoing a course of therapeutic radiation, where the affected trigeminal nerve was in the field of radiation, within the 1 year before clinical onset or clinical worsening of trigeminal neuropathy;\n4.           having osteoradionecrosis of the mandible at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n5.           having bisphosphonate-related osteonecrosis of the jaw at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n6.           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;\n2.       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 rheumatoid arthritis or sarcoidosis at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n2.       having one of the following systemic vasculitides:\n  1.           Behçet disease;\n  2.           eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome);\n  3.           giant cell arteritis;\n  4.           granulomatosis with polyangiitis (Wegener granulomatosis);\n  5.            polyarteritis nodosa;\n  6.            Takayasu arteritis;\n\n\nat the time of clinical onset or clinical worsening of trigeminal neuropathy;\n\n1.       having invasive bacterial or fungal paranasal sinusitis or viral meningoencephalitis, at the time of clinical onset or clinical worsening of trigeminal neuralgia;\n2.       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;\n  10.             syphilis (Treponema pallidum infection);\n3.       having acute herpes zoster involving the affected trigeminal nerve, within the 1 year before clinical onset or clinical worsening of trigeminal neuropathy;\n4.       having infection with human immunodeficiency virus at the time of 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.       having diabetes mellitus at the time of clinical onset or clinical worsening of trigeminal neuropathy;\n9.       being treated with one of the following medications:\n  1.           cisplatin;\n  2.           hydroxystilbamidine isethionate (stilbamidine);\n  3.           vincristine;\n\n\nfor a continuous period of at least 7 days, within the 3 months before clinical onset or clinical worsening of trigeminal neuropathy;\n\n1.       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;\n2.       having an episode of acute intoxication, from inhaling, ingesting or having cutaneous contact with trichloroethylene or ethylene glycol, within the 30 days before clinical onset or clinical worsening of trigeminal neuropathy;\n3.       having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 2 weeks of clinical onset of trigeminal neuralgia;\n\n\nNote: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).\n\n1.       inability to obtain appropriate clinical management for trigeminal neuralgia before clinical worsening of trigeminal neuralgia;\n2.       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(2) 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)          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                               trigeminal neuralgia or trigeminal neuropathy —see subsection 7(2).\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                               VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier separate Statements for trigeminal neuropathy and trigeminal neuralgia (section 4) and consolidates them into a single Statement (section 1), explicitly including death from the condition (section 7(4)). It applies to VEA and MRCA claims (section 5). The new Statement adds or clarifies many explicit factors and temporal thresholds (section 9), and sets clinical‑worsening rules tied to whether the condition pre‑existed service (section 10), so the scope and evidentiary tests have been broadened and clarified compared with the prior instruments."},"complexity_factors":["Detailed medical definitions distinguishing trigeminal neuralgia from trigeminal neuropathy with multiple exclusions and clinical criteria (section 7(2)).","Long list of diverse causal factors (trauma, infections, autoimmune disease, vascular compression, procedures, medications, chemical exposures, radiation, COVID-19) with differing temporal windows (sections 9(1)–9(33)).","Different time thresholds for presumptive linkage (e.g. 3 months, 1 year, 2 years, 30 days, 6 months, 2 weeks) creating multiple temporal rules (section 9).","Inclusion of clinical worsening rules that apply only where condition existed before or during but did not arise out of service (section 10(1)–(2)).","Interaction with other Statements of Principles: where a factor refers to an injury/disease covered elsewhere, that other Statement applies (section 11).","Repeal and consolidation of two prior Statements, requiring cross-checking of prior case law and guidance for transitional claims (section 4).","Use of the \"reasonable hypothesis\" standard and reliance on medical-scientific evidence which requires factual, clinical assessment rather than bright-line legal tests (recitals and section 8).","Administrative application scope limited to VEA/MRCA claims and defined categories of relevant service, which affects which applicants are covered (section 5; Schedule 1)."],"plain_english_summary":"Sets a Statement of Principles under the Veterans' Entitlements Act that defines trigeminal neuralgia and trigeminal neuropathy, and lists the medical conditions, procedures, infections, exposures and time limits that, if present, raise a reasonable hypothesis linking the condition (including death) to a person's relevant service. It repeals two earlier Statements and applies to claims under the VEA and MRCA, so it directs what kinds of evidence can support a service connection for affected veterans and service members."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument merges two separate 2015 Statements of Principles (one for trigeminal neuralgia, one for trigeminal neuropathy) into a single consolidated instrument. It also expands the scope by adding new causal factors including SARS-CoV-2 (COVID-19) infection, reflecting evolving medical knowledge. The consolidation represents a deliberate expansion from two narrow, condition-specific instruments to one broader instrument covering both related conditions, with updated medical evidence and modernised factor structures."},"complexity_factors":["27 distinct causal factors with varying timeframes (30 days to 2 years before onset/worsening)","Dual condition structure requiring careful parsing — factors apply to either trigeminal neuralgia, trigeminal neuropathy, or both, with different exclusions for each","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","Specific medication and chemical exposure requirements with precise dosage/duration thresholds (e.g., '30 occasions' of trichloroethylene exposure, '7 days' of cisplatin treatment)","Nested definitions with mutual exclusions (trigeminal neuralgia excludes trigeminal neuropathy and vice versa)"],"plain_english_summary":"This instrument sets the medical rules for when Australian veterans and defence members can claim compensation for trigeminal neuralgia or trigeminal neuropathy, identifying 27 medical factors that can create a \"reasonable hypothesis\" linking the condition to service. It applies to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004.\n\nBy replacing two 2015 instruments and updating medical evidence (including COVID‑19 as a potential trigger), it broadens pathways for affected veterans to access compensation."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes","history":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes/history","analysis":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes/analysis","conflicts":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes/important-cases","documents":"/api/acts/statement-of-principles-concerning-trigeminal-neuralgia-or-trigeminal-neuropathy-reasonable-hypothes/documents"}}